There Is a Place for Antidepressants

When I was six months pregnant, I attended a birthing preparation class with my husband and about 12 other expectant parents. During the fifth session, the instructor asked the mothers whether or not they were going to use medication to get through the pain of childbirth labor.

“Everyone who wants to try for a natural birth, stand over here,” she said. “And everyone who plans on having an epidural or taking other pain medication, stand over here.”

I looked at the two groups, which held about the same number of people. My head went from one to the other, much like a puppet with a tic. Like most decisions in my life (including which dressing I want on my salad), I had analyzed the hell out of this one — done all the research on both sides — and still couldn’t commit.

“What a feeling of triumph to be able to do it without drugs,” I thought to myself. “I could wear a T-shirt for the rest of my life that says, WOMAN WARRIOR: I GAVE BIRTH NATURALLY.” But I also knew that acute pain — just like severe depression — has devastating effects on the body, and that white-knuckling it isn’t always the heroic thing to do. Plus, I’m not a huge fan of pain. I try not to bring it on when I don’t have to. I could see myself wearing another T-shirt, too: PAIN IS NOT MY FRIEND: I CAVED TO THE EPIDURAL.

I walked up to the two groups and stood in the middle of them.


“I’m undecided,” I explained to both camps, who glared at each other with disdain.

I’ve tried my best to stay in that spot — in the middle, gazing at the opposing sides from my peripheral vision — for most of my time as a mental-health blogger. I believe that the center is by far the most interesting place to be, because you get to read the memos from each group and decide whether or not you agree.

But it also gets lonely.

And that’s because the world of medication is so divisive, especially when it comes to using antidepressants or any kind of psychotropic medication to treat depression and anxiety. There is the camp that believes anyone who uses them is avoiding the hard work that has to be done to move beyond sadness — that the meds are agents of evil, poisoning our systems with harmful toxins. And then there is the camp that believes that medication is the one-and-only way of treating depression, that mood disorders are strictly biological and can’t benefit from any introspective work, and that the disorders are in no way influenced by one’s diet or lifestyle habits.

For the first 10 years of my blogging life, I was publicly pummeled for “copping out” and popping pills. People called me irresponsible for disseminating harmful information to the public, accused me of sleeping with Big Pharma (even though I never saw any cash), and also of being weak, small-minded, and caving to a popular culture that says good health is only one prescription away. I’ve never believed that medication alone will heal you from depression — that a script is all you need to get to sanity. But that’s what some people heard.

Now I’m getting lambasted from the other side. I’m getting the “Shame on you” a lot for pursuing natural therapies to treat depression, and thereby supposedly influencing people to go off of their meds, which could “kill 20 people.” The tragedies that are so often attached to mental illness in the news are the fault of people like me who encourage folks to mistrust psychiatry.

Let me say this about medication:

I would not be alive today without it.

I credit my psychiatrist for saving my life in March of 2006.

I believe that antidepressants and mood stabilizers are agents of healing.

There is absolutely a place for medication, and I would never say otherwise.

When I was holed up in my bedroom closet, sobbing in fetal position with a bag of prescriptions that I intended to use to flatten my pulse, I was incapable of pursuing the steps I am now — Bikram yoga, helping others, working with an integrative doctor — to deliver me from that hell. Rarely did I have the stamina to make it to the grocery store, let alone to blend green smoothies and learn how to cook nutritious meals. It was through the intervention of a skillful doctor, and the right combination of meds, that I stabilized.

Being on meds was absolutely the right thing to do.

But over the last seven years, I have not responded to the medications as I did earlier in my life. They have failed to bring relief from my death thoughts. Plus, their side effects compromised my health in ways that were keeping me depressed.

For example, I believe (after reviewing some research) that my experimentation with antipsychotics, or possibly my long-term use of Zoloft (sertraline), is what caused my pituitary tumor, which completely throws off the hypothalamic-pituitary-adrenal axis that is critical to mood. If the tumor gets big enough, it can affect your vision and even render you blind (the pituitary gland pushes up next to the optical nerve). To manage the growing tumor, I went on a medication called Cabergoline, which, according to research, is linked to aortic valve regurgitation, which I now have — andthe connection between cardiovascular disease and depression has long been established. At the same time, I developed hypothyroidism and some expanding nodules in my thyroid gland that can happen with Lithium use. As I’ve written in the past, the thyroid is a delicate and powerful gland that governs so many essential activities in our body related to hormones and mood. Finally, many of my medications have gastrointestinal side effects, which I suspect have something to do with my current inflammatory bowel disease. Our gut is our second brain, so problems there leak into anxiety and depression.

Therefore, I was forced to look into other kinds of therapies to treat my symptoms.

If I’ve been inching closer to the tree-hugger camp in my writing as of late, it’s only to make these two points:

  1. Diet and lifestyle are more effective than I previously thought to managesymptoms of depression, if you know what you’re doing: some adjustments COULD help reduce the amount of medication you need to take.
  2. Medications aren’t risk-free. Their side effects can inadvertently contribute to your depression and negatively impact your health for years to come, so do your homework.

Ultimately, though, it’s about doing a cost-benefit analysis.

I would live with blindness and a goiter the size of a football if that’s what I had to do to stay alive. Chronic illness isn’t fun, but it’s better than being dead. And if I felt some relief from the medications, I would tolerate a host of side effects. I believe a person should take the course he or she needs in order to relieve the most suffering. So in my case, when the negatives began to outweigh the positives, I knew it was time to take my health in a different direction.

That’s not to say I don’t support the use of medication for people who struggle with depression.

My son’s birth ended up being a traumatic one. I held off on the epidural until the very last moment, but was glad I had taken it, because when his heart rate began to plummet, the doctors performed an emergency C-section. Had I opted to do it naturally, they would have completely knocked me out for the surgery, and I would have missed the entire birth.

Modern science saved little David’s life, much like my own.

Fifteen years later, if I were in that birthing class, I’d stand in the same place.

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