Do I just resign myself to being a Prozac junkie?
October 24, 2014 9:51 PM Subscribe
So, I'm too lazy to link to them, but many of my previous questions have waxed poetic on my experiences with depression, its effects on my cognition and motivation, as well as my trials with a number of treatment modalities- some pharmaceutical, some alternative, some psychological.
After years of back-and-forth experiments with nearly everything in the book, I come to the same conclusion time and again: Fluoxetine is the only thing that works.- slowly, under only the best conditions, and for a very short time before I need to up my dose. ( We're talking weeks). What's going on here?
YANMD. TINMA. Gotcha. I just feel like whenever Prozac works the way people say it should- clearing out the cobwebs and obsessive thoughts, motivating me and keeping me awake, keeping me from overeating, etc., it always feels more like a high that I have to constantly worry about coming down from rather than a baseline improvement. This is after being on it for the recommended six to eight weeks. Unless I'm on that high ( almost hypomanic but not), I can't help but feel like it isn't doing enough, even with coffee or energy drinks in my system.
The high invariably fades after a week or two ( and isn't even consistent in that time) and I go back to being a zombie, only more tense and anxious now that there's extra serotonin in my system that my brain apparently doesn't know what to do with. I then up my dose ( I'm now at 60 mg) and have to deal with the muscle spasticity ( which I don't need more of) and headaches all over again. A few good days ( with coffee, otherwise it does nothing), then bam. Nothing.
I've tried Wellbutrin, Lexapro, Zoloft, 5HTP, Pristiq, Celexa, St. John's Wort and a host of vitamins. Only Prozac has ever gotten me where I want to be. It's easier to find words, things aren't a chore, and nothing feels heavy. It's a wonder drug AFAIC, but why the hell can't I get consistent relief? Why does my body treat an SSRI like an addictive substance?
Apologies for the WOT, but both anecdata and advice are very, very much appreciated. Cheers, hivemind!
YANMD. TINMA. Gotcha. I just feel like whenever Prozac works the way people say it should- clearing out the cobwebs and obsessive thoughts, motivating me and keeping me awake, keeping me from overeating, etc., it always feels more like a high that I have to constantly worry about coming down from rather than a baseline improvement. This is after being on it for the recommended six to eight weeks. Unless I'm on that high ( almost hypomanic but not), I can't help but feel like it isn't doing enough, even with coffee or energy drinks in my system.
The high invariably fades after a week or two ( and isn't even consistent in that time) and I go back to being a zombie, only more tense and anxious now that there's extra serotonin in my system that my brain apparently doesn't know what to do with. I then up my dose ( I'm now at 60 mg) and have to deal with the muscle spasticity ( which I don't need more of) and headaches all over again. A few good days ( with coffee, otherwise it does nothing), then bam. Nothing.
I've tried Wellbutrin, Lexapro, Zoloft, 5HTP, Pristiq, Celexa, St. John's Wort and a host of vitamins. Only Prozac has ever gotten me where I want to be. It's easier to find words, things aren't a chore, and nothing feels heavy. It's a wonder drug AFAIC, but why the hell can't I get consistent relief? Why does my body treat an SSRI like an addictive substance?
Apologies for the WOT, but both anecdata and advice are very, very much appreciated. Cheers, hivemind!
Response by poster: Not to threadsit, but just to nip the ADHD thing in the bud- I'm pretty sure I do have some form of it, and that it's gotten worse over the years, but I can't really take a prescription stimulant because I'm already dealing with high blood pressure. Not that you'd think I cared, given the amount of 5-hour energy I consume in a week, but something about a plastic bottle you can buy on Amazon feels less like playing Russian Roulette with my heart- bullshit, I know.
posted by marsbar77 at 11:00 PM on October 24, 2014
posted by marsbar77 at 11:00 PM on October 24, 2014
Response by poster: Also, too many horror stories about being hooked on stuff for me to be comfortable taking it, even if I could. I'm enough of an addict when it comes to 5HE
posted by marsbar77 at 11:02 PM on October 24, 2014
posted by marsbar77 at 11:02 PM on October 24, 2014
Best answer: I had the same experience with fluoxetine. The short time when it worked was amazing, but then it was back to depression plus additional and increasing brain fog within a few weeks.
The only thing that's worked reliably for me is SAM-e (S-adenosyl-L-methionine), which is available over the counter and is used as an antidepressant in Europe. It's been shown to be better than placebo and as effective as tricyclic antidepressants in clinical studies. It's a bit expensive compared to supplements but in line with most antidepressant medication. SAM-e is a crucial methyl donor in DNA methylation processes, and its biochemistry is explained here if you're interested.
posted by dialetheia at 11:24 PM on October 24, 2014 [6 favorites]
The only thing that's worked reliably for me is SAM-e (S-adenosyl-L-methionine), which is available over the counter and is used as an antidepressant in Europe. It's been shown to be better than placebo and as effective as tricyclic antidepressants in clinical studies. It's a bit expensive compared to supplements but in line with most antidepressant medication. SAM-e is a crucial methyl donor in DNA methylation processes, and its biochemistry is explained here if you're interested.
posted by dialetheia at 11:24 PM on October 24, 2014 [6 favorites]
Best answer: A few things spring to mind when reading your question. The first is that you haven't actually tried that many antidepressants. (I know!). Basically, you've tried a bunch of SSRIs, one SNRI and one NDRI. That's fine for a first pass, but there are some obvious things you haven't had a go at:
-Mood stabiliser. Either alone or with the fluoxetine. Springs to mind immediately because you describe the initial effect as almost-but-not hypomania: why not test the hypothesis that it's mild hypomanic response and that what you need is a bipolary-type drug?
-Mirtazapine. Really good for anxiety and sleep. Not so good for overeating, but worth a try
-MAOI, if you can hack the food restrictions
-Tricyclics
The second is that you sound like you're suffering some of the exhaustion that comes with constant hypervigilance and a feeling of being out of control. The drugs aren't going to help that - you need contact with LGBTQ people, disabled rights advocacy groups, anything you can grab onto to make you feel more like the author of your life. And the experience of depression itself can be traumatic - I was hospitalised at the end of last year, and I feel like I'm still trying to get over the shock of what happened and how ill I got. Sometimes you just need to take a bit of time acknowledging these things. I'm not going to go into too much detail as it's elsewhere in your questions but I don't think society has been kind to you or made it easy for you to value yourself, and that creates low-level stress that will wear a person down.
The third is that the coffee and energy drinks are not helping at all. When I was in hospital I quit caffeine altogether. Your goal should be to remove the background hum of anxiety, not to push through exhaustion. Healing from depression takes way longer than you might think, and you need to create an environment where healing can happen - and that means no stimulants. Then after a while - a long while, months - re-introduce them slowly. And by that I mean no more than one cup of coffee a day, ever, and most days no cups of coffee.
The fourth is that you should be looking at some kind of meditation, again to attempt to reverse the effect that constant hypervigilance has on your body. Do it in the gentlest way possible - be careful of loads of hardcore mindfulness, you should be doing it kindly and lovingly.
posted by Acheman at 12:47 AM on October 25, 2014 [17 favorites]
-Mood stabiliser. Either alone or with the fluoxetine. Springs to mind immediately because you describe the initial effect as almost-but-not hypomania: why not test the hypothesis that it's mild hypomanic response and that what you need is a bipolary-type drug?
-Mirtazapine. Really good for anxiety and sleep. Not so good for overeating, but worth a try
-MAOI, if you can hack the food restrictions
-Tricyclics
The second is that you sound like you're suffering some of the exhaustion that comes with constant hypervigilance and a feeling of being out of control. The drugs aren't going to help that - you need contact with LGBTQ people, disabled rights advocacy groups, anything you can grab onto to make you feel more like the author of your life. And the experience of depression itself can be traumatic - I was hospitalised at the end of last year, and I feel like I'm still trying to get over the shock of what happened and how ill I got. Sometimes you just need to take a bit of time acknowledging these things. I'm not going to go into too much detail as it's elsewhere in your questions but I don't think society has been kind to you or made it easy for you to value yourself, and that creates low-level stress that will wear a person down.
The third is that the coffee and energy drinks are not helping at all. When I was in hospital I quit caffeine altogether. Your goal should be to remove the background hum of anxiety, not to push through exhaustion. Healing from depression takes way longer than you might think, and you need to create an environment where healing can happen - and that means no stimulants. Then after a while - a long while, months - re-introduce them slowly. And by that I mean no more than one cup of coffee a day, ever, and most days no cups of coffee.
The fourth is that you should be looking at some kind of meditation, again to attempt to reverse the effect that constant hypervigilance has on your body. Do it in the gentlest way possible - be careful of loads of hardcore mindfulness, you should be doing it kindly and lovingly.
posted by Acheman at 12:47 AM on October 25, 2014 [17 favorites]
Best answer: A few thoughts. These aren't mutually exclusive. First, you could up the Prozac. I've been on 110mg before. Second, you might add modafinil. It's a stimulant that should work synergistically with the SSRI. Third, you might add Strattera. It (in theory) should augment the SSRI, and help with the ADHD. Fourth, you might add a tricyclic. SSRI+25-75 mg clomipramine has been a magic bullet for me in the past.
I think the first place I'd go, though, is Lamictal. If you can take it (it caused way too much brain fog for me), it tends to augment antidepressants nicely, as well as having mood stabilizing effects. Given your short description here, I'd not be surprised were you to get a bipolar II diagnosis. Though maybe not--when I've been depressed and some drug works for me, it's a bit of a high. It's not hypomania--more just relief.
I concur with the above that getting off large amounts of stimulants is important.
Good luck. I know it's really hard stuff.
posted by persona au gratin at 2:40 AM on October 25, 2014 [1 favorite]
I think the first place I'd go, though, is Lamictal. If you can take it (it caused way too much brain fog for me), it tends to augment antidepressants nicely, as well as having mood stabilizing effects. Given your short description here, I'd not be surprised were you to get a bipolar II diagnosis. Though maybe not--when I've been depressed and some drug works for me, it's a bit of a high. It's not hypomania--more just relief.
I concur with the above that getting off large amounts of stimulants is important.
Good luck. I know it's really hard stuff.
posted by persona au gratin at 2:40 AM on October 25, 2014 [1 favorite]
+1 on Strattera. It's expensive as hell and was a complete life-changer for me.
posted by chesty_a_arthur at 5:19 AM on October 25, 2014 [1 favorite]
posted by chesty_a_arthur at 5:19 AM on October 25, 2014 [1 favorite]
I've always felt that while Zoloft is indeed a wonder drug, it's not much help without a weekly regimen of exercise. Nothing special, just hour long walks 3-4 times a week. YMMV, of course.
posted by chainsofreedom at 5:21 AM on October 25, 2014 [2 favorites]
posted by chainsofreedom at 5:21 AM on October 25, 2014 [2 favorites]
Hey, not much on the meds front, but please check your language on the stuff like "junkie", "hooked", and other derogatory terms. Mental health issues already have a huge negative connotation. Associating it with those terms, which are completely wrong anyhow, makes things worse.
posted by kellyblah at 5:22 AM on October 25, 2014 [5 favorites]
posted by kellyblah at 5:22 AM on October 25, 2014 [5 favorites]
Response by poster: Good advice so far, thanks all. Apologies if anyone feels like the language is in any way aloof or derogatory. I've dealt with pretty serious, disabling depression for about eight years now, on top of a cerebral palsy diagnosis. I know what misguided stigma can do. However, these words reflect my own experiences accurately - I wouldn't have used them otherwise. I see where the argument comes from, but I think it's pretty obvious, considering my circumstances, that I'm not trying to give off holier-than-thou vibes here. Sorry if it seemed that way.
Re: the Sam-e: I've for some reason always believed it was only safe for women because of something-or-other to do with hormones . Am I wrong?
Also just wanted to note that overeating and brain fog are probably the two most salient symptoms of my depression, so anything I take really needs to work against those things, not aggravate them. I don't think I could deal...
FINAL BONUS: How the heck do I get off the energy shots without wasting away days on end in bed? This happens every time I've tried to quit, and I always give in.
posted by marsbar77 at 7:12 AM on October 25, 2014
Re: the Sam-e: I've for some reason always believed it was only safe for women because of something-or-other to do with hormones . Am I wrong?
Also just wanted to note that overeating and brain fog are probably the two most salient symptoms of my depression, so anything I take really needs to work against those things, not aggravate them. I don't think I could deal...
FINAL BONUS: How the heck do I get off the energy shots without wasting away days on end in bed? This happens every time I've tried to quit, and I always give in.
posted by marsbar77 at 7:12 AM on October 25, 2014
How the heck do I get off the energy shots without wasting away days on end in bed?
I wish I knew - when I read you question, my first thought was that the caffeine was not a good idea when you need to level out.
Have you talked to any of your doctors about quitting energy drinks and coffee? Or at least setting limits? They might consider caffeine trivial - most people drink coffee - but it seems like these ups and downs are not trivial and are interfering with you efforts to find a balance. Also, your BP.
I'd also suggest that you talk more with whomever (MD, talk therapist) about brain fog. I'm wondering if your scale is off and you equate anything less than a stimulated state as down.
I wouldn't be surprised if physical limitations (which you seem to have) and your depression history make you leary of anything that seems slow or steady state.
posted by Lesser Shrew at 7:29 AM on October 25, 2014 [2 favorites]
I wish I knew - when I read you question, my first thought was that the caffeine was not a good idea when you need to level out.
Have you talked to any of your doctors about quitting energy drinks and coffee? Or at least setting limits? They might consider caffeine trivial - most people drink coffee - but it seems like these ups and downs are not trivial and are interfering with you efforts to find a balance. Also, your BP.
I'd also suggest that you talk more with whomever (MD, talk therapist) about brain fog. I'm wondering if your scale is off and you equate anything less than a stimulated state as down.
I wouldn't be surprised if physical limitations (which you seem to have) and your depression history make you leary of anything that seems slow or steady state.
posted by Lesser Shrew at 7:29 AM on October 25, 2014 [2 favorites]
I'd suggest quitting cold turkey which is a mess but you will level back out in a week or two. Last time I quit I actually had more energy and focus because I wasn't running around doing caffinated things and respected my limits.
It is ok to cut back slowly. Keep a log of all all you consume in a day (you listed a few sources) and don't forget things like chocolate. Drop one drink a week or every few days.
The caffeine may be causing your anxiety. It also can affect your heart so it would be overall just good for your body. You will also be saving money as energy drinks and 5 hour energy and whatnot are expensive.
You can also switch the doses. That requires looking up the mg of caffeine and switching it or for something less powerful. Like instead of a energy drink drink a regular soda. You can slowly cut down and then eliminate the caffeine entirely.
posted by AlexiaSky at 8:57 AM on October 25, 2014 [1 favorite]
It is ok to cut back slowly. Keep a log of all all you consume in a day (you listed a few sources) and don't forget things like chocolate. Drop one drink a week or every few days.
The caffeine may be causing your anxiety. It also can affect your heart so it would be overall just good for your body. You will also be saving money as energy drinks and 5 hour energy and whatnot are expensive.
You can also switch the doses. That requires looking up the mg of caffeine and switching it or for something less powerful. Like instead of a energy drink drink a regular soda. You can slowly cut down and then eliminate the caffeine entirely.
posted by AlexiaSky at 8:57 AM on October 25, 2014 [1 favorite]
Can you take a few days off work to kick the caffeine? Maybe like a Thursday and Friday so you can also have Saturday and Sunday to recover? It's paradoxical but the more coffee i drink, the more tired I get as the day goes on. When I cut back to just one cup in the morning, it's rough going for a few days - I'm exhausted and I sleep like 10 hours at night. When I push through that, though, I have tons more energy.
posted by sutel at 9:05 AM on October 25, 2014
posted by sutel at 9:05 AM on October 25, 2014
"FINAL BONUS: How the heck do I get off the energy shots without wasting away days on end in bed? This happens every time I've tried to quit, and I always give in."
Cold turkey is definitely faster, but a gentler way is to push back your first caffeine of the morning by 30 minutes while pulling in your last of the evening by another 30 minutes. So when I was drinking an appalling amount of caffeine I'd have my first when I got to work at 9 a.m. ... so I made myself wait until 9:30. I was antsy and headachy and distractable for that half hour but I just did my busywork tasks and then RELIEF at 9:30. Same thing on the other end (only when the caffeine headache kicks in, you can just go to bed.) I was able to move another half-hour every couple of days, so after a couple weeks the times met and I was down to just one soda a day, at lunch, which I turned into a half-soda, and then on a weekend day, got rid of completely. There were still headaches but I was able to remain a functioning member of society during the whole process.
(The time I went cold turkey I was flat on my back for two solid days wanting to dieeeeeee.)
posted by Eyebrows McGee at 9:46 AM on October 25, 2014
Cold turkey is definitely faster, but a gentler way is to push back your first caffeine of the morning by 30 minutes while pulling in your last of the evening by another 30 minutes. So when I was drinking an appalling amount of caffeine I'd have my first when I got to work at 9 a.m. ... so I made myself wait until 9:30. I was antsy and headachy and distractable for that half hour but I just did my busywork tasks and then RELIEF at 9:30. Same thing on the other end (only when the caffeine headache kicks in, you can just go to bed.) I was able to move another half-hour every couple of days, so after a couple weeks the times met and I was down to just one soda a day, at lunch, which I turned into a half-soda, and then on a weekend day, got rid of completely. There were still headaches but I was able to remain a functioning member of society during the whole process.
(The time I went cold turkey I was flat on my back for two solid days wanting to dieeeeeee.)
posted by Eyebrows McGee at 9:46 AM on October 25, 2014
If you do try SAM-e (never heard of issues for males, BTW), you should make sure that all contraindicated drugs, including SSRIs, are out of your system or you risk serotonin syndrome.
Have you tried Cymbalta? It's an SNRI, and may do more for you.
posted by Johnny Wallflower at 10:44 AM on October 25, 2014
Have you tried Cymbalta? It's an SNRI, and may do more for you.
posted by Johnny Wallflower at 10:44 AM on October 25, 2014
Re: the Sam-e: I've for some reason always believed it was only safe for women because of something-or-other to do with hormones . Am I wrong?
Hmm, I've never seen anything like that about SAM-e. I just looked at my package and the only listed warnings are to consult with a doctor first if you have bipolar disorder (it can trigger mania, much like any other antidepressant), are experiencing severe mood issues, are pregnant, or are taking other prescription medication including antidepressants.
The evidence on serotonin syndrome from SAM-e with other antidepressants is mixed; most of the cases where this was a problem seem to be when SAM-e was used with a specific antidepressant (clomipramine), and some studies have found positive potentiating effects when SAM-e is used with an SSRI. Of course, absolutely consult with your doctor first!
If you decide to go with SAM-e, it can be beneficial to take it with specific B-vitamins due to its role in B-vitamin metabolism; "Clinicians recommend taking oral SAMe with vitamin B12, folic acid, methionine and trimethylglycine to enhance absorption." I've never bothered with the methionine and trimethylglycine (usually sold as TMG) but maybe I should try it!
posted by dialetheia at 12:24 PM on October 25, 2014
Hmm, I've never seen anything like that about SAM-e. I just looked at my package and the only listed warnings are to consult with a doctor first if you have bipolar disorder (it can trigger mania, much like any other antidepressant), are experiencing severe mood issues, are pregnant, or are taking other prescription medication including antidepressants.
The evidence on serotonin syndrome from SAM-e with other antidepressants is mixed; most of the cases where this was a problem seem to be when SAM-e was used with a specific antidepressant (clomipramine), and some studies have found positive potentiating effects when SAM-e is used with an SSRI. Of course, absolutely consult with your doctor first!
If you decide to go with SAM-e, it can be beneficial to take it with specific B-vitamins due to its role in B-vitamin metabolism; "Clinicians recommend taking oral SAMe with vitamin B12, folic acid, methionine and trimethylglycine to enhance absorption." I've never bothered with the methionine and trimethylglycine (usually sold as TMG) but maybe I should try it!
posted by dialetheia at 12:24 PM on October 25, 2014
Don't quit cold turkey. No, no. Taper. Even the caffeine.
Try modafinil short term, and CBT longer term, for getting out of bed.
Stay away from mirtazapine, given your issues with eating and fatigue.
posted by persona au gratin at 5:15 PM on October 25, 2014
Try modafinil short term, and CBT longer term, for getting out of bed.
Stay away from mirtazapine, given your issues with eating and fatigue.
posted by persona au gratin at 5:15 PM on October 25, 2014
I've been depressed most of my adult life. I strongly second the idea that exercise helps. It has no side effects and works as well or better than antidepressant drugs. Personally, a walk a few times a week doesn't do it for me--I have to do intense exercise in order to feel the brain-chemical-altering effect. If you haven't tried intense exercise previously, give it a shot. Lift weights, swim... whatever you can do that really gets your heart rate up, even for a short time (a lot of people who do High Intensity Interval Training only do 20 minutes or less in a session).
posted by mysterious_stranger at 9:54 PM on October 25, 2014
posted by mysterious_stranger at 9:54 PM on October 25, 2014
This thread is closed to new comments.
posted by spunweb at 10:55 PM on October 24, 2014 [2 favorites]