Friday, October 21, 2005

Notes from the Prozac Nation, Vol. 1, No. 8

  • Melancholy and Melancholic: Some Notes Toward An Essay Toward Some Notes: Bleak Mouse writes with great philosophical flair about the relationship between chronic, atypical depression and identity. I am always struck by how those who are depressed can so often write about their depression in a meta way. Chronic depression tends to draw one in and reflect on larger questions about what makes me who I am? What this author suggests is that the depression does not give one an inner strength, but rather calls forth inner resources to fight depression. Here is a sample:

    One is of course scarred and shaped by depression. At very least, it is an experience among others; at most, it is an experience that distorts and obscures all others. But one is more than the sum of one's experiences. I should undoubtedly be a vastly different person were it not for depression; but I would also (I reach this counterfactual conclusion without proof) be very much the same, in ways that I can clearly delineate. There are of course shadowy borderlands where the self and the illness blur. If it were not for depression -- Would I be less kind and more selfish? Would I be less introspective and more outgoing? Would I be more certain of the central things -- have some abiding faith in the rightness of things? Would I love the same poems, the same music? Would I write the way I do? Would I speak as I do? Would I have been a greater or lesser sinner? Would I notice what I notice now -- the things that others miss? and would I know what they know, without knowing that they know them?

    I'm afraid I do not believe in what someone called "the inner strength of depression." I do believe that one can (must) call forth inner strength against depression. The fact that gains against it can often seem ephemeral argues defeat -- and argues it daily, incessantly, and with quite an arsenal of quasi-evidence, adduced with tireless repetition. But something else -- the innate, unclouded self -- argues this: At very least, stay where you are. Push ahead if you can, but don't lose ground. Stay, stay, stay.

    Some years back, I took a medication (one among many, before and since) that dispelled my depression for around a year. (For students of psychopharmacology, it was one of the earliest and most traditional antidepressants, an MAOI.) It did not make me happy, which was not among my expectations in any case, but it did make happiness possible. It alleviated my perpetual exhaustion, and cleared my mind wonderfully. It put me back in the world. It gave me a future (something that melancholia obliterates mercilessly.) But, what I remember most of all, is this: I no longer thought about depression. I had periods of normal depression, to be sure, but -- mirabile dictu -- they passed, or could be shaken off -- by playing music, or going out, or by utilizing that most tiresome of folk remedies, "getting some fresh air." Then it stopped working.

    Bleak Mouse also captures the "poop" out effect of antidepressants. Many depression memoirists describe a respite from depression when he/she first takes medication, and then, it stops working. What happens after that fact is generally more interesting.

  • Autumnal Melancholia: Nylon writes a heartwrenching entry on her descent depression and how it makes her reflect on all of her past failures. A horrific feature of depression is rumination and self-loathing. Depression feels bad enough, but then as feature of this illness, it makes you indict your entire life as a failure.

  • High Cost of Depression Care: This article from the Coloradon warns that many people who are diagnosed depressed do not seek out medical attention because they cannot afford it. Because depression is an illness that can spiral out, and get worse and worse, this is not a small problem.

  • Blood: A New Antidepressant: A police assistant in India�s central state of Chhattisgarh killed a fellow villager by slitting his throat with a sword and drank his blood, hoping to cure his own depression, police said on Monday. Sort of makes you grateful for our own version of "witchcraft," that is, we worship the often snake oil remedies put out by Big Pharma. Much less violent!

  • Brain Cell Death in Depression: Researchers are now arguing that cells die in a certain part of the brain in patients with severe depression. Last fall I took my seminar to the NIH and we spoke to the head of the Mood Disorders lab who made a similar argument. If cell death is the cause or related to depression, then new drugs will be made to regenerate those cells. Should be interesting. The researcher at NIH told us that he was able to encourage cell regeneration by keeping patients awake for over 24 hours (I could be getting that detail wrong).