I’m grateful for a hot summer day. I’m grateful for the famers market and tomatoes and gladiolas. I’m grateful for the first tiny, delicious strawberry from the garden. I’m grateful for friends who never close the door and never give up. I’m grateful for seeing differently. I’m grateful for being differently. I’m grateful to be discovering where I’m supposed to be. I’m grateful to be sober today.
I hope you’ve had a chance to listen to Episode 18 of Breakfast with an Alcoholic—it’s a really good one!
I don’t know if you noticed this the other day, but I did:
Study Finds Depression Not Likely Caused by Chemical Imbalances1
Why does this matter? Well, if you’re like me and have struggled with depression for most of your life, and your depression is definitely, inextricably linked to your alcoholism, at some point, a doctor has probably prescribed an SSRI (“Selective Serotonin Reuptake Inhibitor”) like Lexapro, Prozac, Paxil or Zoloft, to name a few and told you not to worry, when the Serotonin levels adjusted in a few weeks or months, you’d feel much better. I know I’ve tried all of the major anti-depressants and to be honest, never felt like they did anything for me. Funny thing—it turns out that there isn’t much evidence that Serotonin levels have anything to do with depression.2 But don’t take it from me here’s the study abstract:
No systematic review of tryptophan depletion studies has been performed since 2007. The two largest and highest quality studies of the SERT gene, one genetic association study (n = 115,257) and one collaborative meta-analysis (n = 43,165), revealed no evidence of an association with depression, or of an interaction between genotype, stress and depression. The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations. Some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentration.
If there’s no evidence to support the idea that all of the anti-depressants we’ve been prescribed over the years actually do anything, where does that leave us? Ask your doctor. Seriously. I feel like the medical establishment doesn’t put too much effort into trying to figure out new ways to help us. I love my doctors, my brother is a doctor, I have friends who are doctors, but I don’t think doctors really care that much about us. Maybe it’s because the most common exposure to alcoholism and addiction is during a grim med school rotation in a VA hospital or psych ward somewhere. Seeing the worst of us at the very end reinforces the idea that we do this to ourselves and don’t deserve a doctor’s concern. I think we get lumped in with smokers, just more people with self-destructive habits. Why spend time on people just trying to kill themselves?
Maybe it’s because there is virtually no mention of alcoholism in Continuing Medical Education seminars or in the traditional medical school curriculum. No general practitioner I’ve seen in the last 15 years has had any familiarity with the few drugs that are out there to treat us, like Naltrexone or Antabuse, much less anything experimental. It’s not their fault, for whatever reason, the prevailing medical view does not really see us as patients. When even the addiction psychiatrists who treat us are willing to publicly question whether it’s a disease, well, it seems like something is wrong. That’s why one of the first things I wrote here was this:
I had a pretty funny Twitter exchange then with Dr. Fisher, who, I’d like to emphasize holds himself out both as a person in recovery and an addiction psychiatrist. He began by misquoting a speech Bill W. gave to demonstrate that even Bill didn’t think alcoholism was a disease. I pointed out that he only needed to read the very first two sentences of the Big Book to realize he was wrong3:
We of Alcoholics Anonymous, are more than one hundred men and women who have recovered from a seemingly hopeless state of mind and body. To show other alcoholics precisely how we recovered is the main purpose of this book.
Big Book, p. xiii (The Foreword to the First Edition).
I also provided a few other Big Book page references (he didn’t seem very familiar with it), the link to the rest of the speech he misquoted with some other passages highlighted and then asked him, since he tells people he’s in recovery but believes it’s “misleading to call addiction a disease,” what exactly was he recovering from?4
My only point is this: We alcoholics and addicts are dying like this is a disease, it would be great if the medical establishment would treat us that way.
Thanks for Letting Me Share
The full study is here: The serotonin theory of depression: a systematic umbrella review of the evidence
Back when I was a practicing lawyer, when the law changed or important cases got decided, I was proactive and told them about the latest changes and how it might affect them. Especially, if those changes meant that previous advice I had given them might need to be re-evaluated. Just saying.
He also did not seem to be aware about the part of the Big Book called “The Doctor’s Opinion.”
He answered that he wasn’t “quite sure” and that it was “complicated.” Then he deleted the tweet about the Bill W. speech, but thank goodness I know about screenshots!
<mic drop> Wow--I had no idea about the studies on serotonin and depression. I’m going to dig into that since my oldest has been struggling to find the right meds that help (spoiler alert: none so far).
Also, I agree that doctors don’t give us info about drugs that can help the addict. It wasn’t until I attended a family workshop at my son’s rehab that I learned about any of them. Vivitrol makes me especially hopeful.
And I’ve had many angry moments recounting all the times I took him to his pediatrician (at my son’s request) for his inability to eat or gain weight and other symptoms that should have triggered a drug test or SOME kind of evaluation of whether he was struggling with the disease of addiction.
Thanks for peeling back the layers of the onion.
I feel like I won the jackpot with SSRIs. I’ve heard plenty of story and know several people where it just didn’t work, or it worked for a small period of time and they’d have to switch to different meds. I’ve been on the same SSRI at the same dosage for years and it’s done wonders for my mental health.
On a side note, this also reminded me why I’m a fan of Dr. Drew. He uses his platform to really push this idea into the mainstream when he can.