What happens to a writer’s creative output when he or she takes anti-depressants? It’s a myth that treatment harms creativity, according to numerous poets and other creative artists, as well as those who treat them.

Richard M. Berlin, M.D., is a psychiatrist whose book of poems, How JFK Killed My Father, won the Pearl Poetry Prize in 2002, and whose poetry appears monthly in Psychiatric Times

An Associate Professor of Psychiatry at the University of Massachusetts Medical School, Berlin is the editor of Poets on Prozac: Mental Illness, Treatment and the Creative Process. In our interview, he reiterated that treatment won’t make a person creative, but it will at least open the door to that possibility.


Q: It seems so many emotionally troubled people think of taking pills as “cheating,” including one or two in your book. Yet no one ever worries that drinking alcohol is cheating, and many of those same people drink or drank heavily. Why do you think that is?

RB: While alcohol is a commonly used psychoactive substance, the antidepressant and antianxiety medications account for billions of dollars in market share and are among the most commonly prescribed medications in the United States.

When I was writing the introduction for Poets on Prozac, I was fascinated by the higher rates of antidepressant and antianxiety medication being prescribed in the U.S. as compared to Japan. The Japanese place a much higher cultural value on suffering as a stimulus for growth and change than Americans. Of course, the Japanese also pay a price with a higher suicide rate.

Cultural values and stigmatization erode trust, and the disturbing overlap between the medical profession and Big Pharma also makes people uncertain about who to trust.  Which brings us back to alcohol, which is legal, cheap, “natural,” easily accessible, does not require a prescription, and provides short-term relief, even if its long-term effects are potentially devastating. Patients can use a drug like alcohol and also maintain a certain level of control over their care. However, “natural” remedies, including alcohol, are part of a billion dollar industry, are promoted heavily, and have a complicated pharmacology. What I tell my patients is that we have medications that have been studied for safety and effectiveness, and other medications that have yet to be tested.

Q: Why is individual response to particular medications so various? Seems like many of your poet/essayists have tried or are on quite a number of different meds.

RB: Unfortunately, that’s a common problem. We still don’t have a single psychiatric disorder which can be diagnosed with a biological test, and we still don’t understand the fundamental biology at play. For example, people know that Prozac increases a neurotransmitter called serotonin. But serotonin is one of hundreds of neurotransmitters, and an increase in brain serotonin usually takes a few weeks to work. For roughly half the people who take this type of antidepressant, there is no beneficial response. And everyone’s body handles medications differently: I see patients who have immediate effects from very low doses of medication and others whose dosing has to go way beyond the usually recommended limits in order for them to benefit.

This brings us to the doctor-patient relationship. Most of the time, we can find a medication or combination of medications that can be helpful, but alas, the process is one of educated guess-work and trial and error. The doctor needs to create a context of hope and trust, and be an active guide through the entire process.


Q: On the subject of regaining or retaining or accessing one’s creativity, how vital is the talking part of the “cure,” compared to the medicinal part?

RB:  Recent studies demonstrate that the combination of psychotherapy and medication tends to have a better outcome than either treatment alone. And perhaps most interesting of all, actual scans of the brain show changes in the same areas when patients respond to either medication or psychotherapy.

Q: I got the impression from some of the essays in your book, that as creative linguistically as these poets are, they aren’t above-average when it comes to psychological issues, in that they “think they’ve tried everything,” or “feel they have no other choice,” that sort of thing.

RB: Being ill and suffering really narrow a person’s viewpoint and resilience. In people with psychiatric disorders, an additional component is the distortion in world-view: people who are depressed tend to see things as hopeless, including the possibility of recovery, and people who experience delusions and hallucinations often don’t even see themselves as “sick.” So yes, people become less resilient, but that may be due to the state of being ill rather than an enduring trait.

Q: Is there really such a thing as “creative gestation” that happens during deeply depressed episodes? Does the brain need that sort of “rest”?

RB: Two of the poet/essayists write about their “creative gestation.” Gwyneth Lewis discusses her severe, recurrent episodes of immobilizing depression this way, and David Budbill compares his periods of depression to the cycles of growth and rest we see in the natural world.