Sunday, August 16, 2015

Depression, Medications, and Me

A number of years ago, I read a letter to the editor of the journal of the Christian Medical and Dental Association that questioned the use of anti-depressants. The author suggested that if some of the authors of the Bible like David and Jeremiah had lived in modern days they would have never written their portions of the Bible because they would have been medicated. At the time, I disagreed with the assertion, but I didn't have the confidence or experience to write back. Now, fifteen years later, I'm going to respond to that unknown physician.

Anti-depressants are used to treat depression, not sadness or guilt. Depression is not ordinary sadness. Yes, the primary symptom is sadness, but it also includes lack of motivation, inability to feel happiness, and physical symptoms such as sleep disorders and appetite changes. 

We know that anti-depressants work when someone starts to feel normal emotions, not just happiness. In fact, someone on anti-depressants will feel sad at appropriate times, but will be able to feel happy at reasonable times, as well. A depressed person can't feel normal emotions. I can speak to this because of my experience as a physician who has prescribed anti-depressants to patients, but also because of my own depression.

There's no evidence that David was depressed. He was still able to write much of the book of Psalms. A depressed person has difficulty doing things because of a lack of motivation. According to Psalm 51, David did feel appropriate regret and remorse from his "affair" with Bathsheba and his subsequent murder of her husband.

Jeremiah was very sad about the state of Judah and the prophecies that God had given him, but he was also able to continue to prophecy. Again, there was no evidence that he was depressed.

So, the whole issue comes down to whether or not anti-depressants make us "not ourselves" and whether or not God wants us to use them. After all, if they would change us so much that God wouldn't be able to use us to do something like inspire the writing of the Bible, then they must be pretty bad.

Hogwash! Depression is an illness of the brain. It makes it's victims feel sad and melancholy and unable to feel happiness. Anti-depressants don't make a person feel happy; they make a person able to feel normal emotions, both happy and sad.

I've felt the stigma of depression, but I'm glad I've been willing to accept treatment. My risk for depression was really high based on my family tree. There is depression and addiction scattered throughout my family tree on both sides. I was fortunate that my first bout didn't happen until I was in my 30s. Now that I've got chronic migraine, depression is an unwelcome companion.

Without treatment, I wouldn't just be sad, I'd be sitting on the sofa and doing nothing. My doctor and I are titrating up my dose of amitriptyline, which is the second anti-depressant I'm on (I'm also on citalopram). I don't really like the side effects of the amitriptyline (dry mouth, hunger, fatigue) but I've spent this summer being sad and headache-y from trying to go without my medication. 

My depression meds aren't my entire treatment. They help adjust my brain chemicals, but they are helped significantly by counseling, exercise (when my head doesn't hurt too much), and a (somewhat) healthy diet. 

Depression is real. It's treatable with non-medical treatment and with medications. It seems to me that if God is OK with antibiotics for strep throat, then he's OK with anti-depressants for the biological illness of depression.

And the meds work. I'm still having headaches, but my mood is finally better. I'm tolerating the headaches better. I'm not happy about the headaches, but i can feel a range of emotions again. And it feels so good.

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