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Buddhadharma : Spring 2009
buddhadharma: the practitioner’s quarterly SPRING 2 0 09 76 had participated in two or more weeklong retreats, and had used antidepressants in the last two years. By far the most commonly used medications were selective serotonin reuptake inhibitors (SSRIs)—such as Prozac, Zoloft, and Celexa— which as the name indicates specifically inhibit the reuptake of the mood-regulating neurotransmitter serotonin. We asked these practitioners for detailed reports on their experiences while taking antidepressants, both in daily life and on retreat. We wanted to find out not only if the antidepres- sants seemed to help, but exactly how they helped, and what effects they had on mind, meditation, and daily life. The effects proved powerful and positive. Most of our sub- jects reported that antidepressants helped them with multiple emotional, motivational, and cognitive functions. Emotional changes were consistent with an antidepressant effect. The painful emotions of anger and sadness decreased significantly, but fear showed a smaller response. The positive emotions of happiness, joy, love, and compassion all increased, as did self-esteem. Motivation underwent an intriguing shift. Depression is often accompanied by a dispirited lack of motivation and inter- est, so it is significant that our subjects felt more motivated. Yet at the same time they reported that attachments or craving actually diminished. Clearly, they were reporting a motiva- tional shift in a healthy direction. Subjects also felt calmer and that their awareness was clearer. One would expect this kind of result, given that the subjects were no longer wrestling with intense, painful emotions. Two benefits we had anticipated were not clearly displayed by the participants. During depressive episodes, people often complain of low energy and poor concentration. Consequently, we expected that successful antidepressant treatment would improve energy and concentration. However, while there was a trend in this direction, it did not reach statistically significant levels. The largest effect of all was a dramatic increase in equa- nimity. Equanimity is the capacity to experience provocative stimuli fully and nondefensively, without psychological dis- turbance. It is highly valued across contemplative disciplines, and has been described as “divine apathea” by the Christian Desert Fathers, “euthymia” by Stoics, “dispassion” by yogis, and “serenity” by Hassidic Jews. In Buddhism, equanimity is one of the seven factors of enlightenment (seven mental quali- ties that are particularly vital for spiritual maturation) and the last of the four immeasurables, or four divine abodes, of loving kindness, compassion, empathic joy, and equanimity. What We Have Learned What do these findings suggest? Clearly, the large majority of these meditators felt that they, and their spiritual prac- tice, benefited significantly from taking antidepressants. The changes they described bear this out. In fact, whether looked at from either a classical contemplative or a contemporary psychological perspective, the multiple benefits they describe suggest greater psychological and spiritual well-being. Several subjects reported that the antidepressants enabled them to recommence or significantly improve their medita- tion and spiritual practice. In addition, two subjects spontane- ously reported that antidepressants gave them a lift that they were subsequently able to maintain with meditation alone. This observation that meditation may maintain gains initially obtained with medication is particularly important because it is now painfully apparent that major depression can be a long- term, relapsing condition, especially if left untreated. In fact, the longer major depression goes untreated, the more likely it is to become chronic, to relapse, and to become resistant to treatment. Early effective treatment and relapse prevention are crucial. But how to prevent relapses is the challenge. Most physi- cians—and therefore their patients—now rely on long-term pharmacotherapy alone, even though once medication has alleviated the initial crisis, psychotherapy is sometimes more effective in preventing relapse. A similar pattern is emerging for other psychological disorders, such as panic disorder and obsessive–compulsive disorder. Here, too, initial medication can be helpful or even essential, but psychotherapy is some- times more effective for maintenance. Certainly some people continue to require medication to prevent relapse. But psycho- therapy helps others to maintain their health after eventually stopping the medication. It seems likely, then, that meditation and other spiritual practice—especially daily, long-term practice—might also help to prevent relapse and maintain health. In fact, the combina- tion of meditation and cognitive therapy in mindfulness-based cognitive therapy has already proven particularly helpful in preventing relapse back into depression. Limitations of Antidepressants Of course, antidepressants are not panaceas. They do not work well for everyone and, like all drugs, can have side effects. Unfortunately, they are often the only treatment offered by some physicians, and the only one medical insurance will pay for, even though they work best when carefully titrated by a psychiatrist and combined with other approaches. An optimal combination might include antidepressants, psychotherapy, spiritual practice, and a healthy lifestyle. Such a lifestyle would certainly incorporate exercise, which can Most of our subjects reported that antidepressants helped them with multiple emotional, motivational, and cognitive functions. The largest effect of all was a dramatic increase in equanimity. ➤ continued from page 35