Julie Holland: The main kind of antidepressant that is the most popularly prescribed are the SSRIs and these are medicines that increase serotonin transmission. And when you start to push on the doses of these SSRIs, you start to lose some sort of quintessential feminine things. First of all it becomes much hard to climax and it becomes much, much harder to cry. But you also see decreases in empathy, in sensitivity, in passion.
The simple way of thinking about an SSRI is that you have two brain cells and one is a pitcher and one is a catcher. So pitch, catch. Pitch, catch. So this nerve cell is throwing serotonin across and this one is catching it. What the medicines do is they block the recycling back into the pitcher. So, you know, I’m throwing; I’m throwing. Some of this gets caught; some of it gets dropped. It just doesn’t get over there, but I’ll suck it back in and try again. So if you block the recycling, more is in the middle to get across. So there’s more, you know, the space between the nerve cells is called the synapse. If you block the recycling of the serotonin into the releasing cell, more is available for the catching cell. So it ends up enhancing the transmission. How enhanced serotonergic transmission translates into feeling better and feeling less anxious is much more complicated. But, you know, the simplistic way to think about it is that if you have higher levels of serotonin, if your transmission is better, you will be more relaxed and more happy. It’s a little easier to smile. It’s a little harder to cry.
So, you know, I’ve had patients come to me and say, you know, I’ve tried antidepressants before, but they always made me feel like a zombie or they didn’t make me feel like myself. Or I had a patient who said like I cut my finger and I looked down and I saw that it was bleeding and I saw that it was my blood, but I didn’t really feel like connected to my finger or the blood. You know, things like that that are really, really worrisome. Or I’ve had patients say, you know, I was in this situation where I knew I should be crying and I couldn’t cry. And, you know, I felt terrible that I couldn’t express that emotion to bond with my friend or something like that.
So these antidepressants do scale back a lot of expression of emotion and feeling emotion even sort of thinking emotional thoughts. If you’re terribly depressed and you need antidepressants to get out of bed and function and go to work, I get it. That’s one thing. But what I’m worried about is more and more women deciding to go on antidepressants because their friends are doing it and that’s what’s, you know, more and more women who are at work are taking these SSRIs so that they cannot cry, not get flustered, keep going forward. You know I think it jives with this sort of forward-momentum agenda that so many of us have and especially in the workplace. But, you know, I would say at what cost? You know it is true that SSRIs can help you get ahead and there have been really interesting animal studies where, you know, the primates who are on SSRIs ascended up the dominance hierarchy. And the ones who became dominated over got stressed out and had lower serotonin levels. So there does seem to be some component of serotonin affecting dominance hierarchies and, you know, the ability to move ahead or to lean in.
So I totally get that there are advantages to being on an SSRI in the workplace. But, you’re going to miss out on knowing what’s right because you feel it or being hurt by what somebody said and showing them that you’re hurt. And so that person can learn that their behavior has emotional consequences for other people. So and it changes the whole sort of tone of the workplace. There’s going to be less accountability and less sort of calling people on their misbehavior if you’re not even feeling that anyone misbehaved.
When you think about risks, you know, if you’re really being thorough, you want to look down both tunnels. You know if this really works out well, how is that — if this works out badly, how is that and how would that be for me. And so when you’re evaluating risk you need to be in touch with things like fear or vulnerability or anxiety. So if you’re medicating yourself to be invulnerable and to let things sort of flow by you and, you know, oh it’s all good, no problem, whatever. You really may make decisions that are riskier and feel better about them. There are other antidepressants like there’s an antidepressant called Wellbutrin, which — well the makers of Wellbutrin won’t really say what it’s mechanism of action is. It does seem that it more increases your dopamine. It’s not so much of a serotonergic antidepressant. It increases dopamine and dopamine helps you to be motivated and to have a vector and keep going and to be pretty headstrong.
So again in that situation, you may make decisions that are potentially disastrous, you know, in the same way that somebody who is sort of hypomanic. If you think about somebody who’s manic depressive and they have ups and downs; when they’re in this hypomanic up they get some bad ideas that seem like pretty reasonable ideas to them. Somebody who’s in a hypomanic episode may be more promiscuous and make bad choices sexually, spend money that they don’t have, you know. There’s this overinflated sense of self and invulnerability. And you can see the same thing with somebody who is sort of overmedicated on serotonergic medicines is damn the torpedoes, full steam ahead. And sometimes those torpedoes are going to get you.
So there’s quite a few things you can do that aren’t prescription medicine. You know the first thing is to really look at how you’re living your life. How much sleep are you getting? What is your diet like? Are you moving your body? Are you getting sunshine? Just sort of, you know, the basic things that we as social primates should be doing which also includes being social, being interactive and not being isolated and withdrawn. My patients who have sort of gotten off their meds and left me for the most part are people who have adopted regular cardio practice where they’re exercising regularly. I think that’s really important. The other thing is that you can take herbal medicines. You can take things like St. John’s Wort or 5HTP, which is an amino acid. Or you can take SAMe. There is also a lot of evidence that the ancient medicinal plant cannabis can be used to treat insomnia, anxiety, depression. So you do have other options.