Antidepressants and artificial happiness

[Marcus Marulus]

Johann Hari: Do I really need this artificial happiness?

For the first few years, I was defensive about any criticism of my beloved antidepressants

Published: 10 August 2006



I belong to the first generation of people who have been antidepressed all our adult lives. I started taking the antidepressant Seroxat when I was 17. I come from the Chernobyl of nuclear families, and it had finally imploded; and together with it, so had my neuroses. I couldn't get out of bed in the morning except in a tearful, uncomprehending rage. A familiar story passed in the suburbs once I had my pills: the toxic black fog of depression parted; it was like wearing glasses for the first time and discovering you had been half-blind since birth. Life went from being a muggy minefield to being a bouncy castle. Now - a decade later - I do not know what life would be like without it, and I am starting to wonder and to worry.

There are millions of people like this, scattered across the developed world, with their blue and yellow and white pills making their minds cleaner, or clearer, or more tolerable to live in. Most of them wonder too if, amidst the glories, there are drawbacks.

For the first few years, I was extremely defensive about any criticism of my beloved antidepressants. I became fond of quoting the writer Andrew Solomon, who in his gargantuan study of depression, The Noonday Demon, compares his need for anti-depressants to a diabetic's need for insulin. "If you discover somebody is diabetic at a party, you don't pat them on the shoulder and say, 'I hope you're off it soon', so why should you do it to somebody on antidepressants?" he asked. Depression, he said, was caused by malfunctioning neurotransmitters. It's an engineering problem in the brain, and SSRIs - the family of antidepressants created in the 1980s - are the crew sent in to fix it.

I was even tempted by the arguments of Dr Peter Kramer, whose book Listening to Prozac argued that SSRIs are actually a way to enhance the human species. He interviewed hundreds of people who had seen their bad tempers or obsessive fears dissolved by the drugs, and concluded that SSRIs are like antiseptic steel knives that cleanly, painlessly slice off the ugly parts of your character, leaving a fresher, more efficient person behind. He called this "cosmetic neuropharmacology", and recommended it even for the non-depressed.

But doubts began to poke through this Promethean optimism a few years ago. I have never regretted taking the anti-depressants to lift me out of depression, and never will, but I began to wonder if they were really a lifetime companion rather than a long fling. I sensed somewhere that they had drawbacks, but I could never really articulate what they were - until I recently read the book Artificial Happiness: The Dark Side of the New Happy Class by Dr Ronald W Dworkin, which has been causing a chemical stir in the US.

He doesn't buy into the hysteria about Seroxat causing suicide, and nor do I: most metastudies show that suicide rates have fallen dramatically in countries after the introduction of SSRIs. No, he has a very different objection. He says that anti-depressants quite quickly create a state of artificial happiness, where your life and your mind slip out of synch. The ordinary signals that you receive from the world - I don't like that, I like this - become blunted, because you feel pretty good no matter what happens. Just as people who lose physical sensation become extremely vulnerable to being burned or bruised without noticing it, people who lose the mental sensations of unhappiness become vulnerable to social damage that they can't feel is happening to them.

Dworkin illustrates this by talking about a fortysomething friend called Kenny who became depressed because every night he would head to bars to chat up beautiful 20-year-old girls, only to find they were no longer interested in him. He would slope home alone at the end of the night feeling rejected and dejected, and began to show the symptoms of mild depression - weepiness, listlessness, despair.

Kenny went to his doctor, who explained that his neurotransmitters clearly weren't functioning properly, and gave him an SSRI prescription. As a result, Kenny kept going to the bars and he kept getting rejected - only now it didn't really hurt. He's still there, still objectively miserable, except with a sweet foam of Prozac to draw the sting.

Dworkin says people like Kenny "don't feel the unhappiness they need to feel in order to move forward with their lives. Sometimes people need a critical mass of unhappiness to push them out of a bad life situation. Artificially happy people lose this impulse to change. When I read this, I recognised handfuls of my SSRI-taking friends, like the smart 27-year-old guy I know still living with his parents, unemployed, in a miserable situation, but kept happy - and stuck - by Seroxat, because he never felt miserable enough to change.

And, I admitted after a few months of jabbing the thought away, it applied to me too. Dworkin believes antidepressants are useful tools for lifting people out of chronic depression, and I suspect he would have supported my initial prescription. But after my depression was soaked up, I kept taking it. All sorts of things came along, as they do in every life, that would have made me miserable and forced me to change if I hadn't been antidepressed: a bad relationship, swollen debts, over-eating. All continued far longer than they needed to because they didn't really make me feel really bad; nothing did.

Yes, I think Dworkin overstates his case. At points he presents the antidepressed as almost alien people, disconnected from the world, conscienceless, "incapable of empathy", people who "don't know what kindness is" - not features I think apply to me or to the dozens of other antidepressed people I know.

But his book - and my sweet decade-long romance with Seroxat that I know now must end - has taught me that although depression is a disease, unhappiness is not. On the contrary, it is an essential state, a signal we all need from time to time to show us when our lives are going wrong. Stripped of that signal, it is easy to lose your way - as many, many people who take antidepressants for too long do. Don't get me wrong: I'm not some Calvinist (or sadist) who believes unhappiness is a good thing, a morally enriching experience. I'm not even a Stoic, who believes unhappiness should be piously endured; I believe maximising happiness is and should be the most basic goal of human ethics.

But we can only steer ourselves towards real happiness if we know when we are going off the road - and an adult lifetime on antidepressants clouds the windshield. That's why I have decided, with one last synthetic tear, to bid the antidepressants goodbye.

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[Susi]

This article is very interesting and is why I will never ever tell a doctor my feelings :p.

It shows how messed up society is when we need some kind of pill to keep us in a happy-coma rather than facing the facts and dealing with it. Depressed people can overcome things without pills.

[Marcus Marulus]

Originally Posted by Susi

This article is very interesting and is why I will never ever tell a doctor my feelings :p.

It shows how messed up society is when we need some kind of pill to keep us in a happy-coma rather than facing the facts and dealing with it. Depressed people can overcome things without pills.

Artificial happiness is contradiction in terms...not too much to achieve through chemical means in this respect.

I think I heard in the media that a group of people, mostly from Britain, started a lawsuit against the British pharmaceutical company Glaxo, Smith & Klein, because of the antidepressant Seroxat, which caused intestinal troubles, sexual dysfunction, high blood pressure and other nice concomitant effetcts among those who used it.

[Menydh]

"Depression? We did not know about that. That's an illness of a society that evolves around leisure. We did not have time to entertain ourselves with being depressed."

--my grandfather--

[Carnyx]

That's rather a illness of a drepressing society that offers nothing "tasty". This is self-destruction for the mediocres in a mediocre world.

Some people are naturally depressed. It runs in their veins. I have heared of cases unrelated to "leisure". Unless you consider being depressed is a "hobby". That being said, some of them you would like to kick their ass to shake them, like alcoholics and addicts.

[MKULTRA]

Oh, brave new world!

[Susi]

Originally Posted by Carnyx

Some people are naturally depressed. It runs in their veins. I have heared of cases unrelated to "leisure". Unless you consider being depressed is a "hobby". That being said, some of them you would like to kick their ass to shake them, like alcoholics and addicts.

I would say I'm less depressed when I'm doing something even if it is a leisure activity. If I'm doing nothing, I feel more depressed. I'm not exactly sure of the causes of depression, per se, but I would say 100% that just going out and having fun with friends and acquaintances is infinitely more healthy and better than taking some green/blue/white/etc. pills.

[Carnyx]

Originally Posted by Susi

I would say I'm less depressed when I'm doing something even if it is a leisure activity. If I'm doing nothing, I feel more depressed. I'm not exactly sure of the causes of depression, per se, but I would say 100% that just going out and having fun with friends and acquaintances is infinitely more healthy and better than taking some green/blue/white/etc. pills.

I often hear that. Activity just act as a blinder for depressives. The problem being for people who are still depressed although busy (an occupation, etc.).

[Susi]

Work can be depressing (despite doing something) , especially if there seems to be no point to it... dead end jobs, etc.

[Marcus Marulus]

Originally Posted by Susi

Work can be depressing (despite doing something) , especially if there seems to be no point to it... dead end jobs, etc.

Also called rat race...

[Sergius]

From my own experience with psych wards, the majority of ambulant patients are indeed victims of 'silly' lifestyle problems, caused by two things: partly that people in Denmark live in a state of illusion of safety, as they are used to living in a society where nothing can go wrong - if you lose your job, you'll get public amnesty; you break an arm, you'll get it fixed for free; someone spills hot coffe on you, you'll get invalidation benefits for the rest of your life, and so on. But when people become lonely or depressed, there is no one single answer that will help you. And the majority of Danes in our society do jobs that are prone to make you feel depressed - as some people here say: in Denmark, taxes redistribute the income of the 80% middle class of the public to the same 80% of the public - the same applies to a large part of the workforce. Everyone here does a job that essentially amounts to redistributing wealth or doing largely useless services, i.e. rubbing each other's backs. I strongly believe that a man who cannot see any real product of his work, is prone to depression from it.
That, and, of course, the religious question...

[Marcus Marulus]

Richer but less happy, we are now a pill-popping people

It will take more than a change in prescription rules to break Britain's growing dependence on antidepressants

Jackie Ashley
The Guardian, Monday February 11 2008

We are hooked. We are pill-popping people, gobbling down antidepressants, painkillers and antibiotics as if they were sweets. As with gun crime or obesity, we are following where the Americans have led. Last week Heath Ledger, the actor dead at 28, became the symbol of a new culture of pharmaceutical recreation. He accidentally poisoned himself with "anti-anxiety medication". You could indeed hardly make it up.

But the real problem is not one of the affluent or the famous. It is the routine use of legal drugs that should really alarm us - cases like the one reported recently of a woman from Lancashire who was taking up to 64 Nurofen Plus tablets a day, a habit that killed her. The problem is just as serious with prescription drugs. A commons committee has attacked GPs for overprescribing, ignoring advice about how long the strongest tranquillisers should be used for. Apparently the Home Office blames these drugs, benzodiazepines, for up to 17,000 deaths since they were introduced in the 60s.

In one way, this is all just another affliction of prosperity. Gorging seems to be deep in our makeup. Today's westerners, surrounded by almost limitless amounts of cheap, attractively presented, sugary sustenance, find it hard to know when to stop. Similarly, if pills to take the pain away are easy to get, carry no stigma, and give you a little buzz, why hold back? Adults in the modern pharmacy are children in an unmanaged sweet shop.

At first glance, the answer is easy: tighten the rules on prescribing. Take some of the stronger painkillers off open shelves. Insist on clearer warnings. Commission some public education. Then the pill-popping will reduce. But of course it's not that simple. Why not? Partly because of the problem identified by the painter David Hockney, in his letters to the Guardian, who as a strong cigarette enthusiast argued that when you remove one oral fix with the smoking ban, you just encourage people to move on to the next - in this case, pills. Perhaps we all need our favourite poison, booze or drugs or fags, and it is both arrogant and foolish of government to try to close down the consolations one by one. And indeed, you could argue that pills are relatively benign. They don't kill that many people - those Home Office figures, remember, cover nearly half a century. They aren't a source of street rowdiness, like beer. And you don't get cancer from passive pill-popping. Some psychologists argue that if pills can beat the blues by raising your serotonin levels, it would be perverse not to take them.

Yet the real problem is that we are mixing up cause and effect, or illness and symptom. The biggest reason for the sharp rise in pill-popping is not recreational kicks, but a general increase in depression. The number of people claiming benefits because of mental illness rises remorselessly, every year. The pill-popping mania is not about having fun. It is about feeling sad. There is a fashion for "me and my depression" memoirs, to follow the fashion for "my horrible childhood" memoirs but they describe something real. And here is where the politics kicks in.

According to official figures, up to 12% of people now experience depression in any one year. More telling is a deeper government study that shows that half of people with common mental health problems recover within 18 months but that "poorer people, the long-term sick and unemployed people are more likely to be still affected", and that women are much likelier to be treated for mental health problems than men.

So there we have it, courtesy of the Office for National Statistics confirming the bloody obvious: people get depressed because they don't have enough money to keep up in a materialistic and competitive society; because they are ill, or feel worthless without a job and role, or are struggling with caring responsibilities. Doctors aren't prescribing antidepressants because they are stupid, or don't care but because there is such pressure for quick-fix treatments for real feelings of unhappiness.

One answer is to look for alternatives to pills, taking the patients seriously. According to the Mental Health Foundation, only 42% of people visiting their doctor for depression were offered counselling, though twice that proportion would have been willing to try it; more than half of doctors think a talking cure works best for moderate depression, yet more than three-quarters prescribe antidepressants instead.

They don't have the resources. It takes just a couple of minutes to write out a prescription, and the patient leaves the surgery satisfied. It would take much longer to engage in a real exploration of what is causing the patient's symptoms and to discuss ways of dealing with the root of the problem.

That shouldn't stop us trying. In a thoroughly sensible and useful intervention, the new Liberal Democrat leader, Nick Clegg, is now calling for the health service to guarantee that nobody waits longer than 13 weeks for their first treatment when they report mental illness, with much more money for psychological therapies. This, says Clegg, would help grapple with our "Prozac nation" status. He is absolutely right, and other studies on wellbeing show it. I would be very surprised if the government's new cabinet committee on well-being, chaired by Ed Miliband, doesn't grapple with the same failure.

Yet even this is about how to deal with the symptoms of social stress, not the cause. The wellbeing agenda is about higher employment rates, better education, less social exclusion, more support for carers and getting people off benefits. It is also about time - giving people time to see their families, to have a social life and to take part in other activities than just work.

It's odd. As we have grown richer, we have become less confident and optimistic about the future. Our increased material competitiveness has not made us happier. Our frenzied activity leaves us stressed. The days when free-market theorists believed we would be liberated and happy through privatisation seem a world away. The answers are the same as they ever were. To adapt the famous slogan, the government needs to be tough on pill-popping, and tough on the causes of pill-popping. Prozac is powerful. But it isn't as powerful as politics.

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[M.R.]

I take the best antidepressant few times a week - it's called alcohol.

Seriously, I agree with most of the things in this thread, depression many times appears because of boredom.

[Marcus Marulus]

Originally Posted by M.R.

I take the best antidepressant few times a week - it's called alcohol.