I’m far away from my first career as a physicist, but not so far that I didn’t learn a few things. In particular, when preoccupied with the search for a theory of everything and being foiled yet again, physicists discover there’s always another level of complexity that they hadn’t considered. So when someone presents a theory of depression in absolute terms, I have to take a pause, consider my fellow physicists, and realize that medical doctors are as prone to the search for an elegant theory as anyone.
The problem I have with theories is this. If you search long and hard enough, you’ll find exceptions to the rules. Sometimes, you don’t have to search that hard.
I’m told that we have to remove the idea of “chemical imbalance” from a theory of depression. It makes me wonder why then, that the side effects of some drugs – not necessarily psychoactive ones – have such dramatic effects on the brain. Something tells me there is a complex chain of cause and effect, a cascade that trickles all the way up to the brain.
When I went on Prednisone for a vicious case of pneumonia associated with my Sjogren’s, in a few days I descended rapidly into a suicidal depression. Likewise, when taking Plaquenil for the same syndrome, I experienced a significant mood disturbance that likewise resulted in deep depression, and as a result I could only take half of the recommended therapeutic dose. I eventually realized that any benefit from the drug was outweighed by the mood disorder. So it disturbs me that if we are to throw out a chemical theory of the brain, why do these drugs have such significant effects on mood? And if there are drugs that have harmful effects, why can’t there be drugs that have beneficial effects?
I know there are. I have experienced them, and been saved by them. If we dismiss these effects as a placebo effect, we do a great disservice to the many individuals these medicines help. To reduce depression to a purely cognitive exercise might seem elegant, but it doesn’t work. In this model, the brain is treated like a train set: we need only lay in new cognitive pathways and switch off the old ones, and the sufferer is cured. Depending on how long the person has been suffering, surely these “dysfunctional” pathways become more like superhighways?
It’s always been a source of shame that I suffered from depression, and on those rare occasions I dared to speak out, reactions from other people gave me more reason to feel ashamed. I’ve worked so hard over the years to eradicate depression*, and yet the assertion that I could resolve this in a matter of weeks with cognitive written exercises makes me stumble, and think: have I tried hard enough? Did I rely on the meds too much? Did I fail because I was morally, spiritually, physically or mentally weak?
After 23 years of dealing with it, I conclude that the answer is emphatically no! I’ve been to the doorways of hell with this illness and yet I’ve travelled so far, and maintained a deep core of love and compassion for humanity, no matter that for so many years I was a virtual leper. I’ve learned that there is no grand theory of everything, especially depression. It’s a complex disease, and responds best to a range of therapeutic options, which includes in some cases, antidepressants. In my experience, there are so many tools for dealing with depression, and pharmaceuticals are just one item in our toolbox.
I would be the first to agree that if we don’t explore the historical roots of our disease, we only prolong the work that each person must eventually do on themselves. Sometimes, however, antidepressants are a lifeline that help us swim to shore and take stock of how we ended up in the deep water in the first place. Without this, much less, without the support of medical professionals, family and friends, we may find ourselves so many years later as I have, still struggling to shut down those superhighways.
It is vital for people with depression to regard themselves with love and compassion – the tools that I have discovered over the last two years to promise a more permanent recovery and a fuller life. While people living with depression must take responsibility for their healing, let’s not throw away a valuable tool for the sake of a theory. Let’s consider instead that the more tools we have in our possession, the better, and that a treatment modality that doesn’t work for one, may save the life of another.
*Things I’ve tried for depression over the years, some with greater or lesser success include pharmaceuticals, talk therapy, group therapy, cognitive behavioural therapy, self-paced courses and books, Vitamin B6, St John’s Wort, 5-HTP, nutrition, circuit training, bike riding, yoga, meditation, reiki, qigong, aromatherapy, massage, accupuncture, homeopathy, and more.