In yesterday’s post, I mentioned my experience with depression a couple of times. I’d like to write about a few aspects of my experience that I hope will be helpful to others who have depression or might experience it in the future. And I hope it’s not too depressing. Also, I promise not to write about it again.
First, the psychiatric medicines. My first experience with serotonin reuptake inhibitors (SSRIs) was about 17 years ago. I’d asked a doctor to recommend an internist, a family doctor. I didn’t have one at that time. At my first appointment, I expected nothing more than a general physical examination; but after the examination, he said, “You know, you look a little depressed.”
I knew that I wasn’t an easygoing, worry-free kind of guy, but I didn’t think I was depressed. Furthermore, the office visit took place after a day of teaching high school English in one of Philadelphia’s public schools. I am sure I looked tired and somewhat stressed, and besides, doctors make me nervous. He offered me a prescription for Zoloft, one of the new miraculous SSRI drugs at that time. I hadn’t heard of Zoloft, but I had read about Prozac, which supposedly had the magical power to correct a chemical imbalance in your brain and thus transform you into the real you, the person you were meant to be – happy, relaxed, intelligent, and likable. Some asserted that if everyone took Prozac, peace would break out the world over and everyone would be happy.
I hesitated to accept the prescription at first, believing that it was probably not a good idea to take a pill to cure an illness you didn’t think you had. But then I thought it would be like taking a mental vacation, and I never thought I would take it long term, so I filled the prescription.
Within days, I really did feel like a new man. Things that used to upset me now rolled off my back. And I really enjoyed the new me. I didn’t worry about the idea of taking a pill every day, for this pill (I said to myself) merely corrected an abnormal condition in my brain and thus made me “normal.” What could be wrong with that? In addition, there were no unpleasant side effects that I could detect.
After a while, my internist sent me to a psychopharmacologist because he didn’t want to prescribe such drugs anymore. The new doctor, an expert in antidepressants, continued prescribing Zoloft, saying that if I stopped taking it, my depression would return. I forgot that I hadn’t thought I was depressed when I started on Zoloft, and that if I was depressed, it was a very mild depression. After all, I seemed to function satisfactorily before Zoloft. I managed to graduate from college, earn a graduate degree, stay married to the same woman for more than 30 years, help raise two wonderful children who now have families of their own, and function pretty well in a highly stressful job. But I couldn’t think of a reason to stop taking Zoloft.
Then, one day the Zoloft stopped working. I had heard about “Prozac poop-out,” but neither the internist nor the psychopharmacologist offered to talk about it. I remember asking the psychopharmacologist about it, and he said it wouldn’t happen. When it pooped out, I felt at first intermittent anxiety that, after a while, became almost constant. Clinical, major depression followed, and no other drug helped very much.
According to reports, one in ten Americans is on antidepressants. I assume that many of those people are not clinically depressed. One person I know takes Zoloft to fight what she calls “irritability,” which, to my knowledge, is not a disease or illness. Many who take antidepressants feel fine most of the time, but take the pill because they want to feel even better. Also there are lots of people on SSRIs who function normally but are mildly depressed, meaning they often feel unhappy. Should doctors promiscuously prescribe antidepressants to such people? From my experience, I think not.
These people, I believe, should be advised to talk to a psychologist, psychiatrist, or even, if they are religious, their pastor. I know many doctors move patients on to another drug before the original drug stops working. But there is no guarantee that the new drug or any of the others will work.
Another problem one must deal with is doctors. I’d advise patients to be very assertive with their doctors when they prescribe antidepressants. My experience is that doctors can be less than forthcoming about a drug’s side effects. Demand to know all of the possible side effects, and ask your pharmacist to give you a list of them before you start taking a drug. Don’t be surprised if a doctor gets very annoyed by your questions. A lot of doctors can be arrogant and patronizing when questioned. A favorite comeback of my first internist was, “What medical school did you go to?” My psychopharmacologist has a repertoire of condescending insults. Once when I complained about a drug’s very unpleasant side effects, he came out with “I’m biting my tongue,” which I assumed meant, “How dare you question me, you moron. I’m dying to tell you what I really think of you and your inane questions, and I’m doing my best to restrain myself.”
I would also ask therapists if they have ever experienced depression. A skillful therapist who has actually experienced depression would be ideal, but probably hard to find.
Finally, stay away from hospital psychiatric units unless you are on the brink of suicide. One day, on my birthday it turned out, I went to a local hospital ER because I was feeling panicky about something and I thought an ER doctor might give me something to relieve it. Unfortunately, I had gone there a couple of days before with the same complaint. The first time, they gave me a tranquilizer, and I went home feeling better. The second time, a social worker was called in. I would advise anyone who goes to the emergency room for anything having to do with depression and/or anxiety to beware of social workers. She was there to interrogate me and her subject for the day was suicide: Did I ever think of suicide, did I have a “plan,” and had I ever attempted it? I stupidly responded that, yes, I had thought of suicide. The fact that I said, no, I didn’t have a plan and, no, I’d never attempted to do it didn’t matter to her. I cannot imagine that anyone with clinical depression doesn’t have thoughts of suicide; indeed, many, if not all of the drugs prescribed for depression can cause suicidal thoughts. From my experience, I would conclude that social workers are not trained in the skill of separating those who think of suicide from those who are likely to do it.
So the social worker strongly urged me to go to the psychiatric ward. As I understand it, they can keep you for only 72 hours and only if you sign off on it. She also described the psych ward as a small, homey place, sort of like a spa. I remembered seeing ads in Philadelphia Magazine (probably in some doctor’s waiting room) that touted the intensive treatment provided at the psych ward of this hospital . The way I felt, I thought, Why not? It’s only for a few days and I would get intensive therapy from experienced psychiatrists. So I signed the paper and was off for a few days of helpful therapy, I believed.
Almost as soon as I set foot in the ward, I knew that everything the social worker had said was a lie. My wife was also horrified by the place and we told the resident Nurse Ratched that we had changed our minds. But the doors were locked. No, she said, you signed the paper, you’re not going anywhere.
I was shown to my room where my roommate was snoring away in the middle of the day. He was obese, and when awake, walked around the place wearing too small pajamas with weird designs. The room next door held a young woman who screamed and cursed both night and day and argued with people who were present only in her mind.
Next they took away all my possessions, including my belt, shoelaces, and even the little strings that held up pajamas. I know they believed that this was a necessary precaution, but it was still demeaning and disheartening.
I spent the next 3 days sitting in a sort of common room trying to read, which was difficult because of the drugs I was given. Still, I was able to observe what was going on. I did see a few doors with psychiatrists’ names on them, but I rarely saw an actual psychiatrist. The only time I saw one was in the morning when they came in, wrote something in a loose-leaf binder, and left. The only times I talked to a doctor was on the first day “intake” evaluation and the day before I left for discharge. Nothing that took place between us could be defined as treatment. And we met outside in the common room where everyone could hear what was being said. I never saw any doctor take an “inmate” into a private office for treatment. Needless to say, I was amazed by their unprofessional behavior.
So most of the day, the inmates (mostly the younger ones) socialized with each other and at night watched television. Yes, there was something called “group therapy.” Out of boredom, I attended two such sessions. The first one was a group “project” in which we were supposed to make a truck or something out of pieces of cardboard. I stayed about 10 minutes. In the other one we sat around a table and were asked to identify and discuss our most “positive” experience. During this “group therapy,” the woman next to me continuously drew with her finger imaginary circles in the air. I left after 5 minutes. And that was it for three days, and I cannot get those days out of my mind. It was worse than prison; in prison at least, you are permitted to go outside daily for some fresh air.
So beware of social workers and other “mental health workers” who want to send you to a psych ward. And the ward in which I spent 3 days is reputed to be the best in the area!
To be fair, I have to say that there was one member of the staff who treated me like a real human being. His job was to order and dispense medicine to the inmates, but he did much more. He did everything he could to make me and others as comfortable as he could. He understood that this was a very unpleasant experience for me and let me know that he didn’t think I belonged there. He also asked me once why I was doing this to myself. An interesting and, I think, an important question that was the closest I came to therapy during my stay.
A lot of the time, nowadays, I am feeling better. I do things that I avoided before, like going out, talking to friends, and traveling. Writing this blog seems to be therapeutic as well. Still, it has been a rough ride.