I still can’t quite pin it down. But something happened. Maybe around 2010, in the aftermath of the ’08 financial meltdown perhaps? Or was it the (first, our first) meth epidemic? Was it the "end of AIDS" and the corresponding loss of a unifying passion? The post-June 2011 fork in the road of those who chose to be parents vs. those who insisted on liberation from such a mating for life, Norman Rockwell ideal? Or did we simply grow old? Newly invisible. Newly arthralgic.

Something though happened.

(If you’d prefer to skip all this historical rehash and preamble and get straight to my alternative ideas for thinking about and correcting depressive or anxious tendencies, sign up for my private newsletter (it is and will always be free), All of Us Still Learning, where I am freeer to share this kind of information that may be construed as medical adivce.)

I had left NYC in 2006 after being summarily relieved of my post at TAG, a group I had dedicated my life to (and labored, for a pittance) since 1997, a year earlier.

Well, and the HIV/AIDS Center at St. Vincent’s was coming apart at the seams. Proximate cause, ironically, was the “end of AIDS,” the blockbuster in-patient census plummeting precipitously.

Eventually like dominos the entire network of Catholic hospitals in NYC would officially declare bankruptcy. Goodbye St. Vincent’s, so long Cabrini, adios St. Claire’s.

Each time I returned to the city, another and then another of my once engaging, funny, vibrant acquaintances had turned, Body Snatcher-like, into kind of an emotionless shell of his former self.

Americans represent 5% of the global population, yet  take 50% of the world’s pills— including 80% of the world’s painkillers.

I get it. We have been through alot. Alot, alot.

It took nights and nights of weeping in front of Pose and then Pose cast panel discussions, and more recently, Fellow Travelers (and my current fave Fellow Travelers Brit viewfest conversation), I’m afraid, for me to finally/fully come to grips with exactly ALL we’ve been through.

“After” AIDS: 9-11

A financial meltdown with mass lay-offs & losses

Catastrophic loss of newspapers (& many magazines, including this one) nationwide & of community news

Catastrophic, horrendously violent invasions of two, three, four sovereign nations: Afghanistan, Iraq, Syria, Libya, Yemen

Trump

Covid

Putin

Netanyahu (again)

Trump (again)

Despots just won’t go gentle ...

And I was there once too, my nightstand or kitchen cupboard overflowing with anxiety and mood and sleep meds.

Somehow I escaped.

I am tempted to credit Gui Pi Tang, also known as “Ginseng and Longan Formula.” Precise ingredients being: ginseng, astragalus, atractylodes (rhizome), licorice root, poria sclerotium, Chinese angelica root, longan fruit, jujube seed, costus root and (fresh) ginger.

Not because it was necessarily indicated for such, but only because I sampled just about EVERY Chinese herbal medicine formula we studied in school. And, who knew?, this one turned out tailored for me, at least at that time in my life.

And yoga.

Yoga not because of how it helped me (although I love, love, love a good yoga class (increasingly difficult to find), preferably with an ample supply of sweaty/hairy men’s bodies)

But yoga because it made me see how this drug (Celexa) was affecting the energy in my body. Basically, freezing it up. (And it killed the endorphin rush slash euphoria from exercise.)

Sorry if that sounds new agey.

(I actually long ago gave up massages because the effect lasts for maybe 24 hours (if you’re lucky) and now rely solely on yoga— because the relaxation and even “high” from yoga can last for days. Shiatsu, Thai massage, medical massage and Chinese Tui Na massage might be exceptions.)

But also because Anthony moved to PA to raise llamas or something with his husband. (Anthony, I am so grateful for those years we had together in the EV!)

(Remember Gant Johnson and Flamingo East Salon Wednesdays?)

But it makes me so, so sad.

What have we lost? What are we still losing?

[remind me to insert here a sentence or two from that menopause (-ish) book i was reading. (i’ve also recently become a little obsessed with menopause. mostly because i think it’s so interesting how some women suffer tremendously (and for years and years) while others almost don’t even notice it. DM me if you have any interest in my up-and-coming oeuvre: “Mayan Women Don’t Get Hot Flashes.”)  Moody Bitches? i think was the title. I eventually got it from the libary and read more than just the free Kindle preview. Turns out it’s not nearly the book I had hoped it would be. After lashing out at medicine (& psychiatry) by prescription pad, she then appends an appendix with all her favorite drugs and how she uses then. Buzz kill. But I still appreciated these stats & background from her Intro:

The drug companies started direct-to-consumer advertising in the 1980s. Soon after I started my private practice in the mid 1990s, it became less heavily regulated. Ads started springing up on television and in magazines, trumpeting the latest antidepressants and sleeping pills. I went along for the ride as America’s use of all prescription psychiatric medications tripled during the 90s as a direct result of this powerful marketing. By 2006 the antidepressant Zoloft had made more money than Tide detergent, and it became clear to me that something new was happening. Drug companies are spending billions of dollars to turn normal human experiences like fear or sadness into medical diseases. ($5 billion in 2008 alone.) They aren’t developing cures, they’re creating customers. The problem is not our emotionality; the problem is that we are being persuaded to medicate it away.

 

The latest news is particularly terrifying. Abilify, a medicine originally formulated to treat people with schizophrenia, expanded into the depression market and is now our nation’s top selling medication, and not just of psych meds. America’s number one money making medicine is an antipsychotic. As a psychiatrist, I must tell you this is insane. There is an ancient Greek word pharmakon which held disparate meetings– sacrament, medicine, and poison. It is a common saying in medicine that sometimes the treatment is worse than a disease. There are many medications (chemotherapy is a good example) that are helpful or curative at lower doses but dangerously toxic at higher amounts. It is also true that there are powerful medicines that are appropriately used for one diagnosis but are complete overkill for another. prescribing antipsychotics to treat depression seems particularly out of balance, especially given the risk of irreversible side effects like diabetes or movement disorders inherent in this class of medicines.

 

We represent 5% of the global population, yet we take 50% of the world’s pills. (We also take 80% of the world’s painkillers.) Meanwhile, the percentage of people labeled with psychiatric diagnoses is continually growing. Is it possible there really is an epidemic of mental illness and disability happening in our lifetime? Or are physicians too quick to reach for their prescription pads instead of offering harder solutions to their patients’ complaints? Medical journals are full of only one kind of ad: pages of information on the newest drugs and exactly how to prescribe them. (let us not forget the Sackler Empire started in medical journal advertising.) four out of five prescriptions for antidepressants are not even written by psychiatrists, but rather by general practitioners. and more often than not, prescribed for patients without an actual diagnosis of depression. Particularly troubling, surveys of primary care doctors show they routinely overestimate what antidepressants can do. they’ve been put by the ads just like the rest of America.

We want to function in this world, I get it. We want to feel even-keeled. But is this really functioning? Is this living even?

(There are tons of books, even as far back as "Talking Back To Prozac," on this theme. And maybe I can post a table or chart tomorrow.)

And it makes me even sadder to think that all these beautiful people will spend the rest of their lives— to the “end of their days”— sleepwalking around town (or in the case of those on more stimulating antidepressant drugs like Wellbutrin (and Prozac!) or other dual-neurotransmitter reuptake inhibitor), rabidly agitated) until it’s over.

I can remember when Zoloft first appeared.

It makes me even sadder to think that all these once engaging, playful, endearingly vulnerable people will spend the rest of their days sleepwalking (or maniacally prancing, Joker-like) through life.

This beautiful man I was dating in 1998 or so was enamored of it. I think he had initially taken Prozac.

But I couldn’t help thinking there was something a little “off” with him. All the inappropriate and grandiose sharing. Reminds me now of that Six Feet Under episode intro where the wife whacks self-involved, endlessly chatty hubbie with a cast iron skillet. The tortured analyzing of every thought and emotion. I actually think the talk therapy he was also doing was making him worse. We eventually ended in an odd friendship.

Then came Celexa or Cymbalta. What was the exact licensing sequence? I’m going to check...

1991, Zoloft; 1992, Paxil, 1994, Effexor; 1998, Celexa; 2000, Wellbutrin (although originally approved in 1985 as amfebutamone-- I kid you not); 2004, Cymbalta

It was actually Peter Kramer’s "Listening To Prozac“ that caused me to suspend my skepticism. His book came out in 1993 and was, as they say, the Talk of the Town. The drug promised to free us to be our authentic selves. No more pretending. ”Better than well," I also remember as its slogan. Geez, how we all fell for that!

Now of course, thanks to genius and aggressive marketing, practically no one is on just one drug. Anti-psychotics are routinely added into the mix. And now I learned of what appears to be a ketamine nasal spray, Spravato? Scratch all this. Sign me up!

Trazodone (Desyrel) and Pristiq and Viibryd, now Exxua (!!??) appeared. 

I ran into an old friend, after not seeing him for many years, on Seventh Avenue outside of what once ago was Barney’s. He gleefully informed me that his doctor had “finally gotten to the root” of this depression: he was bipolar. I got super sad when he recounted how he had spent a year in a really dark depression, even to the point of thinking about ending it all. Now, of course, I want to know more about what was going on in his life during, and just leading up to, this time. But we were two ships passing in the night. He was SO HAPPY to share with me the double or triple drug therapy he had been put on. I am remembering Effexor + Abilify: out of the gate! All the gray clouds had magically dispersed. So why does this sadden me then? Shouldn’t I be happy for him? Because he is no longer who(m) I remember. He is getting by. He thinks he is happy. But he is sleepwalking through life.

Another friend chose the other side of the road: endless stimulation. Apparently it’s the Prozac and, as we always knew, Wellbutrin antidepressants that have this stimulating effect. (Recall that before Wellbutrin was Wellbutrin it was Amfebutamone.)

This friend talks non-stop. Has enormous (and even enviable) self-regard. Never follows up on a single conversational thread from your end. Takes nary a slim reed of interest in your life, your challenges, your dreams and disappointments. Goes on and on and on only about himself. Or his new 20-year old boyfriend.

I have a female friend, also on Wellbutrin, who more or less acts the same. These folks are not so much sleepwalking through life— not the highly medicated zombies— but more like drag racing through life (not the delightfully colorful RuPaul way but more like an expensive souped-up car overturned in flames)— and missing everything around them.

I could go on.

I could talk about David and Shawn and Enrique.

Of Jeffrey and Thomas and Eric.

But I’m guessing you get the picture.

And speaking of dropping threads, I kind of did that when starting to speak of my own journey through this land mined, medicalization (of more fundamental imbalances) terrain.

It was shortly after Peter Kramer’s book came out. Not too long after the super depressing Berlin AIDS conference. Then in 1997 a big break-up. Totally out of the blue. I found my work suffering at St. Vincent’s, a job that I loved. My lovely, lovely, absolutely lovely (did I tell you how lovely he is/was?) MD suggested I was dysthymic, or cyclothymic (I would have weeks of productivity and then a stretch of struggling to get anything at all done), I think he said. Surely today I would be diagnosed bipolar— even if I never had (sorry for me) any of the true manic moments— and I can pretty safely say that ZERO of my friends now on bipolar meds (or triple, quadruple bipolar therapies!!) ever experienced such.

He suggested Celexa.

I had just gone through a pretty traumatic break-up. St. Vincent’s was in its death throes. My doctor suggested I might be  ’cyclothymic.’ He suggested Celexa.

Little did I know at the time that he had, perhaps coincidentally, perhaps not, taken up a bit of a friendship with the Forest Labs rep. (Forest Labs initially licensed citalopram aka Celexa).

I’m not saying that this is what amped up his enthusiasm for the drug. Maybe he would have liked it and prescribed it non-stop without this new wining-dining-flattering friendship. But that is pretty much the exact script from the pharma sales playbook.

I’m assuming you’ve watched Dopesick.

Within 24 hours I was horny as hell. Hard-ons would last forever. And yet orgasm was impossible. What cruel joke was this?

I became so, so sleepy. All I wanted to do was sleep.

WIthin 3 or 4 days, certainly within 5, that chorus of negative voices in my head...SILENCED. They were gone!

Within 24 hours I was horny as hell. Wood at the mere thought of it, like a teenager. And yet orgasm impossible. What cruel joke was this?

But how could this be?

And weird for me, where I would typically say no to every invite, now I only said yes. I would follow people I didn’t really even like, or company/conversation enjoy, for dinner or drinks or parties. This was not me! Where I once felt like I belonged nowhere, now I suddently belonged anywhere and everywhere. This isn’t serotonin. Oxytocin maybe. But more than likely an entirely altered neural circuitry. And just a little bit scary. How do they let GPs prescribe these drugs? And after only a 15 minute consult!

“Sounds to me like you might be bipolar. I’m going to start you on these two [often new] drugs.” Uggggh...

My entirely personality (and decision making mechanisms) was/were undergoing a fundamental makeover, for arguably the good but also for the worse, and no one anywhere was overseeing this. You get the script and are then free to fly (and fall) on your own. This is care??

With the “voices” gone, so too the performance anxiety. (I’m wondering now if it was even a kind of post-trauma thing.) I no longer saw images of that KS pocked calf hanging over my shoulder in a French bathhouse. Or flash-backs of my first fudgesicled phallus upon sodomizing a fast food manager over spring break in college. Newly free of these fears, I had just doubled the field of potential amourous companions. I could now give and take with equal élan. Maybe this was why these drugs had become so popular?

I only recently really began to sort of start analyzing those years. And I now see most of these short-term personality changes rooted in ramped up hormone production, including oxytocin and estradiol.

I have become to some degree a little OBSESSED with the marketing, mis-marketing, misrepresentation of the entire SSRI class of medicines. But also with what now seem like much more plausible explanations for what these drugs really do. And it has absolutely nothing (or nearly nothing) to do with serotonin.

In large part I credit this absolutely AMAZING Bethesda-based psychiatrist, Robert Hedaya, whom I was so fortunate to meet through the IFM, for this kind of eureka moment.

SSRIs don’t really have a significant or certainly lasting effect on brain levels of activity of serotonin!

Just think about it. And what are they really doing then?

“Expect to wait 2 weeks to notice any improvement, and about a month for real change”

That was the official SSRI guidance to doctors and patients alike.

But then why was I horny as a goat-- the very next day?

Why did all the voices in my head disappear-- by week’s end?

Why was I hopelessly somnolent. Almost immediately?

It made no sense.

There is a growing and convincing body of literature to support the contention that the SSRIs/SNRIs have only a fleeting if any effect on brain serotonin-norepinephrine levels.

Didn’t sleep great, but I could stay hard for days.

My (absolutely lovely, really lovely) doctor had also rx’d me Ambien for occasional insomnia. (Turns out after the initially endless sleepiness induced by starting Celexa, eventually you end up with sleep PROBLEMS. For me it was mostly waking— I’m talking joltingly awake— at like 4 or 5 a.m. with zero chance of getting back to sleep. And then later, actual trouble falling asleep. That too is now documented, and even explained. But different bodies react differently to medicines, supplements, botanicals. Just look up the title "Biochemical Individuality."

He had also rx’d me Klonopin. Which I grew to LOVE.

I would solve the "rebound insomnia" from having taken Ambien the night before with a health dose of Klonopin.

Soon I was taking Klonopin EVERY night.

I remember once I went in for a refill, and he offered to write me a script for like 1,000 Klonopin. I kid you not. I had like a two-year supply.

“What a friend we have in Jesus!”

By 2011 or so I was off all of these drugs. And I am only now realizing how their (unappreciated) effects at the time influenced the trajectory of both my professional and personal lives. And also what they led me to lose. Losses that cannot be undone.

So maybe I am unfairly projecting when I run into all these old acquaintances, some I might even call friends or former friends, mostly on the streets of New York but sometimes in social situations. Maybe I shouldn’t be sad for them. But I am. And I will tell you why in a follow-up post. (As well as all the really good science I have since learned & discovered.) As if anyone really cares what I think. But I suppose it’s a form of therapy. So thank you if you made it here with me to what for now is the end.

So two quick things to wrap this up: 

#1 There is a huge and growing body of literature to back me up. Again, I thank Dr. Hedaya for first kind of legitimizing my suspicions about this. But there are others. And I will highlight 1-2 key papers in coming weeks.

#2 My zombie friends. Yes, some of them will tell you how much these medicines have helped them. But I too would more than likely have told you that back when I was taking 40 mg (yes, 40 mg!!!) of Celexa, in 1999, 2000, even 2001. I will also post a few case studies of people who were lucky enough to find real thinking medical professionals— medical detectives as all doctors worth their degree need to be— who worked with them to figure out and fix (without drugs) the reason(s) their mood or mind was struggling. Here is a provisional link to an admittedly abbreviated sampling of such approaches. Fuller discussion to follow...

Will leave you for now with a short list of my favorite reads on this, more or less in the order that I encountered them. And will pluck out selected cases in follow-up post:

  1. Hyman, UltraMind Solution (2009)
  2. Mayer, The Mind-Gut Connection (2016)
  3. Arango, Viadro, Underwood, Bugs, Bowels, And Behavior (2013)
  4. Fasano, Gut Feelings (2021)
  5. Hedaya, Understanding Biological Psychiatry (1996)
  6. Greenblatt, The Breakthrough Depression Solution (2011)
  7. Anderson, Cryan, Dinan, The Psychobiotic Revolution (2017)
  8. Hedaya, Depression, Advancing the Treatment Paradigm (A Functional Medicine Monograph) (2008)
  9. Valenstein, Blaming the Brain (1998)

Mike Barr, a longtime Poz Contributing Editor and founding member of and scribe (then, overnight, persona non grata) for the Treatment Action Group (TAG), is a functional medicine practitioner and herbalist in NYC. Reach out to him here. Or sign up for his curated (and 20-25% discounted) professional grade supplement dispensary here.