celexa, prozac, zoloft. everyone i know seems to be on one of these. or should be. my best friend, or who used to be my best friend, is offically fucked up. self-declared, of course. she's taking the pills. they've won. they don't do shit. she still cries herself to sleep at night. she still cuts herself.

she cuts herself. she draws lines on her wrists with a razor. she's not trying to die, she only wants the physical pain to numb her sadness. she's sad. and we don't know why.

both of my parents have been on antidepressants at some point in the past five years. they say that your teenage years are the best ones of your life. that's just something old people say. if they're right, i'd might as well kill myself now. my parents have been happily divorced for some time, but that's not why they let the pills win.

it's times like this i wish i could cry. i've been the shoulder, the one who listened, the one who comforted for far too long. some doctors say that depression is caused by chemical imbalances. what's wrong with me is not in my brain. it's been caused by my fucking environment..

on my 18th birthday, in my first year of university, my mother suggested maybe i get on some sort of pills. the pills will always win. within that week, there was an ad in the school newspaper. it was like a sign. they were doing a study on some new drugs. i could get them for free. if i was depressed enough.
i took the test. my denial kicked in. i told her that yeah, i had the symptoms, but i did not tell her how severe they actually were. i didn't qualify for the study. i was only moderately depressed. she told me that i should really seek help. but that i wasn't depressed enough. i was only moderately depressed.

that's the closest i've ever come to seeking help. i'm too scared to do anything else. i've never been to a doctor. i'm fucking terrified of everything. the only thing i can do is ride the bus. it's familiar. whenever i see people i know, i hide behind corners, i pretend to be asleep. anything, if only to avoid talking to them. i wanted to get a tattoo. i couldn't even go into the building.

i'd kill myself, but i'm too scared to do that either. meanwhile, i listen to my best friend talk about cutting herself, and wanting to increase her dosage. she's let the drugs win. they always do. i listen to my mother talk about crying in rush hour traffic, about having a nervous breakdown. i listen to my brother talk about not seeing the point of still living. of hating everything. i listen, i absorb it all, and it's destroying me.

ignorance is bliss i shit you not.

You are being killed by a false dichotomy.

I will explain this idea. Don't quit. I agree with you at the end.

1) All depression is neurochemical, but none of it is merely neurochemical. If someone's life seems hopeless and unrewarding for long stretches of time, they will become depressed. If I starve someone and don't permit them to sleep for days on end, they will become depressed. If I give them a chemical that depletes their brain's serotonin, they will become depressed. Obviously their symptoms and outlooks and self-concepts will be different, but all of them will feel and behave in certain similar ways, and all of them will have low levels of serotonin and other neurotransmitters.

2) All recovery is neurochemical, but recovery that's merely neurochemical is empty. Imagine three depressed people. One takes Prozac™. One goes into cognitive behavioral therapy and learns to recognize depressive automatic thoughts and challenge them with statements that will allow her to feel more hopeful. One gets more sleep, regular exercise, and schedules more pleasurable activities. All of them will probably experience a period of hopelessness and futility, but if they persevere and do it appropriately, there's a good chance they'll all recover. When they do, all of them will have increased neurological activity and higher levels of serotonin!

I'm not saying that drugs are always the answer, or never the answer. They have lots of side effects; they don't lead to increased insight or coping skills; people who improve on them tend to backslide when they stop. But being able to lead a normal life can be a kind of psychotherapy, and there are some people who are so blackly hopeless that without a chemical boost, they'd never be able to focus on learning to help themselves!

The pills are not a self-sustaining, intelligent enemy. They're things, stupid little things that can't really do anything right. You can use them well, or use them poorly. The difference is night and day, like the difference between someone who drinks a cup of coffee when he's sleepy but need to drive, and someone who constantly pops Penguin Mints™, Vivarin™, and cigarettes to avoid passing out. They're one thing, that has one kind of effect, and wise helpers (including those who help themselves) will use them as a single instrument in the concert of techniques which they must employ to bring a depressed person back to their humanity.

What's my point? Simply that no... drugging yourself into a stupor isn't the answer. And any doctor who does that to you, or who gives any depressed and self-destructive person drugs without therapy, makes me furious. They're abusers, in some cases murderers. They're certainly incompetent and they're soiling the honor and the compassion of my discipline.

But even if all pill-pushers were well-trained saints, the onus would still be on the person who needs help. Find a trustworthy therapist, work with them, let yourself change. Don't be afraid of the drugs; they don't take away anything you can't take back. And don't be afraid to lose your depression; I guarantee there will be something left.

(Credibility note: I have a BA in clinical psychology and have been in therapy myself for depression and other problems. I have talked to many SSRI users, some of whom have improved and some of whom haven't.)

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