My relationship with anti-depressants is complicated, I read widely and I know that they often perform little better than placebo. There may be long term side effects that we just don't know about yet. No one likes BIG PHARM and it is hard not to be suspicious of researchers and physicians that receive funding or other benefits from the industry. However, these pills have simply saved my life. They alllow me to function when nothing else will. (I am only on expert on my own experiences). Mild depression may remit completely with exercise and fresh food, talk therapy or simply by the passage of time. But when you are severely depressed and cannot get out of bed, it is almost impossible to recover with these methods- at least in my case.

My first depression occurred at 19. I was an impoverished student though financial aid made me better off than at home. I had no insurance. I couldn't afford therapy, even on a sliding scale. And to be honest I was too ashamed to go to therapy. I had been brought up to believe only truly crazy people do that. I found a nice physician who gave me free samples of Prozac for a few months and my mom scraped together some funds for a few more. The change was remarkable. I had been unable to get out of bed and would weep for hours on end. That year, I ended up studying abroad (I had never been out of my home state) and had my first boyfriend at the age of 20.

I ran out of the meds around Christmastime and wasn't able to get any over the holidays. I went through a light withdrawal since I hadn't tapered off - I slept for about 2 weeks straight- but after this period I felt ok. I was actually kind of relieved to be off the medication. Now I could be normal. 

The pattern continued. I got depressed to the point of not functioning. I sought out the cheapest therapy I could - students on a sliding scale - and when I was working I paid for a Cognitive Behavioral Therapy professional well respected in the field. I didn't drink, I didn't smoke, I ate healthy and exercised. I took my vitamins. I read self help books by the bushel. I would get to the point of no return, of no functioning, not being able to work, to interact with the world at any level and I would have no option left but anti-depressants. I was very conflicted and would discontinue as soon as possible, tapering off and under the care of a doctor.  I would also read books on the evils of pharmaceuticals, often as I consumed them.  

Eight years ago I started seeing a therapist-in-training who was anti-medication. He was very "new age" and believed in many alternative therapies. I was taking medication at the time at a very low dose and was a bit tired of the see sawing on and off medication. I was deeply in love with a man for the first time. But the therapist insisted I not take medication. I readily complied. I tried many of the therapies and tactics he promoted. After a while I began to get depressed. I got lower and lower. I lost my job. I lost the man I love. I almost lost my mind. 

I would ask him, "Should I go on medication?"  and he would say "No, not yet. You need to descend into the darkness first and then come through reborn." Yes, he actually said that. Our relationship was more like guru/ disciple. Myths figured quite heavily. 

I got to the point where I couldn't go on. I went to see him. He wanted to commit me to a hospital. I did one of the bravest things I have ever done. I fired him. I walked out and made an appointment with a psychiatrist. I started on Lexapro. The therapist called me many times, told me to come back. I never spoke to him again.

There is something called kindling. Basically each depressive episode you have increases the probability that you will have a future episode. At 4-5 prior episodes, my probability is roughly 90%. For people like me, it is better to stay on  medication than to keep going on and off. I have accepted that I will probably be on medication for the rest of my life. I am lucky. I have virtually no short term side effects and as for long term effects - well, they look better than a mental hospital or suicide whatever they end up being.

One thing that has been hard to accept is that I have never fully recovered from that last episode. At most I have achieved 50% remission. I've increased doses and switched medications but have never gone above 50%. The most troubling symptom is my fatigue. I can drink espresso and lie there like a log. I am an old woman in my 30s. I exercise regularly, eat well and have seen different therapists. I seem to have plateau'd out. Its been 6 years. I am 34.

Do I accept half a life?