My students are on drugs.

A few years ago, most of the students in my class were on drugs, mostly a cocktail of prescribed anti-depressants. Seriously. I know this because they told me themselves. Most were taking drugs prescribed for them by local doctors or therapists. More recently, several students told me that they too, were on meds. Setting aside those rare individuals (they do exist) who will require a lifetime of medication, most people do not. Teenagers are distressed but most should not be on any form of medication. There are few mood-altering medications that have been tested and found both safe and effective for someone under 18. Almost none are. Local doctors, many with no more than minimal training in treating psychological issues, prescribe anti-depressants for my students that have not been proven to be either safe or effective for teenagers. Aside from physical health, there is the danger of suicide.

With even less expertise—and I am merely well-read, so it’s fair to say it, “What do I know?”—I would argue that most of the teenagers I know who are depressed have good reasons for their feelings. That is, they are not mentally ill, but responding rationally to horrific circumstances. They are taking drugs to mute feelings no one should be surprised that they feel. They are told that their frustration, sadness, grief, confusion, and desperate longing are signs of mental illness. I wonder sometimes if these professionals remember their teenage years at all?

Instead of developing a strategy to cope with life, they may be addicted . . . or suicidal. Suicide rates in the U.S. have been climbing ever since the introduction of antidepressants. These students may find themselves on drugs for years, even for the rest of their lives. That isn’t necessarily their fate.

Some day, they might choose to stop. And that is likely to be tough. Doctors have tended to dismiss the withdrawal symptoms of people who have spent years on mood-altering medication. More recent studies suggest that the challenge of abandoning mood-altering medication is formidable. Neither is it an impossible task. With patience, it can be done.

Most recently professionals have been working on strategies. One might be as simple as slowing everything down.

In one 2010 study cited in the new paper, Japanese researchers found that 78 percent of people trying to taper off Paxil suffered severe withdrawal symptoms. The research team had them taper much more slowly, over an average of nine months and for as long as four years. With this regimen, only 6 percent of subjects experienced withdrawal.

In another study, Dutch researchers in 2018 found that 70 percent of people who’d had trouble giving up Paxil or Effexor quit their prescriptions safely by following an extended tapering regimen, reducing their dosage by smaller and smaller increments, down to one-fortieth of the original amount. This is the regimen recommended in the new paper.—The New York Times

Just as we having been asking patients to withdraw from medication too fast, we are doing other things wrong. Our lives are all about hurryhurryhurry. It is good advice to slow down. That seems merely impossible advice in modern society. Our environment is toxic in other ways.

Beyond social media, we breathe and drink poison in our water and eat it in our food. We do not sleep enough. We spend the majority of our time communing with machinery rather than people. We do not enjoy our daily chores, we hardly know how to feed and dress ourselves. We obsess over any number of trivial fears and inconveniences that simply do not matter at all.

The New York Times wonders will we have a Mac or Amazon household? Why put down the laundry first when we can tell a machine to turn on a light? Why walk clear across the room to the lamp? We might wonder if it really is too much to reach out our hand and turn the lights on and off with a switch? Flush the toilet. Lock a door.

We are a marvelously adaptable species. We can develop any number of skills. We did not evolve as a species to require a third of us to take lifelong prescription medication. We did not evolve to be “night owls.” We did not evolve to interact more often with machinery than other human beings. Nearly our entire species evolved to eat cooked food, mostly vegetables, to sleep in the dark, to live in community and in close physical contact—actually touching—other people.

Sometimes terrible things happen and we mourn, we regret, we grieve. I have a friend with a serious mood disorder who is permanently on antidepressants. His medication mostly works for him, but he says he misses the highs that he lost with the lows. His is a lifelong addiction.

Modern medicine is just one of the factors that has extended average lifespan. Our water is cleaner. Our food is inspected. Our medications diverse. Vaccinations have saved the lives of millions of children. Medicine is not always an easy fix.

We have an “opioid crisis” just now. The president wants to blame this on people who bring drugs across our southern border. But it is not the drug cartels who created the addiction. People choose to abuse. I know I am supposed to view drug abuse as a disease, as out of control, but this view seems to exist only in relation to certain drug abuse and not other, to certain people and not others, and that is something of a lie. Years ago a local doctor warned that people in her profession were overprescribing powerful narcotics and that patients were demanding them. “A little pain is not a bad thing,” she insisted. She was at least a decade ahead of her time.

A little pain is what all of us experience. Sometimes a great deal of pain dumps all at once and bends us double. That is also part of every person’s real life. The death of parents and loved ones, the frustration of a goal, fear, loss, grief. It is what we all must expect and overcome.

Today we work hard, overburden ourselves with worry and anxiety, and stare at screens. We fail to do what our mothers always told us: Take care of ourselves. If we are burdened by feelings of sadness we might be wise to investigate how we live our lives day-to-day before we assume our despair is who we are. Our easy fix makes us weak and dependent.

Sometimes we are ill and need intervention, but sometimes we are overwhelmingly sad or tired because our lives are depressing and exhausting. We accept pain as our due but want a simple solution. And our medication is making us sick.

Maybe it is time to look for healthier solutions.

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update April 2019.

From The New Yorker article “Bitter Pill.”:

“Laura had always assumed that depression was caused by a precisely defined chemical imbalance, which her medications were designed to recalibrate. She began reading about the history of psychiatry and realized that this theory, promoted heavily by pharmaceutical companies, is not clearly supported by evidence. Genetics plays a role in mental disorder, as do environmental influences, but the drugs do not have the specificity to target the causes of an illness. Wayne Goodman, a former chair of the F.D.A.’s Psychopharmacologic Drugs Advisory Committee, has called the idea that pills fix chemical imbalances a ‘useful metaphor’ that he would never use with his patients. Ronald Pies, a former editor of Psychiatric Times, has said, ‘My impression is that most psychiatrists who use this expression’—that the pills fix chemical imbalances—’feel uncomfortable and a little embarrassed when they do so. It’s kind of a bumper-sticker phrase that saves time.’ ”

One challenge is that many patients, like Laura in this article, and many therapists as well believe implicitly in that “chemical imbalance” line. It is more accurately a deception.