Depression and Stimulus

Ok so this post has nothing to do with macroeconomics, though it borrows its concepts from there. As the more perceptive of you might have figured out by now (ha, i love that line!) I was diagnosed with clinical depression about a year back. Actually that was the second time I had been diagnosed with that diagnosis, the first being a full six months earlier, when I had suddenly stopped medication after I had lost trust in that psychiatrist.

For over a year now, I have been on anti-depressants. It started with 37.5 mg per day of Venlafaxine (brand name Veniz), which got slowly bumped up until at 187.5 mg per day I started going crazy and having crazy mood swings and had to be scaled back to 150 mg. I was at that level for over six months when I realized that I had plateaued – that there was no real improvement in my mental situation thanks to continuous intake of the drug and perhaps I should consider getting off.

I proposed this idea to the psychiatrist when I met her last month and amazingly she agreed without any hesitation and quickly drew up a plan on how I need to get off the drug (you need to decrease dosage slowly else you’ll have withdrawal symptoms which are pretty bad). I found it a little disconcerting that she so readily agreed to take me off the drug, given that she had herself not given any indication of wanting to take me off the drug. I was disconcerted that I had been taking the drug for much longer than necessary, perhaps.

The doctor, however, paired the paring of my anti-depressant with doubling the dosage of the stimulant that I have been taking for my ADHD for the last six months. As it happened, though, I went through a major bout of NED that evening, and didn’t muster the enthu to go to the one pharmacy that legally sells Methylphenidate (the ADHD drug,  supposed to have similar chemical composition as cocaine) in Bangalore. That I managed to function pretty well the following one week, including the three days spent at my client’s office, meant that I probably didn’t need teh ADHD drug also. So as I write this I’m off all mind-altering substances (apart from my several-times-a-day doses of caffeine and occasional ingestion of ethanol).

Recently I met a friend who told me that I had been too generous in my praise of psychiatric drugs in my blog, and that I hadn’t taken into consideration their various side effects and addictive symptoms. I’ve heard this from other people also – that I probably wasn’t doing the right thing by taking anti-depressants. So do I now regret taking them, given that I’ve chosen to go off them? Probably not.

This is where the analogy of economic depression and clinical depression comes in. In an economic depression, there is a halt in economic activity thanks to which there isn’t much circulation of money. When people start earning less, they start spending less, which further depresses their income and the whole economy goes into a tailspin. Going by Keynes’s theory, letting the economy slowly repair itself would take an extraordinarily long time (in the course of which we will all be dead, as the joke goes), so it is recommended that the government steps in and spends heavily in order to “stimulate” the economy and break the vicious circle it was getting itself into.

When you suffer from clinical depression, there is a shortage of flow of this chemical compound called Seretonin in your brain. Thanks to that, your mental energy is at a much lower level and you get tired and stressed out easily. Moreover, depression also leads to a significant drop in your confidence levels. You start believing that you are useless and not capable of anything. But then, your lowered mental energy levels mean that it is tough for you to be good at work, and do things that are likely to give your confidence a boost. And this in turn leads to further lowering of confidence and there is no way out for you to break out of this vicious circle.

A number of people believe that depression can be conquered with “willpower”, but this is applicable only if you’ve recognized it in its early stages. In most cases though, you realize it only when it’s deep into the vicious circle, and your “willpower”, much like “normal economics” during an economic depression, will take way too long to break you out of the vicious circle, and by then half your productive life will be gone.

Hence, to draw the Keynesian analogy, you need a stimulus. You need some sort of an artificial stimulus that breaks you out of your vicious cycle of low self-esteem and low performance. Sometimes, there can be a fortuitous life event which by matter of chance gives you a sudden sense of achievement and helps you break out of the cycle (for example, I was quite depressed (most likely clinically) through most of my life at IIT, but success in CAT proved to be a good stimulant in helping me break out of that cycle). But then, most of the time, life is structured such that there are few opportunities for such positive black swans, especially when you are older and especially when your mental energy levels are in general quite low.

Under these circumstances, I believe, there is no way out but chemical stimulants to help you get out of your depressive state. Clinical researchers and psychiatrists over the years have found the answer to be this molecule called “SSRI” which slows down the rate of seretonin uptake into the brain, with the result that there is greater flow of seretonin in your nervous system (continuing our economic analogy this is like the government cutting taxes as a form of stimulus). Greater seretonin in the system means greater mental energy, and sometimes the difference in energy levels is itself enough to push up your self-esteem levels, and the new energy levels means you have given yourself a chance to perform, and the cycle breaks.

Keynes said, as part of his theory, that it is important that a stimulus is short and targeted, and that in good times a government needs to be fiscally conservative so that, if not anything else, it has the necessary firepower to deliver a stimulus when necessary. Similarly, it is important that you don’t get yourself addicted on these anti-depressants and that you don’t become immune to them. Which is why psychiatrists typically wean you off your anti-depressants six months to a year after you started on it. By then, they expect, and in my case it did, that the stimulus would have been delivered.

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