Sunday, 10 May 2020

Medication

So far I haven't touched upon the subject of medication. If you have severe depression, you will almost certainly be recommended to take antidepressants. It is thought that these work by increasing the level of chemicals in the brain known as neurotransmitters. Serotonin and noradrenaline are particularly linked to mood and emotion.

There are several types of antidepressants:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serontonin-noradrenaline reuptake inhibitors (SNRIs)
  • Noradrenaline and specific serotonergic antidepressants (NASSAs)
  • Tricyclic antidepressants (TCAs) 
When you read the above list, you can't fail to be impressed by the scientific sounding terminology. However, the situation is far more mysterious than you might imagine. Serotonin, for example, is very hard to measure. It is possible that having more serotonin in the brain may lift your mood - but there is no evidence to suggest that having a deficiency of it causes depression in the first place. Furthermore, there are some antidepressants that have no effect on serotonin and some that actually reduce it which have also been shown to be effective. The bottom line is that the brain is a very complicated organ and nobody knows how it works exactly. When you add the mystery of the brain to the mystery of depression - you end up with a very inexact science.



However, antidepressants do seem to work for some people. They may not, as critics point out, solve the causes of depression but they can alleviate the symptoms long enough to allow people to look more rationally at the causes. Classically, clinical depression is treated with a combination of medication and talking therapies.

I have to say that antidepressants didn't seem to work for me. I tried several different types but neither the panic nor the gloom lifted. It has to be pointed out also that there is a long lag time before antidepressants become effective. They can take up to 4-6 weeks to kick in. Often GPs will start with low doses and gradually increase them if there is no effect. If one type is ineffective they will swap you to another and the 4-6 weeks lag time will begin again. They also have a myriad of side effects. When you're on antidepressants it's sometimes difficult to know what is the depression and what is the side effects. Things can get very confused.

During my illness I also took anti-psychotics, anti-anxieties and anti-inflammatories. I once made a list of all the different tablets that I took. The only thing that gave me any relief was diazepam - which is addictive and shouldn't be taken too often. Here are some of the others:

  • citalopram
  • pericyazine
  • venlafaxin
  • vortioxetine
  • risperidone
  • aripiprazole
  • amiltriptyline
  • beta blockers
  • lithium
  • sertraline

At the moment I don't take anything. I'm not proud of this - it is just how it is. I was recently reading an article about Leonard Cohen and his approach to medication. He, too, gained little relief from it and had this to say: ' These things don't even begin to confront my predicament. I figured, if I am going to go down I would rather go down with my eyes wide open.'

:-)