TO WRITE: Who are You on Meds?
This morning's New York Times features an essay asking: If you've grown up on antidepressants, or even been on them a long time as an adult, do you still have a sense of who you are?

I know my mood is dramatically better, my thoughts less self-critical and morbid and out-of-touch, on my medication. But after more than 20 years on the stuff, who am I? There are things I notice: It 's very hard for me to feel really excited happiness (perhaps due to my mood stabilizer?) and I physically am unable to cry except in the most extreme situations (Have all those antidepressants pumped me up that much?). But I wonder if there's more.

According to the article, by Richard A. Friedman, M.D., we know very little about the long-term effects of these medicines. The studies generally focus on people's reactions for only 4-12 weeks. The longest maintenance study so far has been on Effexor, and lasted two years. (It was better than a placebo at preventing relapses.)

Play with this. . .
Writing continuously for 20 minutes, compare what you notice about yourself on and off medicines. Consider your moods, your thoughts, your feelings, your bodily symptoms, and how long you've taken these drugs. Do your meds affect you ability to work or study, or your relationships? And do they affect your "sense of who you are"?

Hopefully, you'll conclude that you're heading in the direction that is healthiest for you. If not, talk with your mental health care provider.

TO READ: Antidepressants Don't Help Most Patients?
Could we have been misled by the "non-publishing" of studies that show poor results for common antidepressants? New research combining both the "good" and "bad" results of many studies on antidepressants' effectiveness suggests so. The new data says the medicines are no more beneficial to most patients than a placebo pill, and only help certain severely depressed people.


Irving Kirsch of the University of Hull, in the United Kingdom, along with colleagues from the US and Canada, studied Prozac, Effexor, Serzone and Paxil. They used a statistical "meta-analysis" to combined the data from all the trials submitted to the US Food and Drug Administration. Data from some of these studies had never been published, and some included what might be considered disappointing results.


The scientists found that patients with moderate depression responded almost equally well to the drugs versus a placebo. In addition, "Drug–placebo differences . . . are relatively small even for severely depressed patients." The severely depressed people seemed to respond to medicine somewhat better, but this was attributable to the fact that they responded worse to the placebo.

For additional info: see PLos Medicine (a peer-reviewed journal of the Public Library of Science) for February 26, 2008.

TO WRITE: Are You Friendly with Your Little Pink Tablets?
If you take antidepressants - or mood stabilizers, antipsychotics, anti-anxiety drugs, sedatives, stimulants or any other of the panoply of psych meds - how do you feel about them? For many people with depression, that handful of tablets and capsules that it sometimes seems we gobble like candies can be hard to get down. That is, while we know intellectually that these drugs are helping us, or at least could help us, many of us still have mixed emotions about taking them.

Have you ever wondered what exactly those pink or white or turquoise or yellow pills are doing once you swallow them? Scientists still can't fully explain how they operate to change our thoughts and our entire mood. How does that mystery leave you feeling? At different times I've felt dumbfounded, nervous, grateful, embarrassed, angry, resentful and relieved to reach for my regular doses from those amber bottles.

Play with this...
Write continuously for 20 minutes describing your feelings about taking medicines for psychiatric reasons. What emotions did you feel initially? Have they changed at all? How do you feel when you take your prescribed dose today? And would you feel any differently if these were drugs you were taking for some non-psychiatric ailment? Untangling such thoughts and feelings may provide some insight into our attitudes toward our depression and our life situations as well as our treatments.

TO READ: Genes May Predict Antidepressants' Effects
If you're reading this blog, chances are you've been there: Your doctor is prescribing an antidepressant for your unipolar or bipolar depression, then mentions the caveat - a big caveat - that this may take up to eight weeks to be effective, if it even is effective for you. When you're miserable, eight weeks is a very long time.

Once again, however, genetics may soon come to our rescue. I've written previously on the burgeoning use of genetics in other aspects of depression diagnosis and treatment (see 10/9/06 and 11/13/06), but now researchers are approaching the very practical issue of predicting "Which med will work for me?"

National Institute of Mental Health scientists screened the genes of nearly 2,000 people being treated with Celexa. They found variations in two genes associated with the treatment. One turned out to be linked to serotonin, one to glutamate, both of which are brain chemicals (neurotransmitters) involved in depression. It's only a start, but ultimately researchers hope to have a panel of genetic markers that can be used to predict which patients are at high risk of failure or side effects if the proposed medicine is used. Hopefully before long we'll see the end of the sometimes endless trial-and-error method of finding the right antidepressants for each suffering person.

For more info: WebMD.com for WebMD Medical News, 12/6/2006.