A PET scan performed at the Mayo Clinic compares brain activity in someone during a depressive episode and when not depressed.

Taking an anti-depressant is like the start of a new relationship. You need a few dates before you get to know it, how it treats you, what it brings out in you. My mishap with Celexa™ that had triggered a six hour-long panic attack, could be described as a really bad date. The kind where the guy turns up in low risers that show his ass crack, jibbers on about his investment plans in the UAE for an hour, then leaves you to pick up the check. But the first drug actually prescribed to me by a physician I had got to third base and moved in with by the end of the week.

The first thing I noticed when I began taking Wellbutrin was that I was better able to concentrate. On anything; a bird’s wing, a letter, a conversation. And so, I was able to work for the first time in months. It felt good to edit radio again. To do something I was good at and do it well. And to complete it! A total marvel.

With a renewed ability to concentrate came some clearer thinking, and this included some reflections about the nature of chemical happiness. A friend had warned me about what she’d referred to as “the soma factor”—of feeling like you’ve joined a cult of  people whose smiles you know are chemically enhanced. Since I knew a couple of people who lived with serious depression and were on medication for it, I didn’t have a negative view of those who turn to pharmacology to treat their condition. In fact, quite the opposite. (One close friend had terrified us all by going off his medication, announcing the start of a ‘vision quest’ and then disappearing into the desert for a week with no water). But even though I didn’t disapprove of anti-depressants and had seen the difference in people when they work, I still felt somewhere deep within me that I had ‘failed’ by turning to a drug. And I know that having been a practicing Buddhist for so many years compounded that feeling.

But this made no sense whatsoever. I had been ‘medicating’ myself with alcohol for months. I’d suffered blackouts, memory loss, serious losses of judgement. It had taken a toll on my body, left me fuzzy-headed and even more depressed. But somehow that was more acceptable than taking a pill that had a proven track record of helping people feel better. Bizarre.

Even my dad had tried to talk me out of going on medication. “It’s a crutch,” he’d said conclusively. “You’re smarter than that.” As if it were possible to somehow outwit depression like Wile. E. Coyote, always coming up with some devilish new scheme, and always thinking this is the day he’ll catch Roadrunner!

Eight days after the first dose of Wellbutrin I wrote:

I don’t have that stabbing pain in my chest any more. It’s amazing. It’s just gone. What happened to it? I’m still sad, but it doesn’t feel like the sadness is all there is.

There was also the suggestion in my dad’s remark, that only the dimmer-witted take medication for depression. The rest, I don’t know, write depressing poetry and put their head in the oven like Sylvia Plath. (Come to think of it I do write depressing poetry, just not the kind that’s won a Pulitzer.)

The odd thing is that the opposite was true. Going on anti-depressants to help me to manage depression was one of the smarter things I’ve ever done. And one of the most hopeful. It gave me the breathing space I needed to come to terms with things I hadn’t. It helped me to ‘move on’.

Nariman Mehta, inventor of Buproprion marketed as Wellbutrin™

But then there’s that thing where you feel a bit like a walking ad for big pharma. I’m quite aware that I’ve mentioned the word ‘Wellbutrin’ over a dozen times in my recent posts. And true, I’m not keen to be one of their poster children. (Plus, I know one person who took it and had acute anxiety and another who had no reaction at all.)

What finally persuaded me to try an anti-depressant was some of the recent research in neuroplasticity, basically the brain’s ability to change. This research is challenging the notion that the brain stops changing after childhood, and suggests that ones experiences can actually effect the brain’s anatomy and physiology. A person with depression tends to repeat negative thought and behaviour patterns, and these neural pathways can become entrenched. Long-term depression can carve out some pretty mean streets that result in dead ends. As the brain becomes habitualized to this road map, it can lose its ability to find its way out of the bad neighbourhoods. In his book The Noonday Demon: An Atlas of Depression, Solomon writes that there is growing opinion that even if one’s depression was triggered by circumstance, it can lead to organic (and far more intractable) depression if left untreated. This all really spoke to me. I wrote the following during a depressive episode, which I believe was my mind noticing these negative neural pathways I was unwittingly creating.

As I turned the key in the door tonight, a thought hit me. I am becoming habituated to feelings of loss. Loss is coming to define not just particular events and periods in my life, but my attitude to life itself.

And then there is the whole debate about ‘natural’ vs. ‘chemical’. I know people who would rather spend hundreds of dollars on some obscure Tasmanian root, with little more than internet rumours to its name, than take a pill that’s been successfully helping people to manage their depression for over thirty years. They say things like, “But I don’t want to take a ‘drug’ because it’s not natural”. I’m sure I don’t know what natural is. The drug has to interact with your own body chemistry to work. Buproprion (the active ingredient in Wellbutrin) acts as a reuptake inhibitor for the neurotransmitters norephonephrine and dopamine, leading to an increase in adrenergic and dompaminergic neurotransmission. And I don’t think it gets more natural than that! But all joking aside, waking up every day feeling disappointed to still be alive–is that natural?

The hard truth is that all that time you spend walking around in a fog, your relationships deteriorating, your confidence and self-esteem withering, your bank account dwindling because you can’t focus on work–you don’t get that time back. It’s gone for good. Studies have shown that most people who suffer from depression never seek the help they need. The world is full of fake smiles. People grin through their anger, laugh through their tears. I’ve faked my share. Today my smile may be chemically enhanced, but at least it’s the real thing 🙂