Saturday, March 03, 2007

"Good Enough Marriage"? Then My Case is Hopeless

“The Noonday Demon”

The more episodes you have, the more likely you are to have more episodes, over a life time, get worse and closer together. This acceleration is a clue to how the disease works. The initial onset of depression is usually connected either to kindling events or to tragedy; people with a genetic predisposition to develop depression are, as Kay Jamison… has observed, “like dry and brittle pyres, unshielded against the inevitable sparks thrown off by living.” (p. 56)

According to studies done in Pittsburgh, the first episode of major depression is usually closely tied to events; the second, somewhat less; by the fourth and fifth episodes life events seem to play no part at all… It is clear that stress drives up rates of depression. The biggest stress is humiliation; the second is loss. The best defence, for people with biological vulnerability, is a “good enough” marriage, which absorbs external humiliations and minimizes them. (p. 63)


… the decision to behave with such a hunger to be rid of the self was typical of agitated depression. All I had to do was to get sick, and that would give me permission. The wish for a more visible illness was, I would later learn, a commonplace among depressives, who often engage in forms of self-mutilation to bring the physical state in line with the mental. I know that my suicide would be devastating for my family and sad for my friends, but I felt they would all understand that I had had no choice. (p. 71)


Robert post, of the [National Institute of Mental Health], concurs: “People worry about side effects from staying on medication for a life time, but the side effects of doing that appears to be insubstantial, very insubstantial compared to the lethality of undertreated depression…” The side effects of these drugs are for most people much healthier than the illness they address. (p. 80)

In an ideal world, one would not take any drugs and one’s body would regulate itself adequately; who wants to take drugs? But the ludicrous assertions made in such stringently foolish books as Prozac Backlash cannot be taken for more than pandering to the cheapest fears of an apprehensive audience. I deplore the cynics who keep suffering patients from the essentially benign cures that might give them back their lives. (p. 81)

I have done pretty well with for side effects. My current psychopharmacologist is expert in side-effect management. I have had some sexual side effects from my medications – a slightly decreased libido ad the universal problem of much-delayed orgasm. A few years ago, I added Willbutrin to my regimen; it seemed to get my libido running again, though thing have never come up to old standards. My psychopharmacologist has also given me Viagra, just in case I get that side effect, and has since added dexamphetamine, which is supposed to increase sexual drive. (p. 91)

For many years, talking about depression was considered the best cure for it. It is still a cure. “Take notes,” wrote Virginia Woolf in The Years, “and the pain goes away.” That is the underlying process of most psychotherapy. The role of the doctor is to listen closely and attentively while the client gets in touch with his true motivations, so that he can understand why he acts as he does… Depression is often occasioned by isolation. A good therapist can help a depressed person to connect with the people around him and to set up structures of support that mitigate the severity of depression. (p. 103)

セラピストと話すと確かに気分がす~っと楽になる。ただ、問題はセラピストは家族じゃなく、“good enough” marriage を与えてはくれないこと。

The sexual side effects are often brushed aside as insignificant compared to a severe depression, and by that standard they are insignificant. Nonetheless, they are unacceptable… When you’re first recovering from depressive episode, when you’ve got other things on your mind, sexual deficiency is not so bothersome, but then to get over unbearable pain at the cost of erotic pleasure -- well, it sure struck me as a bum deal. (p. 115)


In may case, Xanax made the horror disappear as a magician makes a rabbit vanish… For people who are not inclined towards abuse, [benzodiazepines] save lives… Though benzos can help anxiety, they do not, by themselves, alleviate depression. They can affect short-term memory. Over the long term, they can have depressant qualities and long-term sustained use should be closely monitored. (p. 119)

“Depression these days is curable,” people told me. “You take antidepressants like people take aspirin for a headache.” This is not true. Depression these days is treatable; you take antidepressants like you take radiation for cancer. They sometimes do miraculous things, but none of it is easy and results are inconsistent (p. 119)


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