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For those of you that take Prozac, Paxil, Zoloft, etc.
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View this Thread in Original format
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Here's a somewhat old, yet interesting study that was done:
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Against Depression, a Sugar Pill Is Hard to Beat
Placebos Improve Mood, Change Brain Chemistry in Majority of Trials of Antidepressants
By Shankar Vedantam
Washington Post Staff Writer
Tuesday, May 7, 2002; Page A01
After thousands of studies, hundreds of millions of prescriptions and tens of billions of dollars in sales, two things are certain about pills that treat depression: Antidepressants like Prozac, Paxil and Zoloft work. And so do sugar pills.
A new analysis has found that in the majority of trials conducted by drug companies in recent decades, sugar pills have done as well as -- or better than -- antidepressants. Companies have had to conduct numerous trials to get two that show a positive result, which is the Food and Drug Administration's minimum for approval.
What's more, the sugar pills, or placebos, cause profound changes in the same areas of the brain affected by the medicines, according to research published last week. One researcher has ruefully concluded that a higher percentage of depressed patients get better on placebos today than 20 years ago.
Placebos -- or dud pills -- have long been used to help scientists separate the "real" effectiveness of medicines from the "illusory" feelings of patients. The placebo effect -- the phenomenon of patients feeling better after they've been treated with dud pills -- is seen throughout the field of medicine. But new research suggests that the placebo may play an extraordinary role in the treatment of depression -- where how people feel spells the difference between sickness and health.
The new research may shed light on findings such as those from a trial last month that compared the herbal remedy St. John's wort against Zoloft. St. John's wort fully cured 24 percent of the depressed people who received it, and Zoloft cured 25 percent -- but the placebo fully cured 32 percent.
The confounding and controversial findings do not mean that antidepressants do not work. But clinicians and researchers say the results do suggest that Americans may be overestimating the power of the drugs, and that the medicines' greatest benefits may come from the care and concern shown to patients during a clinical trial -- a context that does not exist for millions of patients using the drugs in the real world.
"The drugs work, and I prescribe them, but they are not what they are cracked up to be," said Wayne Blackmon, a Washington psychiatrist whose practice largely comprises patients who suffer from depression. "I know from clinical experience the drugs alone don't do the job."
Still, drugs may have become the reflexive treatment for the vast majority of Americans receiving medical attention for depression: As the number of doctor visits for depression rose from 14 million in 1987 to almost 25 million last year, medications were prescribed for nine in 10 patients, according to research published last week.
It is not clear how many patients received medicines in a context of therapy, although research has indicated that combining medicines with psychotherapy produces the best results.
But Randall Stafford, the Stanford University physician who conducted the study on doctor visits, found that less than one-third of them in 2001 were to psychiatrists and two-thirds of them were to primary care physicians. The former are more likely to situate the medicines in a larger context of therapy, while the latter are less knowledgeable about therapy, more pressed for time and less likely to offer patients anything like the attention they would receive in a clinical trial.
The average participant in an eight-week trial spends about 20 hours being examined by top experts and highly trained caregivers, said Seattle psychiatrist Arif Khan, who studied the placebo effect in trials submitted to the FDA. Participants -- including those being given sugar pills -- are asked detailed questions about how they are feeling, and their every psychological change is closely noted.
In comparison, Khan noted, the average patient with depression sees a doctor perhaps 20 minutes a month.
His analysis of 96 antidepressant trials between 1979 and 1996 showed that in 52 percent of them, the effect of the antidepressant could not be distinguished from that of the placebo. Khan said the makers of Prozac had to run five trials to obtain two that were positive, and the makers of Paxil and Zoloft had to run even more. He analyzed trials that were made public in the medical literature, which tend to show positive results, and those that were not.
"It speaks to the difficulty we have in classifying and identifying the disorders we deal with," said Thomas Laughren, who heads the group of scientists at the FDA that evaluates the medicines. "Psychiatric diagnosis is descriptive. We don't really understand psychiatric disorders at a biological level."
Patients with similar symptoms, he explained, may have different problems with their brain chemistry. Scientists don't understand the neural mechanisms of depression -- or why medicines like Prozac and Paxil work.
"We like to think we give people treatments and they get better," said Andrew Leuchter, a professor of psychiatry at UCLA. "We have this fallacy of success, but we don't know in any individual why they get better. Undoubtedly one of those factors is the time we spend with people and the connectedness that gives patients."
In January, Leuchter published a study in the American Journal of Psychiatry, in which he tracked some of the brain changes associated with drugs such as Prozac and Effexor, which are called selective serotonin reuptake inhibitors. When Leuchter compared the brain changes in patients on placebos, he was amazed to find that many of them had changes in the same parts of the brain that are thought to control important facets of mood.
Patients who got better on placebos showed heightened activity in the prefrontal lobe, and that activity continued to rise during the eight weeks of the study. Those who responded to medicine initially showed a decline in prefrontal brain activity, then a rise that eventually tapered off. Thirty-eight percent of patients responded to the placebo, and 52 percent to the medicines.
Once the trial was over and the patients who had been given placebos were told as much, they quickly deteriorated. People's belief in the power of antidepressants may explain why they do well on placebos. Patients in trials are not told which they are receiving.
Likewise, sea changes in the treatment of depression -- including the reduction in the stigma attached to mental illness, the widespread use of antidepressants and the immense marketing efforts by their manufacturers -- may explain why Timothy Walsh, a psychiatrist at Columbia University, recently found that the placebo effect has grown in recent years. He found that greater percentages of people tended to get better on placebos during trials of antidepressants in 2000 than in 1981.
Some observers assert that the medicines themselves work because of the placebo effect, but most psychiatrists believe the drugs do have an effect of their own. Drugs are a "placebo-plus" treatment, said Helen Mayberg, head of neuropsychiatry at the Rotman Research Institute at the University of Toronto.
In a study published last week in the American Journal of Psychiatry, Mayberg evaluated brain changes during trials using a sophisticated brain imaging technique. She found that medicines, besides working on areas that are activated by placebos, also work on areas deep in the brain stem, the hippocampus and striatum.
Since both depression and the effect of the medicines are still not well understood, it's not clear what these changes mean. While they could be irrelevant effects, Mayberg said a better explanation is that the drugs affect areas deep within the brain and then work upward to affect parts of the brain that control mood. Placebos may work in the reverse direction. In part, this may explain why drug effects tend to be more reliable than placebos in the long run.
Mayberg likened depression to a room with a hole in one window.
"You are trying to set a thermostat -- it's 100 degrees outside and you want it to be 70," she said. "If you set the thermostat to 70, that doesn't work. But if I set my thermostat to 50, that fools the system and gets the temperature back to 70."
Both drugs and placebos -- chemicals and beliefs -- may impose different chemical pressures on the brain that reset the "temperature." The real problem, of course, is that no one knows how to fix the hole in the window, or even where exactly it is. "This is a thousand-piece puzzle with no picture on the box," sighed Mayberg.
Blackmon, the Washington psychiatrist, said it behooved mental health clinicians to better integrate the power of biological treatments with the effects of belief and therapy.
"We would say it's absurd if an internist says, 'I believe in penicillin, so everyone should get penicillin whether they have cancer or a broken bone," he said.
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wow that is really interesting. and uplifting. i jsut read a very distrubing article about anti-depressants in new york city:
here's the article.. from http://www.newyorkmetro.com/nymetro...8763/index.html
Pill Culture Pops
With the stigma attached to mood-improving (not to mention sex-life-improving) drugs all but gone, New Yorkers are becoming their own Dr. Feelgoods, self-medicating as never before. Inside the new (totally respectable) drug scene.
By Ariel Levy
(Photo credit: Chago Akii-Bua & Brian Jones)
Sound the alarm. there’s a new drug epidemic in town. And most of the city wants in on it. “In certain circles of New York, it’s just regular table conversation,” says a 37-year-old publisher. “I was at lunch with clients the other day—it was a totally professional situation—and I mentioned that I have to give a speech at my parents’ fortieth wedding anniversary. I said, ‘I’ve got to get some Klonopin; I’m going to be so uptight.’ Somebody else said, ‘Oh, I always take a Klonopin before a big presentation.’ One thing led to the next, and soon everyone at the table was talking about how they’re on Xanax or Klonopin or Vicodin. No one wants to go through the hassle of seeing a psychiatrist because they don’t necessarily feel there’s anything wrong with them. It’s just the way life is in New York: Everyone’s stressed about something.”
We have entered the golden age of self-medication. Drugs have become like hair products or cosmetics: This is brain styling, not mind altering. The early buzz was that Prozac makes you a different person—changes you fundamentally, if subtly. But, habitual drug users that we are, we know that’s not true. You’re you on meds, only less freaky and more well-rested.
We have been listening to Prozac now for over ten years. In that time, SSRIs (selective serotonin reuptake inhibitors, in case you’re not on one) have become as socially acceptable as Sudafed. Not that long ago, the only people who used prescription drugs for their mental health were the deeply and obviously messy. At that time (the crack epidemic still raged), you wouldn’t have talked to your colleagues about what you took for insomnia, you bummed cigarettes off your friends instead of Ativan, and it might not even have occurred to you to take a pill for your garden-variety depression or anxiety. Now the question is not “Should I take something?” It’s “Am I taking enough?” Or “Am I taking the right one[s]?” And any lingering doubts we had about drugging our way to better mental health seem to have been washed away in the past two dark years.
The Right Pill When. . .
Ambien
•Job interview tomorrow at ten.
•The plane to L.A.
Klonopin
•Husband wants some space.
•Marijuana-delivery guy is late.
Paxil
•Hate to socialize. Have to socialize.
•Ex is dating a celebrity.
•Shrink leaves in August.
Percocet
•Chewed out by the boss.
•Dr. Feelgood: my dentist.
•Relaxing takes time-- that you haven't got.
Ritalin
•Big dinner to organize.
•Deadline pushed up.
•Studying for the bar.
Valium
•Son won't take to toilet training.
•Is that a gray hair?
•Internet blind date tonight.
Viagra
•Bumped into ex-girlfriend.
•Had three too many cocktails.
•"I swear, this has never happened to me before."
Vicodin
•Time to kick back.
•Class reunion coming up.
•Got rejection slip from publisher.
Wellbutrin
•No smoking ever.
•Will the market ever go up?
•Passed over for promotion.
Xanax
•Have to fire the nanny.
•Got seventh parking ticket this month.
•Paxil prescription has run out.
‘The other night, the one person I know who doesn’t take medication said, ‘Is everyone in New York mildly sedated?’ I was like, ‘Wake up and smell the Valium,’ ” says a 26-year-old fashion publicist. “When I was in high school, it was pot; in college, it was coke; and now it’s Klonopin. Last week, my friend asked me, ‘Will you be mad if I don’t show for this benefit?’ And I said, ‘It’s fine, but why not?’ She was waiting by her phone for her psychopharmacologist to call. And I can totally relate. The psychopharmacologist is the new drug dealer—like a Park Avenue drug dealer.”
The line between medication and recreation has become blurred. What is really the difference between fixing ourselves and pleasing ourselves? “For a long time, I just took Ritalin when I thought I needed to concentrate,” says a 34-year-old writer. “But then I realized if it makes me feel normal, I should feel normal all the time. So now I take it when I get up every day—I have a friend who takes it every three hours.” (He also mentions that his dog is on an anti-anxiety medication called Clomicalm.)
When you relinquish the idea that your moods and weirdnesses are a constant, not to be messed with, any mental unpleasantness becomes fair game for treatment with a touch of this, a milligram of that. And once you start tinkering with things between your ears, more and more areas that could use fix-ups—tweaking—become apparent. Even if our doctors were worried about prescribing us Zoloft for depression and Ativan for anxiety and Ambien for insomnia, our friends aren’t.
“Somebody gave me a mother lode of Xanax,” says a 35-year-old man in the design industry. “I often give them out to friends who are getting on planes, or—for people who I know appreciate them—they make a lovely parting gift after a dinner party, packaged in a brightly colored plastic stacking box. I prefer ruby or orange.”
Jan, 25, recently sampled a friend’s Adderall, the drug now frequently prescribed for attention-deficit disorder in place of the less modish Ritalin. “I was helping out my friend, and she was like, ‘You’ve got to try this little blue pill.’ I could conquer the world if I took those pills! I was thinking of getting diagnosed with ADD just so I could get them, but I don’t want to be one of those people. We were having an auction and I was so overwhelmed; I thought, ‘There’s no way I can do all this.’ But after an hour, that little pill kicked in and suddenly I had everything organized and I had made all kinds of lists and put everything in order! My friend said when she tried coke it was like a really, really bad version of her pills. She was like, ‘Why would I ever do coke?’ ”
For many New Yorkers, the promise of the sixties slogan “Better living through chemistry” has been realized. Unless you are recklessly gobbling up piles of pills like Vanessa from Six Feet Under, psychopharmaceuticals feel like a less risky, more precise, more civilized way of getting the job done than those messy, old-school street drugs. Potentially, these drugs could actually get us off those drugs—could make those drugs uncool. “My dealer sells Xanax and Valium along with coke and ketamine and ecstasy,” says a 30-year-old journalist, “and often the prescription drugs are in higher demand than the illegal ones. Sometimes the dealers will do trades: their drugs for your prescriptions.”
As with illegal drugs, there’s a hierarchy of cool within the world of prescription pills. “Mood-stabilizing drugs—the breakfast of champions—that’s what’s still stigmatized,” says the fashion publicist. “Something like bipolar or, God forbid, schizophrenia, those are very taboo because they’re real. It’s still cool to be sane. You’re just supposed to be sane and medicated. You don’t talk about hard-core depression or being bipolar or anything that’s in essence a disorder. You talk about what’s chic and of the moment. You’re not trading those pills at a cocktail party. You trade leisure drugs—Ambien and Valium—anything you’re going to do in tandem with drinking. Ask someone when they take their meds. If the answer is ‘In the morning,’ then they’ve got some going on. If it’s ‘In the evening,’ they’re just playing with pills. A morning thing is you’re seeing someone and you’re working through some real issues. An evening thing is you have three martinis, two olives, and a little yellow pill.”
There are a lot of choices in the chemical armamentarium. There’s Klonopin (or clonazepam, the generic), a drug designed to prevent seizures that has the pleasant, fortuitous side effect of calming the truly anxious or putting the relatively relaxed straight to sleep. There’s Ambien, a sleeping pill remarkable for its lightning speed: unlike benzodiazepines (drugs like Ativan, Valium, and the ever-popular Xanax), Ambien can knock you unconscious in twenty minutes flat, so psychopharmacologists often tell patients not to take the pill until they are actually in bed. Recreational users like to force themselves to stay awake on Ambien, because it can produce a cracked-out, almost hallucinatory state of awareness, if that’s your bag.
Of course, there’s good old Prozac, which has a new fan base among ecstasy aficionados since Johns Hopkins researchers George Ricaurte and Una McCann conducted a study on animals that showed that ingesting Prozac within six hours of taking MDMA (ecstasy) prevents “most or all of the serotonin system reduction” associated with the drug, which is to say you don’t crash.
Wellbutrin helps people stop smoking, and unlike other antidepressants, it rarely has sexual side effects, but it doesn’t seem to work as well as, say, Zoloft on depression. “When I first went in for depression, they gave me Zoloft and stuff like that, and there was basically a guarantee that I would have trouble having sex and getting aroused,” says Robert, a 59-year-old management consultant who started mucking around with his mental state before the advent of Viagra. “I specifically remember thinking: I’m depressed. The one thing I still enjoy is sex, and you’re taking that away from me? It’s like a Woody Allen twist, like, ‘Sure, we’re gonna cure you, but now you can’t read.’ As I remember, Zoloft was very good as an antidepressant, but it had a very deleterious effect on my erection, so that’s when I said, ‘Give me a break.’ I opted for the middle ground, which was balancing a little Prozac and a little Wellbutrin so I could have a little sex.”
With solutions come side effects, and compromises—and cocktails—need to be made. “I take an antidepressant called Celexa,” says Sabina, a 25-year-old graduate student, “and I take Ambien. And then I stay up an extra half-hour just so I can feel kind of looped—I call it my little Ambien party, a party for one. Also, I sometimes get Ritalin from a friend, because I’m in school now and it’s harder to get a prescription for that.”
Even though Sabina is obtaining her pills through creative trade routes, the fact that somebody went to a doctor makes her feel that she has nothing to worry about. “In a way, you feel like it’s prescription—it should be okay,” she says. “In my life, most of the time, I try to be natural and good to my body, but when it comes to prescriptions . . . I’m not too worried about it. I have fun with it. And there’s a certain sort of cool about it.
“I don’t think I need any of it,” she continues. “Like with Celexa: I just wanted to see how I felt so when I go off it, it would give me a comparison, a reference point. And there’s no stigma because it’s New York, and we all have that image of the New York neurotic. I moved here from Boston two years ago, and I felt way more aware of being anxious once I got here. Then again, I moved here five days before September 11.”
New York has been the epicenter of our national fearing and grieving period, the house where we’ve held the shivah, and our medicating has gone up correspondingly. According to the Office of National Drug Control Policy’s Website, whitehousedrugpolicy.gov, between September and October 2001, new prescriptions for benzodiazepines (usually prescribed for anxiety) increased a whopping 23 percent in New York City, compared with an 11 percent increase nationally. Likewise, we took 26 percent more sleeping pills here, while the rest of the country spiked only a more modest 11 percent. Though we took more than twice as many of both of those drug groups as regular Americans, the place you could really see New Yorkers lapping the rest of the country was in our consumption of antidepressants: We went up 18 percent, and they went up 3. As one young woman puts it, “Even your mother was medicated on September 12.”
Lorraine, a 58-year-old mother of two who lives on Central Park West, says that September 11 pushed her from being an occasional Ativan borrower to becoming a full-fledged pill fan: “I love Paxil. I love it. I started after September 11, and it wasn’t specifically about that, but I realized that I was obsessing about everything. I’d been in traditional therapy for ten years, and my therapist didn’t really believe in medication. But then a friend started seeing this fabulous psychopharmacologist and I said, Why not? So I went to see him, and he told me, ‘You know, with all that’s gone on in your family, why shouldn’t you have some relief? Why shouldn’t you get to feel better?’ He was like Dr. Feelgood. He said I could take Paxil for the rest of my life and Ambien every night. He felt I had low serotonin.”
“I love Paxil. I love it. What it’s done is it the glass is half full. People say ‘I’m anxious’ and I think how quaint.”
Did he give her a test?
“No.” She laughs. “I was wondering how he knew that. But I love Paxil. I love it. What it’s done is it makes me feel more like the glass is half full. People say, ‘I’m anxious,’ and I think, How quaint. I was supposed to go down to a lower dose, but I was thinking on the way over there, You know what? I really don’t want to. I’ve been through enough.”
The last time she was at general Store, a Portlandy restaurant on Avenue B where they play soothing acoustic guitar and serve omelettes in personal-size cast-iron skillets, Molly Small dumped an enormous container of pills—blue ones, green ones, ovals and squares—all over the antique pine table so her friends could pick out a few things to take on their flight to L.A. “Friends who ask for Xanax or Klonopin generally need it,” she says. “I don’t think there’s anything wrong with having something on flights. If you have a plane phobia, there’s no reason to sit there and freak out the whole time when you could take a Klonopin and pass out and not deal with it. Because what are you going to do about it? All this face-your-fear : That’s so very eighties, and I don’t really believe in it.”
Today, she is dressed in a peach-and-black-striped slip dress and massive silver hoop earrings. Everything about Small is big: big voice, big eyes, big breasts, big hair. Seven years ago, she had a big nervous breakdown. “Like you think that people have ‘nervous breakdowns’ and you know what that means? But I did,” she says. Now she takes various drugs at various times of the day: Prozac in the morning, Klonopin in the evening, Neurontin at suppertime.
She is tired, she says, of defending herself against concerned relatives and friends who are worried about her pill-popping. “People are like, Who knows what you could be doing right now if you weren’t medicated? It’s just crap. What I could be doing is crying in my room. Look, I take a minimum of fourteen pills a day. It’s not attractive. It’s not something pleasing. It’s something you have to explain to people when you start dating. I’d prefer they make one little pill that I could swallow casually, because I really do think it’s the volume of these pills—the way they’re all different sizes and shapes—that makes people think it’s like I’m in Candyland and I’m playing. But I’m not. I’m trying to keep myself sane.”
Despite the prevalence of medication in this city, the assumption persists (among the uninitiated) that taking meds will make you a grief-free zombie— that you’ll lose your edge and end up more of a suburbanite than a New Yorker. “That’s crap,” says Small. “It’s not like I walk around happy as a bee. I’m still just as conflicted and crazy as I ever was. I’m still pissy and cynical. But now I can live my life and I’m content.”
Actually, Small recently gave up Prozac for a while, just to see if she could: “You have doubting periods; you have periods where you think, Oh, I’ve just moved from being addicted to one kind of drug to another. Or: There’s nothing really wrong with me—I’m just creating all of this.” She laughs. “I went off Prozac in December. By the end of February, I was a complete and total nightmare.”
For all the well-meaning, drug-eschewing people in her life who offer advice, Small has a little tip of her own: “When I see people who so obviously need to be on medicine, I’m like, What are you waiting for? There’s an answer. I have this friend who’s been this anxious, depressed wreck for the last year or so. And it’s like: You are depressed all the time. You need, need, need, need. I really don’t have the patience to sit here and listen to you talk about how miserable you are when you won’t do anything about it. I almost find it like if you didn’t go to the dentist and then you started freaking out that you have cavities. Take care of it. Suck it up.”
Well, that was the conventional wisdom until recently. Ron Winchel, a Manhattan-based psychopharmacologist, says that the psychiatric community is only now coming to realize the potentially disastrous effect of treating bipolar people with SSRIs—and that bipolarity isn’t the easiest thing to recognize. “SSRIs are almost benign, except to the large number of people who at first look to doctors as if they have a unipolar depression, but who in reality have a variant form of one of the bipolar disorders,” he says. “For them, exposure to any antidepressant can actually make them worse, because if you give someone who is potentially bipolar an antidepressant, you can engender more of the ‘high’ side of their disorder. That leads to more depression, because you have accelerated the cycle.”
Winchel calls this “an enormous problem,” because bipolarity can masquerade as regular vanilla depression. “They may never even show mania till after they’ve been exposed to these medications. So what percentage of people who we are blithely handing out SSRIs to, thinking, Oh, there’s no side effect, are actually bipolar?”
But Winchel is also quick to point out another, less frightening, equally surprising medical possibility: “Everyone is always asking me, ‘Is this going to hurt my brain after I’m on it for a long time?’ But no one ever says to me, ‘Is it going to be good for my brain?’ There’s a couple examples—like lithium—where a drug has actually been shown to encourage the growth of healthy brain cells in regions of the brain where there is diminished activity in people with mood syndromes. And we do believe that it is bad for the brain to experience spurts of anxiety, because they are associated with secretions of chemicals that are actually toxic for the brain. So the possibility that some of these drugs that we’re using in psychiatry have neuroprotective effects is real.”
The creative usage and trading of psychopharmaceuticals—the cocktail party as pill bazaar—is what worries the doctors who prescribe the drugs. “There’s a tremendous amount wrong with it,” says Darwin Buschman, a clinical psychopharmacologist affiliated with Mount Sinai, Lenox Hill, Saint Luke’s, and Gracie Square. “Psychostimulants, which include Ritalin and Adderall, and benzodiazepines, which include Xanax and Ativan, are both highly addictive. When one is addicted to benzodiazepines, withdrawal can be life-threatening—particularly with Xanax. Heroin withdrawal is very uncomfortable but not life-threatening; same for coke. But with benzodiazepines, you can die. Period. So I am very careful as to how I prescribe those medications.”
Buschman says that “if you take a benzodiazepine every day for a month, you are addicted,” but he also says that he has patients who take these drugs several times a day and have been doing so for years: “They’re addicted, but it’s what they need. I make sure they don’t run out so they won’t have life-threatening seizures from withdrawal. See, it’s complicated, because while you can die from withdrawal, you cannot overdose on these medications. You can take 5,000 Valium, and you will sleep for a very long time, but you will not die.”
For many doctors, the frustration of working with psychopharmaceuticals is the somewhat arbitrary regulation of the different genres: Some of the least dangerous drugs are the most highly monitored, especially here. New York is the only state in which benzodiazepines are considered a controlled substance, which means they require a triplicate prescription. “Meanwhile, Vicodin isn’t a controlled substance, and it’s infinitely more dangerous than Ativan,” says Buschman.
“What drives me crazy is the people who say ‘Why don’t you try Saint-John’s-wort?’ ” says a high-profile 39-year-old who just started taking her SSRI again after an ill-fated psychopharmaceutical hiatus. “I’m like, what the is that? Because it doesn’t have a stigma and it may not work? Because it’s not regulated? Because I can buy it at some disgusting health-food store? It just amazes me. I was telling this friend: For the past few weeks, I’ve had traditional, horrible depression. I’ve got to go back on meds. And she was like, ‘I don’t know, man.’ I said, ‘Well, I’ve been smoking a lot of pot.’ And she was like, ‘You’ve got a high-pressure job! That’s okay.’ So I said, ‘I smoked a cigarette the other night,’ which for me is a really big deal. ‘Don’t worry about it,’ she said. Then I said, ‘I think I should go back on meds.’ ‘Oh, man,’ she said. ‘You better watch that .’ Why?! It’s not like coke or alcohol or drugs, where you wake up the next morning and the problem is ten times worse.”
Ubiquitous lawyer (and Bonfire of the Vanities inspiration) Ed Hayes says, “I just wish the medication had been available to my father and his father. If they had this, they wouldn’t have been drunks. I have very primitive values as to what constitutes masculinity, and I used to think taking medication would mean I wasn’t man enough to handle my problems.” He got over it. “Now I take a simple medication, and the side effects are nothing.”
Before Viagra, the only options open to doctors trying to keep their patients both erect and depression-free were to minimize their dosage, prescribe intermittent “medication holidays,” or supplement an insufficient dose of a given SSRI with Wellbutrin. Even now, when you can buy Viagra over the Internet, some men still opt to work within the new sexual terrain they find their medication has redrawn for them. In certain cases, SSRIs can have the effect of delaying orgasm rather than causing impotence—not necessarily an unwelcome event for all men (or their partners).
“When you first notice the sexual side effects, you’re probably so depressed you just want to get better and you probably don’t feel much like having sex anyway,” says a filmmaker in his early thirties. “But then you start to feel better, and of course you notice. It’s a weird thing . . . I have friends who say they’re into it because it makes them last longer. For me, it’s not a great thing, but for some reason I was like, Yeah, I can live with the fact that my sex life is totally screwed up. But the second I noticed I was getting fat, I was like, Forget this.”
“I take at least 14 pills a day. People are like, ‘Who knows what you could be doing right now if you weren’t medicated?’ It's just crap. What I could be doing is crying in my room.”
Like other prescription drugs circulating through the city, Viagra also has a second life. “Viagra has worked its way into the gays, at least, for recreation,” reports the designer who favors perky stacking boxes stuffed with Xanax for his party favors. “The idea is you’re doing a lot of crystal and a lot of gay party drugs, and it makes it hard to get it up. So the combo plate is you do that and Viagra and it keeps you hard and, um, ups the ante so you don’t have to worry about getting a softy from doing too much K.”
It reminds him, he says wistfully, of his very first prescription party drugs: “My first experience with pills was with downs, to come off disco drugs. It could have been a Valium, and sometimes you’d score with Rohypnol before it became the date-rape drug. That was the best. After you’re through partying, after however long you’ve been up, you want the thing that’ll bring you down the fastest and the hardest, and that’s how the hierarchy was set up.”
Using prescription drugs to work a little harder, sleep a little better, relax a little faster, has become a given in the city’s mainstream. “A friend of mine coined the term cosmetic psychopharmacology,” says Winchel.
“Is this good, or is this bad? is a quasi-philosophical question, an ethical question, more than a medical question. We do enter into this in psychiatry because of the emerging issue of whether or not there are some people we cannot diagnose with a symptom but who seem to benefit from an antidepressant nonetheless.”
A friend of mine who is currently taking Zoloft seems to be getting more agitation from this question than relief from her pills. “If you’re taking something to make your life suck less, then why don’t you just make your life suck less? This is 2003 in an advanced society of which you are one of the most fortunate members! Think if you were a little child in Cambodia who never got education, and compare that to your incredible ing life! And you’re depressed? How can you be sure it’s not just that you’re a spoiled brat? They say chemicals are not something that you would respond to if you were not depressed, but part of me thinks that’s bull.”
It’s true that there are similarities between the way we test meds and the way we used to test witches. If a woman swims, she’s a witch, so you have to kill her; and if she drowns, she’s innocent. But either way, she’s dead. If a person is depressed and a medication affects her mood, then she needs it; if she’s depressed and it doesn’t, she needs a different one. Either way, she’s got to be medicated. “The way that people take it in New York,” says my friend, “I mean, everybody is on something, and that’s stupid! It’s impossible that all highly functioning people are depressed and that they all live in Manhattan.”
I ask what her psychiatrist says about all this.
“She says I’m probably on the wrong drug.” |
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| Spad |
It's a bit of a generalisation to include all forms of anti-depressant in one study, as
a) they all work differently
b) people are different, some may respond to placebo's whereas others may not.
I think that in cases of depression where a chemical inbalance is to blame it's unlikely that a placebo will have much effect over a long period, but as far as treating panic/anxiety disorders placebo's could be very effective when coupled with other ongoing treatment. |
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| butterfly |
| quote: | Originally posted by Spad
It's a bit of a generalisation to include all forms of anti-depressant in one study, as
a) they all work differently
b) people are different, some may respond to placebo's whereas others may not.
I think that in cases of depression where a chemical inbalance is to blame it's unlikely that a placebo will have much effect over a long period, but as far as treating panic/anxiety disorders placebo's could be very effective when coupled with other ongoing treatment. |
true, but natural chemical imbalances are acutally pretty rare. |
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| occrider |
| quote: | Originally posted by butterfly
true, but natural chemical imbalances are acutally pretty rare. |
Exactly, drugs such as prozac and zoloft are prescribed for general conditions of depression. Perhaps in most cases they are not really as necessary as we think. What did people do before these drugs were created? |
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| DaveSaenz |
| quote: | Originally posted by occrider
Exactly, drugs such as prozac and zoloft are prescribed for general conditions of depression. Perhaps in most cases they are not really as necessary as we think. What did people do before these drugs were created? |
kill themselves....:conf: |
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| occrider |
| quote: | Originally posted by DaveSaenz
kill themselves....:conf: |
Hehe I wonder what the suicide rate in Africa is as compared to the suicide rate in the US or Europe. |
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| Spad |
| quote: | Originally posted by occrider
Exactly, drugs such as prozac and zoloft are prescribed for general conditions of depression. Perhaps in most cases they are not really as necessary as we think. What did people do before these drugs were created? |
Yeah, I think there's a definate problem (especially in the states) with drugs like these being perscribed where they're not neccessary. People go to a doctor and instead of being given the support and councilling they may need to overcome their problems, they're stuck on pills for a year and then come off them right back into the same mess. In the end they're dependant on them because they're the only things that help. |
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| butterfly |
| quote: | Originally posted by occrider
Hehe I wonder what the suicide rate in Africa is as compared to the suicide rate in the US or Europe. |
actually i heard depression really inst an issue in many thrisd world countries. really interesting predicament we put ourselves in ehre. |
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