In her provocative new book, a psychiatrist takes a hard look at the way we use antidepressants.
By Beth Levine
At some point (OK, maybe at several points), you have probably unleashed your inner dragoness, the one who gets enraged, spits a little fire and -- goddess forbid! -- isn't a ray of sunshine. Traditionally, we've been taught that this side of ourselves is bad, bad, bad. And increasingly, we're being prescribed antidepressants and antianxiety meds to proceed on a more even, less emotional keel. But Julie Holland, MD, a psychiatrist who specializes in psychopharmacology and is the author of the cheekily titled new book Moody Bitches: The Truth About the Drugs You're Taking, the Sleep You're Missing, the Sex You're Not Having, and What's Really Making You Crazy, says that the more we medicate, the more we cheat ourselves out of rich, full lives. "I'm not saying women with clear psychiatric disorders, such as major chronic depression and bipolar disorder, should stop taking their meds," says Holland. "But I do believe that too many women are being told to medicate away their essential, authentic selves."
Research does show that mood disorders may be overdiagnosed: A 2013 study of more than 5,000 people found that nearly 62 percent had been told by a medical professional that they had depression even though they did not meet the clinical criteria. Holland's advice: Embrace your moods. All of them. "One of the gifts women have is the ability to be sensitive to their environment and empathic to people around them," she says. "We can intuit what's going on and who needs what -- and we shouldn't tamp down our natural emotionality." Yet while advocating against overmedication seems sensible enough, are things really that simple? We asked Holland, who has treated patients for nearly 20 years, to convince us that there's a pill-free way to develop a healthy balance.
Q: What's so great about being angry or anxious?
A: Many people don't recognize that their feelings can be an important feedback system. Irritation or resentment could tip you off to an imbalance of effort or compassion in a relationship. Depression may mean something in your life needs to change. I had a patient who called me crying from work one day and said, "I think we need to up my antidepressants." Then she proceeded to tell me a horrible story about her abusive boss. My response: "We don't need to medicate away your indignant feelings. He behaved very badly, and for you to increase your medicine so you don't mind that he behaved very badly doesn't do anyone any favors." My point was that being more accommodating and thick-skinned isn't necessarily the answer. You can't just medicate yourself so you don't care! Silencing the signals that you need to make necessary changes in your life -- like confronting a mean manager or ending a bad relationship -- can leave you in a paralyzing state of denial.
Q: Are you saying antidepressants make it hard to take a clear-eyed look at our problems?
A: A large number of my patients feel happier and more relaxed on the antidepressants known as SSRIs (selective serotonin reuptake inhibitors), and nearly all antianxiety meds are sedating. These drugs can clearly work, but there may be a cost. Not only may you be more likely to experience apathy, you may also feel less empathy. And many women are on a combination of oral contraception and antidepressants. So they have artificially high estrogen levels from the pill and artificially high serotonin levels from the antidepressants, which may improve their moods to the point where there's a lot of accommodating going on. They end up suppressing their own agenda and desires in service to others. Another issue is that women will say they don't feel things as deeply, which may be a relief, but again, they're not being their real selves.
Q: I was surprised to learn that fewer than 30 percent of Americans taking one antidepressant and fewer than half of those taking multiple meds have seen a mental health professional in the past year.
A: Here's the analogy I use: If you're going down a bumpy road, you need some shock absorbers. Otherwise, you'll feel every pothole. Therapy is like a set of emotional shock absorbers. If you do the work, you learn how to create patterns in your thinking and behavior that can help you be more resilient in times of stress. If you're only taking meds without also seeing a therapist, you're not learning any new skills, so when you stop taking the drugs, you're not really any better off. I encourage -- borderline insist -- that my patients go into therapy. I want people to adopt healthier coping strategies so they can get off meds. That's the goal. You're not meant to stay on these drugs for decades.
Q: So patients in therapy are more likely to eventually get off antidepressants?
A: Yes, but I would add that among my patients, the ones who are most likely to get off meds are also the ones who do regular cardio. I've seen it over and over. When people become regular exercisers, they need lower doses or they can get off their meds entirely. As much as I bug my patients about being in therapy, I really noodge them about physical activity. It makes a big difference in helping people feel their best—at which point they don't have the need to blunt their natural emotions with medicine.
Q: You also say women should track their hormonal cycle in order to tap into their moods. Why?
A: I had a patient who told me that none of her previous doctors had ever brought up the idea that there could be a cyclical pattern to her depression. I actually have quite a few patients who never put it together until I asked them to find their natural emotional baseline by tracking their moods over the course of one monthly cycle. There are times when estrogen and serotonin are high -- usually the first half of the cycle -- when everything's probably better and you feel resilient and efficient. That's a time to get things done. Right before your period, when estrogen and serotonin levels bottom out, you may feel on edge -- more aware of social slights, more sensitive to rejection. If you chart the highs and lows, you'll know what to expect and prepare better.
Q: But should we have to plan our lives around our hormones?
A: Part of being authentic means owning the fact that you're reactive, adaptive and emotional. On the days you're less accommodating and more critical, I suggest you use that time to take an honest inventory. What's important to you? What's out of place? What's overwhelming? When you're feeling more diplomatic, you can start to implement some changes. But you have to own those critical feelings. Don't brush them off as PMS. When you take stock and address any issues you notice, you're giving yourself the chance to remain true to you.