It's May!

[pockysquirrel]

 And May is Mental Health Month, so it's time for my annual offer to make use of my education and chosen career for the general benefit of fandom. Ask me about mental health stuff, friends list! I will answer anything put to me, to the best of my ability. That means both fandom-related stuff ("Do you think [insert character here] could have [insert psychiatric condition here]", "How can I portray mental health issues more accurately in my fanfic?" etc.) and IRL stuff ("What's your opinion of this antidepressant medication?" "Is this an issue I should be seeking help for?" "I'm worried about my friend/family member, what can I do?") and anything in between.

If you feel more comfortable asking something privately, send me a PM or comment anonymously. But unless you flat-out ask me not to, I will be posting answers publicly. Because chances are, if you're asking, you're not the only one it's relevant to.

So let's raise some awareness, kick stigma to the curb, and perhaps even have a little fun, eh? 

Comments

[eirenical]

OK. Finally at a computer. Yay!

So, this is a fandom question. A friend and I were discussing the idea of the body swap trope the other day and it raised a few questions about mental illness. The main one was this: if you swapped bodies with someone who had a mental illness, would it go with them or stay with the body? Obviously as an answerable question, that's useless since not every mental illness works the same. So my specific question is this: what about depression? From what I understand there is an imbalance of chemicals in the brain that at least contributes to depression, right? How much of depression is psychological and how much is biological? Is it both?

And my follow up questions about about depression in general, and in particular: how do antidepressants work? Because I know friends who have been on antidepressants and still have "low" periods when they can't get out of bed and seem to exhibit all the symptoms that I would think that antidepressants should prevent...? But since I don't really know how they work, I don't really know why they don't. O_o;;;

(Also, bonus crack fandom question: if someone were to try to self-medicate for depression, what kind of things would they be drawn to?)

(*coughs* This, uh... may or may not be gearing up to actually attempting this fic, but I guess we'll see. ^_~ Thanks for doing this!)

[pockysquirrel]

Ohhh my gosh. This is so much FUN! And I intend to have fun with it! Now, let's see.

One thing about pretty much all mental health conditions that people tend to overlook is that you just can't divorce what's going on in the mind from what's going on in the body. Many mental health conditions have physical symptoms. Eating disorders are the most obvious. But anxiety disorders? Panic attacks are very physical experiences that can cause elevated heart rate, muscle tension and increased sweating, to name a few. And depression? Aches and pains, fatigue, sleep disturbance, and changes in weight.

I personally don't care for the term "chemical imbalance" because I think it does very little to educate people on how depression actually works and tends to provide fuel for divas with personality disorders to try and convince their providers (and themselves) that their depression is 'special' and harder to treat. But that's just my personal beef. And we still know so little about how the brain actually functions that a lot of what goes into mental health treatment and the development of psychiatric medications is frankly guesswork. There's the physical brain, the more nebulous concept of a mind or a consciousness, and the two are inseperable. Granted, some cases of depression are situational, caused by stress or grief, and some are more chronic and seem to have more of a root in brain chemistry or genetics. But when you ask how much of depression is biological and how much is psychological, the answer is that it really is both.

Which brings us then to antidepressants and how they work. Now, I'm only going to cover SSRIs here because I'm most familiar with them and because they're the most common form of antidepressant on the market. There are a handful of other meds that work in different ways, but all the medications you think of when you think of antidepressants - Prozac, Paxil, Zoloft, etc. - are SSRIs. SSRI stands for Selective Serotonin Reuptake Inhibitor. Say what? Let's unpack that. Serotonin is a neurotransmitter that impacts mood. In a non-depressed brain, serotonin is released, floats around for awhile, and then gets sucked up into specialized receptors. In a depressed brain, the receptors suck up the serotonin prematurely, leaving a lower-than-average amount of free-floating serotonin. The medication in an SSRI blocks some of those receptors, so serotonin reuptake happens more slowly, leaving more serotonin floating around, which in turn, can reduce depression.

If you have a friend who is on an antidepressant and still has symptoms of depression, it could be due to any number of things. Sometimes, the medication itself doesn't work as well as it could. Everyone's brain is unique, and even though a lot of antidepressants belong to the same class of medications, they are each slightly different and some people respond better to one than another. A person for whom Prozac doesn't work well might have a great response to Zoloft, or vice-versa. Or if it is the right medication, a dosage adjustment may be needed. Or the person isn't using their medication correctly. SSRIs are long-acting meds that build up in the bloodstream over time - we're talking weeks, here. So they need to be taken consistently to work, and missing doses can cause the level of medication in the body to drop, and the medication to therefore not work as well.

But those are the simple explanations. 9 times out of 10, when I see someone with depression complaining that their medication isn't working, the problem isn't with the medication. A lot of people think taking an antidepressant will make you happy, and that isn't true. For one, a person on an antidepressant still experiences the normal gamut of emotion - including sadness, grief, and yes, even depression! Depression as a mood is different from depression the illness. Even the most neurotypically-brained people feel depressed from time to time, and it's normal. And there's usually a reason for it. Which brings me to my second point: the absence of depression is NOT happiness. The absence of depression is...the absence of depression. So being on an antidepressant won't make you happy, and it won't fix your life. Because depression is both a biological and psychological illness, there are usually both issues with serotonin that the medication can treat, and environmental issues, which the medication can't treat.

Say a guy is being treated for Major Depressive Disorder. He's on an antidepressant and taking it as he's supposed to. But he's also in a shitty relationship. He and his partner have a massive argument. Afterwards, he notices he's not sleeping well, he can't get out of bed in the morning, he's crying all the time, and his motivation is shot. "Well gee," he thinks. "My medication must not be working." Uhm, no, dude, you're depressed because your relationship sucks. For this reason, people get the best results by using BOTH counseling and an antidepressant AT THE SAME TIME.

And my third point is that some cases of depression - the ones that seem to be more biologically-based, not that we have any real scientific evidence of that - are chronic and can be managed but not cured. An analogy I use with patients a lot when they're discouraged about their progress in recovery is to liken it to another chronic illness. Diabetes, for instance. A person with diabetes can do everything right - mind their diet, take their meds, track their blood sugar. But bodies are weird sometimes, and one day that person's blood sugar may randomly go wonky on them, no matter how good they are at managing their illness. Similarly, someone with depression might just have a flare-up or a bad day, and be back to their baseline in short order.

So now that you've got some info on how depression works, let's come back to the body switching. (NGL, this is my favorite thing about this question and I was saving it for last.) Depending on what you want to accomplish with the fic, you could handle it in two different ways. For simplicity's sake, let's say A is the depressed character and B is the not-depressed character. You could have it so that the presence of A's consciousness in B's body causes B's serotonin to go off the rails, so that A is still depressed regardless of whose body he's in. Or you could have it so A's wonky serotonin levels stay in his own body, leading to a scenario in which B in A's body is going "OMG how do you live like this", while A in B's body is going "...I had forgotten what it was like to feel this good." Both have merit. The second situation could be a good way to make a B who doesn't understand A's depression and thinks he should just "suck it up and deal" realize what living with depression is really like.

And finally, self-medication. How someone with depression might try to self-medicate depends a lot on the person. And some self-help techniques are a lot healthier than others. Some people force themselves into doing positive things in an effort to make themselves feel better: diet, exercise, self-help books, volunteering, meditation, etc. Some people try to comfort themselves: food, staying in and watching TV instead of trying to go out and do things. And some people self-destruct: drugs, alcohol, self-injurious behavior.

[eirenical]

I've had this tab open for a week waiting to have time to make a proper response and I've just resigned myself to the fact that I don't really have time TO make a proper response. :-P But I wanted you to know that I read every word and... PERFECT. That was exactly the kind of information I was looking for! ^_^ Thank you so much for doing this! :D