This is a Review of:
"Is It Me or My Meds?" by David A. Karp

Harvard University Press, May 2006, 293 pages

ISBN: 0674021827

 

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David Karp, a Professor of Sociology at Boston College and the author of Speaking of Sadness: Depression, Disconnection, and the Meanings of Illness, writes about what he knows in his latest book. He has suffered from depression most of his life and knows all too well the personal dilemma involved in taking antidepressants. Along with his own experience, Karp interviewed 50 people who also take medication for depression. In, Is It Me or My Meds? he looks at antidepressants through the eyes of those actually using them. What he finds is an experience much different from what the drug companies portray in their ads. With Americans spending more than 12 billion dollars a year on antidepressants, the equivalent of nearly $44 for every person in the country, there is no doubt the drug companies have been successful in peddling antidepressants. What isn’t clear is how successful they are in actually treating depression. While they claim an 80 percent success rate, this is widely viewed as much higher than is actually the case.

 

Karp outlines the stages people often go through before accepting that they have to take their antidepressants. Many of those interviewed resisted taking psychiatric drugs for years, and when they finally did begin using them, thought of it as a temporary situation. This resistance is not found with other medications for a number of reasons. Even in this enlightened age, there is still a stigma associated with taking pills for depression. The dispute between Brooke Shields and Tom Cruise is evidence of that. Many felt that having to take antidepressants made them feel “defective.” Someone taking a medication for high blood pressure, for example, doesn’t face the same scrutiny from family and friends as those taking psychotropics. There is still the “pull yourself up by your bootstraps” mindset toward those who suffer from depression. A distrust that the person is really ill. Maybe they’re faking it. Maybe they’re just lazy. There is also the internal debate for those taking antidepressants. Does it change who I am? Will it affect my creativity or the way I think? Will it turn me into a zombie? This results in many people trying to stop taking their medications during the course of their treatment, only to find their depression returning and begrudgingly having to take antidepressants once again.

 

One of those interviewed said she would, “go through periods where I am very resigned to the fact that I will be taking these drugs for the rest of my life. Then I will go through these short periods where I get mad about it. I get upset about it. I say, ‘Everybody else doesn’t have to take this. Why do I?’” Some patients try to take as little of the drugs as possible. For many, quitting altogether remains a long-term goal. This is akin, in a reverse sort of way, to alcoholics who often temporarily stop drinking many times before finally realizing they have to give up alcohol permanently to survive. Those of us taking antidepressants may stop taking them many times before realizing that we have to take them to survive.

 

Another reason many people stop taking antidepressants is that they simply don’t work. That is the dirty little secret the pharmaceutical companies don’t advertise. And after finally finding one that works it might only work for a while and then suddenly and mysteriously stop working. This necessitates a merry-go-round of trying one antidepressant after another, looking for the one that relieves the depression with the fewest side affects. Part of the problem is that doctors really don’t know how or why these drugs work. Often it’s a hit or miss proposition when they prescribe these meds. It’s not surprising many of us feel like guinea pigs.

 

One of the side affects that was downplayed for years by the pharmaceutical companies is sexual dysfunction. Many people who take these drugs have trouble achieving orgasm while others lose interest in sex altogether. But many will gladly live with even these side affects if their depression is relieved. Unfortunately, other side affects can be intolerable, ranging from extreme fatigue to extreme mania. Some of the drugs are physically addictive. For many, there is a zombie feeling. Not sad, but not happy either. There is also the serious question of long term side affects, since the current crop of drugs, the selective serotonin reuptake inhibitors (SSRI’s), have not been around that long.

 

Like most of the people he interviews in this book, David Karp is on an “uncertain journey” when it comes to antidepressants. My own journey started about fifteen years ago with Prozac, one of the first of the SSRI’s. These were a new class of drugs designed to increase serotonin, a neurotransmitter thought to have an affect on depression. I had been seeing a psychiatrist for a few months who finally convinced me, after a lot of reluctance on my part, to try Prozac. At that point I had been suffering from depression for more than twenty years, but if not for the affect it was having on my job, I probably still would not have taken an antidepressant. I had many of the same concerns as those interviewed in this book – would it change who I was, what made me “me.” And it did change me. After taking it for a few weeks I began to notice a gradual change in my mood. I became more confident at work, with less anxiety, and the depression abated. I had the usual sexual side affects but the advantages outweighed the disadvantages, and after twenty years of depression I had found some relief. In the back of my mind, though, I viewed Prozac as a temporary solution, always believing I would be able to discontinue using it. I didn’t tell friends, co-workers, or even my parents I was taking an antidepressant. After a couple of years of feeling better I gradually stopped taking Prozac, only to find my depression returning, worse than before.

 

There were new antidepressants on the market by then, and, having stopped seeing the psychiatrist, I got a prescription for Paxil from my family doctor. I was suffering from severe depression, and Paxil helped within a few weeks. The side affects were similar to Prozac, but with an additional frightening one, what became known as the “zaps” among Paxil users. Zaps are a good description of the feeling I would get if I missed a couple doses of Paxil. It was like an electric shock through the brain. I imagined the zaps were not unlike the disturbing electro convulsive therapy scenes from “One Flew Over the Cuckoo’s Nest”. I never knew when this sudden jolt to my brain would hit, and needless to say, it was very disconcerting. As long as I religiously took my daily dose I was ok, but I was worried about taking anything that had such a strange side affect. So after taking Paxil for a couple years I began a slow, painful withdrawal over about six months. The depression returned and I started taking a different antidepressant that caused my heart to skip beats. Still another antidepressant caused me to become so short tempered and angry it scared my wife--and me.

 

I am now on my sixth antidepressant. To paraphrase the late Jerry Garcia of the Grateful Dead, it’s been a long, strange journey. I have no doubt these drugs do change your personality, sometimes for the better, sometimes for the worse. A shy person may become extroverted. An extroverted person may become apathetic and meek. A meek person may become aggressive and angry. But I’ve finally come to accept my need for them. My concerns now are not so much whether they will change who I am, but in finding one that is the most effective with the fewest side affects. Like many of those interviewed in the book, I hate the idea of having to take a pill to feel “normal”. I wonder if the antidepressants have “rewired” my brain, if the way I am is me or my meds. But the alternative, a debilitating depression, is much worse.

 

“There are no maps,” David Karp writes, “You’re driving on dimly lit and poorly marked roads that require constant guesses about which turns to take. Unsettling detours are the norm. The trip is exhausting and you never quite know how far you have traveled. You hope to get to a healthy place, but you’re not sure where it is, whether you’ll ever arrive, or even whether that destination exists for you.”

 

After reading this book, at least you will know you are not alone on this journey.