I watched the Prince Harry-Meghan interview. I believe them and I feel compassion for their difficulties. If it were up to me and I were a British taxpayer, I would be using this occasion to demand the end to the royals. I even had a diary drafted on that subject. If royals are just as ignorant and racist and classless as the rest of us, what’s the point?
But after reading some of the pushback today of the “she can’t be depressed, she’s a princess” variety, I would like to address a more important subject. I have a Bachelor’s degree in Psychology, FWIW. A graduate degree is required to do much with that, so I don’t usually wave that credential about the site, but I think it’s appropriate here. I didn’t study further because I’d entered the field wanting to find out why people, including myself, act “so weird”. The answer was, and continues to be, no one knows for sure.
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Over the decades since I completed my degree, there has been an ongoing debate about mental and emotional disorders in general, whether they are due to nature versus nurture. But I think it is pretty clear that it’s both. There are anxiety- and depression-producing circumstances, such as financial anxiety and cyberbullying and feeling trapped in circumstances outside your control. Yet many people rise above these. There are also life experiences that are wonderful for most people, yet some will have anxiety and/or depression anyway, most famously post partum.
So what is the difference? Almost assuredly, brain chemistry (hormones too, but again, some handle changed hormones with ease whilst others find them extremely difficult). Sure, as a society we could help by providing the best circumstances for each other and supporting each other through life’s ups and downs. I fervently wish we would, but that is clearly a work very much still in progress. Sure, as individuals we can seek out self-help groups and cognitive-behavioral therapists and work on our coping skills. It all helps. For some, such changes will be enough, and they are certainly worth exploring.
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But sometimes, it just takes medication. The most effective medication, the SSRIs, are selective serotonin reuptake inhibitors. You might recognize the brand names Lexapro and Paxil, as examples. Serotoninis a brain chemical “that stabilizes our mood, feelings of well-being, and happiness”. We all have some. Other brain chemicals may have multiple roles, so it’s best when a medication targets serotonin selectively. The difference between up and down moods may be how much serotonin is activated in the brain. So when we feel good, our brain cells shoot out serotonin to communicate with each other. The serotonin is then taken back up by the cells (reuptake) to gradually wind down the good feeling, and prepare for the next feeling in whichever direction. SSRIs inhibit that reuptake so that the good feeling lasts longer. That’s it. It’s a way to compensate for a presumed lack of adequate serotonin without just giving serotonin, the optimal amount of which might be more tricky to determine. If you take an SSRI, the effect is very gradual, but you will probably feel better in a few weeks to months.
So please, enough of claims that “your circumstances aren’t that bad, you can’t possibly be depressed”. Although we all may wish we could be royalty, in the end it’s the luck of the draw in your inherited brain chemistry, not circumstances, that may determine your moods.
If you are feeling suicidal or even less-than-suicidally distressed, there is help. In the US, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Outside the US, just Google “suicide prevention” for a phone number near you.
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Editing/Updating to add: From Stephen Dreyfus in the Comments (Master’s degree in Psychology):
I highly recommend... Let Them Eat Prozac: The Unhealthy Relationship between the Pharmaceutical Industry and Depression, by David Healy. Healy points out the brain has hundreds of neurotransmitters and the idea depression is only linked to serotonin is a specious argument. I was so impressed with this book’s warnings about the dangers of SSRI-Antidepressants, I wrote a book report for my college Psychology students to read , called SSRI’s: Rx for Suicide.
IMO, of course depression and anxiety, like all complicated human traits and states, have multiple causes including the involvement of multiple neurotransmitters. But if treatment can be kept relatively simple, side effects can be kept relatively mild. SSRIs have worked well for people I know, with minimal to no side effects, and my link above shows that that result is widespread. At the same time, definitely, SSRIs will not be the solution for everyone. Humans differ from each other physiologically to an amazing degree. The brain is likewise variable. So everyone who has tried therapy and found no solutions, should approach medications with an experimental attitude as well, and readily ask for changes in dosage or med types. It’s a process: Your doc is likely to start with what works for most, and then over time together find what works for you.
[Another example: After surgery they gave me morphine. Strong drugs, right? Nope. It had zero effect on me. You can imagine the twists and turns before I actually had effective pain medication!]