Side Effects, a film released last month, centres on a woman diagnosed with depression. When her treatments lead to a devastating act, her psychiatrist becomes obsessed with uncovering the truth behind the tragedy.
The subject matter will inevitably prompt audiences to reevaluate their views of mental illness and medication. But how much of the movie is true to life, and how much is dramatic hyperbole?
The film starts with a vivid, sympathetic portrait of depression. As Emily Taylor (Rooney Mara), welcomes her husband, Martin Taylor (Channing Tatum) home from prison, she falls into a state of despair. She describes her feelings as a “poisonous fog,” which saps her strength, leaving her unable to work or concentrate, and deprived of her former joys.
After she deliberately slams her car into a wall, she begins a course of therapy and antidepressants with Dr. Jonathan Banks (Jude Law). She reacts poorly to the medication, and asks to try an experimental new drug. Things take a turn for the worse, and Banks desperately tries to salvage his integrity and his career.
“You are a victim of circumstance and of biology,” Banks tells Emily. In Canada, 8 per cent of the population will experience depression sometime in their lives. Often, it can be traced back to a specific trigger. In other cases, it seems to come out of nowhere. Dr. Perry Adler, a clinical psychologist at the Herzl Family Practice Centre of the Jewish General Hospital, compared the emergence of depression in a person with Chinese water torture. “Each individual drop is innocuous,” he said in an interview with The Daily. “A sad event here, a betrayal there. Over a period of years, it adds up.”
Pharmaceutical companies tend to highlight the biological underpinnings of the disease. In commercials and websites, they give equal weight to physical and emotional symptoms, and frame the disease in terms of chemical imbalances.
These same companies have a clear incentive to emphasize the biology, but this view may have another benefit. Lingering stigmas – that depression is a sign of weakness, that the victim is somehow to blame – leave many sufferers unwilling to seek treatment. A biochemical account can help people accept depression as a treatable medical condition, on par with heart disease or diabetes.
However, chemical imbalances are not the whole story. People with depression have less neural plasticity, which can be caused by exposure to stress. As a result, they have trouble forming chemical connections in brain regions that process positive emotions. Antidepressants can help boost plasticity, but ‘the gold standard’ for treatment combines antidepressants with what Dr. Adler calls “talk therapy.” Through the help of a trained professional, patients can learn new coping strategies that help reestablish some of those positive links. Without this extra step, Adler says, many patients relapse when they stop taking antidepressants.
Non-pharmaceutical treatments have also had some success at treating major depression. Dr. Marcelo Berlim, a psychiatrist at the Douglas Institute, is also the director of the Neuromodulation Research Clinic. Neuromodulation encompasses several techniques that deliver controlled electric or magnetic pulses that can either stimulate or inhibit key areas of the brain. Like antidepressants, these new treatments are not cure-alls, but Dr. Berlim believes the results are promising.
At McGill, students can seek treatment for depression at McGill Mental Health Services (MMHS). While MMHS offers both short-term therapy and medication, it remains cautious of prescribing antidepressants to students. The former director of MMHS, Dr. Norman Hoffman, recommends caution when dealing with Selective Serotonin Reuptake Inhibitors (SSRIs), a class of antidepressants, which increase the level of serotonin in the brain. In a set of recommendations for the Canadian Organization of University and College Health, closely reproduced on the MMHS website, he states that while SSRIs are effective in treating major depression, this diagnosis is rare among young adults. Instead, university-age students experience a range of depressive states, which are liable to change. The effects of SSRIs have not been well documented among young adults. Studies have shown that adolescent and young adult brains are still developing, so hasty interference with pharmaceuticals may actually leave youths more vulnerable to depression later in life. Hoffman believes that labeling depression as purely “biological” is misleading. “While it is important to continue to destigmatize mental illness,” Hoffman believes that “this is best done by helping individuals deal with their emotional difficulties and needs rather than by labelling them.”
Still, pharmaceuticals remain deeply ingrained in psychiatric practice, and that’s unlikely to change anytime soon. In Side Effects. the psychiatrist Dr. Banks plays up a more insidious relationship between doctors and ‘big pharma’. In between writing prescriptions for his wife and lunching with pharmaceutical representatives, Banks rakes in money conducting clinical trials for drug companies. “Everyone takes them,” he says of pills. “They just make it easier to be who you are.”
The pill culture portrayed in the film is undoubtedly exaggerated for dramatic effect. “If someone said, ‘I’m sad because the Canadiens lost,’” Dr. Berlim commented, “and the doctor gave him a pill, that would be malpractice.”
While the events in Side Effects may not be the norm, they tell a compelling cautionary tale. “I tend to mistrust doctors who say ‘I’ll do what I want, [the pharmaceutical companies] won’t influence me.’” Dr. Berlim noted. But, “the idea is not to bash the industry. Doctors should be patient advocates. You’ve been trusted to offer guidance and you’re doing the best you can with the least bias that you can. The doctor should be someone who tries to be independent and skeptical.”