Advice on antidepressants

October 24, 2008 12:49 PM

Antidepressant filter question #4529, I've searched the archive to no avail and I am wondering what antidepressant might be right for me. I know, I know, YANAD, but I am looking for anecdotal info.

I have been struggling with anxiety and depression, and it is poisoning the well of the rest of my life.

Okay, so due to my job, having a small child, and having had a tumultuous life the problem has come to a head, I have finally decided to go talk to a therapist. I don't want to turn into my Dad, and I sure as hell don't want to mess up my kid. So despite not being confortable with the thought, it is time for me to accept this problem and deal with it. I have been going to a therapist (not an MD, but a counselor) for about a month and a half.

I have a unspoken about but clear family history of Depression and Manic Depression on both sides and am going to make an appointment with a psychiatrist to look into antidepressants and maybe anti anxiety meds, as I fear that in addition to my stressful circumstances I may have a physiological problem too.

I am a male in my late 30's. I have always had terrible sleep problems. About 10 years ago I once was put on a low dose of paxil for that and it made me feel weird and made me unable to have an orgasm. I pitched them out after a couple weeks.

I am concerned about weight gain as well (does that happen to men the same way it happens to women? I don't know). I think picking up an additional 40 pounds will make me even more depressed than I am now.

From my research I see that there are different pharmacological types of anti-depressants, for the fellas out there what have been your experience with this. Obviously this is something I need to discuss with a medical professional, but I am hoping to gain enough info from people's anecdotes to at least give me some talking points.

I don't need critical responses please! On a ledge here. I just want some friendly advice from those who have experience with these types of meds and their side effects.

posted by anonymous to health & fitness (24 comments total)

Not a dude. But weight gain side effects can be countered with a bit more careful diet -- watching the carbs. You may want to peek at this website CrazyMeds for some "real person" info on different meds. Yes it's a bit of a crazy site run by a bit of a crazy guy but I've found it to be helpful. FYI Wellbutrin doesn't seem to have much of a weight-gain problem and low on the sexual side effects also. Some docs seem to give it in addition to other AD's. I take a WB and Celexa combo. Not that it's doing a hell of a lot for me, but I still have hope i guess. That's just my experience. Lots of people I know are doing quite well on a WB Celexa combo. Good luck. Oh yeah, I have actually lost weight and don't have any sexual side effects from these meds.
posted by Soulbee at 1:00 PM on October 24, 2008 [1 favorite]

I'm a female. I was on a low dose of Celexa (the only drug I have been on for mild to moderate depression) and was not able to reach orgasm after being on it for a few weeks. I also felt "weird". Nothing really phased me and I felt kind of boring. I felt that this was too much of a price to pay, and no way to live, and stopped the drug. If I were reasonable I would have searched for other alternatives with my psychiatrist but I got it into my head that all SSRIs would have this effect on me and gave up. I have made great strides with talk therapy, good self-care, and exercise, and do not currently take meds.

Be sure to mention your sexual side effects with Paxil and your concerns about weight gain with your doctor. I think it's still possible to maintain your weight or lose weight on some anti-depressants that may lower your metabolism or increase appetite. Even if you are on meds, it's still a matter of calories in and calories out. You may need to consume less and exercise more to avoid weight gain if you see this coming on with your new med. More exercise never hurts in the mental health department. It also wears you out and allows for better sleep.

I think it's great that you are aware of your mental health issues and your desire to not be a destructive parent. Your decision to see a psychiatrist a good one. Talk to her and see what she has to say. Keep exploring your options if you have adverse side-effects. Try to incorporate more healthy habits into your life that are known to be beneficial. Such as, continuing talk therapy, exercise, socializing with friends, gratitude, sunlight, adequate rest, Omega-3s and good nutrition.

Good luck.
posted by Fairchild at 1:31 PM on October 24, 2008

Prozac screwed up my libido and made me anorgasmic. Not fun. I switched to Wellbutrin, which has been fantastic. I think it's elevated my libido a bit, which is only a minor negative (no, really), but it's way less of a change than the Prozac was.

The thing is, you won't know if Prozac - or any other med - will cause side effects until you try it. And they all have side effects. You can try adding Wellbutrin to a libido-killer, to see if they counteract each other; or you can try just switching to a different drug (possibly WB, possibly something else). You just have to stick with it until t works.
posted by spaceman_spiff at 1:32 PM on October 24, 2008

Also not a dude, but these are the things I found useful/wished I'd known when I embarked on the path to getting medical help for brain chemistry issues:

1. When you're researching the available meds, make a list of which ones have side effects that would increase your anxiety/depression (just like you've already started doing) and make this list known to the physician - they can either clarify on rarity vs. likelihood, find a combination that may give you results with fewer side effects, or rule out specific meds as being entirely unhelpful to you. They may also insist that you try one you're worried about, but may be willing to let you try a less worrisome one, first, for comparison.

2. Take notes from the first day of taking a new med and record everything that seems relevant - mood, libido, energy levels, ability to focus, physical responses (like weight, dry mouth, shaking) and bring these notes in with you each time you see your doc. The only way for them to see the effects of their prescriptions is with a clear line of feedback.

3. You may, indeed, have to watch your diet and get more movement. I was already 30# overweight when I started taking meds, and they added another 50# because I didn't know how they would change my metabolism and cravings; by the time I realised what was going on, I was fighting an uphill battle. Agh. Plan some time into your day before you start taking the meds for movement (maybe with baby?) and start figuring out things you can replace in your diet to eliminate refined/process sugars & carbs, as these are the general culprits. Your doc may have more advice on this, so make sure to solicit their input. The good news is that these two changes in lifestyle are able to decrease depression in and of themselves, once you've got the habit.

4. No drug accomplishes everything even for the conditions they're intended for, and few drugs used in treating bi-polarity were originally intended for that use. That means all kinds of weird things can happen and the link may not be clear. Be aware of this when recording and reporting, because even something that seems completely unrelated could be tied to the new meds.

5. Make sure you've got a couple of people close to you paying attention to your energy levels, motivation/drive, food intake, sleep, and even how well you're communicating. They may notice things you're too close to and this is invaluable in determining how well a med is working (or if something worrisome is developing).

6. Be patient. They may try several different drugs on you, and some of them have only short-lived negative side effects while some are instantaneously repugnant or long-term soul-suckers. Try your best to take them for the requisite build-up period, at minimum, so that your doc can get a baseline if you need to be moved off to a better solution. Most of these meds require at least 6wks to reach an effective level in your system, and those six weeks can be a roller-coaster of adaptation and rejection.
posted by batmonkey at 1:33 PM on October 24, 2008

I also do not mean to imply that you are currently a destructive parent.

Again, best wishes and good luck. I think it's great that you are thinking about this and looking for ways to improve your life and feel better.
posted by Fairchild at 1:35 PM on October 24, 2008

My understanding is that while all SSRIs are acheiving the same basic effect depression-wise, its exactly this kind of side effect that differs in each patient/med combo. Let your doc know your previous reaction to Paxil, and try a few till you determine which is best for you.

NB: It may take a few weeks to determine how you are doing on each one.
posted by AuntLisa at 1:36 PM on October 24, 2008

I'm female. I've tried Lexapro, which made me anorgasmic, and Prozac, which actually made me lose weight, and decreased my libido but didn't make me anorgasmic. Both of them made me kind of tired. I'm now trying Wellbutrin but I haven't been on it long enough to make any judgments. Really, though, it's impossible to tell what side effects you will experience until you give it a try. Obviously, make sure to mention your concerns to your doctor and keep careful track of your side effects.
posted by you zombitch at 1:37 PM on October 24, 2008

I'm a long-term user of Wellbutrin. The brand version has worked wonders for me, with no discernible side-effects. However, I've not been as happy with various generic versions of the medication. Both my son and I have experienced very negative effects with different manufacturer's version of Wellbutrin.

Our doctor recently switched my son to Symbyax (which is, essentially, a Zyprexa/Prozac cocktail-in-a-capsule) and the effect has been amazing (in a very good way.) Only time will tell, of course, as to how he fares long-term. There are definite side-effect potentials that we need to keep an eye out for. Otherwise, it's been a very positive move.

Re:Crazymeds.com...You should definitely check-out Crazymeds. However, read it with a huge grain of salt. Maybe an entire salt-lick. Like many such websites, it's overwhelmingly populated by bad experiences and negativity. That's just the nature of boards like that.
posted by Thorzdad at 2:03 PM on October 24, 2008

When I was severely depressed, almost entirely dysfunctional, I recovered by taking paxil for a bit more than a year, but it took over a month to start to help me. It did make me anorgasmic, but the results were worth that, for me.

I'm not saying that paxil is ideal for you, just that you should allow more than a couple of weeks to find out what works for you, and maybe you'll have to put up with side effects.
posted by anadem at 2:28 PM on October 24, 2008

since you are looking for anecdotal, I'll chime in.

I've been on Prozac for 3 or so years. no sexual dysfunction or weight gain (I am female, 40)
the only real side-effect I've had to deal with is an increase in my tooth-grinding, so I got a night guard.

Everyone is different and there is really no way to know what effectiveness and side-effects you will experience without trial and error. Hopefully it won't be too bumpy a path for you to find one that works. I got very lucky and Prozac has made a huge difference in my ability to be pro-active, healthy and productive, even through periods of feeling less chipper than usual.

Good luck!
posted by supermedusa at 2:30 PM on October 24, 2008

also, I took wellbutrin last year to combat a bad case of SAD, just for the winter....it was effective with minimal side effects. this fall I started it again and quickly experienced a dramatic degree of clogged pores/blackheads, which I could not abide, so I have gone off it. YMwillalwaysV :P
posted by supermedusa at 2:33 PM on October 24, 2008

Seconding crazymeds.

I would also make sure to emphasize your family's history of bipolar, that might encourage your shrink to prescribe different meds than they otherwise would.

You might also want something for anxiety as well, benzodiazapenes like Ativan, Xanax, Klonopin are relatively side-effect free and can make a huge difference.
posted by sondrialiac at 2:33 PM on October 24, 2008

Oh, and about crazymeds--I have no idea about the forums, I just read the main site and find it really useful.
posted by sondrialiac at 2:34 PM on October 24, 2008

I've been using Wellbutrin for a year, with the only side effects being slight weight loss and increased libido. It has been very helpful for my depression.

I've found it very important to be consistent in taking it. If I don't, I can feel very out of whack for several days in a very "not good" way. My doc and I have ramped up the dosage over time to 300mg/day.

This won't help with the anxiety though. From what I gather, Lexapro works for both depression and anxiety.
posted by bprater at 3:09 PM on October 24, 2008 [1 favorite]

Celexa made me tired, anorgasmic, and completely libido-less. I felt like I lost all personality, and my dreams were foggy. No weight gain though! It was pretty easy to get off of, too.

I've been on Wellbutrin for a few months now, and it works well for me. The first couple of weeks were a bit "speedy" (jitters, jaw clenching, thinking 'too fast'), but I evened out really nicely. It has had the added benefit of reinforcing quitting smoking. I had been smoke-free for 2 months before I started taking it. I can't even picture myself with a cigarette in my hand, and I'm convinced that the Wellbutrin has something to do with it. My libido is as good as it was when I was a teenager, and I'm having *more* orgasms. I have also been more motivated than ever, and have the feeling that I can do anything I set my mind to. I sleep average hours now, as opposed to too many. The quality of my sleep has improved, and I'm dreaming normally again. My anxiety has also decreased, but that could be more a result of therapy. Fact is, it hasn't increased, thankfully. I also feel like myself, a lot more than I did during my 3 months of celexa.

One drawback (for me, anyway) has been a little weight loss (5-10lb), and I was already underweight by about 5 lb. I guess it could be worse- if I had more of an appetite, I could eat anything I wanted! Oh, and I get more paranoid now when I'm smoking pot. I also sometimes forget to take it and am reminded by a bit of a headache around dinnertime.
posted by sunshinesky at 3:17 PM on October 24, 2008

No one can predict which, or even whether, antidepressants will help a given patient. It doesn't have anything to do with the observed symptoms; it appears to be a genetic thing and the only way to find out is to try each one and see, a process that takes weeks (at least) per medication.

Medical treatment of depression is more art than science at this point. There's basic research going on right now to look for genetic markers that correlate with how well particular groups of medications work on a per-patient basis. If that research pays off, it would be possible to get a blood test that would indicate which groups of medication have the best chance of working. But nothing like that exists now.
posted by Class Goat at 3:21 PM on October 24, 2008 [1 favorite]

Wellbutrin was pretty awesome for me for getting over a severe depression, as well as helping with anxiety, but be aware that it can interfere with sleep. So, if you already have sleep issues, keep that in mind. Usually doctors just advise that you take it as early in the morning as you can. Some people who take it for anxiety actually get worse anxiety while taking it, though it helped me.

One thing I didn't dig about it was that it almost made me *too* calm. I felt a little robotic at times, and sort of "whatever" in situations where I would have expected a little more emotional display from myself. Didn't keep me from sobbing at my sister's wedding, though.

I took Zoloft for awhile in my mid 20s. It wrecked my libido, big time, though it did get me over a depression and helped with social anxiety. I also felt like I was living in a demented cartoon the first few weeks I was taking it. That may be someone else's idea of a good time, but not really mine.
posted by medeine at 3:26 PM on October 24, 2008

Twenty-four year old guy here. I've been on Lexapro/Cipralex (10 mg/day) for depression and anxiety for about a nine months, and it's helped me immensely. I don't fall into the pattern of ruminating thoughts anywhere near as often as I used to, and it's much easier to just "be okay" with things that aren't where I want them to be in my life, but that can't be solved in just one fell swoop of effort -- something that was a major problem for me before. Proper sleep hygiene, which had become a cause and effect of all the anxiety stuff, has also gotten a lot better.

I was kind of expecting to be totally cracked out for the first few weeks, but didn't really notice anything drastic, happily. I got waves of nausea in the hour after taking the pill each morning, but that went away after the first week.

My libido went way down for the first few weeks (which was weird but actually kind of liberating while it lasted), but then came back to normal. It takes me longer to reach orgasm (like maybe thirty minutes instead of fifteen or twenty during sex?), which has not been a problem in the least for me. I've also been enjoying sex a LOT more, which I think is more due to a decrease in anxiety and worrying about being Mr. Perfect Lover. I haven't had any problems with maintaining an erection.

I haven't had any noticeable weight gain or loss, or change in appetite. I do feel a bit less inclined to go running, which may be a side-effect of the drug, or maybe a result of enjoying other things more. Probably both. I certainly don't feel unmotivated in other areas of my life -- quite the opposite, actually, as I no longer feel paralyzed and overwhelmed when thinking about important decisions.

A friend of mine who was on Effexor had MAJOR difficulty reaching orgasm (i.e., he couldn't), and also reported that he became much more sensitive to alcohol -- his clarity of thought after successive drinks was about the same as before, but after the first beer he would start slurring and staggering. I know that's an anecdote once removed, but it's something I found interesting. I haven't noticed any change in my tolerance of alcohol.

Note that Effexor is an SNRI while Lexapro is an SSRI (as are Zoloft, Prozac and Paxil).

So yeah, other than all the positive psychological benefits, the only side-effect of Lexapro I've found is the delay in orgasm. Talk to your psychiatrist, of course, but Lexapro has really worked for me.

Other possibly pertinent info: there's a history of anxiety-related (GAD and OCD) and sleep disorders as well as some alcoholism on one side of my family, and some apparently non-anxious depressive disorders on the other side.

Good luck. You're doing the right thing by confronting this and taking steps to take control of your mental health, even if you decide against the pharmaceutical route in the end. And if you and your psychiatrist DO decide that medication is right for you, remember that it's most helpful in conjunction with (not as a replacement for) plain old talk therapy.
posted by DLWM at 5:10 PM on October 24, 2008

I would argue that anecdotal evidence is worthless as the varied responses above and below illustrate. Me and my siblings have roughly the same genetics (parents), roughly the same upbringing and same depressive symptoms. However we all have responded dramatically differently to the same treatments. For me Paxil was all side effects and no good ones. For my brother it was the magic pill. None of my sibs responded well to Zoloft, but it worked brilliantly for me. (It even increased my libido, which is counter to most experiences.) My other brother has varying doses of various drugs for years and never found anything that relieves depression in the long term, or doesn't have side effects worse than the depression.

So 3 of the 4 of us found a drug that worked (though they were all different.) two of us on the first or second try. Maybe not as inspiring as you want, but you will get there, it might just take a little more time and effort than you hope for.
posted by Ookseer at 5:18 PM on October 24, 2008

more anecdote....yes, effexor will trash your ability to handle alcohol (they recommend not drinking at all on it) also effexor gave me such terrible nightmares I went off an otherwise decently effective med.
posted by supermedusa at 5:19 PM on October 24, 2008

If it were me, I wouldn't over-emphasize the bipolar. That makes you more likely to get given antipsychotics or anti-epileptics instead of antidepressants and the antipsychotics are generally a class of medication you want to avoid unless you really, really, really need them.

The newer ones are linked with serious weight gain and diabetes, though less of a risk of tardive dyskinesia (the thing where you shake or make weird tongue movements and it sometimes is *permanent* even if you stop the meds. fortunately, that only tends to happen with long term/high dose of older drugs... but still). the older ones can cause that and dysphoria.

Some doctors will be afraid to use antidepressants if you have a bipolar family history because antidepressants can make some people with such history (and some without) develop mania or hypo-mania (you don't lose contact with reality and think you are jesus, but you talk fast, basically). But it's really not clear because there are people in families with bipolar histories that have plain old depression.

They may alternatively give you lithium or things like neurontin and lamictal, instead of antidepressants, which are definitely preferable to antipsychotics.

Either way, it's basically a crapshoot. the same drug that makes me want to kill myself and murder others may make you feel perfect and well.

So, find someone who really knows what they are doing (psychopharmacologist, not just plain psychiatrist) and be ready to try a few things before you find the right one and don't give up.

Also, benzodiazepines like Xanax, etc, are not "side effect free" because they can cause physical dependence and in rare cases, addiction. That doesn't mean you shouldn't use them if you need them, but it's a different set of issues to deal with. Like doctors who fear prescribing because they think you are a drug-seeker... or who won't prescribe long term even if they work for you because they confuse physical dependence and addiction..
posted by Maias at 5:27 PM on October 24, 2008

I'm a female, and I've been on Prozac, Lexapro, Effexor and Wellbutrin. From my current perspective, I wish I would never have started on the Effexor - it has a very short half-life (and so I felt side effects within a few hours if I didn't take it daily at the same time) and it was a bitch to get off of. My withdrawal wasn't even that bad, if the Internet is to be believed, but it was still rough.
IMO, I would recommend starting on medications that don't have such severe withdrawal symptoms first (of course, I'm not your doctor, and if you agree that such a drug is what would work best for you, ignore me).
Best of luck.
posted by queseyo at 9:19 PM on October 24, 2008

I've had moderately good luck with Prozac. Made me feel "flattened" (not very lively, neither as happy nor as sad). But nothing too horrible.

Paxil is now known to be unsafe for children. Unfortunately, I was given it before they realized how dangerous it can be. It sounds like anonymous hasn't had luck with it either... I'd have trouble recommending it to anyone, even though I know the really bad side effects are said to mainly affect children.
posted by Cygnet at 11:22 PM on October 24, 2008

I have been learning about and prescribing these medicines for more than a decade, and I know a lot about them.

I think your question is fundamentally misguided. I think you need to find someone like me - a doc with experience in these medicines - and go get a personalized recommendation. Depending on your personal situation and neurochemistry, a drug that was great for everyone on this thread may wreak absolute havoc in your life, and if you are adamant about it you might be able to bully some doc into prescribing it for you.
posted by ikkyu2 at 11:59 PM on October 24, 2008