The Journal of the American Medical Association (JAMA) just published the results of six studies, indicating that most adults with dysthymic or moderate depression experience no discernible improvement from taking anti-depressants. By contrast, JAMA also reported that adults with severe depression do benefit from anti-depressants.
The research included control groups who took placebo pills, which according to the findings had essentially the same effect as anti-depressants on people with mild to moderate depression. The more depressed someone was, the more likely they were to benefit from taking anti-depressants. The studies showed that this was true, whether or not the patients took Paxil, a selective serotonin reuptake inhibitor (SSRI), or imipramine, a tricylcic, an older generation of anti-depressant medication.
These findings correspond with my own experience as one who has taken anti-depressants for years to treat my major depression with psychotic features. I have benefited from Zoloft, an SSRI which I have taken for more than a decade, as I did from Prozac, another SSRI which I took years ago.
As I wrote some weeks ago, I can vividly remember speed-walking down Bay State Road in Boston after starting on Prozac. That euphoria did not last forever but the medication continued to help me. Zoloft has too.
This makes sense given that I fit into the category of one with severe depression.
Still, as I have written before, medication alone is no panacea. And medication will not change your personality, as another recent study suggested.
Yesterday, I was fortunate enough to speak at a National Alliance on Mental Illness (NAMI) office on the Westside of Los Angeles. There, I told the attendees that the process of recovery for me was slow. While I saw improvement in my mental condition within weeks of taking anti-depressants, it has taken me years to tame my illness.
As I told the guests at NAMI, all of whom either suffer from mental illness or have a loved one who does, there have been other factors that have contributed to my recovery. One is that I have the loving support of my wife, Barbara. I can't emphasize enough how important she has been and continues to be to my well-being.
And when I had my first psychotic break in 1997, my parents helped me enormously. They were compassionate but they also forced me to get out of the house and attend a day hospital in Connecticut, where I had to show up at 9 a.m. every morning.
In 1999, a week or so after my second break, I returned to work at L.A. Weekly, where I was a proofreader. Fortunately, my boss, in whom I confided, welcomed me back. I recognize that there are dangers in confiding to a co-worker, let alone one's supervisor, and in general I do not recommend it. But I had a good feeling about her, and she proved to be a blessing.
Going to work several days a week allowed me to demonstrate a level of competence in a social setting and at a cognitive and aesthetic level. Every week, every shift, I showed that I could succeed in a marketplace, not just in my own private world.
I also had and have the support of a fine therapist. After I came back from my first break, my late psychiatrist, Dr. Michael McGrail, advised me to join a community of writers, which I did when I got a job at L.A. Weekly. My current psychiatrist, an analyst, allows me to see where my fears originate and reassures me with his kindness and wisdom.
All of which is to say that anti-depressants can help those with severe depression, but the patient needs to work hard at getting better, by getting out of the house and succeeding in the work force if possible, by staying busy at home with various chores, and by engaging in talk therapy. NAMI can also provide support with its Peer to Peer and Family to Family educational programs.
There is never any one reason why a person recovers, but depressed people can get better. I am living proof of that.