TGIF :: Your Thoughts on Antidepressants

#81 || A report out on what was shared and what I learned in response to the inquiry: Are antidepressants and a ClearLife path compatible?

Thank you for trusting me with your time. ClearLife is an exploration of life without “dimmers” such as escapist drinking, eating, snark, exercise, shopping, sex, work, drugs—even generosity. Prior posts are available here, including a summary of The Eight Awarenesses.

Sunrise. December 5, 2024. Mill Valley 🩷

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Two weeks ago I shared that I was starting my research journey on the topic of antidepressants and ClearLife, specifically: Are they compatible?

I’ve read a lot, listened a lot, and talked a bit as I’ve collected nuggets of guidance and wisdom from a diverse set of people including:

• Attendees of our monthly Saturday Sangha (form here),

• Two beloved and well known dharma teacher-friends,

• Two experienced psychotherapists,

• A global expert on the topic of addiction and trauma, and

• …many of you via emails, DMs, voice memos, texts, and and conversations. 🙏🏼 I particularly appreciate those of you who’ve shared your personal experiences and reflections on personal and tender topics including addiction, depression, anxiety, and various dimmers including work, drugs, booze, and disordered eating. Thank you. This is clearly a topic on many people’s hearts and minds!

Today I share some of the highlights of what I’ve learned so far. Note that some of the quoted text has been adjusted to better anonymize the sender.

First, some facts.

Antidepressant medications are most commonly used to help relieve depression, anxiety and other similar mood disorders. They are also prescribed to help with other conditions such as bulimia and chronic pain.

According to the Centers for Disease Control (CDC), at least one in ten Americans aged 12 years and over (~11%) take antidepressant medication.¹ Antidepressant use increases with age, and women are twice as likely as males to take them.

According to The OECD (Organisation for Economic Co-operation and Development) and CDC, other countries with high rates include Iceland (11-15%), Australia (9-12%), Portugal (8-10%), and the United Kingdom (7-10%).² Note that some sources cited even higher rates, but this is the most conservative report I found.

And, this is big business. The global antidepressants market size was valued at USD $15 billion—and growing.³

Given one in four Americans is trying to drink less and one in ten is taking an antidepressant, it isn’t surprising that this topic struck a chord with a number of us in the ClearLife community.

Compatibility with The First Awareness

I was reminded throughout these exchanges that this question is an exploration of how antidepressants intersect with The First Awareness: My life is better clear.

It turns out many of us share an experience of living without a (prior) dimmer of choice. Despite various obstacles and adjustments, life is improving. Yet, for one reason or another (particular life circumstances, a stress in the family, the loss of a loved one, side effects of other medications, financial stress) we speak with a doctor or a therapist about these emotional challenges to hear “Have you considered taking an antidepressant?” What does someone committed to a clear life do?

Are we “clear” if we are taking antidepressants?

What about the value of feeling discomfort as a guide for change?

Could antidepressants somehow interfere with our ability to access and act on what doesn’t feel good?

Are they just another dimmer?

What if life is simply more enjoyable on medication?

What if we can’t live well—or at all—without it?

These are all loaded questions, of course. And, there is no “right” answer.

In learning more about mental health, antidepressants, and how many of you have grappled with these matters, I have developed a deep well of respect for so many facets of this inquiry.

My short (and early in the research process) answer is yes. We can be “clear” while taking these medications, in fact, taking them might help us be clear. As one person put it:

“If someone is very depressed, the anti-depressants can help mute the severe symptoms and lift the bottom they’re stuck in . . . so they can begin to do the things that would help them be less depressed, like basic self-care—getting up in the morning to get dressed, do some aerobic exercise, get some work done, stop isolating and talk with people etc. For [depressed people], the price they pay for lifting themselves out of the cellar can be dimming or muting the joy and happiness that might be available to them.”

Similarly, another person wrote in:

“I used antidepressants after struggling with postpartum depression during the pandemic and they were vital for me. While unable to access many mental health supports during the pandemic, the medicine helped me feel as if I was driving the car and not the depression monster. I actually felt MORE clear, more like "myself," instead of the angry, crazy, sad depressed version of myself spurred on by my depression.”

But what about those who aren’t feeling that bad, just a bit off, a bit down, a bit agitated. Is that just life, signal to perceive and work through, or something we should medicate?

A favorite.

A Confession: The 6th Awareness & Me

Of note: Not a single person wrote or said antidepressants are “bad” or in any way conflict with a desire to live a “clear life.” Quite the contrary. One person shared:

“I don’t think anyone would hesitate to eliminate a heart medication if it helps the function of the heart so why wouldn’t you do the same for the brain.”

It’s a good point.

This positive view characterizes the tone of almost all of the comments and responses.

I was a bit startled by this. Really, no one out there thinks that antidepressants are a no-no for people trying to live clear?

Then I realized I was judging these very personal decisions. Ouch. I’ll own it: I’ve been a bit judgmental on this topic until it became more personal for my family, at least two dear friends, and me—my own breach of The Sixth Awareness (“Do you” —not judging others).

I hate to admit that this isn’t all that surprising—the judgment part. After a bit of compassionate inquiry with myself, I eased up a bit. I grew up in a family that wasn’t terribly tolerant of or compassionate towards those with mental or physical illness. In fact, people who were struggling or needed support seemed to be subtly “othered.” It may have even been a way we survived when my mother lost her life in the grip of depression and addiction herself. I was, we are, different, so we will be okay.

I’ve been striving to grow out of this, change these patterns—for years.

Truth be told, much of my own healing journey, especially after breast cancer last year, has been around giving myself permission to rest. I think a similar perspective can be applied to giving oneself permission to heal. And sometimes we might actually need help—and that could be in the form of medication or one of countless other forms of support. This does not mean that we are weak, or we’ve failed, or are somehow lesser than. I’ll go deeper on this another day, but it felt foundational to this topic, at least my developing perspectives on it.

Antidepressants are like a bridge.

One of my favorite metaphors for this topic, one I read and heard again and again during my research, is that of a bridge: We can look at a period of time taking an antidepressant as bridge connecting one “place” to another. People have found these medications very helpful when we feel stuck. One reader wrote:

So 2020 was the year I chose to go sober. Alcohol had been my antidepressant prior - in retrospect it was its principal role of why I consumed it.

While I was a bit depressed after I stopped, it was manageable - until the continued slog and stress of managing a team during the pandemic eventually led to me acknowledging that I was depressed and burned out in 2021 and I asked my PCP for an antidepressant.

Before prescribing he had me meet with a psychologist who reported up to a psychiatrist who confirmed medical need.

So in Nov 2021 I started low dose Prozac. It was a bit of a game changer AT THAT MOMENT because it dulled the highs and lows - and gave me a predictable mood. Under that mood I worked on self care, self repair, reflection, strengthening my understanding of my own prior traumas so that I could recover in healthier ways. Over the next 2 years I did just that and then found myself wanting to ‘feel’ again.

At the beginning of this year I met my PCP and said I wanted to stop the Prozac - and did.

About a month later when chatting with my therapist, I said “it feels good to feel really sad when I’m sad”. And similarly I’ve found myself brought to tears with beauty as much as pain. And even though depression knocks every now and again, I don’t see going back. I like the undimmed experience yet I have a deep respect for the mindset that the antidepressants gave me to do the work.

Interesting that this reader describes the Prozac as dimming, but also essential to his own healing. I have so much appreciation for this and conscious use of most things, really. A juicy topic for another day.

An attendee shared a similar experience during our Saturday Sangha last week: “Taking an antidepressant helped during a period after choosing to stop drinking to move from one stage or place to another.” The key, I gather from another participant, is knowing when and how to “get off the bridge” too. This choice and step can be as important as the decision to start.

As a tool in the toolbox

Another reader shared their appreciation for their medication as a tool among others that support mental health generally:

“I have been sober for five years and currently take a low dose (10mg) antidepressant.

This is one of several things in my tool box for mental health including diet, exercise, meditation, gratitude journaling, somatic experiencing and integrative medicine best practices. They all work together. I’ve gone off antidepressants for periods of time but have found more consistent and positive results with all the tools combined.”

Another reader noted that they were happy to use antidepressants as a tool from time to time over the decades, but have learned that it’s been important to remember to keep using the other tools. “You don’t want to start taking a pill and then stop meditating, right?” she asked.

@Greens. If you know, you know.

There is no single answer for anyone.

Your shares have been rich with insights, personal stories, and helpful information—and my research continues—I feel as though I’ve barely scratched the surface of this topic. What am I missing? Are there points that should have been made and weren’t? Is there a perspective you are compelled to share? I’d love to hear from you.

One thing is certain, there is no single answer, way, or path. Like navigating anything, there are multiple ways to similar destinations. Our opportunity is to not judge, to trust ourselves, and stay curious.

Love.

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🙏🏼 Gratitude… Thank you for trusting me with your time. I also deeply appreciate your subscriptions, post “likes” and comments, and other things you do to help my work be more discoverable for people who might enjoy or benefit from it.

🌊 No TGIF next week… as I’ll be leading a 5-day workshop on The Eight Awarenesses in Baja. ☀️ (Info here, for the curious.)

💙 Anyone out there enjoying Bluesky? I was able to hear the CEO Jay Graber speak at the WIRED conference in SF this week and she’s pretty amazing. They have 26 million users and a team of just 20! The next Twitter? Are you on Bluesky yet?

1. https://blogs.cdc.gov/nchs/2020/09/04/7001/ & https://www.cdc.gov/nchs/products/databriefs/db76.htm

2. https://en.wikipedia.org/wiki/List_of_countries_by_antidepressant_consumption. Ranges reflect the spread noted across report years and other reliable sources interpreting the data.

3. Source: https://www.fortunebusinessinsights.com/antidepressants-market-105017