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http://www.nytimes.com/2008/04/15/health/1...amp;oref=slogin

Just something to ponder.

Growing up, I have had times that I was not on ADs so I've seen another side (called unmedicated bipolar!) There can be a difference but now that I am stable, I feel somewhat normal. Whatever that is.

But anyway, I thought this might be a thought provoking topic to share.

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I don't know what it's like to be bipolar or to have ADD for instance...

I only have personal experience with depression. I didn't start treating mine till I was 19 and, therefore, fully grown, but I was depressed since I was 12 or 13 if not even younger. I'm pretty sure I would've liked to get treatment sooner, but my parents wouldn't have liked to own up to having a mental illness in the family...

Perhaps it's because I started treatment so late, but I don't have any existential questions. I do like my antidepressants (the ones that work anyway). I've gotten off them from time to time, but the results just weren't pretty.

I do understand the concern that we don't really know what the longterm effects are, especially on a young brain. I don't have an answer to that. It depends on how severe your symptoms are. Serious mental illness probably isn't good for the young brain either...

I'll be stopping my antidepressants only when serious longterm efects are discovered.

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Well...I can understand concern about long term effects. Well, who couldn't, all these lawsuits (vioxx, zyprexa) in the news...

I'm just glad the writer pointed out the short term effects too: like, y'know, potential suicide. Furthermore one forgets the toll taken on the whole body by untreated depression...immune system, cardiovascular, all sorts of stuff is off cuz of stress hormones and whatnot. And if taking a pill can get your ass out of bed and working and exercising (well, more than sitting on a couch slurping ice cream while watching soaps) then there'd have to be some pretty deleterious long term effects to outweigh the benefits provided by ADs.

I DO worry that, as semi-balanced as this article was, it'll scare even more people away from helpful treatment. What, it isn't bad enough these meds screw with your sex life, make you fat and lazy, and whatever else? NOW they might fuck you up 20-30 years down the road (but ooooh we just really really can't know just right this moment)?

I'm not on any ADs, but I'll say this: if any of the meds I'm on give me some weird cancer at the ripe young age of 50...

Fuck it. That's 20 years, 20 pretty good years, that I either wouldn't have had or that would have been a living hell if it weren't for the meds.

Besides, maybe we'll cure cancer in 20 years. ;)

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I've been taking AD's since the age of 18 - I am now 50. I have to say, that I was so severely depressed (hospitalized for weeks on end for it, 6 separate times before I was 24 years old) - that I would have taken almost any drug given, no matter the risks - if I thought it would make the pain go away.

Geez, I dunno - feeling suicidal didn't strike me as "normal" either. So, is the author presuming to tell an entire population of people, who have had the gall to medicate themselves away from feeling suicidal and-or completely crappy most all of the time, that they don't know what it's like to feel "normal"?

I never felt much of an identity crisis, due to taking ADs for 32 years if my life. When my AD meds finally started working for me, I was just so relieved much of my emotional pain was finally subsiding, it didn't cross my mind to feel much except relief. And for awhile, I admit I felt tentative relief, since I'd tried so many different meds, and most hadn't worked very well, for long.

I noticed the author didn't bother to try to define the term "normal". Maybe that's because he knows it's pretty darned elusive. Sorry, but - for me, *that's where his premise fails.

And he wants to suggest that these people could or should feel deprived, endangered, or "bad about themselves", due to this?

Geez - how about simply feeling grateful, that there's a cure for feeling like such total crap, it makes you feel like you should just end it all? It's not a perfect world. Welcome to reality.

Let's extrapolate what seems (to me) to be part of his argument/thesis here:

I see depression as a biological illness. To me, that's what makes it possible for there to be a biological cure like ADs in the first place. Well, if that's true, then -

Maybe next time I need to go to a hospital, for any reason - say for a heart operation, an infection, or gall-stones, I should just tell the doctor I want a homeopathic cure, or none, because I don't believe modern medicine has much to offer me, and I'd rather be crippled, or dead, because it's "more natural"? After all, most surgery poses risks as well.

Is he saying that disease is more "normal" than health-via-medicine? Or what? I am confused.

I can kinda--sorta commend the author for pointing out some " potential draw-backs" to any long-term AD use.

However, I really have to say, that this kind of article has always bothered me, in that it really proposes no legitimate alternative solution to depression sufferers.

Maybe his purpose was just to encourage research. In which case, I can agree - and I hope he sent a copy of his article to all the pertinent pharmacy company and university research lab execs, too - not just The New York Times.

The author states, in his last sentence, that researchers and doctors "owe it to their patients" to answer these questions.

They do. And - until some reliable medical authority definitively does that for all ages of depression sufferers, across the board, for all the AD's they take, I guess I'm not too worried. I am still busy reading conflicting medical studies about whether salt or sugar, for example, in X or Y amounts, will really kill me "before my time", and whether caffeine is really good or bad for me, and whether eating bacon will give me cancer, etc., ad infinitum.

If I had a teen-ager who was being medicated for depression, I might be a tad more concerned. Even then, I'd risk having them take AD's than feeling like total crap all the time, because I know what that feels like. But I don't have a teen-ager, much less one who is depressed. And my meds work pretty well for me.

There are those of us who would rather not just "bite the bullet" and live with suicide-inducing, severe depession. I tried living without my meds - and ended up trying to kill myself.

What exactly, are the authors proposing people like me do? Just smile, try to sing, and fake "it" instead? Most of the folks I know who suffer from severe MDD, know that's never gonna work for them.

While I can appreciate the questioning of long-term AD use - until some reliable medical authority can propose a truly better solution, I'll stick with my Lexa-Pro.

No offense to the OP intended - I know she was just forwarding some reading material, and it was an interesting read. ;)

- Susan

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There are an endless amount of opinions that I have on this subject (very interesting thread, as these are things that I've thought in my own life quite a bit, being an almost 21 year old that started ADs at 18) but--

I want to just first say that another thing that the article failed to take into account is the number of young people and teens who SELF-medicate to treat their mental illness. Absolutely, suicide is a very big factor in medicating vs. not, but think of the number of teens that start possibly life long addictions and issues from substance abuse.

Compare a teen taking an AD and their potential long term ill-effects with a teen who starts binge-drinking at age 14 and then turns to other illegal drugs or has full-blown alcoholism not too long down the road.

We know where that leads, we have proof that trying to escape and numb emotions and MI with alcohol, etc. has pretty harsh effects on your body and life---we don't know specifics of how ADs affect the body, but if they do half of what alcoholism or a meth habit does physically but really really help in the rest of your life, then I'll take the ADs, thanks.

You know?

I think that when the debate of medicating/non-medicating comes up, it's also very important to look at what that non-medicated kid is likely to use as their own 'medication'.

end rambling point making ;)

as far as the rest of it goes, yes, I've had points where I wonder what the supposed 'real me' is like, but if people think that I should believe the 'real me' is the un-medicated corpse of a human being laying in bed in silent agony, then screw them.

not the most diplomatic way of saying it, but I personally don't think that the half-dead thing that takes over is me. I am the person who was being strangled and muffled and hidden by the depression. Medication is the only thing that I've found so far that is able to get rid of the depression and allowed me to become who I want to be.

in an odd way, I almost feel more free to decide and define who I am than some of my friends, who are still held back by years and years of trying to sort through themselves little by little and being weighed down by their past 'me's and perceptions of who they should be.

by becoming so depressed so early and then subsequently put on meds, I feel like I got the chance to start over and leave a lot of the things that I hated about myself back with that strange waxy half-dead girl in bed.

does that make any sense to anyone?

I'm not trying to paint everything rosy and write a self-help column about the perks of being suicidally depressed, and I am certainly not ignoring the burden that comes of dealing with this illness for the rest of my life-- but I feel very lucky in a sort of way that I was forced to almost start over at age 20 (when most people are just beginning to sort out who they are) and decide what person I wanted to be.

The medication doesn't define me-- it just gives me the breathing room to let ME define me.

anyone get it? am rambly and sleepy.

thanks for letting me,

m

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Yes, it makes a lot of sense to me. Excellent point, meg, re: Self-medicating leading to perhaps life-long substance-abuse problems for non-medicated (or wrongly medicated) teens and young adults who suffer from depression.

- Susan

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I was close to committing suicide before taking medication. I couldn't apply all the things I was supposed to learn in therapy to my life because I had no control over my emotions. Antidepressants pulled me out of that Hell just enough so I could get some work done. At no point did I forget my problems - in fact, I became more aware of them because I was able to think clearly.

Many people are attached to the idea that there is a part of ourselves that never changes. The part of ourself is related to our moods, our interests, our behaviors, etc. Who we are. Because we know that the brain controls our speech, our vision, touch, etc., we associate who we are with the brain. To tinker with the brain is to imply that there is something wrong with who we are. Some people fear that tinkering with the brain can cause damage to who we are.

I am not attached to the who I am idea. My emotions, likes and dislikes, sense of humor, and other things are the result of neurons firing - thoughts. Thoughts are real in the sense that they occur when neurons fire. However, thoughts are transient. It is difficult to define oneself based on neural activity, which can change in social situations, when alone, or with the weather. Identity is fluid. I am not the same person as I was when I was five years old, and I anticipate being very different as I age. Who I am is not euphoric or euthymic, it is not an illness, it is not an occupation, it is not gender, and it is not the role I play in my family.

I do not feel that taking medication has affected my identity. Medication has simply altered my mood. I still love my husband and pets, I still enjoy reading and learning, and I still dislike Reality TV. I am not attached to these things, and I am willing to accept changes to them as they come.

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What an excellent post, jensaisquois.

I agree. Even though the brain is also a biological organ, since nobody can seem to define where consciousness comes from - and the answer to this question has eluded people for millions of years, whenever some people - portions of the medical community included - start discussing medicating mental illnesses - the conversation can seem to suddenly devolve - as if they are putting AD and-or anti-psychotic medicines on the level of using VooDoo dolls, when they use them to help patients feel some relief.

I suppose it's a legitimate and philosophically interesting question/issue - theroetically. But practically speaking, these folks sometimes make me wonder if they might be distant cousins of Tom Cruise. It might be nice if they'd just admit they are really talking about a philosophical issue, and not a purely medical or scientific one (at least by my standards), in the first place.

In fairness to the author of the article - I am all for long-term AD drug studies (perhaps not sponsored by pharm companies, thus not conflicting w/their profit motive) that examine solutions for problems posed by the side effects of some ADs - side effects such as dis-interest in things sexual, for example.

Side effects that might seem inconsequential to pharmacy execs - but may seem much more consequential to the patients who may have to live with them, long-term - simply because no other drugs without these side effects (generally) are available on the market.

Thus problems like the inevitable weight gain, that accompanies many anti-psychotic and AD meds, might be more readily remedied.

*I agree that pharm companies seem to have no particular incentive for studying any long-term ill effects of AD use.

ADs have only been around since what? -the early 1970's? - which is a little over 30 years - so "life-time" effects of AD studies don't seem possible (yet). The author never defined what he means by "long-term".

But, maybe some laws could be passed mandating that some more "long-term" AD-effects studies be done (besides the one mentioned in the article). I wonder where the FDA is in all of this, as far as considering mandating any long -term study? Maybe it's not in their venue.

Just how remedying the situation might happen, the author doesn't exactly propose. I am not holding my breath, but maybe a strong consumer lobby might provide a strong voice to which pharm companies might listen, who knows?

*Capitalism certainly seems here to stay, at least in the U.S., and pharmacuetical companies will be making a profit. But, we also have the FDA, and lawyers, and Congress, and university research labs. So that's a good thing.

This article seems to be touching on questions that nobody has ever really figured out the answers to yet, despite centuries of trying: "What is consciousness?", "What makes a person human?" , "Where does personality come from?", etc.

Entire religions have developed, attempting to answer these kinds of questions. Maybe that's why some P-docs I know seem so interested in religions and spirituality.

Frankly, I vote for keeping my AD medicines and my religious/philosophical issues, as separate as church and state are in the U.S. constitution. I like to believe the docs have "moral gray areas" covered, when it comes to medicating patients, by taking the Hippocratic oath: "Do no harm" (intentionally, that is). But maybe I am being a bit naive.

There are questions that seem to come up frequently in the medical community (stem cell research: good or bad?, for example) in which doctors opinions re: something being "necessary" can fall on both sides of an issue (as it can for the public).

However, I was always under the impression doctors seemed to focus on the "medical/biological model" re: Treating an illness. If a med or an approach can treat a symptom and alleviate pain, then it's generally considered medically acceptable to use (*as long as the FDA approves it's use as well, of course).

Viewing a treatment from this perspective, seems to eliminate some of these philosophical conundrums (some of which have no answer) for doctors. I see that overall as a good thing, really. Patients can then make informed decisions - with the information available at the time, to make it with. Maybe the queries run a bit deeper for some psychiatrists, because they deal with the human psyche, I dunno.

Just because the level of information that does exist doesn't cover every possibility re: What could ever happen down the road, as a result of using an FDA-approved AD med, isn't a reason (for me) to forego taking it. You work with what you've got.

***I also have to wonder if the author would be asking whether an amputee felt "deprived of a normality" just because he/she wore a prosthesis, instead of having a flesh-and-blood limb - especially knowing there was no other alternative?

While it's certainly hard to argue that research into the medical long-term effects of ADs isn't a good thing - I have to ask why this issue seems to come up more often, specifically in relation to drugs treating mental illness - (maybe I am just paranoid - but I don't think so, really. I think it does).

It seems careless to me, for the author to (perhaps un-intentionally) seem to propose that AD's are merely a "necessary evil", when:

1) There's no current alternative that works as well, and -

2) Many doctors wouldn't dream of saying a similar thing, to someone with a "physical illness or "defect". Nobody, for instance, proposed that the Jarvik heart was a "necessary evil" when it was invented. Ditto for pace-makers. They were touted as "miracles".

Let's get one thing straight, America: Mental illness is a physical illness. If it wasn't, there would not be a bio-chemical-physical treatment available, which works.

I will say that maybe it should be mandated by law, that pharmacuetical company execs take the Hippocratic Oath as well, hehe. In any case, Yay Thomas Jefferson! ;)

- Susan

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It is amazing and wonderful how much unnecessary suffering we are able to spare people these days. Especially kids and adolescents, who often do not have the option to seek and achieve adequate treatment on their own. And the fact that so many parents are willing to recognize when there is something seriously wrong with their kids, and seek effective treatment for them and advocate for them on their behalf... Sometimes there are things that are right with the world, you know? They could be better. But still. There's a lot of compassion out there and that give me some hope for people-in-general that I wouldn't otherwise have.

The "I don't know what's really me / they don't know what's really them" question assumes both that there is an authentic self and that knowing and being your authentic self will benefit both you and others. Essentializing things - believing that they have some kind of underlying essence that makes them what they are - is a pretty normal human tendency, despite the fact that it's often not true. I think it's debatable that simply taking me off medication would let me experience my authentic true self. I have all kinds of wacky evolutionary-novel things that fundamentally alter my brain chemistry / patterns of thinking - higher education, absence of close kin, lack of babies despite being 28, access to obscene amounts of sugar that my distant ancestors never had, etc. I could attempt to run around on the African savannah gathering nuts and berries but I don't think that's going to help me or anyone else

The belief that being your authentic self benefits you and others is not a cultural universal; many places de-emphasize that while emphasizing the importance of relating to others in ways that are good for them. (There's been a bunch of research on this with China and Korea, as well as Japan although Japan tends to emphasize both more heavily.) The fact that the "authentic self = good" idea is culturally bound doesn't mean it's a bad thing per se - the notion that relationships should take precedence over expressing your authentic self is also culturally bound. The point is that plenty of places get along well without making expression of an authentic self, or experiencing an authentic self, or having an authentic self, a sacred value.

Most people who offer the "authentic self = good" notion probably don't turn the other cheek when others' authentic selves have negative consequences for them.

Done with soapbox now.

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Wow. What a great point to bring up, resonance: The idea of an authentic self being "better" being culturally-bound. I emphatically agree, upon reflection (thanks for bringing it up).

I think this might also be tied into what I consider the author's mis-concpetion (or pre-conception) that "growth" stops at "adult-hood". When is that, anyway? 18? 21? 25? 30? Another "culturally bound" concept, it seems. I intend to "grow" until I die.

If I was "done" growing, psychologically, at age 18, then why couldn't I just die then, and get it over with? I certainly felt like it, as I recall.

I know the author's saying that the human brain, as an organ, isn't "mature" in adolescence, and from what I've read, he's right. But the question gets to be a bit of a conundrum from there on out - being that the brain's development is tied up with personality development, etc.

However, I will say that "developing my "identity" didn't stop for me when I turned 18. It's fluid, and it's still changing - and hopefully it will be until I am gone. I always thought the idea a person's "identity" was fully formed at the age of 30 (which I'd heard touted by some P-docs) was mis-leading, sometimes dis-heartening, just another (of many) popular "theories". Didn't Frued think that every woman also had "penis envy"? I guess it all depends on who you want to believe...

I vote for letting "sleeping dogs lie" and unapologetically taking my current meds. Until something better might come along.

- Susan

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I want to just first say that another thing that the article failed to take into account is the number of young people and teens who SELF-medicate to treat their mental illness. Absolutely, suicide is a very big factor in medicating vs. not, but think of the number of teens that start possibly life long addictions and issues from substance abuse.

Oh my yes. Speaking from not so much an AD POV, but more mood stabilzer side of things, well, not a big difference in the end maybe...but... By God if I'd've been properly treated earlier, even by a couple years, maybe I wouldn't be the lousy drunk I am now and by GOD I would have saved a couple years of sheer hell...jail, rehab, joblessness, nearly homelessness (well OK moving in with the parents, but really, under the bridge would probably be a better option there!).

I can't even guess what years of out-of-control drinking did to me, and while I'm much better now, it's not like I've stopped.

I just can't imagine any long term effects from an AD or other pill that can outweigh the consequences of rampant substance abuse--even weight gain pales compared to most substance effects (and beer makes you fat anyways).

Aside from that--well, my "true" self was, I would have to say, forged in the fires of my manias and depressions. But what of it? Our "true" selves are built from our experiences and the lives we live...and I wouldn't mind having a different self built on stability and moderation, even though I kinda like the style of the "me" that I am. The price I paid to be "me"...well, it's just too damn high.

And therin, I think, lies the rub. All these "normal" people can fret about "us" and these meds messing with our existential selves. But there's always a price, one they don't have to pay. When your alternatives are existential "trueness" that is misery and pain, or a medically induced alter-existentiality (yes, i like making up terms as I go along)...well shit. There ya go.

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I truly agree with that point, too, CNS (and would have written more about it earlier, but sort of got off on a tangent about other stuff. By the time I got done, I'd written so much already, I felt kind of ridiculous. No offense to meg - because it was such an outstanding point, IMO, for her to have brought up).

Yes, me as well. I definitely "self-medicated" - for at least 10 (long) years, as a result of my MDD. I know I hurt some other people - and myself, along the way. I wonder if some of the folks who think it might be better to be more our "authentic selves" and who seem (to me) to question the use of these meds, truly realize just how painful being our "authentic selves" (meaning sans MI meds) can be.

If they do, I wonder if it's really ethical for them to urge patients who really need them, to question whether it's a good thing to take these meds. I really doubt it. Maybe that's not what the author intended, but - that's ultimately what it came off sounding like what he meant (to me). And I also found myself thinking that's what one effect of the article could be (along with affecting the attitude of the general public).

I find it irritating to read this kind of thing in relation to MI meds - especially written by a psychiatrist teaching at a medical school. I'm sure he thinks he's right - and that he probably didn't mean it to come off, the way it did (to me) BUT, it seems to de-legitimize the whole rationale for taking MI meds - and when I read the article, it just sounded to me like he was saying:

"Oh, it's a shame these poor kids have to take these MI meds. I wish I didn't have to prescribe them to patients so young, but I do it anyway, because well, what choice have I got?"

It wasn't blatant - more an overall insinuation. I'd wager many people are going to be more likely to just believe this attitude is auto-justifiable, without really thinking about it, simply because he's (after all) a doctor teaching at a medical school. That's what I guess I find extra-objectionable.

I just found myself thinking:

Geez, if this guy can't appreciate helping sick people via MI meds, then why be a psychiatrist? It's what they do. Why are MI meds somehow "less legitimate" to prescribe, than other meds? I don't see doctors writing articles like this about, say, insulin for diabetics (although it's possible they do. I just don't see them published in "The New York Times" ). Why write an article about it, potentially getting the public worked up about it (one more time), if there really isn't much they can do about it, aside from letting non-medicated teens suffer without AD meds?

If what he was actually objecting to, was doctors "over-prescribing" AD meds, then he should have been less vague, and just plainly come out and said it, IMO. The article didn't do that, really, but it did seem (to me) to me to insinuate there was "something wrong" with the idea of long-term AD med use.

If he was really objecting to the fact that some patients can become addicted to some MI meds, well, maybe he should have come out and said that, point-blank, as well.

Perhaps I should credit him with being compassionate, instead of patronizing and un-thinking. Hmmm.

Hey - maybe he's just a bad writer, or a busy, busy guy. He's a med school teacher, and a doctor. In which case, IMO, maybe he can just forgo submitting articles to the NYT, until he's "polished" his articles a bit more. Like they say, with fame and education come great responsibility (or something like that). Or maybe, it's the Editor's fault and the article was "cut". In any case, I say: "Let the buyer (reader) beware".

I probably over-reacted, because the article did have (what I considered to be) legitimate things to say as well re: More "long-term" studies on the effects of ADs needing to be done. But I consider that something that would be a good idea for any prescription med - not just AD meds.

*Maybe for me, it's a problem that short articles like this, can leave more questions than answers, at times. And if it works the same way for much of the general public, I'm not sure that's always such a great thing. Unless they're gonna follow it up by reading "deeper" articles in medical journals, or something, which seems un-likely, on the whole. I don't do that, usually, although I have, on occasion. Maybe mostly because I can be personally affected by articles like this, being an "MI consumer" myself. But I could be wrong, I dunno. Maybe the general public will, too.

I therefore can tend to find it somewhat irresponsible, when writers and editors don't seem to "have their bases covered".

On the other hand, it's the NYT, and that's maybe what their readership wants (and thinks they need). So does TIME magazine's readership want that (I was a marketing management major in college, so if that's the case, I "get that"). But hey - I also hear people complain all the time about things like "sound byte" television, and general media etc. So there you go.

Suppose a long-term study of AD meds does find some horrible side effect of ADs exist, that nobody previously knew about? Well, in that case - the public and AD patients can just...what? Hope there is a better alternative drug at that point, can't we?...or...what?

Like I said, maybe I am paranoid, or being too critcal, or maybe I "think too much" (sorry, maybe it's the OCD), but at that point, I found myself wondering:

What exactly, is really the point here, of this article?

In any case, it was a very good thought-provoking topic, and thanks to the OP for contributing it. ;)

- Susan

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