Sex, Drugs and...well no, just drugs.

[I love colors!]

I've got another book recommendation! My life is consumed with mental health right now and I'm loving it.

I finished reading a book called Listening to Prozac, written by a psychiatrist in the early '90s, who talks about how Prozac transformed psychiatry. There is so much to think about mood-altering drugs. It's a subject that comes up with most clients; it's something I've considered periodically for several years. Many people I know feel medication is one of the best things that ever happened to them. Many others see it as a last resort. I think there's still a lot of worry and stigma attached to it.

This book brings up many of the worries and existential questions I've had around mood-altering drugs, and systematically makes them seem, well, dated.

Many people think antidepressants are only for people who can't function well. This book is about high functioning patients who saw their lives transformed by Prozac. In many ways, what they experienced was a personality change: people who were timid, rigid, sensitive, socially anxious, or overly caretaking became relaxed, confident, assertive, and flexible.

The author found himself conflicted about these patients and spends a lot of time trying to understand why. What does it mean if a drug can alter personality, not just mood?

• Does Prozac, he wondered, make people conform more easily to social norms? Our society tends to reward "hyperthymic" personalities: people who are highly energetic, productive, cheerful, and social. It does not tend to reward more introspective, brooding, serious personality types. Maybe Prozac changes people into more socially acceptable beings, to the detriment of what can be gained by other types of character.
• In monkeys, high serotonin levels are associated with alphas. Maybe it's evolutionarily necessary for serotonin levels to vary. We can't all be alphas, after all.
• In some patients, he found himself a little disappointed by their personalities on Prozac. He found them a little less interesting, a little less textured. He admits this concern is "aesthetic rather than doctorly."
• Many people have argued that there may be something beneficial in depression. Perhaps depression forces people to slow down, rest, and face issues before they do more damage. Perhaps it is caused by psychic material ready to emerge and be processed. Maybe psychic pain is helpful, even necessary, to creativity. What if Prozac dulls us to necessary aspects of our being? What if it's a band-aid that keeps people from getting the heart of their real problems?

To counter these concerns, he uses both research and his own experience.

1. [I love lists!]
2. In many cases, people on Prozac say, "I feel more myself than ever." Now that is an interesting statement. What does that say about the nature of the self?
3. Many people are more able to access buried psychic material on Prozac. Many become more insightful. Many reach insights they find helpful the rest of their lives, even off medication.
4. Some research is showing that, in many people, mental health problems represent a lifelong, often degenerative disease that plays out in cycles or episodes. For example, "rapid cycling," a very hard-to-treat illness characterized by dramatic mood swings, seems to be the end stage of a lifelong illness similar to bipolar. Many people with depression and anxiety seem to experience them in episodes that get worse over a lifetime. Each episode probably does damage to the brain that then predisposes an individual to more episodes.
5. This is useful to think about when considering the potential side effects of medication. It is important to consider medication's effects, but depression also affects the brain and body in many ways we are just beginning to understand. Babies born to depressed mothers often show difficulties, as well as those born to medicated mothers.
6. The author is very swayed by experiments done on rhesus monkeys, who are (he says) our closest genetic relatives. Childhood trauma to the monkeys (like separation from caretakers, etc.) can produce many of the same personality distinctions of his patients: timidity, rigidity, rejection-sensitivity, aggression, etc. The right circumstances can buffer these traits, but traumatized monkeys respond to subsequent separation from the group with more depression, anxiety, and stress than non-traumatized monkeys. These reactions tended to get worse with each separation. They even did things like rocking, hair-pulling, and self-harm like many humans do. And they had lower serotonin levels.
7. These experiments suggest that many personality idiosyncracies may actually be the result of childhood traumas, even those passed down through generations through brain chemistry. He suggests that what Prozac might do is give people the brain chemistry of someone with a healthy childhood and resilient genes.
8. Many people become more creative on Prozac, also. He's a big believer in psychotherapy, self-awareness, and being in touch with all aspects of your being. But suggesting suffering is necessary becomes less convincing after reading this research. Not to mention that it's counter to the ethics of any doctor.

Medication is not the holy grail. And plenty of research suggests brain chemistry can also be altered by psychotherapy, exercise, all sorts of things. But sometimes people get further with medication than they get in years of therapy. This book dissolved my concerns and made me feel no qualms about supporting clients to try meds and trying them myself.