In days gone by, I’ve not been in the habit of posting full articles from online publications. Much better to post a salient extract and a link.
Then, The Times pulled down the shutters and erected a paywall, so that approach no longer works properly. This leaves a couple of alternatives – either don’t use material from The Times, or post the entire article.
On most reporting matters, this doesn’t present a problem – The Times just rehash the same AP/PA/Reuters piece that the Telegraph does, so the Telegraph gets my link.
Recently, there’s been a new round of debate on the validity of treating depression with pills. A report said that talking therapies work better. Sherlock Holmes would agree, but would point out that talking therapy costs upward of £200 a month, against the £10 cost of a month’s supply of generic Prozac.
For your £10 you get what you were expecting – 20mg of fluoxetine – regardless of the vendor.
For your £200 of talk therapy, you have no idea what you are getting. There are no KPIs for therapists. It’s fluffy and fuzzy. What this means is that the ‘profession’ is awash with charlatans and imbeciles, Labour voters to a man, who are likely to do more harm than good.
So, with a nod to a friend who has been prescribed anti-depressants, but won’t take the bloody things, here’s the best thing Robert Crampton has ever written for The Times.
Well it works for me. I started on fluoxetine, popularly known as Prozac, five years ago this October, when I was 41. I’ve been taking 20mg every morning ever since, green and white pill, down it goes with the first coffee of the day. There have been big benefits, and no side-effects as far as I’m aware. I see no reason to stop. Neither does my wife. Neither does my GP, Dr Cahill. “I know the years of disquiet you had, and I also know how much better you felt when you started the medication.” These are the opinions that matter to me, rather more than the opinion of Professor Irving Kirsch.
I feel better with antidepressants than I did without them. I can’t say whether this is a result of a placebo effect. I suppose it would be arrogant to discount it. But two factors make me think that whatever is helping me is more likely to be the result of an actual chemical change, rather than a psychological trick.
First, it took two weeks for any change in my state of mind to register. If the change was wrought simply by taking a pill, rather than by real pharmacological effects that pill was causing in my head, why the delay? It seems illogical that you would pop a placebo then not feel the effect for a fortnight.
Just to interrupt for a moment, this is easily explained by the fact that your doctor and every online source will tell you that you will not feel any effect for up to 2 weeks. Carry on.
Second, the biggest change in my behaviour, once I was on the pills, was too dramatic to have been caused by mere self-deception. That change was that I stopped losing my temper. I was someone who had always lost his temper a lot. When I started taking Prozac I became, and have remained, someone who loses his temper infrequently. I am more stable, less prey to paranoia and panic, less prey to pride, too, the sort of paralysing pride that can barricade you into a dead-end for decades.
This represents a huge improvement in my life and a huge blessing for the people around me. Losing my temper — smashing things, shouting — was a blight. It got me into all sorts of trouble as a child and young man. It never solved a damned thing. It was frightening. I’m ashamed of it.
I don’t believe this behaviour would have stopped without the medication. And I don’t believe it stopped because of a placebo effect. It wasn’t as if I started taking Prozac to cure my temper. I started taking it because I felt miserable, lethargic, morose, sometimes unable to function. Depressed in other words. Stopping the temper has been the best outcome but not one I was expecting.
Professor Kirsch says that in the long term “talking therapies” work better than antidepressants. Maybe he’s right, for some people, maybe most people, possibly all people, if they have the time, if they find the right therapist to talk to, if their long term lasts long enough. For me, however, talking therapies have not been a success. I was sent to see a child guidance counsellor when I was 7. And again when I was 10.
And again when I was 17, except by then it was called an educational psychologist. We talked. Maybe it did me some good. And maybe it did me some harm, in that the talking, the special treatment, served to legitimate in my juvenile mind behaviour (temper again) that was unacceptable and should stop.
Later, in my twenties, I tried the talking cure again, a full-on shrink this time. She stuck religiously to the Freudian playbook, no guidance, no opinion. In about week six, she said that by now I viewed her as an object of sexual desire. No I don’t, I said. Yes you do. No, really, honestly, no disrespect, I don’t. It was hopeless.
A few years ago, before I started on Prozac, my GP suggested some cognitive behavioural therapy, or CBT. I went for a couple of sessions. The guy was fine, but we didn’t truly hit it off and by then, mid-career, father of two young children, I was quite busy, too busy to spend hours bringing someone up to speed on the ins and outs of my life history.
Because the thing is, on the subject of what it is to be me, I’m an expert. I don’t need a novice’s take on the nuances of what it is to be Robert Crampton. I am not, to put it mildly, a stranger to introspection, to thinking, talking (and indeed writing) about myself. Other people, of course, people who haven’t had the privileges I’ve had, or people who’ve been better at snapping out of it and pulling their socks up and all those clichés, people who’ve coped, and who then for whatever reason can cope no longer, for them talking to a therapist might be revelatory. But talking is not something I do too little of. I come from a family of talkers. Sometimes I think we’ve talked too much.
What I’ve got, I think, is a chemical problem. There is a history of depression — going back generations, including suicide and institutionalisation — in my family. Certain families are prone to heart problems, or breast cancer. Mine, I think — not all of us, but some of us — has a predisposition towards depression, a tendency towards a personality that makes life more difficult than it ought to be. I think it is legitimate that we get a little chemical assistance, a jolt, a shove in the right direction. Not a panacea, just something to put us back in the game.
“There’s still a stigma attached to being depressed,” Dr Cahill says.“If you had high blood pressure and I said ‘you need to take these drugs for the rest of your life’ you wouldn’t blink, you’d say ‘yes doctor’. I view the antidepressants that work in the same manner.”