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Depression As Illness: A Case Study

sadness 1In a recent post I asked the question, “Is Depression an Illness?” Many expressed strong feelings on this subject. Some argued that it is indeed an illness; others made the case that it was an experience that most of us go through, some more than others for sure, but classifying it as an illness leads one down a path toward taking unhealthy drugs that in the long run cause more harm than good.

In my recent post, I described Ms. Laren Stover’s story, who, rather than pathologizing her experiences of deep melancholy, she avoided taking psychiatric drugs to deal with it, and defended her experience as having artistic value.

sadness 3“Whatever happened to experiencing the grace of melancholy, which requires reflection: a sort of mental steeping, like tea?….It visits you like a mist, a vapor, a fog. It is generally uninvited. And as some people are born into royalty, wealth and prestige, others inherit a disposition for sadness.”

Shortly after writing my article, I came upon another one published in the AARP Magazine titled, “The True Story of My Life on Antidepressants.” Today I thought I would summarize this story and then provide my personal comments.

A Summary of Meg Grant’s Story

Meg Grant, tells us that the first 25 years of her life was “pretty darn good.” She had a good marriage, wonderful friends, and both she and her husband had excellent jobs–she a journalist and he a clinical psychologist.

Then, after a major move to another city and taking on a new job, one morning she woke up very disoriented and fearful. She describes this incident as follows:

panic 1“My ears buzzed, my leg muscles spasmed, and my throat closed. What was worse: I did not know where — not even who — I was.”

After about five minutes, she started to become less confused. And then, as she tells us:

I shook my husband awake, paced the living room floor, then finally ran out into the street, where I doubled over, struggling to catch my breath.

“Take me to the hospital!” I demanded. Instead, Greg [her husband] walked me back into the house and calmed me down, telling me I’d probably just had a disorienting dream. “We’re in a new place,” he said, donning his therapist hat. “It’s normal that you might at times feel scared.” He managed to coax me, still shaking, back into bed, where he held me tight. With him at my side, I tossed and turned until dawn.

We then learn that over the course of the next three weeks Ms. Grant was concerned about her hands trembling, lack of sleep and appetite. According to her, she “was in panic mode 24/7.”

Ms Grant as a young reporter.

Ms. Grant as a young reporter.

To help her through these experiences, she conferred with her internist, increased her exercise, and went to counseling. When none of this led to feeling as well as she would have liked, she decided to go to a psychiatrist. He or she explained to Ms. Grant that she was suffering from a serious depression, along with panic disorder, and then convinced her to take one of the drugs that the pharmaceutical industry refers to as “antidepressants.” She felt that this drug tamped down her anxiety enough to allow her to sleep. Nevertheless her problems continued.

ocean tidesFor months my symptoms swept in and out like pernicious tides. One day I’d be able to savor a meal or talk to my sister on the phone without crying; the next, nothing would seem real, including me. I’d be lost in a fog — numb and dull. Travel, meeting new people and unstructured time all made me uneasy, which quickly morphed into a vague feeling of free-falling, then anxiety, then hopelessness about ever feeling normal again. Indeed, merely anticipating what I saw as the next inevitable bout of panic seemed to bring one on.

CONSTIPATIONHer second psychiatrist, a Dr. Verhulst, at one point, upped her “antidepressant” dosage, which gave her dry mouth, constipation, and fatigue but quelled her panic. She felt that to live without all the angst was worth the side effects.

At about the time that she decided to have children, she was feeling well enough to see if she could withdraw from the drug that she was taking. There are some good reasons to consider getting off such drugs before a woman does become pregnant. Research studies suggest that there may be a number of very serious negative effects on the developing fetus and newborns when a mother takes these types of drugs during her pregnancy.

ProzacMs. Grant’s efforts to get off the drug that she was taking at that time, Prozac, was not easy. She first tried cutting her dose in half. She learned that these types of drugs can lead to a very uncomfortable withdrawal syndrome. She experienced muscle cramps in her thighs, trembling hands, a dry lump in her throat, obsessive thoughts about going crazy and being locked away in a mental hospital.

By tapering off the Prozac in much smaller increments, she found that she was able to wean herself off entirely after six months. Now, med-free, she and Greg welcomed the birth of a baby girl. How did she fare off the drug?

My unmedicated life was kind of a beautiful thing. Yes, I was better. And yes, it felt liberating to no longer rely on a chemical crutch. But most important was my fading sense of alienation. I could now count myself among the normal masses, a healthy woman who, with my husband, had just started a family — something, in the throes of my illness, I feared would be closed off to me.

baby-boyI remember those four years free of antidepressants as a cheerful but busy blur of baby-raising — decorating a nursery, changing diapers, hiring a nanny — while balancing my career. But after the birth of our second child, a strapping son, signs of a relapse appeared.

Ms. Grant quickly scheduled an appointment with a new psychiatrist. Without hesitating, he put her back on Prozac. Three months went by with no relief. She then tried Zoloft, again with no success. Finally, a colleague of Greg’s recommended Effexor. This seemed to help. As Ms. Grant tells it, the “crashing waves of fear and hopelessness began sliding out to sea.” It had taken her two years to regain what she referred to as “a sense of stability.”

Since then, she has decided to stay on her drug for the rest of her life. In making this decision, she conferred with a number of experts. Kenneth Duckworth, M.D., medical director of the National Alliance on Mental Illness, told her that there was not enough research on the long term safety of these types of drugs to offer any assurances that down the line she might have to pay a serious negative health consequence. “Medicines are tested for weeks or months, not years, to get FDA approval,” Dr. Duckworth said. “Once things are on the market, we rely on voluntary reporting for side effects.”

NIMHA researcher at NIMH, a Dr. Rudorfer told her, “It took many years to figure out that the older antipsychotics could cause tardive dyskinesia — a terrible, permanent neurological disorder. There does not seem to be anything that drastic with these antidepressants, but we’re talking about medications we are intentionally getting into the brain — and that should be taken very seriously.”

risksDr. Rudorfer, did offer Ms. Grant some words of encouragement. In his opinion, “The risk of untreated depression is greater than the risk of any adverse effect of antidepressants.” Toward the end of her story, Ms. Grant states that she recognizes there are more ways to treat depression and panic experiences than with the drug that she was taking, but she came to believe that she could never have recovered without it.

My Comments

Jeff Rubin

Jeff Rubin

First of all, I wish Ms. Grant well, and I fully support her right to choose how she wants to deal with her challenging experiences. She has far more expertise in what has been going on in her life than I do. I mean her no disrespect because of my disagreement with her drug approach for dealing with the type of experiences that so troubled her. Moreover, I have met people who chose to take drugs to deal with these kinds of experiences and they struck me as intelligent, decent folks.

That said, I wish to point out that in 30 plus years of providing counseling, I have met many people who struggled with panic experiences that sound very similar to what Ms. Grant described. As Ms. Grant mentioned, there are other ways to deal with panic and depression than drugs, and it just so happens I have experience using one such method. I taught people expressing concerns about their personal panic experiences that they can easily get through them by finding a quiet place, sitting in a comfortable position, and then practicing a type of meditation which involves observing the physical sensations they are experiencing in a nonjudgmental manner, as if they were tasting for the first time, fresh island mountain water. I encourage them to learn to befriend these experiences. I then taught them how to meditate on a regular schedule (twenty minutes in the morning and twenty minutes before the evening meal) even when they were not experiencing a panic episode.

Some found that after a while they stopped having these experiences. The others continued to have panic episodes from time to time after learning these skills, but they became less intense, occurred less frequently and lasted for much shorter periods of time. All my counseling cases got on with their lives without having to deal with the side effects of the drugs and being concerned about their long term health risks. None were ever hospitalized or committed suicide as a result of such experiences.

Besides the panic attacks, how would I handle the other sad and fearful experiences that accompanied Ms. Grant’s concerns? In an earlier post, I discussed three ways to deal with emotional pain that does not cost any money (see HERE). I refer you to that article. For those who find that they can use some additional help getting through these challenging experiences, counseling can be very helpful.

There was one particular part of Ms. Grant’s story that irked me. risk-zoneIt occurred when Dr. Rudorfer told her that in his opinion, “The risk of untreated depression is greater than the risk of any adverse effect of antidepressants.” As someone who has participated in a number of debates on the use of psychiatric drugs, I have heard a number of physicians make the same claim. Whenever I asked these doctors what risks they were referring to regarding untreated depression, the answer has always been an increased risk of suicide. The doctors’ statements about this imply that if treated with “antidepressants” this can decrease the risk of suicide enough so that the depressed patient, by taking the drug, is better off than facing the risk of any adverse effects of the drug. But the doctors don’t know what the long term effects of taking the drugs are. What’s more, the scientific evidence currently available indicates that these drugs do not reduce the risk of suicide; for some, they may actually increase it. So, I did want to clarify this issue a bit.

Okay then, that’s my “From Insults to Respect” post for this week. I hope you have found in it some ideas worth thinking about.

My Best to You All,

Jeff

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

 

Is Depression an Illness?
The Mental Illness Construct: Does it Reduce Shame and Guilt?

About the Author

Jeffrey Rubin grew up in Brooklyn, received his PhD from the University of Minnesota and has taught conflict resolution there as well as at a psychiatric clinic, a correctional facility and a number of public schools. He has published articles on anger and conflict resolution and has authored three novels.

5 Comments

  1. Nice, clear outline of a case, and nice suggestions for an alternative way to view emotional distress other than seeing it as “abnormal” or “brain disorder.” I would venture to say that the woman in the case was perhaps on the edge of a spiritual crisis, and something in her was trying to push her very hard toward spiritual development; toward going inward and releasing a sense of identity for a period of time, in order to go deeper, to a deeper level of knowing oneself that what was previously available by being locked in to the previous sense of identity. But she rejected that call to go inward and develop herself from a deep place within. Instead, she seemed very concerned about identity, and especially about “being normal,” or appearing normal, as if that is something to aspire to. It seems when she made a shift in identity into motherhood, she calmed down and was occupied with her new identity, then after some time she wore through that identity as well, but then had no aspiration again to deepen her sense of self, of identity, of going inward toward a more ground level of being, but instead remained concerned with the superficial concept of “being normal” even though being such a way means being spiritually void and occupied with playing roles rather than being. It is fascinating how easily people swallow the ideas from society about who they are supposed to be and what they are supposed to be doing in life. To get past that, one necessarily needs a “break down” to rid oneself of society’s shackles, so that venturing into a deeper part of oneself and developing a sense of self from an internal place, a sense of identity from that place, rather than from an external source… but I suppose that is too difficult for normal people to do and it certainly would result in a life that requires a deeper sense of responsibility than what one otherwise has to take on when one is not self-made but is made simply through adoption of an external idea. Most people don’t want that deeper level of responsibility in life; it is easier to just “be normal” and do what one is “supposed” to do and feel how one is “supposed” to feel according to normal society’s dictates. However, I am happy to see that this is becoming more difficult in society over time. Eventually no one will be able to “be normal” because what is considered normal is actually an entirely unsustainable way of being.

    • Much thanks for your thoughtful comment, Anonymous. Many people do feel pressured to do what they conceive as “what they are suppose to do.” It takes some time to listen within to discover what fits your own personal life.

      • Hi, yes, I agree. I wrote my comment when I was in a hurry; if I had more time it would be more clear. Basically my thought is that when people look toward external sources to tell them who they are and how they should feel and think, they get lost. But luckily, because depression is naturally a thrust inward, a recoil from the outer world, a call from the neglected soul, if it is followed rather than feared, it leads to a period of contemplation and sustained contact with the soul so that it can be developed. But if the call inward is ignored, it becomes a kind of stagnation and decay felt as “depression”. Ignoring the soul does not make its needs disappear; the “pull downward” I think is the soul beckoning for engagement because that is where self development occurs, through the soul. Basically I think depression is a sign that the soul needs to be attended to; ideally one would drop out of society for a period of time to sustain contact with the soul for self development, but this is difficult to do in modern civilization. But if it were possible, it is the most direct, fastest way that the self is developed, and once the self is developed from within rather than from without, then it is a genuine self rather than a role being played; an empty ‘should’ being carried out through the dictates of social prescription. If that happens, identity is no longer an issue because identity is then no longer dependent on external sources for nurturing and validation, etc. (Not sure if this makes my idea more clear; pretty hard to summarize; anyway I like your writing style on this blog because it is very clear and direct; nice job!)

  2. Interesting article. I am curious about your approach to schizophrenia? My son has been on antipsychotic for 8 years and recently reduced his meds. Decisión slowly returned. He, and I, do not see an alternative. A devastating disease to an otherwise extremely intelligent young man.

    • Hi Mark King. I understand, to some extent, how hard it must be to be a parent with a son who has been acting in ways that raises serious concerns about his own well being and those who interact with him. Of course each case is so individualistic so that I can’t claim to know all of what you and your family have been experiencing. It is therefore a mistake for me to provide specific advice with regards to your son. In general, it is my opinion that the psychiatric drugs prescribed by doctors to treat the collection of concerns that they refer to as schizophrenia tend to cause far more harm than good. If you want to seriously look at the question you posed, I recommend reading a book titled Anatomy of an Epidemic by Robert Whitaker.

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