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"It is a happy talent to know how to play."

Can Antidepressants Accidentally Make You Lonely?

8/17/2017

5 Comments

 
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Love is pretty much the greatest thing ever. People who don't understand evolution think sex is the most important thing ever -- but without love, our species wouldn't exist. It doesn't matter how many women you can knock up if no one loves or cares for anyone and all the babies die.

As such, we evolved to be acutely sensitive to loneliness (and other negative emotions, like jealousy). And we evolved to love love. 
That's why anthropologists, psychologists, sociologists, and neuroscientists have all tried so hard to understand and define it.

There are still a lot of grey areas, but most scientists agree that there are three main components of love: lust, love and deep attachment. 

Anyone who's been in love can probably agree that it's, like, the most incredible thing ever.

And why wouldn't it be? When you're in love, you have increased activity in the ventral tegmental area (VTA) of the brain. 


The VTA is essentially a tiny dopamine factory. It is a very powerful part of the brain's reward system. It regulates wanting, motivation, craving, pleasure -- even cocaine addiction. ​​
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And, in many ways, love is like an addiction. I wish I could remember where, but I remember reading that people who are in love think about their significant other up to 90% of the time. Is it perfectly accurate? I don't know.

But I do know what it's like to be in love, and don't think it can be that far off. 


Because this is how love starts -- with dopamine. With feelings of pleasure, craving and reward. With obsession. With motivation to do what it takes to make your partner happy -- both because you want them to love you, and because nothing makes you happier than seeing them happy.

For many people, there is also sexual component to falling in love. Lust motivates these people to try to find a partner. To them, sexual activity is an important part of the relationship. It is gratifying and helps promote bonding. (After all, as I wrote in The Orgasm Gap is Real, But Don't Blame It On The Patriarchy, from a neurochemical perspective, there is no such thing as "no strings attached" sex.)
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So what do antidepressants have to do with this? A lot, actually. ​

Every year, doctors write over 239 million prescriptions for antidepressants, including selective serotonin reuptake inhibitors (SSRIs). SSRIs are believed to increase the extracellular level of serotonin in the brain by preventing neurons from absorbing it. ​
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Doctors write these prescriptions without necessarily telling patients that the efficacy of SSRIs in patients with moderate depression is highly debatable.  And they write them without mentioning that SSRIs can prevent you from falling in love... and even cause you to fall out of love. 

Why? Medical research shows that increasing serotonin levels causes decreases in dopamine production.  Meaning SSRI patients don't get that obsession. They don't get that intense feeling of reward, longing and craving. 

Not to mention that somewhere between 17-41% of patients taking SSRIs experience sexual side effects, such as decreased libido and erectile dysfunction. So those people who are motivated by lust to find love... are no longer motivated. Sexual anxiety and fear of rejection may, in fact, disincentivize romantic partnerships for these people. For some, these side effects may not go away  -- even after discontinuation of SSRI treatment (Post-SSRI sexual dysfunction). 

Yet doctors and patients continue to see antidepressants as a quick and easy fix for sadness. Not depression, but sadness. I've heard of doctors prescribing SSRIs to grieving widows -- even though grief is not the same thing as depression, and even though antidepressants have been shown to have no effect on grief. ​

In fact, I was at the rock wall a few years ago with a friend who happens to be a doctor. Like, a family medicine type. I was telling him about a dangerous encounter I'd had with a psychostalker, and how I had bad dreams about it sometimes.

He suddenly got a strange look on his face and said, "If we were in my clinic, I'd have to cut you off now. I wouldn't have time to listen to the whole story -- I'd just write you a prescription."

"For what? An antidepressant? I don't have depression."

"I know," he answered. "But I wouldn't have time to talk to you more, so I'd just -- "

"What? Write me a prescription for something that could permanently affect my brain chemistry, without any good reason?"

He shrugged, and that was that. 

Long story short: just because a doctor prescribes it, doesn't mean it's good.

If you're going to start taking an antidepressant (or, in my opinion, an antibiotic you're not sure you need), make sure you fully understand the side effects. Make sure you fully understand why it's being prescribed and how you'll know if it is working. And, for the love of God, set up some therapy sessions. Studies show that drugs alone aren't nearly as powerful or lasting as talking to a good therapist (someone who uses CBT and calls you out on your bullshit -- not someone who still believes in "psychoanalysis", aka "self-masturbatory ruminating").

Or, if therapy's not for you, check out F*ck Feelings: One Shrink's Practical Advice for Managing All Life's Impossible Problems, by Michael Bennett, MD, and Sarah Bennett.
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Or even their more recent, Fuck Love: One Shrink's Practical Advice for Finding a Lasting Relationship.
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Because if you don't address the underlying behaviors, issues, and attitudes, the drugs won't change much. 

Also, important aside: before you get any stupid ideas, this is not the advice I'd give about things for which there is strong evidence and scientific consensus. Don't take "scientists don't understand how and why antidepressants work, or even what causes depression, so be careful about taking SSRIs" to mean something dumb, like "vaccines are all part of the conspiracy, and even though basically 100% of scientists agree that vaccines are important and safe, I'm going to be ruled by emotions and put my faith in one fraudulent paper that has long since been thoroughly debunked."

There's a huge difference between SSRIs, for which there is mixed and insufficient evidence, and vaccines, which ARE​ safe. Like, seriously, anti-vaxxers. What do you think is the difference between a vaccine and a "chicken pox party" -- other than one group of kids gets sick, and the other doesn't?
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I really, truly hope you can understand the difference. (Want to know more? Check out I'm Not Arrogant, I'm Just Right -- The Trouble With Debating the Masses. Or download Just Stop: A Brief Guide to Rational Thought for the Modern Conspiracy Theorist.)
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End side note.

Having had no direct experience with depression or antidepressants, I'm not here to tell people with depression what medical treatments they need. 
I know that some people literally need meds to get out of bed in the morning. 
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​But I also know that many people would do just as well -- or better -- with talk therapy. (As long as it's not the stupid kind.)

The only think I think people 
should do, regardless of mental health status, is to practice mindfulness and take responsibility for your own health and recovery. Empower yourself. Do your research. Know what you're getting yourself into. Ask questions -- like, physically put yourself between your doctor and the door until all your questions are answered if you need to. That's what I did before my shoulder surgery.

Also, exercise. Date (people who say "you have to love yourself before you can expect other people to love you" are full of shit -- that's not how human survival and evolution work). Eat healthy.

And don't mindlessly trust your doctor to make important life decisions for you.
5 Comments
Jadzia
8/20/2017 12:00:15 am

I've now read almost all of Fuck Feelings. What interests me is that it is very much at odds with your frequent claim that "There are no victims, only volunteers". The whole point of Fuck Feelings is accepting that you only have a certain amount of control over your life, that things will happen that are outside your control and that sometimes you have to put up with crap in order to preserve your safety/job/family harmony. I'm interested that you recommend it.

I will add that the claim that there are no victims, only volunteers is the sort of thing people say to create an illusion of security. As far as I can tell, a major part of victim blaming comes from people wanting to believe that what happened to someone else could not have happened to them. When you apply it, is usually in social situations where a person has the option to act differently. Please consider how it sounds to people who have been badly harmed, often in circumstances they could not control.

Reply
Eva Glasrud link
8/23/2017 05:59:53 pm

I didn't think Fuck Feelings was PERFECT. What I liked about it was the idea of acceptance. I know it's a cliche to say "accept the things you cannot change," but that's kind of the message of Fuck Feelings - but in really specific and relatable ways. On the one hand, I'm all about accountability and empowerment and a "don't be a volunteer" mentality. But there are some things you legit cannot change -- a shitty boss (unless you're willing to uproot your career/life and switch jobs), a selfish mom, an alcohol problem. You'll drive yourself crazy trying to "fix" something that can't be fixed.

To use a basketball example (you know I love those):

I'm a girl. I'm the ONLY girl about 99% of the time. Lots of guys are sexist, and there's little I can do to change that. I can:

- Worry about the sexism all the time and feel victimized and let that affect my level of play.
- Quit playing basketball and find a sport more women like so I don't have to worry about sexism.
- Confront people who behave in stupid ways -- even if that means learning how to say no better or working on assertiveness.
- Get REALLY good at parts of the game I can excel at, even on days everyone I'm playing with is a sexist jerk who won't pass to me.
- Get upset when people underestimate me.
- Get smug when people underestimate me and then I totally school them.

It'd be great if everyone would stop being sexist. To some degree, that problem resolved itself when I continued playing, month after month, and demonstrating to more and more people that I'm a competent player. I get a lot more respect now than I did when i started playing at this gym however many years ago.

But some people are still dicks.

And one incredibly positive outcome has been that no one pushes me around in any part of life anymore. I've become a more assertive person, and I'm prepared to handle conflict whenever it arises. (Whether at basketball or other parts of life.)

I've also gotten incredibly good at defense -- the people I guard hardly ever score or get rebounds. When I'm guarding someone who's puny and sucks (because sexism -- if your team wins, you don't get to pick who you guard in the next game, and lots of puny sucky people end up trying to match up with you), I use the opportunity to get lots of steals and blocks on help defense.

And I've also learned how to harness the power of smugness to cancel out negative feelings.

Or, to use an example from a recent Atlantic article (https://www.theatlantic.com/magazine/archive/2017/09/the-queen-bee-in-the-corner-office/534213/):

> One time, Shannon emailed a female partner—one of the passive-aggressive variety—saying, “Attached is a revised list of issues and documents we need from the client. Let me know of anything I may have left off.”

> “Here’s another example” of you not being confident, the partner responded, according to Shannon. “The ‘I may have left off’ language is not as much being solicitous of my ideas as it is suggesting a lack of confidence in the completeness of your list.”

> Shannon admits that she can be a little sensitive, but she wasn’t the only one who noticed. “Almost every girl cried at some point,” she says. Some of the male partners could be curt, she said, but others were nice. Almost all of the female partners, on the other hand, were very tough.

Later, the article reports:

> Compared with the women in firms where they were better represented, women in the male-dominated settings thought less of one another and offered weak support, if any.

Here, Shannon chooses to play the victim. It doesn't sound to me like her boss was being passive aggressive -- it actually sounds like she was trying to provide actionable feedback about how Shannon could grow in the firm.

A better way of seeing this would be saying, "Fuck feelings -- I'm not a volunteer! That feedback stung a little, but that's just how my boss is, and she's trying to help me fit in in a male-dominated culture. She's not trying to tear me down because I'm a woman, any more than any of the 'curt' male partners are."

"There are no victims, only volunteers" is about how you respond to things -- even/especially things you can't change.

I definitely agree with the second half of your comment -- there ARE victims. There are people who would cause you harm and victimize you. I don't apply this advice universally to any situation. You hit the nail on the head that I apply this advice in certain social situations where you're in control of your reaction.

Can you think of a better way of saying "there are no victims, only volunteers," that makes the distinction clear? I shall think on it -- but would love your suggestions if you have one!

Thanks for yet another insightful comment!

Reply
Jadzia
8/24/2017 01:12:03 am

I'll think about it. I suppose that it's a bit like law, where certain maxims apply in certain situations. Or sayings generally, where you have to choose whether "better safe than sorry" or "he who dares wins" is best applied in the context.

If I have a criticism of FF it's that I have made progress in recovery to a level beyond what the authors seem to think is possible.

candice
11/17/2017 05:49:06 pm

Socialization does help depression, I agree completely. I think depression should be treated from all angles, just like other illnesses. I think physical components should be acknowledged, social and lifestyle components as well. Depression is not like a physical illness in that, it can be a physical reaction to a life event or circumstance....You have to put the cast on the part of the person that is broken...but you have to figure out what that part is first.

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candace
11/17/2017 06:08:34 pm

It can come from so many things, which is why i agree its important to work with a therapist,...Love comes in many forms...so the love from a therapist or a caretaker can help you heal as well. Relationships if they were positive and nurturing can help, but its important also to acknowledge if a physical component exists. Its usually easier to accept the help of a doctor if you also have the help of a therapist, because a therapist can look in on you and make sure you are okay. Life is kind of like a circle, its not just one or two things that you change,...but it sure helps alot to change one. Improving your physical capacity for love can help you find more satisfying love, having more energy in the morning can help you get to your appointment with your therapist on time. getting to your appointment with your therapist can lead to positive conversations about your future and love.

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    Eva is a content specialist with a passion for play, travel... and a little bit of girl power.  Read more >


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