Sitting with Depression

Depressed people think they know themselves, but maybe they only know depression.

By Mark Epstein

A woman named Sally called me not long ago seeking advice. I had seen her for a single session in consultation months before, and we had talked about a variety of therapeutic and spiritual issues. Like many people with an interest in spirituality, she was suspicious of the role of psychiatric medications in today's culture. It seemed like the mark of some kind of Brave New World to have mood-altering drugs so readily available. But like many others, Sally wondered if there might be a medicine that could help her. She had been plagued with chronic feelings of anxiety and depression for much of her adult life, and despite a healthy investment in psychotherapy, she still felt that there was something the matter with her. When I spoke with Sally the second time, she had been taking a small dose of an antidepressant for several weeks, 25 milligrams of Zoloft, and she was finding that she felt calmer, less irritable, and, dare she say, happier. She was going on a two-week meditation retreat later that month. Something about taking her medication while on retreat made Sally uncomfortable, and that was the reason for her call. "Perhaps I should go more deeply into my problems while I'm away," she said. She worried that the antidepressant would impede that process by making her problems less accessible to her. "What do you think?" she asked.

Let me be clear right from the start that there is no universal answer in a situation like this. Some people notice when they take drugs like Prozac, Paxil, or Zoloft, antidepressants of the SSRI (selective serotonin re-uptake inhibitor) variety, that they feel cut-off from themselves as a result. They don't feel their feelings quite so acutely and sometimes report feeling numb. Some, both men and women, find that the drugs interfere with their ability to reach orgasm. Many others find that the damping down of their feelings is more subtle. One of my patients notices she no longer cries in movies, for example, but she is willing to accept this because she also no longer worries to the point of exhaustion about things she can do nothing about.

I was relieved to hear that Sally was feeling better. People who respond well to these antidepressants often have none of the side effects mentioned above. Instead they feel restored, healed of the depressive symptoms that they were expending so much of their energy trying to fend off. Less preoccupied with their internal states, they are freer to participate in their own lives, yet they often wonder if they are cheating. "This isn't the real me," they protest. "I'm the tired, cranky, no-good one you remember from a couple of weeks ago." As a psychiatrist, I am often in the position to encourage people to question those identifications. Depressed people think they know themselves, but maybe they only know depression.

Sally's question was interesting not only because of the drug issue but because of her assumptions about the nature of spiritual work. The notion that we need to go more deeply into our problems in order to be healed is a prevalent one, and one that, as a therapist, I am sympathetic toward.

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