Drugs and Despair

From: Eirikur Hallgrimsson (eh@mad.scientist.com)
Date: Thu May 18 2000 - 22:49:52 MDT

Xiaoguang Li wrote:
> actually, i find that sometimes raw stimulants work pretty
> well. wasn't there some data that consumption of caffeine is
> associated with lower suicide risk?

I suspect that there is a huge amount of self-medication for low mood
and outright despair using caffeine and nicotine and alcohol. The
hideous thing about alcohol is that it actually works quickly to
reduce the psychic pain of depression, but it pushes your
biochemistry significantly further toward the depressed mode over

The antidepressant discussion has yanked me out of my normal lurk mode.
Antidepressants are very interesting in Extropian terms--basically
they are a primitive form of self-modification, and all the issues
about modifying oneself show up in one way or another in the
antidepressant arena, starting with the fact that many, if not most,
people are threatened by those of us who want to modify ourselves,
and want to be able to control or restrict this. And just try to
tell a psychiatrist that *you* are in control of your treatment.

There's an interesting argument made by Peter Breggin in "Talking
Back to Prozac" about antidepressants and stimulants. The history of
new antidepressant drugs is one of initial enthusiasm for each
innovation, but an eventual realization that new drug X is basically
a stimulant. "Talking Back" is an anti-Prozac tract, but it has a
number of interesting and thought-provoking nuggets like this.
The reason that stimulants are not ultimately successful as
antidepressants is that the body is very good at building tolerance
to stimulants. Our homeostatic mechanisms recognize the state of
being overstimulated and clamp down pretty quickly.

The stimulant analogy connects for me to the "Prozac poop-out effect"
that many people experience at around seven years on SSRIs.
Seemingly SSRIs are hard for the body's homeostatic mechanisms to
work around. Maybe it even takes seven years. Which would make a
heck of a lot of sense because the speculated mechanism whereby you
develop a tolerance for SSRIs is that you actually prune connections,
losing synapses to get the data rates (where?) back to where they
want to be. Scary stuff. There just aren't any long term studies.
Exactly how bad do the drug companies want to prove that you lose
synapses? I was pretty worried about being expected to be a good
sheep and take high doses of SSRIs as permanent maintenance for life.

The best reading on the philosophical issues surrounding SSRIs is
"Listening to Prozac" by Peter Kramer. "Listening" is for the
most part a pro-side rant, but Kramer actually covers more of the
research history than Breggin, and the research history is pretty
damning in terms of circular reasoning.

Speaking from too much personal experience, it is deeply weird to have
your subjective outlook turned around by a pill or the act of
stopping the pills. I once went cold-turkey from high doses of
Prozac and watched the world get colder, darker, dirtier, and uglier
by the hour over a handful of days while I was fully aware that no
such thing was actually happening external to me. And that ugliness
projected on the world made me feel very bad. Incredibly strange.

I think that you can push the brain around with strong drugs, but
they aren't the answer for life, partly because of tolerance
development, but also because there's no learning in a drug, and
depression appears to be a learned thing, which has serious
biochemical effects on you, but those effects aren't the cause.
My theory is that the brain chemistry changes are how the evolved
depression mechanism gets its results. My thinking is that
depression is a mechanism designed to allow an individual to survive
and possibly get a chance to reproduce, given serious low-status, low
pecking-order in our ancestral tribal environment. Some of us fall
into the depressed mode more easily, but everyone has the potential
to get there if pushed hard enough and long enough.

I guess that my take on drugs is that they are good for intervention
but not for maintenance, which is exactly opposite to the
current clinical approach.

My experience is that "attack" dosages of 2 to 3X the max spec'd
dosage of SSRIs can significantly impact acute despair in 4 to 8
hours, but I'm not a doctor and that's playing with fire. This
personal experience of mine has never been confirmed in another
person, so I could very well be off base here. I'd really like to
see research on this, though, because it would be nice to have a
powerful tool to pull people back from the brink.

St. John's Wort, an herb available as capsules at most any health
food store, has significant SSRI effects. For some reason, that
fact doesn't seem to get into press much. Even the people who make
the capsules tout the mood benefits, but not the Prozac connection.
I like the fact that you don't have to deal with the AMA and the
prescription drug establishment to gain access to the current state
of the art in antidepressants. If you are going to self medicate,
read both "Listening to..." and "Talking Back to...." cited above, as
well as anything else you can get your hands on. Playing with your
neurotransmitters is risky, and far from an exact science.

Oh, one parting note about SSRI's (or any effective antidepressant,
actually) and suicide or violence. Take someone who is essentially
completely disabled by depression. Stimulate the heck out of some of
their neural pathways with a drug. They aren't collapsed on the
couch anymore. They actually could carry out suicide plans that were
probably beyond them in the totally depressed state. The same goes
for taking action against someone else. I've not read anything about
this, but I have spoken to several clinicians who regard this as a
significant risk of SSRIs, and give it as a reason why they always
start patients with low doses.


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