Is this how antidepressants work?

August 4, 2018 11:33 PM

I'm feeling depressed because some truly terrible shit is going down in my life. Is this what antidepressants are for?

I was considering asking my doctor for an antidepressant prescription. But I'm not sure if this is "correct" usage of antidepressants. Here's the deal:

-- Almost 20 years ago, I had a period of deeply sad feelings that were out of proportion to the actual reality of my life. I described this to my GP, and answered honestly that I had no desire for self-harm. He prescribed me Celexa, and the deal was I had to check in with a psychiatrist once every few months to get my prescription renewed. This wasn't therapy, it was really 15 minutes just to make sure I wasn't suicidal. I never was. I stayed on the Celexa for maybe 18 months, then felt that I had a better grip on my feelings. I don't remember any of the dosages, but I think I'd started on 1.5 pills per day, then was on 1 pill per day for a long time. I decided to self-wean, without discussing it with either doc, and dropped down to .5 pill per day, then .5 every other day, then just stopped. All was well, and my life moved along.

-- Now, some objectively horrible stuff is happening in my life -- mostly revolving around my best friend being in a long, drawn-out and most probably fatal bout of cancer. It's horrible. There is literal pain and suffering every day in my life now. I'm finding myself crying a lot -- which is normal, I acknowledge. But after a few weeks of crying maybe 5x per day, I'm wondering if antidepressants might be helpful. (To be clear: I have no thoughts of self-harm whatsoever. I'm just super, super sad.)

But it occurs to me that I don't understand if this is how antidepressants work. Is my sadness due to some brain chemistry that medicine can fix? Or is my sadness just due to the shitty, sad thing that is happening, and antidepressants would not help?

I don't take any other relevant medicines, and I am already engaged in typical mood-lifting endeavors like getting some exercise, some sun on my face, some time off from the terror of death by cancer, etc. But I'm still so damn sad. Would appreciate any advice in this matter.

posted by anonymous to Health & Fitness (14 answers total)

So, part of depression is focus on only the bad. You're crying everyday over something serious, but...it's also not the entirety of your life . There is likely a bunch of other stuff happening too some good, some bad.

Medicine may make it possible to switch emotional tasks, so to speak. So when your doing something you enjoy...you feel enjoyment! Even if terrible things are happening.

For me, to make the decision if an anti depressant would be useful I would ask these questions of myself: are there daily life activities that I should do that I'm not doing because of my feelings? Are there activities that I use to enjoy that now when I do them I feel nothing or sadness ? Has my sleep changed? Are my life activities (work, cooking, childcare whatever) impacted in a negative way by my sadness?

If the answer to some or all of these is yes, then an antidepressant might help.
posted by AlexiaSky at 12:37 AM on August 5, 2018 [9 favorites]

I wouldn't discount talking to a psychiatrist or even just your family or close friends. You're going through some heavy shit. Talking about it can help.

From what I understand, it's rare that an anti-depressant is helpful without some kind of therapy. If you're stuck in negative thought patterns, you might need chemical help to get out of that rut but you also need help to stay more stable. It doesn't sound like you have the emotional support you need right now.
posted by Merus at 1:37 AM on August 5, 2018 [2 favorites]

I'm not a doctor, so I'm not going to tell you whether or not you need anti-depressants. But I'll relate my experience.

I've had two periods in my life when I've needed anti-depressants - both times for about 18 months. Each time I was going through some tough situations - first in an almost intolerable work situation, and the second time after my marriage broke down and I had to take on a large financial burden.

Like you I wasn't taking any other medication, and was taking good care of myself, never ever thought of self-harm. But I definitely needed help, and the anti-depressant (Seroxat - Paxil in the USA) gave me some equilibrium to help me cope with the problems in my life. Within a relatively short period of time after starting Seroxat, I felt more able to cope, felt less anxious, sleeping better - and as a result I was able to gain perspective on what was happening around me. It didn't change what was happening, but it definitely helped my ability to handle it and to make better choices about how to deal with it.

Since then I've had what I would describe as situational depression - shit going on that's really brought me down, such as having to have elderly pets euthanised, or walking away from a toxic friendship. But I've been able to lift that kind of depression , by doing things to make me feel better, such as a spa day, volunteering at an animal shelter, nice food, clean sheets on the bed, etc..

And I've been able to recognise that this situational depression is a completely different animal from clinical depression, for which I needed that medication those two times. That's because no matter what was going on in my life, when I was clinically depressed, nothing I could do to try to help myself - exercise, sunshine, holiday, shopping, sex, animals - made me feel any better.

I'm pretty sure I would be aware if I was sinking back into that hole where there is an absence of light and where there is nothing I can do to stop the sadness. Listen to your body.
posted by essexjan at 2:10 AM on August 5, 2018 [10 favorites]

A relative of mine took Prozac for a short period of time (several months, I think) after a sudden and devastating bereavement. She had been so consumed with grief that she was unable to sleep or eat, and the medicine let her do that again, which made it possible to at least get through those months. She says it helped her. Under similar circumstances, I would also ask my doctor about antidepressants.

I’m very sorry for the pain you’re going through now and I wish you all the best in coping with it.
posted by daisyk at 5:08 AM on August 5, 2018 [3 favorites]

Is my sadness due to some brain chemistry that medicine can fix? Or is my sadness just due to the shitty, sad thing that is happening, and antidepressants would not help?

Whether antidepressants will help or not really doesn't depend on why you're sad, because brain chemistry both reflects and conditions brain activity. Thinking about shitty, sad things affects brain chemistry in much the same way regardless of whether those shitty, sad things are rooted in the external world or in the internal stories we habitually tell ourselves about ourselves, and messing with our brain chemistry will change the way we think regardless of whether we're stuck in a hole of our own brain's making or one the outside world has dug for us.

If shitty, sad things are happening and you start a course of antidepressants, you will most likely find yourself reacting to those things with somewhat less sadness, because you have altered your brain's chemistry in a way that makes that happen. Whether or not you actually experience the resulting state of affairs as better is a bit unpredictable, though.

About thirty years ago, not long after Prozac first appeared on the Australian market and started being ballyhooed in the media as some kind of wonder drug, a friend and fellow inner-space cadet got hold of some and started taking a normal therapeutic dose just to see what would happen (he wasn't depressed, just curious). He gave it up after two months, because his formerly borderline-intolerable shitty job had become easily tolerable and he found that utterly disconcerting; he didn't want to be the kind of person who would be completely OK with an employer just walking all over him that way.

I'm still so damn sad. Would appreciate any advice in this matter.

Happiness is not mandatory, and it's arguable that trying to put on a happy face whilst in the middle of a genuinely awful experience is maladaptive and can even be a bit grotesque. If we're in the middle of a pile of shit then it's completely healthy and appropriate to feel shitty about it because that's usually what's required to motivate us to do something about it instead of just wallowing.

But if there's genuinely nothing you can do to fix the shit you're in, and you find yourself suffering more persistent and/or intense grief than you think is appropriate given your circumstances, and you just need a bit of a break from that to get yourself together, then antidepressants can certainly give you that. Be aware, though, that using them causes personality changes that can alter the ways in which you relate to those close to you, and that those changes might not be perceived either by those people or by you as improvements.

We are our neurocircuitry, and if yours isn't working as you'd prefer that it did, there are all kinds of tools you can wield to try to change that. Just remain aware that all psychoactive drugs are powerful and profound, all psychoactive drugs have side effects that you might or might not find more troublesome than whatever problems prompted you to try them in the first place, and that quite a lot of the time a bit of sun on your face and taking time off when you need it and eating well and making sure you get good sleep is the best that can be done until the shit tide goes back out again.

But when none of that feels like enough - when you find yourself so hemmed in by awfulness as to feel helpless in the face of it - then altering your brain chemistry with psych drugs is sometimes exactly the right thing to do. Just don't do it on your own. Work with health care professionals who have experience with prescribing the drugs in question and keep them in the loop about how they're affecting you.
posted by flabdablet at 5:36 AM on August 5, 2018 [7 favorites]

Also very helpful to have that prior experience with Celexa under your belt, because you're already familiar with the tradeoffs involved with using that substance. If it did good things for you on balance the last time you needed it, it will probably work similarly for you again.
posted by flabdablet at 5:41 AM on August 5, 2018 [2 favorites]

You can talk to your doc about this and ask about going back on Celexa and get their advice. You can see if that seems to help and taper off (preferably working with doc) if you find it's not helpful.

This article about situational depression does mention anti-depressant medication as a treatment option.

I'm so sorry about your friend's illness. Thank you for being there for her.
posted by bunderful at 7:33 AM on August 5, 2018

Though asked under the category Health and Fitness, it may be more suitable for Religion and Philosophy. There are certainly psychiatrists who will prescribe antidepressants in your situation and it is possible that the "correct" one will make you less sad. I don't believe that there exists some correct amount of sadness which is the appropriate for your situation and that science can tell us what that is. At the same time, I do believe that one's feelings can be out of proportion to what is happening and that one might want to address that possibility. In my way of thinking, this could occur in your case because other sadnesses from your past (and present) have taken the opportunity to hitch a ride on what's currently happening, not because of some sort of chemical imbalance but,there's no way to prove this objectively. I doubt that taking a pill and making your sadness disappear would feel right to you and I doubt that would happen in any event but it's ultimately your choice what you want to do in this situation. It certainly can't hurt to talk this out with a professional.
posted by Obscure Reference at 7:41 AM on August 5, 2018

You may have situational depression. Sometimes life is hard and that makes you sad. Especially when you are stuck in a place that actually literally is hard. Cognitive behavioral therapy can help if you are having distorted thinking, but when you are actually in a tight spot, therapy is more of a support than a fix/change. Antidepressants can give you a boost and so can therapy, but in situational depression, a boost is all you may get. Life will get easier with time, I hear.

Please get a bit of a boost with meds and therapy if you think it will help.
posted by Kalmya at 7:50 AM on August 5, 2018 [1 favorite]

I am so sorry about your friend. It sounds incredibly hard for both of you.

There’s something called “adjustment disorder” which is basically the clinical term for “really going through some shit.” (It’s sort of an odd term - was diagnosed with it after my dad died and I moved to another state, and I was like “wtf, you mean I’m supposed to adjust to this in an orderly manner?” But it’s the same thing as situational depression.) Depression with an external trigger can behave a lot like depression that stems from a glitch in your brain chemistry, and they can be treated similarly. The threshold for either is “is it interfering with your daily life?” It sounds like it is.

Trying medication doesn’t mean your feelings right now are wrong or exaggerated, nor does it mean your medicated feelings will be inauthentic or blunted. Depression, situational or not, often makes your brain repeatedly get stuck in the same pits, and antidepressants can help keep your brain from rolling right into those pits over and over again.

I think it’s a good idea to try, under close supervision of a psychiatrist. It’s also worth finding a therapist you click with: you’re providing a lot of support to your friend who can’t fully reciprocate, and you need adequate support for yourself too.
posted by Metroid Baby at 8:07 AM on August 5, 2018 [3 favorites]

I took sertraline for about 18months to help cope with a reactive depression (situational depression). The situation was that my youngest child was diagnosed with autism and it became rapidly obvious that it was very severe and he is profoundly disabled by it. His care needs were very high and coming to terms with the situation was very hard and I was struggling to do both at once. I had enough energy to care for him but every day the grief at what he was going through, and we a'll as a family were facing was a fresh agonising cut. The SSRI really helped me to survive the initial rawness. 18 months on I'm off the SSRI and he's obviously still disabled! But the SSRI made both the caring and the coming to terms that tiny bit easier so I could manage them both while I adjusted. We are in a peaceful and positive place now with our beautiful quirky son and with the life we can help him have. Talk to your Dr.
posted by intergalacticvelvet at 2:24 PM on August 5, 2018 [4 favorites]

The term you're looking for is "episodic depression," and yes, medication can be prescribed for it. Different meds may be indicated than for chronic depression however, as some antidepressants are easier to stop/start than others. Totally worth discussing with your doctor. Be sure to emphasize that you just want something to help you get through a temporary rough patch, and that you do not anticipate wanting to take antidepressants permanently.
posted by Anticipation Of A New Lover's Arrival, The at 4:22 PM on August 5, 2018

I think the short version of your question is, can antidepressants help me, and I think the short answer is, maybe. Your question is kind of like, am I getting wet because it’s raining or because I’m walking by a sprinkler, and the answer is, I can’t say based on what you’ve said but a rain jacket and umbrella may help.

In general, I think most people aren’t on most prescription drugs indefinitely which suggests to me that your case isn’t unusual - drugs may help you get over the hump, so to speak. On the other hand, I’m on antidepressants indefinitely but I’m okay with that. I think my life is better on them than not so here we are.

A reason I say “maybe” and not “probably”, aside from the fact that I’m not a doctor and not your doctor, is that antidepressants vary widely. If you find something that works for you, stick with it. If not, keep looking.

Since you seem hesitant to use antidepressants, maybe it would be helpful to spend a few weeks making sure you’re getting enough sleep, exercise, and healthy food. If you’ve got those bases covered and you’re still struggling, I’d encourage you to try antidepressants. For me, they didn’t make me stop feeling sad when it’s appropriate to feel sad, they just evened out the feelings so my lows aren’t catastrophically low. Good luck.
posted by kat518 at 9:38 PM on August 5, 2018

1) most anti depressants take at least 6 weeks to kick in, by which time therapy and the nature of situational depression may have combined to lift you out of the worst of it, but

2) n=1 experience, antidepressants do work, and adjunctive therapy like lithium can work within days, even when the depression feels like something that is a totally logical response to a shitty life situation. the situation will still be shitty, but it is possible to feel radically different about it.
posted by ahundredjarsofsky at 11:39 PM on August 5, 2018 [1 favorite]