Dean voices skepticism about the FDA publicized suicide risks associated with anti-depressants. I typically agree with his health writing and conclusions, but I think the post is a bit dismissive. Statistically, he may have a point (I have not been able to find many large studies that isolate the multifactorial problem of increased suicide rates during anti-depressant treatment), but my personal experiences with antidepressants and the experiences of people that I know point to more than a minor phenomenon.

There are various severities and types of depression, and the state that I was in prior to my wild ride was outright despondent. Not twitchy, or crushed, but despondent. Seeking the help of a doc, I was recommended buproprion (WellButrin), a popular anti-smoking aid/anti-depressant that is thought to work on Dopamine receptors in the brain (though this theory is weak). Buproprion tends to give you energy rather than chill you out, and can actually increase sex drive/function rather than diminish it (which is a common SSRI side effect).

I started taking the drug and tapering up slowly. Within a few days, I was having mild headaches. I was told to tough it out. After a week, I became a bit jumpy and the headaches continued to come and go. The dose was maintained, and once again, "give it time to work." Two weeks in I hit a crucial phase: time to up the dose by a large percentage. Following doctor's orders, I took the appropriate amount and took a very frightening ride, one where I had little control over what was happening to me.

Where I had been sad and aloof before, now I was frightened and beside myself with emotional pain. Where I had not looked forward to going to work before, now I was largely incapable. I would wake up mindlessly upset before work. I called in sick several days. Once again, the doctor told me that this was a function of my anxiety and depression, and that I needed to tough it out.

I took vacation the next week, because I knew that I needed to get myself straightened out before attempting to work. It only got worse. My negative thoughts didn't flit in and out of my head, they materialized and stayed, tripping around and around until I found it unbearable. Without putting too fine of a point on it, I hit a very, very dark, terrifying place. I finally wound up needing family support to help me out. I was literally shaking with agitation and anxiety. This was very uncharacteristic, to say the least.

All of these effects - the headaches, the mental fog, racing thoughts and finally anxiety, crushing depression and even suicidal ideation - were directly related to starting and upping the dosage of the drug. My doctor, a psych at a major University teaching hospital, had followed standard protocol in slowly weaning me onto the drug, and advising a waiting period to "tough out" deleterious side effects. In retrospect, he should have pulled me off of it as they hit a certain severity, but the coup de grace of scary ideation and massive depression came on so suddenly that I doubt that this would have eliminated the problem.

What might have helped was a warning prior to starting the drug. About two months after surviving this scary encounter, I read this eerily similar account first published in the New York Times, written by a psychiatrist at UCSF who experienced the same effects while trying the drug herself. She was absolutely puzzled by this sudden assault on her emotions, and her subtle guilt over previously telling patients to merely "tough it out" is fairly evident. I cannot tell you how much reading this account helped my state of mind, helped me to realize that my actions and reaction to this substance were not merely a sign of weakness or a fundamental culpability for how I behaved.

Do I blame my doc? Not really. Do I hate anti-depressants and think that they are evil drugs? Not really. They have a place and they help a great deal of people out of crippling depression. BUT - these commonly-prescribed things can have sudden and catastrophic effects on a segment of the population that is susceptible to the mysterious, sudden changes in brain chemistry that occur with the introduction or removal of these substances into one's system. Their prescription is not something that should be taken as lightly as a GP-prescribed beta-blocker or round of ambien.

In this case my experience tells me to screw statistics - the negative effects were stunning and real. And I'm glad that the FDA is revising protocol to include careful monitoring of new patients and the introduction of warning labels - it might have helped me out.