A new National Institute of Mental Health study, published in Archives of General Psychiatry, concludes that a classification of anti-depressants, the so-called SSRI's -- selective serotonin re-uptake inhibitors -- can not only relieve depression but can also change a patient's personality.
We have heard this before. Peter Kramer famously made this point in his book, Listening to Prozac.
I remain skeptical.
I have taken anti-depressants on and off for 18 years, and never have they transformed my personality. They have, however, improved my mood. I can vividly recall speed-walking down Bay State Road in Boston back in 1991, when I first started taking Prozac. There is no question that it "jazzed me up" as my psychiatrist suggested it might.
But it did not alter my personality. And that is a good thing. I would not want to lose my core identity.
From my experience, SSRI's can help lift the mood of a patient, but that is all. Nor can these anti-depressants work effectively unless the patient makes an effort to get better.
In 1997, when I was recuperating from my first psychotic break, I had to wake up every day by 8 a.m., get out of bed and drive five miles to a day hospital in New Haven, Conn. The first day my mother drove me to the program, but after that I drove there and back every day.
The ethos of the program was such that it required participation. No one would make me lunch; I had to do it myself. And my clinician wouldn't let me off the hook when I first suggested that the program would not benefit me. She encouraged me to speak in group therapy, which I was reluctant to do initially. And every day, I, like all the rest of the patients, had to announce my goals at the morning meeting and then indicate in the final session in the afternoon if I had achieved those goals.
At that time, I was taking Zoloft as well as Wellbutrin, another anti-depressant, and Risperdal, an anti-psychotic. They all helped me to get better, a process that took several months, before I felt well enough to return to Los Angeles.
However, the credit also goes to the people in the day hospital program, to my mother who took me out on walks every day, to my father who read my novel and told me, "you did good work this past year," and to me for not giving up.
Depressed people often don't realize when they have done a good job. Sometimes, the depression is so overwhelming that you can't imagine that you will ever be able to work again.
But you can ameliorate your depression just by doing mundane, daily activities such as getting out of bed, making lunch, reading the paper, paying the bills. It is important to leave the house and interact with the world. Before you know it, you have developed a level of competence in given areas.
Some years ago when I gave a talk at a day hospital, I met a young man who did not know what a résumé was, let alone how to prepare one. I asked him what he really wanted to be, and he said that his dream was to be a cowboy. "Then that's what you should do," I said.
Part of my depression was due to my failure to pursue my true passion: writing. That I worked on my novel, wrote cover letters, applied for jobs, and yes, put together résumés, during my illness, were all positive signs that I was getting better. Within two months of returning to Los Angeles in 1997, I had a job at L.A. Weekly and a girlfriend, who would become my wife.
There is no doubt that Zoloft, which I have taken since 1996, has helped me, as have various anti-psychotic medications. SSRI's are a wonderful boon to those of us living today. Imagine how daunting it was for depressed people, even 25 years ago, who could not avail themselves of Prozac, Zoloft and the like.
Yet these pills are no panacea, and they will not make a shy person the life of the party, unless that person has always been a bit of an extrovert in certain settings. Hamlet will still be Hamlet, and Horatio Horatio.
What anti-depressants will do is stabilize you, allow you to sleep, give you a reassuring feeling that you will be alright. It helps to have a supportive family, as I did and still do. And it helps to know that you will still be yourself when you're on the medication.
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