When did you decide to give meds a shot? Did they change everything? How?

September 28, 2009 9:11 AM

Anti depressants for mild depression? Does it really help just "get you out of a funk"? I know SSRIs are the only thing that help a lot of people get out of depression, but what about someone who can pretty much manage, but feels like it would be nice to not have to just manage?

At what point did you decide to go on anti depressants? I am very weary of SSRIs for mild depression, but a lot of my twenty-something friends are on them. Several of them are women. A lot of them are on wellbutrin (actually, is that even an SSRI?). Either way, I'm curious, because the people I know who are on meds, I would never have pegged for really depressed people, but I know depression comes in many different forms. I know meds can help immensely, and it seems to have helped people I know, at least with the combination of therapy. I am in therapy, which I believe is really important, and things like exercise, diet, a cup of coffee to get rolling, friendships, projects, all really help me get going and get out of it. But, I also struggle with self doubt, self esteem, and it's annoying, because I feel like if I didn't have to question myself so much I could just be happier, and maybe actually get more done. Do meds actually help anybody get more done? Is that a bad reason to take them? If I felt more confident, less questioning of myself, could I get more done? And is getting more done even the answer? I'd like to really go after some things in my life, but I'm constantly running up against my blocks (I'm not good enough/smart enough/don't make enough money/not attractive enough...whatever... doubts). I don't think this is serious depression, but it's gone on long enough that I wonder if some type of medication would be helpful.

posted by Rocket26 to health & fitness (28 comments total)

This is a bit of a tangent to your question, but I've been reading Martin Seligman's Learned Optimism, which is a (more pop-psych than I like, but still good) book on how Cognitive Behavior Therapy techniques can help pull people out of depression. At least two friends of mine who were on SSRIs and HATED them found the concepts in Seligman's books to be a much more tolerable way to work through their patterns. For both of them, they found the "leveling" effect of SSRIs was a bit too much like (as one of them put it) "living on a sheet of plain white paper." The main common complaint between both of them was the sexual side effects, which they could not abide.
posted by hippybear at 9:22 AM on September 28 [1 favorite]

You'll have to decide if it's worth it for you, but I've found Zoloft helpful for my chronic, mild depression (dysthymia.)
posted by callmejay at 9:37 AM on September 28

Both ideas above are great answers. I've used optimism/positive thinking techniques to help pull me out of mild depression and I've used anti-depressants. Every once in a while my brain chemistry is just off and I need a "tune-up" to help me remember what it feels like to be happy. Sometimes doing the mental work is enough, sometimes I have needed medication to get me over the hump. Both have drastically improved the quality of my life.

Both are reasonable choices to make--you need to decide (perhaps with the help of your therapist?) what you would like to try to feel better. Maybe start with the mental work and then move on to medication if you need extra help if that makes you more comfortable.

Good luck!
posted by Kimberly at 9:48 AM on September 28

I absolutely suggest speaking with your primary care provider about this.

If you and your doctor decide that this is something worth trying, please, please, please stick with it (barring your doctor's ok to stop). I've gone on and off various antidepressants over the last several years. Every time I've thought I would be able to "just manage" I've eventually run into a brick wall and crawled back. Don't let the social stigma stop you: Only recently have I finally accepted that I need vitamin SSRI in my diet, and that this is not likely to change.
posted by PunkSoTawny at 9:50 AM on September 28

And if you're interested in Congitive-Behavioral Therapy, Burns's Feeling Good is a great, helpful book. Seligman just talks about it, Burns shows you how to do it.
posted by callmejay at 9:56 AM on September 28

I'm also really curious about specific examples, of how SSRIs made you better. I mean, did you feel more motivated? More confident? Happier and therefore more motivated? Less anxious and therefore happier? The book sounds like a great place to start. I'm going to get it today, someone else told me about it recently too.
posted by Rocket26 at 9:58 AM on September 28

the people I know who are on meds, I would never have pegged for really depressed people, but I know depression comes in many different forms

There's a good chance that it's because of the help from the meds that they don't come across as depressed.

If you're in the states, you probably want to consider issues of insurance/pre-existing conditions as part of your decision making process. (As well as cost of the meds, of course. Wellbutrin, for example, has a 'generic' equivalent that many people and doctors think is not actually as good for many people, but since the insurance company considers it a generic, getting the name brand is a lot more expensive).

Also, are you doing therapy? From what you describe, that could be enough on its own. If not, anti-depressants are shown to be more effective in combination with therapy, in any case, but it may be worth trying one without the other to start.
posted by Salamandrous at 10:02 AM on September 28

For me, the meds made it possible to get out of the house and start taking care of myself in the ways you mentioned - exercise, diet, friendships, projects, etc.
posted by Salamandrous at 10:03 AM on September 28

I feel much happier after going on the SSRI Pexeva--specifically much less anticipatory anxiety, fewer ungrounded fears, less angry and less sorrowful.
posted by PunkSoTawny at 10:05 AM on September 28

...wellbutrin (actually, is that even an SSRI?)
No. It's primarily a dopamine reuptake inhibitor.
posted by Thorzdad at 10:06 AM on September 28

Are you doing everything you can to maintain a healthy lifestyle? Do you exercise regularly and eat healthy food? Do you seek out positive social interactions? Do you have work (or hobbies) that engage your mind? If you answered no to any of these, then there is no reason to medicate yourself yet.
posted by whiskeyspider at 10:06 AM on September 28 [1 favorite]

If it's bad enough that you feel that it's negatively effecting your life, I think you should talk to a psychiatrist about the option of trying an SSRI. If you're worried about outlaying the money for a session (which is admittedly quite high under many insurance plans), see if your school/workplace offers counseling for free so you can see if they think you need a referral to someone who can prescribe meds.

I also strongly encourage you to try cognitive behavioral therapy, like hippybear suggested. I'm a fan of Dr. David Burn's Feeling Good series. CBT mainly focuses on objectively thinking through your anxiety and insecurity, so you are able to see clearly why your emotion is irrational. It sounds like it wouldn't help, but it actually is really reassuring. Eventually, you learn to frame your thoughts so that you have more reasonable reactions and expectations.

In fact, you might be smarter to just try out the book first and see if it improves your mood to the point that you want. It's cheaper than seeing a psychiatrist, and you won't be left with side effects. You'll want to buy your own copy, or at least get a notebook to go with a copy from the library, as it has a lot of written work, which is needed if you want it to work. I also know from experience that the book works great in tandem with an SSRI.

If you want a specific description of what an SSRI is like, I'd say that it's almost a bit like your brain gives you "permission" to be optimistic and to want to do things. Having fun became worth the energy it took to start doing activities. In my experience, I've responded to depression by doing less and becoming withdrawn, though, so that may be different for you. I had to try several medications before I found the one that worked for me.

Good luck with your treatment, and I hope it all goes well for you.
posted by mccarty.tim at 10:18 AM on September 28

I also suggest CBT to start out with. Ask around and find someone good. Once you have a couple of sessions ask them their opinion if drugs will help.

I am currently on zoloft myself, but have been on a couple of other meds, and am still tweaking- it's a constant, never ending process to find what works for you. I still feel like I'm in a little bit of a funk, but it's better than being in a massive "I can't get out of bed" funk.

The meds that may work now, may not work in 6 months or a year from now- this is something that you have to be vigilant about if you do go on meds.

I used to have a huge stigma against going on drugs, but I will tell you (and so will my wife) that it was one of the best decisions I have ever made.

I would caution against asking your GP for his input on meds as they hardly know anything about the crazy brain chemistry- if you are going to go the meds route, go see someone who has a good history and training in it. Also, it's not unreasonable to get a couple of different opinions from both psychiatrists and psychologists.

Good luck!
posted by TheBones at 10:30 AM on September 28

I would caution against asking your GP for his input on meds as they hardly know anything about the crazy brain chemistry...

Some GPs do. I was referred by my therapist to my current GP and the two of them have communicated (with my written permission, of course) about my treatment and I've been pleased and impressed with the level of care. This is not, in my experience, typical, but the GP I've been consulting with has demonstrated more care and knowledge than the student health services practitioner that wrote me my first prescription.
posted by stet at 10:44 AM on September 28

Dysthymia - a milder but more chronic form of depression - is what I have, and sounds similar to what you're going through (IANAD, etc). It can be tricky to diagnose and treat, because people with dysthymia often get through the day okay, and because it can go on for so long, it's really easy to start thinking "that's just what I'm like" instead of viewing it as something that can be treated.

I first went on medication (Cymbalta, specifically) maybe four years ago, and it made a world of difference. It didn't make me happy-all-the-time, and it didn't suddenly give me the ability to find and grab whatever it is that might make me totally fulfilled. I am still very much me when I'm medicated, warts and all; I don't suddenly get enthusiastic about taking out the trash or anything. What medication does do for me, though, is squash that little depressive voice in my head that likes to scream that the sky is falling and it's somehow all my fault. I still get stressed and sad sometimes, but it's for actual real reasons, like I didn't get enough sleep or someone at work's being a dick, and I can figure that out so much better when I'm medicated. Antidepressants essentially fix my what's-wrong-o-meter and put me back in the context of the rest of the world.

Antidepressants may work for you too. On the other hand, CBT could do the trick. Or perhaps getting into a regular exercise routine, or taking vitamins, etc. Some people, myself included, find a combination of all of the above helpful. I'd probably start out with meeting with a good therapist and see what they recommend.
posted by Metroid Baby at 10:57 AM on September 28 [1 favorite]

I took Lexapro for two years, and it helped me clear my brain. Instead of having twenty anxious "I'm not good enough" thoughts dancing in my head, I only had a few, and I could use the techniques I had learned in therapy to put those to rest and get on with my life.

I didn't want to be on them forever if I could possibly help it, and so once I felt that the lessons I had learned in therapy had progressed to a point where I could deal with the anxiety and depression on my own, I stopped taking the meds, continued with therapy for another year, and am now striking out without either of them, so far with a lot of success.

I don't know if I could have done it with therapy alone--I was trying therapy alone before I started taking meds, and even though my therapist and I were coming up with good ideas, my mind didn't want to cooperate. The SSRIs slowed my thoughts down and made everything a little bit less intense. This sounds weird, because people often worry that SSRIs will put them in a funk where they don't feel anything, but a funk was what I needed, so that I could actually deal with scary thoughts methodically instead of becoming overwhelmed by them.
posted by besonders at 11:00 AM on September 28

I can still remember the day in high school when my antidepressant (Luvox - an SSRI - at the time) "kicked in" - I woke up, felt like getting out of bed, and it was like the world was in colours again, and I hadn't even realized that I was seeing it in black-and-white. This summer, when I started taking stimulant medication for what I now know was undiagnosed ADHD, probably leading to depression, it was like I had been living in an impressionist painting without realizing it - all of a sudden, I noticed detail. (I'm a very visually-oriented person/visual learner - does it show? ;)

Overall, I have found that both medications (I'm now on Wellbutrin as an antidepressant, and Ritalin SR 3x daily as a stimulant) help me to achieve a basic level of functioning in which I can:
- Focus on schoolwork
- Be aware of my diet/exercise (rather than being unable to get out of bed/eating whatever is available)
- Be optimistic about the future
- Be mindful of my thought processes (a lot of books about ADHD that I have read recommend meditation - it is sometimes recommended for depression as well, but for me, I found that when I was "at the bottom", it just became a golden opportunity to think really negative thoughts - YMMV).

I still have days in which I am stressed, tired, frustrated, etc., but I'm able to cope pretty well with the demands of daily life, and to make progress towards getting even better (i.e. being able to do pretty well in my current diploma program).
posted by purlgurly at 11:09 AM on September 28

What type of therapy are you in? Talk therapy may not be what you need right now. Others mentioned CBT, and I have to enthusiastically agree. Having a therapist who incorporates this would really help your progress.

"I'm not good enough/smart enough/don't make enough money/not attractive enough..." In my experience, antidepressants made it easier to get everyday stuff done, but they didn't nix that specific thought habit. It will follow you around and hold you back until you do something about it.

In addition to CBT, you might try these things:
* Every night, make a list of things you did successfully that day. Include little things and stuff you might be taking for granted. You're building your self-efficacy here, which boosts your self-confidence considerably and contributes to your motivation. The more confident and motivated you feel, the more you succeed in the ways you want to. (Be flexible about how you define success, by the way. One person might consider being a corporate magnate a success. Another might consider living a quiet life with close connections a success.)
* Make a list of things you've succeeded at in the past. Refer to it every once in a while.
* Are you living a high-stress lifestyle? Do what you can to mitigate that, and do daily relaxation.
* I know this doesn't directly address those thought patterns, but it's my favorite and most effective mood boost: every night, or at random points during the day, make a list of things you're grateful for, or that you enjoy, or that you appreciate. It can include the same things every time, and it can include new things. Once again, don't overlook the small stuff. (I'm grateful for cats on my keyboard, for example, because they really, really love me and want my attention. I'm grateful for bright smiles from my little girl, modern conveniences, the vast amount of knowledge and support available via the internet, sunsets through my window, and at this exact moment, chocolate walnut brownies.)

You say you're exercising. You might want to kick it up a notch, if you're only putting the minimum in. There's not nearly as much research on it as would be nice, but one study finds 30 minutes of moderate aerobic exercise every day does help with depression.

You might find "Mindset: the new psychology of success" by Carol Dweck a particularly apt and helpful read.
posted by moira at 11:41 AM on September 28 [2 favorites]

(Prepare to put significant energy into this, by the way. It's worth it; remind yourself of the reasons why.)
posted by moira at 11:45 AM on September 28

After long resistance in the context of long-term therapy I tried Paxil for essentially lifelong non-major depression and anxiety. Its effect on my mood was not that notable; research I've done since suggested to me that this is probably not uncommon, but I don't have those results at my fingertips and anyway, the science student in my knows that this sort of layperson review of a subject of non-expertise is of limited value. There is certainly no slam-dunk research on the efficacy of SSRIs for dysthymia and indeed there is plenty of controversy over the efficacy of antidepressants in general.

That being said it seemed to me when I was on Paxil that I felt distinctly less anxious (experienced anxiety less frequently and at a generally lower level) and in particular I found it easier to interrupt and get away from repetetive, cyclical patterns of negative thought (worrying about bad things happening about which I could do nothing, for example, or dwelling on imaginary negative conversations with others in my head).

My feelings about my time on Paxil are mixed and if anything have become more so. At the time I felt these positive effects afforded me some emotional space over a number of issues that I subsequently made progress in dealing with cognitively - but as time passes I wonder if I would have really would have accomplished less in changing the way I thought if I hadn't used it. It was one of the "solutions" out there and I don't really regret trying it.

But: I had an unusually hard time keeping off cigarettes the whole time I was on it, and I hit my all-time fattest, and I had terrible trouble getting up virtually every morning. If I missed a pill or even blew the time schedule too seriously I would have nasty little physical sensation side-effects. It lowered my libido substantially. And when I quit the physiological withdrawal was intense and nasty (though this was a lot my fault, since I looked at the step-down schedule my psychiatrist suggested, thought it seemed like a ridiculously long time, and quit cold turkey. Probably not my brightest moment). I was glad to be off it and barring a serious setback in mental health I don't expect to be on anything again.
posted by nanojath at 11:55 AM on September 28

Exercise, 5-HTP, vitamin D, and a lightbox in the winter help me fight off the blues.
posted by bink at 12:21 PM on September 28

In my experience, SSRIs can be a great solution for many people. If it were me, personally, though--I'd always choose therapy (even once a month therapy, if the cost is prohibitive) with someone who specializes in depression before meds if the symptoms are on the lower/fewer end. In my mind, meds are never the first option I'd jump to unless someone has schizophrenia, bipolar disorder, or perhaps expresses suicidal thoughts/actions. The side effects are sometimes not worth it to people, if the depression is not severe enough that the medication seems necessary.

As a therapist working specifically with women and girls, I believe very strongly that a lot of women who discuss depressive symptoms are overly medicated and pathologized. I wouldn't interpret the fact that a bunch of your female friends are taking meds as a sign that it's the most appropriate treatment, really. We live in a culture that glorifies people's "choice" of medication, and while I'm certainly not against medication, I am against having it sold to me based on foggy, false ideas like "this will make you feel better! *poof!*".
posted by so_gracefully at 12:56 PM on September 28

I suspect that modern life contributes quite a bit to the number of people with clinical depression. We have smaller, more distant families, and most of us live in stressful surroundings, with not a lot of control over our lives. In much of the Western world, people spend little time outdoors, and exercise seldom. It's sad that we have to use drugs to make life manageable, but please don't take away my Zoloft. I've struggled with depression since i was in my teens, and Zoloft makes my life way more live-able.
posted by theora55 at 1:23 PM on September 28

SSRIs are extremely helpful for many people. However, since you say you're not suffering from major depression, it might not hurt to try out Sam-e and/or 5-HTP (I take both), two dietary supplements that have worked very very well for me.
posted by eunoia at 1:49 PM on September 28

Nthing exercise, at least 45 minutes a day, outdoors, in sunshine and nature if possible. I had problems with depression for many years, tried various meds, exercise works better.
posted by mareli at 5:17 PM on September 28

I'm sorry you're not always feeling well.

I was on SSRIs for around 15 years. There was a pattern where they gave me relief but then the mitigation of depression would level off and even stop. Transitioning off of them and then back on seemed to help - but these are powerful substances, and the transitions can be crazy-making.

Now I don't use them any more. I found extraordinary relief by taking Omega-3s and Sam-E.

200mg of Sam-E in the morning, along with 2-4 grams of Omega-3s (fish oil and now flaxseed oil), turned out to be better than any SSRI for me.

Your mileage may vary, but I can highly recommend this combo. Talk to your doctor about it, of course! Brains are complex - about the most complex things that we know about. Having one, and being subject to it's whims, is a bitch.

I hope you achieve life long happiness.
posted by markjamesmurphy at 5:41 PM on September 28

Yeah, pretty much agreeing. I found that Zoloft gave me a bit of a shield against the BS of daily life. I was free to allow myself to experience the ups and downs of life without fearing a tailspin into The Darkness for weeks at a time. It seems to make me less sensitive to stress. (And the converse is that when I was taking too much (for me), I was a little oblivious.)

For me, it's (I guess) like a long-acting benzo. Not that I've ever tried one. But from the descriptions. It just takes the edge off so I can actually function like a human.
posted by gjc at 6:01 PM on September 28

That may be true for others, whiskeyspider, but I find I simply cannot do any of those things (let alone all of them, simultaneously) if my brain chemistry isn't sorted through medication first.
posted by Space Kitty at 9:13 PM on September 28 [2 favorites]