Oct 04

“A Cure for Darkness” by Alex Riley

“Depression is something that I’m very familiar with, but the book isn’t just about me; it is not a memoir,” states science writer Alex Riley about A Cure for Darkness: The Story of Depression and How We Treat It. “It is a history of depression from around the world, how it manifests itself in different cultures and, most importantly, how we treat it. An estimated 315 million people live with depression and it is set to become the leading cause of disability bar none” (Alexriley.co.uk).

Riley’s own treatment has included cognitive behavioral therapy and antidepressants, but at times he’s had his doubts about their effectiveness. These led him to researching what else has been out there to help those with depression.

A psychiatrist reviewing A Cure for Darkness on Goodreads notes that Riley first covers pre-1900’s history, which of course includes much about Freud, then 20th-century advances in both biological and talking therapies, and finally what’s happening today as well as what’s in our future. “For example, here, Riley talks about the insights from recent neuroimaging studies and the little-understood links between depression, inflammation and diet, as well as the use of deep brain stimulation (DBS) and psychedelic drugs in the treatment of the condition.”

This reviewer concludes: “What Riley successfully demonstrates throughout this book is that depression is an incredibly complex and diverse clinical condition. He shows how our understanding of the biological, psychological and sociocultural mechanisms underpinning depression has improved, alongside the sometimes empirical, sometimes scientific treatments. By doing so, he sheds light on the reasons why successful treatment of depression can be such a huge challenge for clinicians and patients alike.”

A critique excerpt from Kirkus Reviews:

Treatments would rise and fall—e.g., various forms of lobotomies—and some would rise again (electroshock therapy). Riley discusses numerous studies and anecdotes to illustrate the positives and negatives of each approach to treatment, including modern-day investigations into cognitive behavioral therapy, psychoactive drugs (ayahuasca, LSD, etc.), and deep brain stimulation, often employed for patients whose ‘depression seemed intractable. A diversity of drugs—antidepressants, antipsychotics, tranquilizers, mood stabilizers—couldn’t budge their mental anguish.’

Although very favorably reviewed by many experts, some early lay readers have found A Cure for Darkness to be more textbook-like than they’d have preferred, particularly noting that this is not a self-help book.

Apr 23

Experimental Depression Drugs

Experimental depression drugs—including the use of ketamine, LSD, and propofol—are increasingly in the media. This is happening because sometimes depression is unreachable by the usual antidepressant medications and therapies.

The nasal spray esketamine, derived from ketamine, is one of the most innovative new depression treatments. Just recently approved by the FDA, this is what Psycom wrote in January: “Although it’s been abused in the past as a ‘recreational drug’ because of its hallucinogenic and tranquilizing effects (known on the street as ‘Special K’), today ketamine is drawing a lot of positive attention because it is being used ‘off-label’ to treat treatment-resistant depression—and patients are happy with the results.”

Two other unusual, indeed experimental, drugs have been written about in recent memoirs. Details below.

I. A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage, and My Life (2017) by Ayelet Waldman 

In an “underground” sort of venture, respected writer Ayelet Waldman tried microdoses of LSD for her intractable mood disorder. An excerpt from the publisher’s book description: “As Waldman charts her experience over the course of a month, during which she achieved a newfound feeling of serenity, she also explores the history and mythology of LSD, the cutting-edge research into the drug, and the byzantine policies that control it. Drawing on her experience as a federal public defender, and as the mother of teenagers, and her research into the therapeutic value of psychedelics, Waldman has produced a book that is candid, revealing and completely enthralling.”

“Whatever her foibles or stylistic lapses, she makes a persuasive case for the therapeutic use of psychedelics” (Jennifer Senior, New York Times).

II. The Valedictorian of Being Dead: The True Story of Dying Ten Times to Live (April 2019) by Heather B. Armstrong 

Another bestselling author, Heather B. Armstrong, also found herself unable to find relief from depression. “She had never felt so discouraged by the thought of waking up in the morning, and it threatened to destroy her life. So, for the sake of herself and her family, Heather decided to risk it all by participating in an experimental clinical trial involving a chemically induced coma approximating brain death.”

More from the publisher of this brand new title: “Now, for the first time, Heather recalls the torturous eighteen months of suicidal depression she endured and the month-long experimental study in which doctors used propofol anesthesia to quiet all brain activity for a full fifteen minutes before bringing her back from a flatline. Ten times. The experience wasn’t easy. Not for Heather or her family. But a switch was flipped, and Heather hasn’t experienced a single moment of suicidal depression since.”

Jun 17

“The Noonday Demon”: Andrew Solomon Examines Depression

Listen to the people who love you. Believe that they are worth living for even when you don’t believe it. Seek out the memories depression takes away and project them into the future. Be brave; be strong; take your pills. Exercise because it’s good for you even if every step weighs a thousand pounds. Eat when food itself disgusts you. Reason with yourself when you have lost your reason. Andrew Solomon, The Noonday Demon

Recently I posted about Andrew Solomon‘s new TED talk “Forge Meaning, Build Identity.” Also pertinent to Minding Therapy is his 2001 The Noonday Demon: An Atlas of Depression, a book that’s both personal and sociocultural in scope.

Last year he gave the following TED talk, “Depression, The Secret We Share”:

If you’ve neither watched the above talk nor read The Noonday Demon, you may be interested in some of these quotes from The Noonday Demon:

The Opening Lines

“Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair.”

The Nature of Depression

“Antonin Artaud wrote on one of his drawings, ‘Never real and always true,’ and that is how depression feels. You know that it is not real, that you are someone else, and yet you know that it is absolutely true.”

“Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance.”

“The most important thing to remember about depression is this: you do not get the time back. It is not tacked on at the end of your life to make up for the disaster years. Whatever time is eaten by a depression is gone forever. The minutes that are ticking by as you experience the illness are minutes you will not know again.”

What Helps Depression  

“The people who succeed despite depression do three things. First, they seek an understanding of what’s happening. They they accept that this is a permanent situation. And then they have to transcend their experience and grow from it and put themselves out into the world of real people.”

“A sense of humor is the best indicator that you will recover; it is often the best indicator that people will love you. Sustain that and you have hope.”

“It is important not to suppress your feelings altogether when you are depressed. It is equally important to avoid terrible arguments or expressions of outrage. You should steer clear of emotionally damaging behavior. People forgive, but it is best not to stir things up to the point at which forgiveness is required. When you are depressed, you need the love of other people, and yet depression fosters actions that destroy that love. Depressed people often stick pins into their own life rafts. The conscious mind can intervene. One is not helpless.”

Being on Medication

“Since I am writing a book about depression, I am often asked in social situations to describe my own experiences, and I usually end by saying that I am on medication.
“Still?” people ask. “But you seem fine!” To which I invariably reply that I seem fine because I am fine, and that I am fine in part because of medication.
“So how long do you expect to go on taking this stuff?” people ask. When I say that I will be on medication indefinitely, people who have dealt calmly and sympathetically with the news of suicide attempts, catatonia, missed years of work, significant loss of body weight, and so on stare at me with alarm.
“But it’s really bad to be on medicine that way,” they say. “Surely now you are strong enough to be able to phase out some of these drugs!” If you say to them that this is like phasing the carburetor out of your car or the buttresses out of Notre Dame, they laugh.
“So maybe you’ll stay on a really low maintenance dose?” They ask. You explain that the level of medication you take was chosen because it normalizes the systems that can go haywire, and that a low dose of medication would be like removing half of your carburetor. You add that you have experienced almost no side effects from the medication you are taking, and that there is no evidence of negative effects of long-term medication. You say that you really don’t want to get sick again. But wellness is still, in this area, associated not with achieving control of your problem, but with discontinuation of medication.
“Well, I sure hope you get off it sometime soon,” they say.

Life with Recurrent Depression

“The opposite of depression is not happiness, but vitality and my life, as I write this, is vital even when sad. I may wake up sometime next year without my mind again; it is not likely to stick around all the time. Meanwhile, however, I have discovered what I would have to call a soul, a part of myself I could never have imagined until one day, seven years ago, when hell came to pay me a surprise visit. It’s a precious discovery. Almost every day I feel momentary flashes of hopelessness and wonder every time whether I am slipping. For a petrifying instant here and there, a lightning-quick flash, I want a car to run me over…I hate these feelings but, but I know that they have driven me to look deeper at life, to find and cling to reasons for living, I cannot find it in me to regret entirely the course my life has taken. Every day, I choose, sometimes gamely, and sometimes against the moment’s reason, to be alive. Is that not a rare joy?”