Category Archives: pharmacology

anxiety, depression, pharmacology

Coming Down (going off depression medication)

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Do Not Feed the Fear

So I have now been on anti-depressants and anti-anxiety medication for over two years. My current cocktail (zoloft/sertraline, welbutrin, and clonazapam) has been fairly steady for over a year. Things are going well for the most part, so I am starting to wean myself off of the medications.

The concept is both exciting and terrifying.

When I started taking all of this stuff, I was in a very desperate position. There were few options. It was medication or check myself into a hospital. I’m glad that I made the decision to go on this medication, as it has allowed me to live and regain some semblance of normalcy.

Having said that, there is no doubt that you also lose something by taking anti-depressants and anxiety medication. The lows aren’t nearly as low, but the highs aren’t as high, either. The anxiety medication makes it so that I don’t feel claustrophobic, but it also just makes you a little dulled to the world around you. I feel like I have been tired for two years, and that I don’t even remember what it is like to be fully awake.

I am excited to start the process of going off of them, but I’m also scared. They have served as a safety net for a long time. They are one of the earthly causes to my ongoing healing. I don’t want to go off of them, because I don’t want to go back to where I was. But I don’t want to stay where I am, either.

So there is the dilemma. I can’t stay where I am, but I can’t go forward either.

Well, actually I can. By the mercy of God, I can start this process of going off medication. The absolute worst thing that happens is that I go back it/them for a time. I am baptized. My inheritance is sure, and my future is as certain as Jesus’ death and His words, “for you”.

My flesh and my heart may fail, but God is the strength of my heart and my portion forever. Psalm 73:26

-DMR

anxiety, depression, meditation, pharmacology

Medication or Meditation: Was ist Das?

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One of our gentle writes asked me to write a little about meditation vs. medication. If you read much in the way of comments here, you will find that many of the readers here have a much lower view of pharmacology and medication that I do. That’s okay, I can take the heat.

One does not have to do much research to discover that there is a whole field of study on the relationship between meditation and depression. Some of the articles I found after a quick search are HERE, HERE and HERE. One of the things we have to establish is what is really meant by meditation.

Meditation can mean everything from yoga, visualization techniques, Cognitive Therapy (my personal favorite), and a world of other types of meditation that may or may not have a religious element to them. Probably the common element among them is using some method to cleanse or clear the mind, to focus on one thing, and through this process to change one’s thinking. I won’t claim to be an expert on non-Western forms of meditation, but I know just enough to be dangerous.

Here are a few preliminary observations from a Lutheran perspective:

  • Evaluate whether the technique works within the framework of a religious system that is contrary to Christianity. Some types of meditation are benign; others have a totally skewed view of human spirit (usually a variation on denying original sin). Does the form of meditation have aspects of it that just don’t sit with the theology of the cross? Is meditation seen as a way of supplanting prayer?
  • What are the expectations of the writer/teacher/guide who is leading the meditation? If there is talk about being a disciple of a certain form, I would start to get nervous.
  • Does the form have history, is it established and recognized at least at some level by professionals in different fields? While this isn’t absolutely necessary, if something is written off as complete quackery, it may be because it is.

My therapist has used and is a proponent of cognitive therapy or cognitive reframing. We have also used some basic relaxation techniques to help deal with anxiety. I’ve found them both to be extremely helpful. Are they THE solution? No? Can they replace medication and other means of help? Not for me. If you don’t have the energy to get out of bed, it is very difficult to imagine having the energy to meditate, no matter how relaxing or liberating it may be. I can know something is good for me and still not be able to do it.

Anyway, those are a few initial thoughts. What are yours?

-DMR

anxiety, depression, meditation, pharmacology

Medication or Meditation: Was ist Das?

2 Comments

One of our gentle writes asked me to write a little about meditation vs. medication. If you read much in the way of comments here, you will find that many of the readers here have a much lower view of pharmacology and medication that I do. That’s okay, I can take the heat.

One does not have to do much research to discover that there is a whole field of study on the relationship between meditation and depression. Some of the articles I found after a quick search are HERE, HERE and HERE. One of the things we have to establish is what is really meant by meditation.

Meditation can mean everything from yoga, visualization techniques, Cognitive Therapy (my personal favorite), and a world of other types of meditation that may or may not have a religious element to them. Probably the common element among them is using some method to cleanse or clear the mind, to focus on one thing, and through this process to change one’s thinking. I won’t claim to be an expert on non-Western forms of meditation, but I know just enough to be dangerous.

Here are a few preliminary observations from a Lutheran perspective:

  • Evaluate whether the technique works within the framework of a religious system that is contrary to Christianity. Some types of meditation are benign; others have a totally skewed view of human spirit (usually a variation on denying original sin). Does the form of meditation have aspects of it that just don’t sit with the theology of the cross? Is meditation seen as a way of supplanting prayer?
  • What are the expectations of the writer/teacher/guide who is leading the meditation? If there is talk about being a disciple of a certain form, I would start to get nervous.
  • Does the form have history, is it established and recognized at least at some level by professionals in different fields? While this isn’t absolutely necessary, if something is written off as complete quackery, it may be because it is.

My therapist has used and is a proponent of cognitive therapy or cognitive reframing. We have also used some basic relaxation techniques to help deal with anxiety. I’ve found them both to be extremely helpful. Are they THE solution? No? Can they replace medication and other means of help? Not for me. If you don’t have the energy to get out of bed, it is very difficult to imagine having the energy to meditate, no matter how relaxing or liberating it may be. I can know something is good for me and still not be able to do it.

Anyway, those are a few initial thoughts. What are yours?

-DMR

anfechtung, depression, pharmacology

Depression, Anfechtung, and drugs (oh my!)

8 Comments

Susan over at her pendulum has posted a good and worthwhile question about anti-depressants. Read it here.

I’ve posted on this topic a few times, particularly in my review of the book, Prozac Nation.

Susan has several valid observations and questions:

  1. Does an anti-depressant treat the cause or cover up the symptom?
  2. As a result, does it actually cover up the underlying problem so that it can’t be addressed?
  3. Finally, what is the difference between clinical depression and anfechtung?

The answer to number one is yes and no. I come from a long history of distrust of traditional medicine. My family has lived on chiropractors and homeopathy for about as long as I can remember. So have have no commitment necessarily to standard “slap a drug on it and call it good” approach to medication. However, there is plenty of evidence (more and more each year) that points to the reality that clinical depression is a medical condition, where the neurotransmitters in the brain are not functioning properly. Is this condition a result of sin? Yes (duh). Are there multiple ways it can be addresses? Yes (duh).

I do think that because we are dealing with mental illness that there is an automatic connection made between clinical depression and spiritual distress or temptation (anfechtung). In my observation and deep experience, they are not the same, but one may lead to the other, either direction. This is why there is no one solution to clinical depression. It really requires a multi-pronged approach of a doctor, a counselor, and a pastor. If you take one of those out of the equation, I fear that either the clinical depression or the spiritual distress which caused it or is a result of it will go untreated.

Allow me to use an analogy. I’ve had many parishioners who have had cancer and other terminal illnesses, as well as painful but not terminal illnesses. Few things can test the faith than a terminal illness. It almost inevitably leads to anfechtung. It is also an incredible opportunity for our Lord’s healing hand to be at work, forgiving sins, providing comfort and giving consolation which only he can give. However, as a pastor I would be seriously messed up if I suggested to this patient that they should refuse treatment.

Which brings us to number two. Can anti-depressants cover up the underlying problem? Absolutely! That is why a pharmacological treatment cannot be the sole treatment. The causes for clinical depression are diverse and sometimes impossible to track down. In order to get at the heart of the matter, there is a sense where the patient must recognize the depression for what it is, and try to seek both spiritual and psychological answers. It really requires self-examination which can be very uncomfortable.

However, there is a point where anti-depressants are necessary in order to function and get to the point of asking some of those underlying questions. Sometimes the answers may be spiritual. Sometimes they may be genetic or situational. Sometimes it is nearly impossible to nail down a “cause” to depression. But the fact of the matter is that far, far more people are undermedicated or misdiagnosed when it comes to depression than the other way around.

Which brings us to number three. What’s the difference between clinical depression and anfectungen, or spiritual distress? When you physically can’t move out of bed, that isn’t a spiritual matter, or it at least is not solely a spiritual matter. When you can’t concentrate, can’t remember the day before or even the hour before, when you either can’t sleep at all or sleep 20 hours a day, these are not simply spiritual distress. They are real, physiological symptoms of a medical problem.

Life under the cross does not mean easy fixes or pill-popping solutions. It means that we follow our Lord to die, so that we might rise with Him at the last day. It does not mean that we should avoid earthly help with pain in order to further identify with our Lord and His suffering. That would be montanism, and some of the more twisted views found in monasticism.

If your leg is broken, get it set. If your mind is broken, get the help you need. A part of that help may include medication and therapy. I guarantee that a part of that help is having a pastor and a church that understand the Gospel, and will give you the balm that will heal your soul, even if your mind and body are hurting.

Thanks for the intriguing post, Susan.

-DMR

book reviews, depression, pharmacology

The Second Book I've Read: Prozac Nation

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Ten years ago or so, this book, Prozac Nation, was the hot ticket. Written by a young up-and-coming female writer, it was hailed as fresh and innovative, courageous, raw, and a bunch of other nice things. It was a part of a genre of self-disclosure that was (and is) extremely popular. But written just a few years after William Styron’s Darkness Visible: A Memoir of Madness, this book was written for the young and the restless. Lots of colorful language, a few titillating references to sex, and sort of a super-extension of teenage angst, the book had everything that other books of the genre lacked. It had a movie made about it. It was a bestseller, and so forth.

When I first read this book, early on into my illness, I found it liberating and deeply moving. It described what I couldn’t. Despite the sometimes whiny voice, it served an important purpose for me in understanding what I was going through. I wasn’t crazy; I had a mental illness.

I’ve read it again, and my views on the book are very different. It does describe the state of depression well. It does describe the roller coaster of medications pretty well also. It was, however, written at a time when Prozac was the first of a panoply of anti-depressants to come on the market. In many respects this is better, as more people have more options for healing. But this phenomenon has also added the maddening factor of doctors bouncing you from drug to drug, seeking to find the magic cocktail that will be the right fit. It can be a profounding frustrating and, well, depressing experience.

Back to Prozac Nation. After reading Styron’s book above, and others (which I’ll get to in due time), I find that Wurtzel is not as helpful as other memoir-type books of the genre. One of the dangers of reading memoirs like this while you’re in the midst of the illness is that it can give you ideas, prey upon your already overactive anxieties, and create a mental state which may not have been there at the start. It’s usefulness for those suffering from depression and anxiety comes more as an afterward than as a self-diagnostic tool.

Now what I do find extremely useful in this book is how it chronicles all of the different types of self-medicating that we go through. Alcohol (the pastor’s choice most of the time), uppers and downers of various sorts, over-the-counter drugs, sex, relationships. We can use almost anything as a narcotic against the creeping darkness and the coming fog. They are all attempts to escape from our lives, or to feel SOMETHING so that we can know we are still human. In that respect it is helpful

Completely lacking in the book, though, is any real interaction with the spiritual element of depression and anxiety. Wurtzel is basically a non-practicing Jew, where religion and spirituality of any sort plays no part in her worldview. That is helpful to recognize at the outset, but that also means that the Christian suffering from depression and anxiety is going to find this book completely lacking in one of the key elements of their suffering. It is a picture of the disease, but it is not a complete picture.

If someone were to ask me today what book could I read to describe what I’ve gone through, I’d probably give them Darkness Visible, because it fits my own experience closer than Wurtzel. However, I would also tell them that there isn’t anything out there that I’ve read which really nails it completely, so they’ll have to wait for the book…

-DMR