Earlier this month, the Los Angeles Times ran a high-profile, controversial column titled “Hi, I’m David. I’m a drug addict.” David Lazarus, the author of the piece, explains how he has spent roughly 10 years on antidepressants and is currently trying to “kick the habit,” as he calls it. He reports withdrawal symptoms of sluggishness and moodiness.
Wendy Lendrum, a psychiatric nurse practitioner at Hall Health whom I interviewed previously for my guide to antidepressants, responded to an email about this story with shock.
“Using the word addiction is absurd in this context and actually doesn’t make any sense,” Lendrum said.
Sure, there are valid reasons for someone to want to discontinue their meds. For example, Lendrum said, someone who was prescribed antidepressants for a single episode of depression and now feels that they have gone into remission can slowly taper off antidepressants.
“The recommendation from the science is that they would at least stay on the medication for nine to twelve months,” Lendrum said. Then, if they do decide to quit medication, they should establish a program of gradually lowering their dosage with their doctor. “The body needs time to readjust.”
But this doesn’t seem to be Lazarus’s case. Underlying his piece is a sense that he needs to go off his meds just because, well, he’s been on them for a while.
“Call it an addiction,” Lazarus writes. “Call it a dependence. Call it whatever you please. I’m hooked.”
His flippant exhortation to “call it whatever you please,” though, overlooks the fact that addiction and dependence are completely separate medical phenomena.
In his book “In the Realm of Hungry Ghosts: Close Encounters With Addiction,” Dr. Gabor Maté defines addiction as “any repeated behaviour, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others.”
In contrast, he says, “physical dependence is manifested when a person stops taking a substance and, due to changes in the brain and body, she experiences withdrawal symptoms … Although a feature of drug addiction, a person’s physical dependence on a substance does not necessarily imply that he is addicted to it.”
I’m addicted to caffeine — when I don’t have it in the morning, I crave it. I get splitting headaches and become irritable by the afternoon. I can feel visceral relief of my withdrawal the moment that I take my first sip of coffee, even before the caffeine hits my system.
But I’m not addicted to my antidepressants. I don’t experience any fast-acting psychological changes when I take them; I don’t crave them; I don’t spend all my time waiting for my next “fix.” I’m physically dependent on them, sure, in that if I ran out, my depressive symptoms might reemerge, and I would experience physiological discontinuation symptoms as well. But there is no conscious, uncontrollable, or unhealthy component to this dependence. It doesn’t disrupt my life.
Lendrum confirmed to me that there is no “high” associated with SSRIs. The psychological changes they render are slow and subtle.
“It’s not like you wake up in the morning and you’re like, ‘oh, I can’t wait [to take my antidepressants],’” Lendrum said.
This is why Lendrum characterized Lazarus’s piece as “reckless,” especially regarding his association of antidepressants with more addictive drugs such as opioids and stimulants.
“Never dismiss concerns, absolutely, but let's keep replacing fears with facts,” Gitika Talwar, a clinical-community psychologist at Hall Health Center, said when I interviewed her about Lazarus’s piece.
We discussed common misgivings about medication that she hears from patients in her therapy practice, especially the idea that they alter your personality. Clearly, this perception is pervasive, even amongst antidepressant users like David Lazarus.
In a passage that took me back to the heartache of my personal deliberations around medication, Lazarus wrote, “But who was I? Was I me or was I the product of chemical enhancement? If I came off the drug, what would happen?”
Years ago, I was petrified that going on SSRIs would turn me into someone I wasn’t. Like the powerful pain medication I took briefly after my wisdom teeth extraction, I thought antidepressants would leave me strung out, doped up, and numb to the real pain I was in.
Instead, when I actually worked up the nerve to get a prescription, they helped me avoid succumbing to the pain. I had more energy to exercise and socialize, for instance — two things that help alleviate depression on their own. I still feel pain, and I’ve kept my normal emotional range, but my resilience has increased and my anxiety levels have subsided.
My experience is a pretty standard example of antidepressant “success stories” — when meds are able to step in and help someone get their life back on track when they are unable to break free from the unhealthy habits created by mental illness.
“I'm not telling [patients], ‘You need to change who you are,’” Talwar said. “I'm letting the meds be a tool by which they can function the way they want to function. If you're not doing that, then let's talk about it.”
Talwar also stressed that medication cannot fix any underlying circumstances that may be worsening your mental health, but it can “refill your resilience.”
Though I’ve been on SSRIs for over a year, I don’t foresee myself discontinuing them any time soon. In fact, I would be content to take Zoloft for the rest of my life. The fact that I need medicine to get my serotonin levels up to the same levels as my non–mentally ill peers isn’t a personal issue, it’s a biological one.
“I think for some people, lifelong medication use works just fine,” Talwar said. “And for some people it doesn't. And overall, if people want to get off medication, that's totally their prerogative … [if they’re] doing it to serve themselves, not to live up to some idea of what's shameful and what's not.”
Lendrum noted that people often have irrational reservations against medical intervention in many different situations, from depression to childbirth.
“I feel like people hold on to this idea that if they can do it somehow ‘naturally’ … that it’s somehow better, rather than using the science-based evidence that these medicines are safe, they’re effective … and they save lives,” Lendrum said.
If you’re considering going on antidepressants or other psychiatric medication, please don’t let fear-mongering pieces like Lazarus’ dissuade you from having a serious conversation with your doctor. Only you (with the help of medical professionals!) can decide what is the right course of action for managing your own mental health.
“You are the expert of your experience; I'm the person who has studied mental health ... you're basically joining two experts in the room,” Talwar said. “So I will tell you what the brain science is saying; you tell me, does that work for you?”
Reach Health & Wellness Editor McKenzie Murray at firstname.lastname@example.org. Twitter: @merqto
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