Blue? Only in color, Michael. Oh, also in mood.

October 17, 2012 6:16 AM

I have self-diagnosed low-level depression and anxiety-- so low-level and constant that I think of it more like my personality than any disorder. Still, the days where it ebbs are pretty awesome. I've never been on psychoactive pharmaceuticals before. Experimenting with antidepressants (with a MD's supervision, of course): good idea/bad idea? Alternatives?

To start out: I totally agree with the idea that the pharma industry incentivizes prescribing brain meds at the drop of a hat to anyone who feels a little blue. (Not saying it doesn't help them, of course, just that it's an easy first step.) I also recognize that some people have serious neurotransmitter imbalances that create emotional states that severely impact quality of life, and that medication IS the right answer there. I'm not minimizing that at all.

But I feel like I'm not really in either of those camps. I'm in my late 20s. I've never gotten a diagnosis of "clinical depression" (I think); the worst was when I was in my early teens and it combined with standard self-esteem/outsidery issues. Never to the point of suicidal ideation. I went to a couple therapy appointments, but never got on medication. Not sure why not; guess it wasn't so bad that my parents were concerned to that point. Still never been on medication, even in the subsequent low points.

Instead, I've just lived my life thinking, "Yeah, I'm a little depressed and a little anxious, but not to the point where I need medication." Because of my personality and habits, though, I bet friends and acquaintances would be surprised I've never been on an antidepressant. I have trouble getting motivated to do work and school tasks, and things other than watch TV and play iPhone games at home. I rarely "go out". I always find it difficult to wake up and get out of bed. I always worry about the next deadline bearing down on me from work or class (which oddly enough doesn't help the motivation problem). At the same time, though, I get by just fine: I might occasionally miss a deadline, but it hasn't impacted me professionally. I did well enough in college to feel well-placed for my future. I do enough chores at home to keep my ever-patient wife from tearing me a new one (though we are in couple's counseling).

Some days, though, I feel great. I get out of bed without snoozing the alarm. I genuinely enjoy walking the dog. I get to work on time and am super-productive, barely getting annoyed at all by my boss's inane questions or menial tasks. Get home, hug the dog, nutritious dinner, do homework, sexytimes with the wife, and asleep at a reasonable hour. Alright, that's an exaggeration, but that's what it feels like sometimes. I just want that contented/can-do/"sun is shining" feeling more often. As it is, the frequency is variable, from one day a week to one day a month at most.

It doesn't help that I'm feeling like I'm at a low point right now. I'm familiar with the standard scales of clinical depression, and I'm sure I barely rate on them, mostly because I intellectualize my life: I know things will get better. I just want to feel better now.

So that's a long run-up to this: I'm curious about antidepressants and anti-anxiety drugs. I know medication isn't a panacea, but I want to see if they'll get me a little closer to that ideal headspace a little more often. Is that a terrible idea? I almost feel ridiculous asking, knowing that a lot of people have it worse off than me. I have a primary care doctor I can talk to about this, but no individual therapist or CP. (I used to see our couple's therapist individually, but we try to limit that now that we see her together.)

In short, I'm not that depressed, but I still wish I were less depressed. I just want to feel a little better on a day-to-day basis. Is experimenting with antidepressants a reasonable thing to try?

Alternatives? Meditation? On preview... pot? (Half-serious at most.)

Anonymous e-mail: [e-mail]

posted by anonymous to health & fitness (17 answers total)

I'm not psychiatrist, but it sounds like you're describing dysthymia, which is a form of depression, but not major depressive disorder, which is what youre probably conflating with the concept of "depression" as a whole. Barely-there antidepressants like Wellbutrin (Bupropion) are made exactly for what you describe. If your doctor is up for it, I can't see a downside, honestly. Everyone I know in your situation who tried medication (it was almost always Wellbutrin) either had their life improved, or didn't and stopped taking it to no ill effect. The more powerful antidepressants do have withdrawal effects, though, so I'd be careful about what the doctor wants you to take.

I almost feel ridiculous asking, knowing that a lot of people have it worse off than me.

This should never be a reason to not see a doctor. I'm not going to stop getting my Nexium prescription refilled because I "only" have heartburn and sour stomach and other people are getting esophageal surgery and whatever. Same thing here.
posted by griphus at 6:25 AM on October 17, 2012 [2 favorites]

(Also, a therapist can't prescribe medication, only a medical doctor. So it'd be your primary care doctor or a psychiatrist.)
posted by griphus at 6:26 AM on October 17, 2012

IANAD, but I have many years' first-hand experience with depression, anxiety, and medication. To me you sound like a perfect candidate. It's not a panacea, of course, and there will be some tinkering and experimentation involved before you find the right medication and dosage (to my doctor's amazement, Welbutrin actually makes me feel worse), but I think it's something you should strongly consider.
posted by Faint of Butt at 6:27 AM on October 17, 2012

You're skipping a step.

I think step one is to go to a quality therapist and tell them everything you've said here. CBT or something similar (my therapist uses play therapy, but YM & interest in playing with blocks may vary) can help you develop positive strategies for dealing with these things and will know far better than you when you need to be referred to a psychiatrist for medication.

Look, I understand that you feel comfortable with who you are. That's because humans are resilient and will develop coping mechanisms, convincing themselves that their problems are normal, or not so bad. But you don't need to live like this. I've never been so depressed that I couldn't get out of bed (like, ever), but the decision to see a therapist--and not just crappy parent-mandated or school therapy--has been one of the best in my life. I am challenged intellectually to change my pre-existing patterns in life for the sole purpose of having a better life. And it's worked! My therapist doesn't feel I need medication, but talking with him every other week has seen improvements in my sleep, my friendships, my relationships with loved ones, and with general anxiety levels. It's one of the best, and most loving things you can do for yourself, taking care of yourself. Start there. Then, if that doesn't work, seek out medication.
posted by PhoBWanKenobi at 6:29 AM on October 17, 2012 [4 favorites]

Why not give individual therapy a try for a while? I personally cannot cotton to the idea of taking any psych meds without having at least started talk therapy. And frankly you sound like someone who needs to talk about stuff. A psychologist can refer you to a psychiatrist for meds if he/she feels it would be helpful as an adjunct to therapy.
posted by RRgal at 6:29 AM on October 17, 2012

Why don't you have a few sessions with a therapist to talk about it and explore your options and what you might want to do? Therapy is very effective at treating depression, with an effect size of about 0.80 (or basically 79% of people helped). But, more to the point, it's a place where you could talk about your needs, your wants, and your concerns about what getting treatment might mean. In that sense it would serve a dual function.
posted by OmieWise at 6:29 AM on October 17, 2012

I'm familiar with the standard scales of clinical depression, and I'm sure I barely rate on them,

and

I almost feel ridiculous asking, knowing that a lot of people have it worse off than me.

Well, that's depressions talking right there. "Oh, my problems aren't really even problems, compared to lots of what people deal with; they're hardly worth mentioning, so I'll do nothing or the bare minimum to mitigate them."

So yes, talk to your GP about meds, and/or get a referral to a psychiatrist, and - no "or" - explore actual therapy, whether it's regular talk therapy or some sort of CBT-type therapy. Just randomly trying meds is doing the bare minimum. You deserve more than that.
posted by rtha at 6:38 AM on October 17, 2012 [1 favorite]

Tell you what. I would avoid antidepressants only because it goes on your medical records, and ...insurance.

As someone who has dealt with this and worse in the past, do me a favor and try this first-regular exercise-a daily walk will be fine here-and get into as much sunlight as you can. Supplement with fish oil. After about a month reevaluate. If you still don't feel better, then certainly antidepressants could help you. But exercise really and truly is an antidepressant itself, and is really worth you trying.
posted by St. Alia of the Bunnies at 6:59 AM on October 17, 2012 [2 favorites]

The thing about prescriptions is, there's a vast range of dosages. You mentioned "a lot of people have it worse off than me" - those people will be on much higher dosages. The fact that large problems and large treatments exist is no reason not to do a mild treatment for a mild problem. At least talk to the doctor.

I was about to say that there's no downside to trying meds; maybe St.Alia has a point, though. I honestly have no idea; as someone who has always had insurance through a job, it's never occurred to me that there was such a thing as trying to keep one's records clean, much less seeing that as a reason to avoid bringing something up with the doctor.
posted by aimedwander at 7:25 AM on October 17, 2012

I would absolutely seek treatment; no one should have to live with dysthymia.

I tend to advocate for therapy first, then adding medication if the therapy alone is not sufficient, and continuing with therapy.
posted by insectosaurus at 7:25 AM on October 17, 2012

Therapy-then-meds is the usual route, but things like CBT are mostly useful if you have a lot of harmful patterns of thought that need rearranging. If you're already able to identify depressive/anxious thoughts as such, and don't let them rule your life, you might not need much in the way of therapy. A couple of sessions will probably be helpful to establish what you want out of treatment, but based on what you say here I doubt you'd need it for any length of time.
posted by nonasuch at 7:37 AM on October 17, 2012

Medication can definitely help with dysthymia. Years ago I was diagnosed with it, and a psychiatrist prescribed an SSRI (Celexa). It helped, for sure. It was subtle, but it did lift the veil, so to speak.

It took a personal crisis to get me to go to the mental health clinic in the first place. So I totally understand why, on a normal day, you would think "this isn't so bad, I can handle it." I was the same way. But on the meds, when I felt better, it was sort of shocking how much more invested I was in my life.

BTW, my psychiatrist was of the opinion that therapy for dysthymia was useless without medication. I am not sure if that's the common view or not. When the side effects became too much to bear and I stopped taking the meds, it was against her advice.
posted by cabingirl at 8:22 AM on October 17, 2012

I had a little bit of negative experience with therapy as a teen (seemed like a glorious waste of time) and recently found myself (now in my early thirties) in a bit of a funk occasionally. Just a little off, not too unlike what you are describing.

I contemplated therapy for a while, (and have definitely not ruled it out), but a regular fitness regime seems to have greatly improved my mood and reduced anxiety to boot. Finding someone to talk to may still be a good idea but running & calisthenics has been a free, pleasant, and remarkably effective first step.
posted by rhooke at 8:30 AM on October 17, 2012

Slightly different twist on this: I have dysthymia. Have my whole life. Once a decade or so, I also go into a full-on major depression tailspin. After some experimenting with meds and therapies, the regimen I've come to for myself is that when I'm in tailspin mode, I go on meds. Sometimes therapy in combination with the meds. In between, it works best for me personally to get along without meds.

But the reason I can do that is because I've spent significant chunks of time on meds and that got me out of my head enough to get a clear view of myself. Then I could build some habits and coping mechanisms that for me mean I can go unmedicated for years at a time and still be pretty functional.

Which isn't necessarily for everyone. But it's worth considering that you can try some combination of therapy and/or meds, give it a real serious several-months-long try, but at the end you can step away if you want. Most likely no worse off for the experiment, and quite possibly with some new tools and new perspective on yourself. And then you go from there.

Good luck.
posted by Stacey at 9:12 AM on October 17, 2012 [3 favorites]

exercise. something very physical, like weights or martial arts or intense cycling. an hour a day, as close to every day as you can.

skip the meds. therapy if you think it is necessary on top of couple's counseling. pot will make you depressed in the long term because it'll create a bigger trough/crest cycle in your mood.
posted by par court at 10:05 AM on October 17, 2012

In short, I'm not that depressed, but I still wish I were less depressed. I just want to feel a little better on a day-to-day basis. Is experimenting with antidepressants a reasonable thing to try?

Yes, totally. Antidepressants are not a reward given out to the truly deserving. If you wish you were less depressed, see if they can help you be... less depressed.
posted by DarlingBri at 11:11 AM on October 17, 2012 [2 favorites]

I almost feel ridiculous asking, knowing that a lot of people have it worse off than me.

So this could be me. In fact, I think I said that to my therapist.

I went to therapy and am doing CBT, but the therapist suggested that if I was comfortable with the idea of medication, I should talk to my doctor about a mild form of an anti-depressant.

The CBT has helped, but once I get a doctor I'm going to try medication. This doesn't discount the CBT I'm doing, but it might help it along a lot.

Try both if you can, but there is no reason not to try it.

Good Luck!
posted by right_then at 1:14 PM on October 17, 2012