Can antidepressants help or hinder waking up?
Not long afterward came the backlash. Suddenly, haunted “Prozac Survivors” were appearing on talk shows and the Internet with tales of suicide, murder, self-mutilation, mayhem, or just very, very bad relationships attributed to SSRIs. Talking Back to Prozac by Dr. Peter R. Breggin, M.D. features a shopping list of SSRI fiascoes (“A woman who held her psychiatrist 'hostage' with a razor to her own wrist sued Lilly concerning self-mutilations inflicted while taking Prozac”) and charges that Prozac is a toxic drug that leads to long-term neurotransmitter disruption.
These horror-story effects do not seem to be common—a recent study in the American Journal of Psychiatry laid to rest the rumor that SSRIs were responsible for a rash of suicides—but neither are the drugs responsible for the magical personality makeovers described in Kramer’s book. “I have a caseload of two hundred and thirty patients,” says Jack Engler, a prominent Boston-area psychotherapist and Vipassana teacher. “I keep waiting to see a case like that. I never have.”
Mark Epstein, a New York psychiatrist, practitioner, and author of Going To Pieces Without Falling Apart, concurs. “I haven’t seen anyone become better than they ever were. If you’re not depressed all you get when you take Prozac are the side effects—nausea, headache, sexual dysfunction.” (Yes, Virginia, SSRIs do have side effects—milder than those of earlier antidepressants but troublesome enough that twenty percent of patients discontinue the medication soon after starting.) None of the psychotherapists I interviewed had witnessed Kramer’s “better-than-well” phenomenon, though the prominent transpersonal psychiatrist Seymour Boorstein, who is on the faculty of the University of California, San Francisco, reports striking, transformative change in some patients.
For years before she considered Prozac or realized that she suffered from recurrent depression, my friend “Jan” (not her real name) was drawn to ten-day retreats. But watching her own mind was like climbing a very sleep slope, or sometimes like clawing her way out of a claustrophobic cave. “I was really committed on retreat. I’d always be up and meditating at four a.m., and I’d meditate whether I felt good or bad. Typically, I’d go into this huge despair and I’d watch my mind, and I’d cry, and many times I would move out of it after a while.
“On one retreat I felt as if I had leather belts around my chest that were being cinched tighter and tighter. I was in intense emotional and physical pain. I wish I’d gone up to speak to my teacher about it. I wonder what he would have said. I just thought, 'Well, he says if I just sit and watch my breath and feel the feeling it will go away.'
“When I came home I was like a wild woman, filled with rage and despair. I’d say to my boyfriend, 'You have to go on a Vipassana retreat; it’s so great!' and he’d say, “This doesn’t look like an endorsement.’”
It is not uncommon for practitioners to feel that “coming out” about Prozac risk being judged as failures in their practice. Yet the one Buddhist therapist I found who spoke out against Prozac talked of the conflict in thoughtful and nondogmatic terms.
“If one undertakes this spiritual path one will find oneself before long in the desert, where everything that once seemed attractive becomes empty or even repulsive,” says Bernard Weitzman, who practices “contemplative psychotherapy” in New York City and is on the graduate faculty of the New School for Social Research. “Depressed people are hyperrealistic; they see things as they are; they no longer have the juice to escape into fantasy. You can be depressed about it—or you can be curious.”
Observing his teacher, Chogyam Trungpa Rinpoche, drunk but philosophically trenchant, convinced Weitzman that the mind is not chemical, and neither is depression: “Well-being is not ruled by serotonin.” Rather, he favors the cognitive behavioral view of depression as the fruit of a particular, flawed belief system (“Things go wrong because there is something wrong with me”) for which the best cure is—ultimately—dharma. “The basis of all Buddhist practice is integration of every level of functioning,” he says. “No aspect of one’s mind need be feared or obstructed. When you befriend all these tendencies, when you’re willing to sit there in maitri practice and see, hear, and feel all that internally generated misery, then you become a person who is trustworthy to herself. A person who is not willing to include the texture of depression in her emotional space is not going to be compassionate.”
“What Prozac does,” he adds, “is make you care less; the burning issues become very attenuated; some people say they are changed in funny ways. A different personality takes the driver’s seat. I think it’s a disaster.”
Does this purist view mark Weitzman as part of the old guard in his community, or has he held out bravely against the inroads of an Americanized conception of enlightened mind?
In support of Prozac, those who have suffered from clinical depression report that it resembles an ordinary bad mood or ennui about as much as the sinking of the Titanic resembles an unpleasant Atlantic crossing. Patients with major depression describe a world apart, an alien land where no birds sing—a blasted, desertlike landscape or a frozen tundra. “I felt it was an entirely different experience from ordinary unhappiness,” says Minneapolis Zen practitioner Philip Martin, author of The Zen Path Through Depression (HarperCollins San Francisco, 1999), an insightful book that includes techniques and guided meditations, drawn from his experience with Zen practice and his own major depression, for healing and/or working with the pain of depression. “My body felt heavy, my sleep patterns and all my body systems were changed. I felt there had to be something more to it.”