Is it me or my meds?

February 25, 2014 8:58 AM

Are my meds making me feel miserable and hopeless or is it the depression trying to peek through (no worries; not going to do anything)?

How does one know if their medication is giving them ugly thoughts or is it their situation? I WON'T do anything about it because I have a toddler whom I love very much but lately, I've been having these "if it weren't for him, that's it" thoughts and I'm starting to wonder if it's my prozac?

I've been on 20 mg for about 3 years. It's been going well. I had a few lapses where my therapist thought that upping to 30mg would help but I'm hypersensitive to dosages and it turned into heavy anxiety and the shakes like I was on coke. So we went back down to 20mg. But she also noticed a trend in PMS time and depression/moodiness as well as constant low energy levels so she added Deplin (15mg) to my regimen. It's been going ok as far as tired levels but I'm also feeling a bit hyper and anxious where I'm having a hard time focusing, I hate my job, I just hate life. Part of it is because both of my parents died within 1.5 years of each other after long battling health issues and it was very hard to realize you are born, go to work to make sure you don't go broke and then bam you get old, sick and you die. To me, that's just bullshit and it's left me jaded. I'm not sad that my parents are gone (I would describe it as weird; we had a dysfunctional relationship) but not depressed that I lost my parents. They were old and very ill so I accept what happened. But what I can't accept is this feeling of I'm 42 and all I do is wake up, go to work, come home, spend an hour with our son and go to bed. Fun time is non existent. Work, due to a reorg, is so pointless and with no direction I wake up wondering why do I even go---BUT it has awesome benefits so here I am due to responsibility.

I could go on and on about the overwhelming feeling that being responsible is my only goal in life ( and that sucks) but I won't.

My point is I dont' know if it's the prozac talking or my depression trying to break through the prozac and it's manifesting like this. I don't want to tell my therapist either that I'm having these thoughts because I cannot risk being committed. I WON'T do anything. I am just being honest with how I am feeling and I don't want to be punished for telling the truth (I did that when I was in my 20s and wound up involuntarily committed and it was a traumatic experience).

Any advice on how to approach it? I'm also nervous of the guinea pig effect antidepressants have--you have trial and error until you can find something. I would LOVE to take time off to get recharged but I can't risk it with work but honestly, I also know I am 1,000% burned out on life after dealing with so much in such a short time.

Also, any advice on how to handle the work situation if I need a break without risking my job or making them think I'm some sort of nut case they have to worry about (which they don't). I don't want to lose my job and honestly, its' the best job I'm going to get. But it's really hard to be at work when some days my anxiety and feelings make me want to either run away and go home or just cry at my desk out of fear of how I'm feeling.

posted by anonymous to Health & Fitness (9 answers total)

We can't know whether you are having a reaction to the meds, or whether the meds have simply stopped being as effective. Medications stop working all the time; it's why treatment for depression is so difficult. And yes, some antidepressants can make depression worse. But only your therapist and prescribing physician can help you figure out which is true in your own case.

You have to tell them what you are experiencing (the thoughts and feelings you describe are all pretty much standard for depression) despite your current medication, and they will work with you to find a solution. It may be a higher dose, or a different med, or an additional med, or extra talk therapy sessions--in fact, given your life stresses, I wouldn't be surprised if more talk therapy was part of the solution. Existential despair and depression aren't the same beast though they often travel together.

I'm very sorry that you had a traumatic run-in with involuntary commitment; it would be hard to trust mental health professionals after that. But know that nothing you have said here would trigger an involuntary commitment from ANY responsible professional*: your thoughts and symptoms are very common. I have said almost identical things to many therapists, and no one has ever so much as suggested hospitalization.

Hugs and luck to you, OP.

*If you feel your therapist is NOT a responsible professional, please find a new one (perhaps if you give your location to a mod, people can even recommend someone near you.)
posted by like_a_friend at 9:20 AM on February 25, 2014

At first, I was going to say that your post sounds like good old-fashioned mid-life crisis, combined with some exhaustion, and that advice from parents might be as useful as advice from psychologists OR psychiatrists. Then I got to your last few paragraphs, especially "it's really hard to be at work when some days my anxiety and feelings make me want to either run away and go home or just cry at my desk out of fear of how I'm feeling." That made it clear how much you're suffering right now. {hugs}

Whether the anxiety or depression that's coming up is inherent to you or a side effect doesn't matter; the next step is probably to share that information with the psychiatrist who prescribed the medication. Trial and error can be tricky, but the current situation doesn't sound tenable. You're hanging in there now, so you will find a way to hang in there at work or otherwise cope while trying to find a better match, medication-wise. But do get moving, so that you can use your hanging-in-there energy while adjusting to the new meds and getting to the other side of this tunnel. Best of luck getting the meds sorted out.

I'm so sorry about everything you've been going through with your family and at work. You don't say if you're in therapy, but I wonder if that would help. You're going through a lot of stressors right now, and having some place to vent and find some support could be nice. Take care of yourself. You got through this once; you can get through it again.
posted by salvia at 9:23 AM on February 25, 2014

Thinking that life is pointless and feeling utterly burned out isn't the same as feeling suicidal, and I think the risk of being honest with your therapist is very low. The person who is best positioned to help analyse your current situation with meds and what's going on in your life is your therapist, not least of all because the Internet (and Ask) is filled with three million stories of "here are the horrible things that happened to me on Prozac." You may need to up your dose or lower your dose or add a med or switch meds entirely, but the only person who can help you with any of that is your therapist.

But it is also important to realise that situational depression and organic depression are not the same thing. If you are living a life where you hate your job and your world outside of it is utterly devoid of fun, you're going to be depressed and Prozac isn't going to cover that up. If there are fun things in your life but you can't take pleasure in them that's one thing; if there is literally no fun in your life, that's something else. Again, your therapist is going to be key to helping you sort that out.

Can you take vacation or medical leave from work? Medical leave can be arranged via your GP in conjunction with your therapist; it need not be obvious it's mental health leave.
posted by DarlingBri at 9:23 AM on February 25, 2014 [2 favorites]

I think there are a lot of other issues here which are being ably addressed by other commenters. But since you asked: I had a bad reaction to an antidepressant and I could tell because my depression was qualitatively different from my previous experiences. At the time I had had depression on and off (more on than off) for over a decade, so I knew my symptoms pretty well. I had apparent pooping out of my old antidepressant combo, so my doc tried me on a new one, Pristiq. It was FANTASTIC. I felt happy and energized and great. Except when there was a screwup with my insurance and I missed a dose. A single dose missed and I was weepy and overwhelmed -- which of course made it harder to get the insurance situation squared away. Any more than one day off the meds and I started having suicidal ideation, which I had never ever had before. It was much like you describe -- I had no plans or desire to do anything, just a sense that "Well, if this is all there is, is there any point in going on living?". It was awful.
Again, I had never had anything like suicidal thoughts before. It was really pretty freaky to have a sudden new category of thoughts while on the drug. Now I'm back on my old combination and it's working again. I'm at a low point because of the winter weather, but it feels like it always did in the past -- low and draggy, not despairing and futile.
Either way, you should talk to your therapist about this, or find a therapist you can trust to talk to about it. You shouldn't be feeling this way, and they can help you feel better.
posted by katemonster at 9:46 AM on February 25, 2014

Came in to say what DarlingBri said only not as clearly.

Stayed to add, please consider a life coach as an addition to your therapist, perhaps as a one-off if you don't have much time to commit.

If you see your job as "the best you're likely to get" but if it makes you this miserable, I feel like there have to be alternatives. A life coach or careers advisor can help you find and recognise opportunities to change your lot.

You're not a hamster on a wheel. You're a valuable, unique person, with a lot to give the world and who should be getting a lot out of it. Few people feel happy all day every day, but you have a right to feel a lot more security and fulfillment than you currently are.

Seek it out. Get help to do that if you need it. You deserve it. You can do it.
posted by greenish at 9:46 AM on February 25, 2014

Absolutely speak with your GP or psychiatrist and let them know that you are having some issues with breakthrough symptoms but you're not sure if they're situational -- work stress, the loss of your parents, the seemingly Sisyphean daily grind -- or medication-related.

The abject terror that messing with your meds can bring about, in and of itself, is completely understandable, but you already know that's no reason to force yourself to endure this kind of relentless, grinding misery in hopes that your hatred of life will eventually dissipate. I spent the overwhelming majority of my life suicidal and unmedicated and went through well over a dozen drugs before finding a pill that works so well that I refer to it as a miracle drug without an ounce of hyperbole (spoiler alert: it's Prozac). Sometimes you really do just have to slug it out, but the severity of your language indicates that this really isn't one of those times. Brains are weird and ever-changing, your psychiatrist will help you sort it out, and if they don't, drop them and find one who will let you have a strong, central voice in your treatment plan.

I'll go against what I imagine will be the general consensus and say that if you are not comfortable being completely frank with your medical professionals, you can definitely find new ones, but if you really do like your therapist otherwise, I'm a firm believer in the notion that you have every right to play down the intensity of the thoughts you're having to a degree that allows you to express the seriousness of your concerns while still giving you the ability to maintain a comfortable distance from saying anything that might get you locked up again as long as you know you're really safe. If the latter part changes, you need to be brutally honest even if it opens you up to reinstitutionalization. But the simple fact that you have been committed in the past -- especially considering it was involuntary -- can, does, and will flag you for a repeat commitment much more quickly and easily than people who have never been committed. The line between freedom and lockup is much, much easier to cross when you have a documented history of hospitalization. (I have a very similar history to yours on this particular topic but do not want to write about it here; please drop me a MeMail if you'd like to commiserate.)

Work in concert with your medical team to see if you can arrange a short-term leave from work. If pressed, you can tell your employer that you've been having some chronic health issues that have flared up (hey, it's true) and that those issues will prevent you from coming in for the next week? two weeks? or so, but assure them that you will be ready to resume your current spate of duties without a problem upon your return. Depression is a hell of a disease, don't let it convince you that you don't deserve a break to attend to your well-being because it's "just" mental health.

Professionals are the only folks truly equipped to handle most of the ins and outs of your questions, but I do have one piece of layman's advice: Every day, make sure to do something that will make tomorrow easier for you. Set yourself up for success. You'll be amazed at how a habit of tiny little actions will help you chip away at the boulder that has blocked the path between you and a modicum of inner peace. Set out some nice work clothes the night before, pack a lunch for you and your son, step outside to get some fresh air and let the sun shine on your face, put some oats and milk in a slow cooker and turn it on before you go to bed so there's a nice warm breakfast waiting for you in the morning, light a candle or some incense, take a bath, do a quick guided meditation to relax. Think of someone you really admire and try to be more like them when you're presented with the opportunity to do so (whenever I feel stuck, I ask myself, "What would Dessa do?"). Mindfulness is key. Give yourself some room to breathe, then step back and give yourself even more.

My life is also very rote and routine -- get up, go to work, come home, clean the house, play with the dog, go to sleep, repeat -- so I've been using a phone app called Conscious (Android, iPhone) to help me maintain a sense of mindful awareness throughout the day. Repeatedly coming back to focus on the strange miracle of breathing really helps put things in perspective when I'm feeling overwhelmed, crushed, or jaded.

Make an appointment with your prescribing doctor today, and do something nice for yourself when you have a chance. Hang in there, OP. You can do this!
posted by divined by radio at 10:09 AM on February 25, 2014 [8 favorites]

Seconding what divined by radio said about not needing to tell professionals anything that might make them think you're a suicide risk, if you're sure you're not. Tell them what they need to know to help you change medications or get other therapies.

Also, you have a toddler... are you getting adequate sleep? That can make a huge difference. If not, is there any way you can ask family to take on more of the nighttime load while you get back on track?
posted by metasarah at 10:58 AM on February 25, 2014

Active suicidality is quite different from passive suicidality.
Active: "I want to kill myself."
Passive: "I wish I were dead"

Suicidality with a plan is different too. These people are at much higher risk.
With a plan: "I have been thinking about overdosing on my meds/jumping off a bridge/shooting myself."

People who say "I think about ending it all/hurting myself, but I would never actually do it, because of my family/spouse/children" are also quite different. They can "contract for safety".

Therapists and psychiatrists are professionally trained to assess whether a person is actually at risk for suicide. That is because committing someone against their will is very serious business and if you do it without just cause you could face a lawsuit. You have to attest that a person is an active danger to themselves or others. If everyone who ever passively thought about being dead or suicide in the abstract had to be committed, our psychiatric inpatient facilities would be even more bursting at the seams than they already are.

Being honest with your doctors/mental health professionals is the best way to ensure that you get the right treatment.
posted by treehorn+bunny at 11:34 AM on February 25, 2014

It sounds like you're in a pretty rough place. Much sympathy, from having been there.

My first thought is that your meds aren't meeting your needs, and that seeing your doctor and discussing how you're doing — as fully as you feel is possible, and please err on the side of "uncomfortably more detail" — is the best thing you could do right now. "Hey, Doc, the mix you've got me on now isn't working. What other possibilities are there?"

Hang in there. The despair and feeling that nothing matters (except the people you'd disappoint if you left them behind) are full-on lies, no matter how persuasive they sound.
posted by Lexica at 8:53 PM on February 26, 2014