Perspective: Is it me or my medication?

Sarah had never experienced a panic attack until she went on Zoloft. After being hit with this scary experience, she called a friend and said, “This (drug) is making me have panic attacks.”

Her friend persuaded her otherwise, saying “Sarah, it‘s not the medication. It’s your anxiety that you want this to work so bad.”

A later visit with her physician convinced Sarah that another prescription would help calm her down. Even so, she wondered for years if she was the problem, or if it was the Zoloft — right up until the moment I spoke with her as part of a 2007 study exploring competing interpretations of depression and its treatment.

Sarah’s dilemma is one that a lot of people are pondering these days.

Prescriptions for antidepressants rose during the pandemic, so much so that drugs like Zoloft were in short supply. And even before COVID-19, it was estimated that 1 in 8 Americans was taking some form of antidepressant, as reported by The New York Times.

The numbers are even higher among certain demographics: nearly 1 in 4 women ages 60 and over had used antidepressants in the last 30 days during 2015 to 2018, The Wall Street Journal reported. For them and others on these types of medication, every troubling thought or symptom can lead to Sarah’s question: is it me, or the drug?

Lots of questions

One of the classic elements of almost any science experiment is to intentionally simplify conditions so that potential interference from confounding factors is reduced.

This way, the investigation into a specific question or connection remains as clean as possible. Wherever a third or fourth variable may be playing a role, the clarity of the study can quickly become complicated and compromised.

“What’s really going on?” becomes a real, nagging question — much as it has been for many of the people I’ve interviewed about their treatment for depression. When an extra variable gets added to an already complex life, it can be exceedingly hard to figure out what’s going on, and what’s influencing what.

To illustrate, one woman spoke of her frustration at not being able to experience the full range of emotion anymore after she went on medication for depression. “I want to feel deeper. ... those deep, you know, chest feelings that you get. I don’t want to just be superficially happy.”

But why was she feeling this way? Most people I speak with assume this is just a factor of the depression, while Jill and others wondered if their medication was playing a role.

Related

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• Why some Americans ration or skip their medication and what Congress could do to help

Not so easy to tell

It was Boston College sociologist David A. Karp who first explored this question seriously in his 2007 book, “Is It Me or My Meds?”

Karp shared insights from a variety of interviews he had conducted. For instance, he quotes Rachel, 29, saying, “I know I’m better on medication … but there’s been a persistent confusion about the real me since I started taking Prozac.”

People I’ve interviewed ask similar questions: How can I tell what the ‘real me’ is? Does this painful (or positive) feeling come from me, my life or the medication?

Karp admits the same in his own personal experience, wondering whether the drugs themselves were “responsible for the many awful days and nights I’ve experienced over the years” — noting that there were “so many days when I’ve felt ‘drugged.’”

Yet when he opted to try tapering, he said, “I could not distinguish the effects of stopping the drugs from a ferocious return of my mental illness.”

That question alone can have substantial effects on treatment decisions, since those who attribute newfound emotion to a return of depression will likely return to the medication while those who recognize withdrawal effects while tapering can learn to navigate and ride those out.

Skewed evaluations

While interpretations of medical usage are widely diverse, there are some standing patterns worth acknowledging. As psychiatrist Peter Breggin famously said, if something bad is happening, it tends to be attributed to the underlying disorder, and if something good is happening, it tends to be attributed to the medication.

I saw this in my own interviews. When asked whether she attributes emotional turbulence to the depression or the medication, one woman told me, “I usually just think it’s the depression.”

No question, some hold the opposite kind of bias — seeing all problems as arising from a particular drug rather than appreciating the impact of an underlying condition. But this seems a rarity compared with those who are positively biased toward pills.

Although it’s well known that all drugs have side effects, Dr. David Healy from the U.K. notes that “people often don’t link the effect they are experiencing to starting, stopping or changing the dose of a drug.”

Given the widespread confusion on this point, Healy is one of a growing group of researchers working to create resources for people wanting to assess how likely it is their problem is “caused by stopping or starting a prescription drug.”

That awareness is important, once again, to inform skillful treatment adjustments. In the absence of an awareness of the true impact of a particular medical treatment, people may end up staying on something for years that is causing some significant side effects.

To take a rare example, a certain percentage of people have experienced alcohol dependence following antidepressant treatment over the weeks and months that follow. But as study authors point out, “Few people realize this can happen and as a result doctors will usually try to keep the person on their antidepressant in the belief that it may stem from an underlying depression, when in fact stopping the antidepressant can clear up the problem within days.”

As another example, sexual side effects are common with antidepressants — Healy notes that nearly all people taking antidepressants experience such side effects, either during SSRI treatment or after it, yet there is remarkably little awareness of what role the medication itself could be playing. Despite at least 29 studies on the phenomenon since it was first reported in 2006, many people still struggle to recognize the impact of treatment in their own relationships.

So much of this confusion makes sense, given how consuming depression can be for anyone. Across interviews, I understood well why people would do anything to reduce pain and find relief. The intensity of the emotional burden can lead many to conclude the benefits of this kind of treatment outweigh any risks.

As symptoms and circumstances keep changing, this is a determination that people often revisit — aided by any clarity they can find about what comes from the medication itself. Consulting lists of antidepressant side effects and withdrawal effects is a good starting point, along with consulting people and professionals we trust.

None of this is easy. As those facing depression seek ways to deepen their own healing, they deserve our compassion, respect and support in any way they need.

Jacob Hess has a Ph.D. in clinical-community psychology from the University of Illinois, Urbana-Champaign, with a research focus on long-term outcomes of depression treatment. Over the past decade, he has worked to help create online tools and resources for those seeking deeper, more lasting healing from depression, anxiety and pornography addiction.