My Medication

There's an issue in my life that has come up a few times recently, and I feel I should at last tackle it; the issue of properly assessing the drugs I'm taking. It's been going around in my mind since the medication was found to be the root of my intolerable Restless Leg Syndrome, and being accused of performing no better than a placebo, at first in a passing comment by a friend, and then in a magazine article I just read. Usually, as a curious scientist and a control-freak, I would have investiagted any such major voluntary change to the workings of my body immediately, but I suppose two things have prevented me; the first is that if it is a placebo effect, I would rather not read the evidence too carefully so that I could allow it to actually work; and second because I would feel the need to type up my findings here, and so expose my malady!

I'm not often bashful about my medical problems, but this is something I fear would change the idea some people have of me, and cause me to obtain a new and frightful label in their minds, reading everything I do with a new 'schema' of who I am. Please don't let it do that!

So here it is: since spring this year I have been taking Venlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI): I have been affecting my brain chemistry in order to try and fight depression. I have known in fact for some years my tendency towards depression, not least because I am my mother's daughter and she has always been subject to terrific moods (plus she told me of a disturbing history of suicide in our female line - but no worries about that from me dear friends). I noticed some aspects of my life pulling me towards the darkness in previous years, but it wasn't until I moved to Finland two years ago that factors conspired to bring about a full collapse (there I was, a bright, ambitious new graduate, who was only able to find a job giving out free newspapers).

But enough about my personal life: let's just say I largely chose the drugs over therapy (although I do attend a biweekly 'support' group for insight), mostly because it is my belief that I do have the capacity to be happy, indeed four years ago I was just starting the happiest year of my so-far short life. All I need is a change my life situation, and I hoped the pills would clear my mind enough to let me make the right decisions. (Again, I don't want anyone to think this idea of science journalism is some starry-eyed dream of mine to escape my depression; I thought that way about moving to Canada for my PhD, and am not foolish enough to be so disappointed again. I don't expect to be magically cured by changing careers.)

At first, I was extremely pleased with the results: the anxiety that had often prevented me from leaving my bedroom, much less the building, was instantly dampened, so that I could engage in 'normal' behaviour (it's not really a fear of the ouside world, more of having to deal with people). I weighed it up and decided it was likely not a placebo effect, since I had no real expectations of what the pills would do for me anyway. I felt happy for a while (well, at least more active). Then, more recently, much of the anxiety has returned, to my great frustration, and that of my poor partner, who, although he admits he doesn't understand it, thankfully supports me anyway. Maybe it was just a placebo after all?

I finally decided to investiage my drugs after painful Restless Legs and admittance of my ailment to my parents, as well as mounting momentum of the idea that the 'new' antidepressants (i.e. SSRIs [e.g. Prozac], as opposed to older Tricyclics [e.g. chlorpromazine]) were no better than placebos, at least for mild-moderate depression sufferers (I am certainly not severe, I tested myself using a standard practitioner's test, and although I'm sure I would assess myself differently than a professional, even my most pessimistic view of my state does not score highly enough, requiring 28 to be deemed 'severe').

A lot of the recent news and magazines articles asserting that antidepressants perform statistically no better than placebos relate back to a study by Irving Kirsch and others, who performed a meta-analyses of drug trials (analysing a larger dataset collected from a number of seperate studies). They concluded that placebos were just as good as the prescribed drugs, making the distinction that when the drugs did perform better, it was because of less patient response to the placebo, not greater response to the drug.

In a quick flurry of Google-research before boaring the plane I'm now on (although it's probably a few days of editing before I post this... if fear of 'exposure' doesn't prevent me from doing so altogether) I read three very different sources of information and opinion about the subject. The first is a much-quoted British Medical Journal article summing-up the findings of the meta-analysis. The second was a New York Times article that thought more skeptically about the result of a similar study published a few years ago. It discussed the short span of many of the original studies, lasting only a matter of weeks, when some antidperessants can take up to six weeks to start showing any effectiveness. These also miss any longer term effects, such as the likelihood of the placebo effect being relatively short-lived, whereas antidepressants are more likely to keep being effective in the long-term. Do some of these same concerns affect the results of the new study? I also wondered myself if any of the original studies or the meta-analysis took into account whether the subject was receiving therapy or not.

The last source I read was a short piece from a medical professional's blog. Keeping away from the science of drug tests and placebos, he focused more on the question of, as a person with depression, what should you do with this information? His answer was simple: whatever is best for you. If you think a placebo will do just as well for you, fine. If you believe the drug is having real, tangible effects on your life, good, keep at it. If you want to try a different antidperessant, you can do that too. I don't entirely agree with his position, especially sine he calls Kirch's research 'his opinion'. Also, suggsesting that selecting between a sugar pill and something equally as effective, but tenfold the cost, is a sensible choice is on shady moral ground (although in this case, the jury for antidepressants is clearly still out, needing that old line of 'more research'). He also says the new family of antidepressants are not as powerful, which is likely true, but blames their lack of use on fierce marketing of newer drugs, rather than on the much worse side effects of the old drugs.

However, it was the only piece I read that allowed me, as a consumer, to re-evaluate my position. My choices are: come off the antidepressants (at the moment not an option, since my dose means quite a sharp and unpleasant withdrawal, which I have encountered on some level when forgetting to take the pills for even one day); carry on as normal (with, at present, no improvement in my mood or ability to concentrate, although I constantly wonder if the me of six months ago would agree with that, after all, I am keeping up this blog at least); or switch pills. In the end, antidepressants are never meant to cure depression, only allow the user to think about their position with a clear mind, which is exactly what I want out of them. I only 'turned myself in' because the inability to function properly was starting to impact my ambition (and my relationship, the final straw).

I'm not sure entirely which option to take yet, but one thing is for sure, next appointment I will ask my doctor what their opinion is on the issue. I hope they engage me: the worst thing would be accepting medication from a professional not versed in the controversies of their own field.