In 1994, Penguin Books published what would become a national bestseller titled, Listening to Prozac written by Dr. Peter Kramer, a Clinical Professor of Psychiatry at Brown University at the time. Throughout the book, he debates the ethics of “cosmetic pharmacology” a term associated with the transformation of personality traits through medication. Kramer describes several patients as becoming “better than well” on Prozac — more socially adept, less inhibited, and more competent in their daily functioning. He also reflects on what this means for patients and for society — that a medication can be so powerful as to alter personality.
Over the years, antidepressants have been the subject of much criticism. Are they really effective in treating depression? Do their side effects detract significantly from potential benefits? Are we treating the root cause of the illness or merely applying a metaphorical band-aid? (Band-aids are effective in many of life’s situations.) Are they associated with increased risk of other chronic illnesses?
These risk-benefit discussions are prudent and scientific assertions must be repeatedly challenged and confirmed or negated. Still, my non-clinical opinion is as follows: Antidepressants are a bounty of science. Everything in my personal experience has corroborated this opinion. When discussing reports of an association between drugs with the potential for anticholinergic activity (Paxil and Prozac are in this class) and the increased risk of dementia with an colleague, she said something to the effect of, “I’ll take the quality of life I have now (on Prozac) rather than worry about disease that may never develop.” Translation: It’s worth it to feel this good.
When in crisis, my drug of choice has been paroxetine, the generic for Paxil and the namesake of this opinion piece. As a mental health researcher, I am familiar with tools that are used to screen for and diagnosis depression. On my worst day, I would not have “screened-positive” for depression. My use has been low-dose, infrequent, interrupted, and not precipitated by any formal diagnosis. With that said, I share these personal observations.
Inflammation of the mind. In my experience, a subclinical dose of Paxil did not turn back or halt any avalanche of emotional pain or anxiety brought on by life circumstance. For instance, in the same summer, my in-laws, both hovering at 80 years old, became ill and died. Watching them decline, and leave behind everything they loved (they were avid collectors), was an unpleasant awakening. There were several other overlapping stressors swirling around this central event. My mother referred to it as, “the perfect storm.” Low-dose Paxil did not magic that stress away. It wasn’t until things calmed down that I noticed it was working at all.
Efficiency of thought. A childhood friend with generalized anxiety disorder said this to me about Paxil: “It’s like having an intern in my head sorting out garbage.” I remember that statement clearly because it mirrored my own experience. It perpetuates a distinct efficiency of thought — the ability to quickly dismiss the unimportant and focus on matters of consequence. It “trimmed the fat” in my decision processing, freeing up energy I might have misplaced under different circumstances.
Comfortable with gray area. Author Malcolm Gladwell refers to the concept of a “reducing valve,” in his bestseller, The Tipping Point. This theory, which he attributes to psychologist Walter Mischel, describes a characteristic whereby people have difficulty accepting that two seemingly opposing personality traits can exist in the same individual. I can attest that, on Paxil, I was able to see a grey area, comfortably accept that it exists, that contradictions in human behavior exist, and move on with my day. The repetitive thoughts that would hang me up in the past (“How could this person care about me and still act like this?” Conclusion: “They must not care about me at all.”) were considered and quickly discarded. Simply put, I became more efficient with my mental and emotional energy. My brain choked off negativity and unnecessary time drains with noticeably greater ease when on-drug.
I have privately speculated — without consulting the scientific literature, I admit — if short-term antidepressant use could be an effective teaching tool for individuals with less severe impairment. Kind of like when I’ve asked myself the question: What would I do on Paxil?
Jennifer L. Barkin is a psychiatric epidemiologist.
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