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With millions of people in the US now taking SSRI medication, its not surprising that many of them are not thrilled with the results. SSRIs like Prozac have significant side effects, and they dont always keep on having the initial results. The main side effects people notice are "physical and mental lethargy, loss of sex drive and performance, and significant weight gain." (p. 1). Such side effects make people less ready to continue taking their medication on a regular basis. People occasionally skip doses or just give up on it altogether. People get tired to taking the same pill day after day.
Robert Hedaya is a psychiatrist at Georgetown University Hospital and also has a private practice. He specializes in "clinical psychopharmacology," which is the science and maybe the art of prescribing mind-altering medication to people. He explains that most psychiatrists have "only a rudimentary knowledge of psychopharmacology" and have even less knowledge of the interaction of such medication with the body. (p. 5). Furthermore, most people who take such medication have never seen a psychiatrist, but instead had it prescribed by their primary-care physicians, who have even less understanding of the effects of these drugs.
So Hedaya has created his Antidepressant Survival Program (lets call it ASP) as a response to the needs of his patients. It is based on what he calls "Whole Psychiatry" (p. 6), which pays attention to the whole person. As evidence of the effectiveness of his program, he says that he has tried it on over three hundred of his own patients, who have had problems with self-esteem, confidence, vitality, vigor, and sex drive. He reports that his program is a success.
So what is this amazing new approach? It requires eating well, getting exercise, checking for underlying non-psychiatric conditions (such as hypothyroidism and food allergies), and adjusting medication to avoid side-effects of medication. Thats it. Big anticlimax. This enormously repetitive book (with 292 pages) is recommending pretty much the same as every other self-help book out there. Nutrition, exercise, stress reduction, play, and spiritual renewal. While I was reading this, my local public television station had one of its frequent pledge-drives and I found myself watching Dr Andrew Weil doing a couple of specials on health and nutrition. Weil, author of Eating Well For Optimum Health and Spontaneous Healing gave remarkably similar advice to Hedaya concerning nutrition.
At this stage, I should admit a personal interest in this book. Ive been taking antidepressants since 1993, for depression and dysthymia. I think they probably help me, but who knows? Maybe it is all placebo effect. What is do know is that generally life is easier when Im taking them. I dont experience any terrible side effects from them. Ive gained some weight, but Im still easily within the normal range, and many men gain weight in their thirties, whether or not they take medication. I have mixed feelings about continuing to take medication for the rest of my life, and I sometimes consider alternatives like St Johns Wort, or maybe just trying six months without medication, at some point when my life becomes stress-free and stable. (This might possibly happen when I retire in thirty years.) But on medication Im productive and Im rather reluctant to endanger my productivity by changing medication.
Nevertheless, I can imagine feeling happier, more productive, more satisfied, more cheerful, friendlier, and calmer. I wonder whether my medication has subtle side effects, and whether I can blame it when my life doesnt go exactly as I want. So I thought about trying the ASP. I thought about it some more. But I didnt do it. I do get some exercise already from walking and jobs around the house and garden, and I eat pretty well, although I probably get too much saturated fat from potato chips and dairy products.
Ive little doubt that if I went on Dr Hedayas program Id feel better than I do, in the long run, even if it meant depriving myself of some indulgences and experiencing some sore muscles in the short term. But then I expect that anyone who went on his program, whether or not they take medication, would feel better in the long run. For those who take psychiatric medication, it would be astonishing to find a psychiatrist who is sympathetic and ready to listen to the possible subtleties of side-effects, digestive issues, the various moods and odd ideas that they experience, and all the other aspects of life covered by "whole psychiatry."
thumb up or down? Would I recommend this book? In the end, despite my feeling that it is far less original and useful than the author thinks, it could be worth reading. The very act of buying it and then reading it could prompt you to do what you already knew you should, i.e., eat better and get more exercise, and insist to your psychiatrist that he or she comes up with some resourceful and helpful suggestions for fine-tuning your overall well-being.