In 1957 a Swiss man named Roland Kuhn reported that the chemical imipramine had a remarkable effect on patients with depression. He wrote: “They again become interested in things, are able to enjoy themselves, despondency gives way to a desire to undertake something, despair gives place to renewed hope in the future.”
And so the world’s first antidepressant was born.
Imipramine was widely used in treating depressive disorders for the next 30 years, but has since been in decline as newer, apparently smarter medications are developed. Now some 60 years since Kuhn’s breakthrough there is a gamut of antidepressant and antipsychotic prescription drugs available, each one more powerful and nuanced than the last. And I have tried them all.
I was first diagnosed with clinical depression when I was 19 and I have been medicated ever since. For the first ten years I was on the same antidepressant, Cypramil, my therapist adjusting the dosage up or down depending on my general mood. And though there were plentyof dark times, I survived that first decade without any major episodes or disruptions to my everyday life. I was what the professionals call a “high functioning depressive”.
My diagnosis was upgraded to “major depressive disorder with melancholia”, a subtype of clinical depression that basically means you don’t want me at your party.
But the years since have proved more of a struggle, as the Cypramil stopped working and my depression intensified. My diagnosis was upgraded to “major depressive disorder with melancholia”, a subtype of clinical depression that basically means you don’t want me at your party. Despite my psychiatrist’s best efforts, and a cocktail of the alleged best meds on the market, my relationships strained, my job suffered and I gradually slid from high functioning to almost catatonic. I began having crippling panic attacks and frequent suicidal ideations, and early last year I had a nervous breakdown that tore my life apart.
To add insult to mental injury I have been classified as “treatment resistant”, which is every bit as awesome as it sounds. Every medication I have tried since the Cypramil lost its sheen has either flat out not worked, has worked for only a brief period, or has brought with it side effects so severe as to prove dangerous to my health. I go on and off medications roughly every few months, meaning I am in an almost perpetual state of withdrawal, and if you want to know how this feels just try sitting in a sauna and slapping yourself in the face repeatedly while simultaneously electrocuting yourself.
Lithium, Lyrica, Solian, Mirtazipine, Lexapro, Efexor, Risperdal, Abilify, Diazepam – these are just some of the many prescription medications I have tried in the past two years. Most of them have proved ultimately powerless in the face of my overwhelming aptitude for despair, and many have brought with them a smorgasbord of side effects from the slight to the serious. Depression may be a malady of the mind, but its battleground is very much the body. I’ve had cold sweats, hot flushes, dry mouth, hand tremors, convulsive fits, dizziness, headaches, vomiting, insomnia, lethargy, nausea, hyperprolactinemia, and a brutally disrupted menstrual cycle. Plus, thanks to one medication in particular, in the past six months I’ve gained at least one Olsen twin in weight, possibly two..
With all this in mind I have recently been questioning whether we’ve made any real medical strides since Roland Kuhn’s 1957 discovery. Does the sheer number of drugs available to treat depression and other psychosomatic illnesses imply advancement in the field, or are they all simply band-aid solutions, inevitably doomed to fail? What happened to the promise of Prozac?
Many mental health professionals argue that we are still very much in the dark when it comes to understanding the pathways that induce depression, and thus in effectively treating the illness. Those in this camp tend to argue that medications purporting to “treat depression” in fact serve only as temporary relief for the symptoms of depression without affecting the source of the illness. My psychiatrist analogises that this is akin to treating the pain caused by a broken arm while ignoring the fractured bones.
Depression may be a malady of the mind, but its battleground is very much the body.
At the head of this branch of thought is the US National Institute of Mental Health, which in 2014 announced that it would no longer fund clinical trials that aim only to ease psychiatric patients’ symptoms without addressing the route cause. Instead, NIMH director Thomas Insel said: “Future trials will follow an experimental medicine approach in which interventions serve not only as potential treatments, but as probes to generate information about the mechanisms underlying a disorder.”
There are countless hypotheses out there for what causes depression, be it a chemical imbalance, a genetic certainty, an auto-immune disease, a brain defect or some combination of the above. Research is being carried out every day, all over the world in the hope of identifying the source of the illness and finding better treatment options. But at present we remain largely ignorant on the subject, and thus the estimated 3 million Australians living with some form of depression or anxiety must continue with treatments that may or may not alleviate their symptoms.
For me, well last week I started taking Imipramine because apparently I’ve now gone through all the modern drugs available. It’s too early to tell whether it’s working or not, nor what wonderful side effects it will bring with it, but I’m pinning all my hopes on Roland Kuhn for now, because unfortunately I don’t have another choice.
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