Sunday, June 9, 2013

Meditation on drugs

Recently a couple of friends admitted something to me.  They both asked me not to judge them, and then sheepishly told me they were taking antidepressants.  On both occasions I looked back at them and said, 'Me too'.

In fact, I've been taking them, off and on, for about a decade, ever since I began having chronic pain.  After trying a number of different drugs, I was prescribed amitriptyline.  It was easily the most helpful medication I'd been offered, and I've stuck with it.

Amitriptyline is an one of a family of older-generation drugs called tricyclic antidepressants.  It affects the levels of both serotonin and norepinephrine in the brain, unlike the newer SSRIs, which more precisely target the reuptake of serotonin.

Nowadays it's very commonly prescribed for chronic pain, usually at a lower dosage than is indicated for depression.  I started off taking 20mg a day in England, which helped me finish my first degree but left me in considerable pain. 

In my first three years in California (with the help of more liberal doctors) I was on 100mg a day.  I had periods when I was pain free, and though I did feel the side-effects (drowsiness and dry mouth) more strongly, I felt that the drug would never do me any harm.

That all changed one winter when I started taking 150mg a day because of some extra pain deriving from some dental surgery.  I began feeling very depressed, and noticed that I was twitching, itching, and sweating profusely all the time. 

I didn't know it, but those were the symptoms of 'serotonitis', an overdose of serotonin.  When I realized, I went cold-turkey, which immeditately made me feel better but which brought the same symptoms on in a more intense form.  I remember sitting in the Castro Theater one night in that period, sweating and itching and twitching, watching some noir classic in a strange euphoria of relief.

After that I was more cautious.  In the last few years I've gone off the drug completely a few times, only to go back on it again.  In some ways being off it isn't that different; I feel the pain much of the time in both states, but it feels more distant and manageable when I'm on the drug (and sometimes it's completely absent). 

Both of my friends who talked to me about antidepressants had spiritual or religious doubts about taking them, so I thought I might raise the issue here.  Are antidepressants antagonistic to a spiritual practice, or complementary? 

I can't answer the question definitively, partly because there are a lot of different drugs and practices out there.  But I have looked into this a bit online, and it might seem at first as if meditation and antidepressants are doing more or less the same thing, since they both raise levels of serotonin in the brain.

This is actually more complicated than it seems, though.  One recent Norwegian study (with only 27 subjects) suggested that regular meditators had higher levels of serotonin than non-meditators, but that meditation itself seemed to reduce the level of serotonin in their blood. 

An older Harvard study appeared to show that people who meditated produced the same amount of norepinephrine (a 'fight or flight' drug), but that it had ceased to trigger an emergency response in meditators. 

So the scientific evidence on this appears complex, and I'm not particularly well-qualified to assess it.  Looking at this from a traditional Buddhist angle also raises some hard questions, such as whether antidepressants should be discouraged as intoxicants, or encouraged as pain-reducing medicines.

I'm not sure that I have much to add from than angle, either.  But I can say a bit more about my own experiences of meditation and one kind of antidepressant, in the hope that it may be useful to other people who are in a similar situation.

I've practised meditation through the whole period I've been on amitriptyline, usually for twenty minutes a day, though occasionally less (and very occasionally more) than that.  Of course all I can do is tell you what it felt like to me (which may not be unimportant).

I think that meditation without the drug is more challenging.  My mind is more anxious and I'm distracted by pain more.  On the other hand, it's also more rewarding, since the difference between my state of mind before and after sitting is more dramatic.

When I'm on a lot of the drug, meditation is often very pleasant.  I breathe in, I breathe in, and it all flows along very pleasantly.  But in some way it feels more superficial.  I feel like things have gone more smoothly but that I have gained less insight about myself and my condition.

Ultimately, the plan is to go off the drugs.  The plan (often revised) usually involves doing more and more meditation as I slowly come off it.  Unfortunately, I've been too busy lately to commit to longer retreats of the kind I had in mind, so full implementation of the plan will have to wait a bit longer.

In the meantime, I try not to beat myself up about it.  Some people take insulin for diabetes.  Other take statins for high cholesterol.  I take amitriptyline for chronic pain.  I also meditate, which is cheaper and doesn't make my mouth dry.  In other ways they're just two different things that help. 

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