Another interesting one from The New York Times, Who Are We? Coming of Age on Antidepressants, by Dr. Richard A. Friedman; I found this one really well done, asking more questions than it answers, but thought-provoking.
The introduction to the article lays out the central existential question posed by long-term treatment with anti-depressants, especially for patients who started on their regimens when very young:
“I’ve grown up on medication,” my patient Julie told me recently. “I don’t have a sense of who I really am without it.”
At 31, she had been on one antidepressant or another nearly continuously since she was 14. There was little question that she had very serious depression and had survived several suicide attempts. In fact, she credited the medication with saving her life.
But now she was raising an equally fundamental question: how the drugs might have affected her psychological development and core identity.
As Friedman points out, the medical testing for these pharmaceuticals doesn’t include long-term research anywhere close to the lengths of time that people are actually spending on the drugs: the longest maintenance study — done on Effexor — lasted two years.
But the more subtle issues that Friedman raises, as far as I’m concerned, are the questions of identity that are clouded by long-term anti-depressant use. He discusses one woman who was concerned about her ‘low sex drive’ and pressure from her boyfriend to have sex after eight years on libido-reducing Zoloft: ‘She had understandably mistaken the side effect of the drug for her “normal” sexual desire and was shocked when I explained it: “And I thought it was just me!”’ I can’t tell from the way Friedman writes this how he feels about the idea that an individual has a ‘normal’ sex drive, something that might exist ‘prior to’ or ‘independent of’ any outside influences, whether that influence be an anti-depressant or a particular life event or the effects of interpersonal dynamics with a partner.
The idea that the ‘anti-depressed’ state might become ‘normal,’ both in the medical sense that intervention seeks to create this state and in the sense that a patient spends so much time in the drug-influenced state that it becomes a kind of reference, suggests yet another way that cultural expectations might become biological ‘nature.’