Can antidepressants help or hinder waking up?
“Terry N.,” another practitioner who did not wish to use her real name, is a driven, successful entrepreneur in upstate New York who is also a long-term Zen student. She was blindsided by depression not long after her fiftieth birthday. “It came on suddenly —a total surprise,” she recalls. “I had always been a totally peppy, upbeat, take-charge person. I was a problem solver. I ran a company. I had little sympathy for people who were depressed.” Her first symptom was crushing fatigue, together with a physical slowness and clumsiness so severe she feared she had a neurological disease. Then her familiar world turned barren, stark and tasteless. “Things turn to ash in your mouth; you feel an exaggerated weltschmertz; nothing gives you pleasure; life seems 'nasty, brutish, and short.' I thought, "How did I get here? What happened to my beautiful life?’”
After a few weeks on an SSRI she surfaced from her depression; but now she was buzzing, and her zazen was affected. “I got this tremendous surge, like caffeine, which stirred up thoughts and ideas. I had agitated, random, distracting thoughts and a ringing in my ears. It was really hard to meditate, hard to settle the waters. At first I couldn’t count my breath for even ten seconds. It was almost like being a beginner again.” After her brain adapted to the antidepressant, the buzziness subsided, and her mind settled down.
One comment I heard again and again is that depression makes it difficult if not impossible to practice—which is not surprising given that “inability to concentrate” appears prominently on the Hamilton Depression Rating Scale used by psychiatrists in diagnosis. “I felt as if I were drowning,” Martin, Zen Path author, remembers. “It was next to impossible to meditate because of the restlessness—the terrible thoughts rolling through my mind. An antidepressant can bring your head above water so you can look for other ways to help yourself.”
When “Jan” started on Prozac eight months ago, she didn’t even try to meditate. “I just thought, 'If I sit and meditate, I’m not really meditating.' But then I tried it and I found I could meditate better. I look forward to going on a ten-day retreat now; I’m wondering if I will have a deeper experience because the anxiety that used to come up will be gone.”
“When depressed people try to meditate,” says Epstein, “a major part of their meditative energy is going into fighting depression. Instead of letting it take them forward, they are using their meditation as an attempt to self-medicate. The bulk of their energy may go into obsessive ruminations or attempts to process emotional pain that feels stuck. They are facing a gradient that is too steep.”
On the other hand, if depression reveals the charnel ground, couldn’t it be viewed as a gift? In his book, Martin writes movingly of the acute awareness of death, decay, and impermanence that was a major feature of his year-long depression. Although he ultimately found relief in an antidepressant, he notes that the bleak landscape of depression offers the Buddhist plenty of rich material. “I had a chance to see that joy is commitment to life and that it is different from mere satisfaction,” he tells me. “I had a better chance to see that because my pain was so intense. Some of the things we ordinarily do to bring happiness didn’t work anymore.”
And yet, if long-term meditators are known to experience dark nights of the soul or desert wastelands on the path, how is one to know if one’s suffering is from one of the warning signs of a debilitating illness or simply piercing the veils of illusion? Is the characteristic “hollowness” and “emptiness” of clinical depression altogether different from the experience of shunyata? By mistaking a glimpse of shunyata for a symptom of depression, might one risk medicating away the early stages of nirvana?
Engler, psychiatrist and Vipassana teacher, avers that the resemblance is only superficial. “In Vipassana meditation, the practice unfolds in a fairly recognizable way through seventeen classic stages of insight. There are two points—at stage three and stage eight - when the meditator experiences something like a depressive withdrawal from the world.
“It’s not like a clinical depression, though. It’s a natural reaction to seeing through the apparent satisfactoriness of things, a natural turning away from everything that isn’t ultimately satisfying. But it’s done with great clarity of mind and equanimity; it’s not like the hopelessness of depression, when you can’t stand outside it. Depressed people feel lifeless and unmotivated; often they cannot practice.”
Says Sylvia Boorstein, psychotherapist and Insight Meditation teacher with the Spirit Rock community in Marin County, California: “In order to see the emptiness and impermanence of all phenomena, you have to have enough energy in the mind to see clearly. When the mind is torpid you can’t see anything.”
Maybe, however, there is such a thing as too little dukkha, the unsatisfactoriness of life that is the premise of the Buddha’s First Noble Truth. “It was like the weather in California,” my friend “Annie”(another practitioner who requested anonymity) tells me of her three and a half years on Paxil. “Everything was always fine. I didn’t want to hear about anyone else’s problems; I thought everyone should just be happy—like me. Now that I’m off it I have my feelings back. Of course, I have to admit it got me out of my depression.”
This “flattened affect,” narrowed emotional range, or lack of depth, is a frequent complaint about the SSRIs; some people say they can’t cry at the world’s saddest movie, or they simply don’t feel like themselves anymore. Opponents of SSRIs accuse the drugs of making people into shallow, insensitive, back-slapping boors, impervious to subtle shades of emotion and intolerant of others. These qualities might be unsettling to anyone, but especially to those who have taken the Bodhisattva Vow, who cultivate the fundamental awareness of dukkha. Without embracing the First Noble Truth, Buddhism risks being one of those New Age light-and-love theologies, wherein everything is getting better and better all the time.
But is the California Effect really a fact of life on Prozac? Virtually all the mental health professionals I interviewed said no: Prozac is not supposed to transform soulful people into perky Stepford wives. When that occurs, it is properly considered an “adverse effect,” usually remedied fairly easily by either lowering the dosage or switching to another SSRI. “One woman I worked with told me that on Prozac she felt like Happy Girl,” says nurse specialist Morgan of Boston. “When she backed down on the dose her full range of emotion was restored.”