How to start psych meds amid many life responsibilities / stressors?
June 18, 2021 8:39 AM Subscribe
Life got really stressful. Then I got anxious and depressed. I am doing pretty much all the non-medication stuff (psychotherapy, exercise, avoid alcohol/caffeine, etc). I’m now considering trying meds (not sure if I want to, nervous about it). The hard thing for me is: My understanding is that starting on psych meds, you might get a little out-of-commission for a while. I feel like I have too many stressors/responsibilities to be able to afford that. Looking for ideas, advice, etc.
Some specifics:
I’m a man in his early fifties. I am going through a divorce and have 6-year-old child. I am self-employed and going through a very challenging time in my business, and a lot of financial challenges.
For the past six weeks or so, I have been experiencing a fair amount of anxiety and depression, and trouble sleeping. I think I probably have what would be described as “mild” to “medium” levels of these things. (I’m able to do [most of] my work, albeit at a reduced capacity. I’m able to do basic stuff like leave the house, go shopping, visit a friend from time-to-time. But I also can get caught in hours of ruminating, have occasional anxiety attacks, low mood most of the time, etc... My sleep is often disrupted, waking several times a night with worry, etc).
I’m considering trying out meds for this. (SSRI’s, or possible Wellbutrin for its lower side-effects).
A lot of reviews have some version of “I was a basket case for a week, but then things were okay”.
I feel like I can’t really afford to be a basket case for a week. As the newly-divorced parent of a little kid: I feel like I need to be able to mostly keep my shit together when I am with him. The prospect that I’d be, like, having enormous panic attacks or crying jags or whatever when looking after my kid seems very worrisome. I don’t think I can comfortably ask my ex to cover for me if things get really bad. (Our current schedule is we alternate every couple of days or so).
In my work: A lot of what I do involves running events, workshops, classes, etc. My job is then to show up, on my own, and do the thing. These are often fairly high-stakes events where it’s really, really, really not good to “call in sick”, and where, often, I need to be able to perform at a pretty high level. (My job now is to be putting more of these into my calendar, which makes me nervous, because filling the calendar also feels like it reduces my freedom to get knocked out by meds, etc)
What are some strategies for getting started on anxiety/depression meds in cases where it feels like you don’t have leeway to mess up? Have you done/tried anything? Am I over-worrying the risks? Any advice/suggestions/etc welcome!
Some specifics:
I’m a man in his early fifties. I am going through a divorce and have 6-year-old child. I am self-employed and going through a very challenging time in my business, and a lot of financial challenges.
For the past six weeks or so, I have been experiencing a fair amount of anxiety and depression, and trouble sleeping. I think I probably have what would be described as “mild” to “medium” levels of these things. (I’m able to do [most of] my work, albeit at a reduced capacity. I’m able to do basic stuff like leave the house, go shopping, visit a friend from time-to-time. But I also can get caught in hours of ruminating, have occasional anxiety attacks, low mood most of the time, etc... My sleep is often disrupted, waking several times a night with worry, etc).
I’m considering trying out meds for this. (SSRI’s, or possible Wellbutrin for its lower side-effects).
A lot of reviews have some version of “I was a basket case for a week, but then things were okay”.
I feel like I can’t really afford to be a basket case for a week. As the newly-divorced parent of a little kid: I feel like I need to be able to mostly keep my shit together when I am with him. The prospect that I’d be, like, having enormous panic attacks or crying jags or whatever when looking after my kid seems very worrisome. I don’t think I can comfortably ask my ex to cover for me if things get really bad. (Our current schedule is we alternate every couple of days or so).
In my work: A lot of what I do involves running events, workshops, classes, etc. My job is then to show up, on my own, and do the thing. These are often fairly high-stakes events where it’s really, really, really not good to “call in sick”, and where, often, I need to be able to perform at a pretty high level. (My job now is to be putting more of these into my calendar, which makes me nervous, because filling the calendar also feels like it reduces my freedom to get knocked out by meds, etc)
What are some strategies for getting started on anxiety/depression meds in cases where it feels like you don’t have leeway to mess up? Have you done/tried anything? Am I over-worrying the risks? Any advice/suggestions/etc welcome!
You are probably over-worrying the risks, but this is also exactly what you should talk to your doctor about. When you start on a psych med, like a lot of meds, you usually start on a low dose and titrate upwards. This makes it easier for your body to adjust. That won't promise you won't have a bad reaction of some sort, but it's more likely to be like "annoying dry mouth" than something that would prevent you from working.
posted by chesty_a_arthur at 8:43 AM on June 18, 2021 [10 favorites]
posted by chesty_a_arthur at 8:43 AM on June 18, 2021 [10 favorites]
(Also, be clear with your doctor how much anxiety you're having about how to get started! That certainly seems more crippling than a lot of the side effects I've ever experienced.)
posted by chesty_a_arthur at 8:44 AM on June 18, 2021 [1 favorite]
posted by chesty_a_arthur at 8:44 AM on June 18, 2021 [1 favorite]
Response by poster: Should also say: I did try one SSRIs several years ago. For me it led to really bad sleep disruption that added a lot to my already-bad anxiety... My sleep is already lousy, which I suspect adds a lot to my current bad state, so I worry about that...
posted by LambSock at 8:47 AM on June 18, 2021
posted by LambSock at 8:47 AM on June 18, 2021
definitely something to talk to your psychiatrist or prescribing physician about. they can start you on a low dosage to see how you adjust to it over a week or two and dial it up as need be. i only had one really bad SSRI onboarding experience, but i called my doctor pretty quickly into that and we changed it to something else. obvs YMMV, but my paxil experience was nothing but smooth and made a pretty big dent in my happiness/anxiety levels.
sleep wise, try looking into a full spectrum CBD with a smudge of THC if legal in your area.
posted by zsh2v1 at 8:52 AM on June 18, 2021 [1 favorite]
sleep wise, try looking into a full spectrum CBD with a smudge of THC if legal in your area.
posted by zsh2v1 at 8:52 AM on June 18, 2021 [1 favorite]
I had a lot of the same concerns you did - I needed (medicated) help, but I also could not afford for it to make the situation worse before it got better. My doc started me at an almost stupidly low dose, and we've been slowly increasing it. I've gotten some annoying side effects (dry mouth, more sweating) but nothing that really changes my life. Meanwhile, the meds were working! Perhaps not solving the problem 100%, but maybe 75%? Trying to get to 100%, we kept going - then my sleep got disrupted (bad dreams can be a side effect) and with my doc we pulled back. I've since learned how to manage the side effects (if I take the pills at night I'm fine, if I take them in the morning my dreams get funky and stressful) and I think I'm almost at my final-final dosage level with only the annoying sweating problem, hah. Meanwhile my doc has made it clear that if things aren't working, and I want to try something else, all I need to do is say the word and we'll figure out next steps.
The key for me was being open and honest with my doc. More honest than I'm usually comfortable with, to be honest -- but the benefits were more important than my ego or any perceived judgement (of which there is absolutely none, but us humans do worry about these things!)
Disclaimer - Canada. No idea about any US-med-system difficulties.
posted by cgg at 9:00 AM on June 18, 2021 [4 favorites]
The key for me was being open and honest with my doc. More honest than I'm usually comfortable with, to be honest -- but the benefits were more important than my ego or any perceived judgement (of which there is absolutely none, but us humans do worry about these things!)
Disclaimer - Canada. No idea about any US-med-system difficulties.
posted by cgg at 9:00 AM on June 18, 2021 [4 favorites]
I definitely think anxiety is playing a big part in this. Very few people have the luxury of taking weeks off for med starts/stops/changes and it is generally not required, just know that a) you're not going to get dramatically better that week but you probably weren't anyway b) it may mess with your sleep, digestion, or equilibrium a little bit but you're probably already experiencing those to some extent and may not even notice a serious difference c) most people just push through that and/or plan up front to treat the symptoms - which is a plan you can work on with your doctor.
In all likelihood, on the other side of this you too will be a person who says, "eh, it wasn't a fantastic couple of weeks but it wasn't the end of the world either." Like, you will probably have an experience you wouldn't recommend to anybody for fun but will consider it worth it to have gotten to a better place with a full dosage giving you all the benefits.
You say you don't have any leeway for things to get worse, but I have bad news about how much benefit you're getting from doing nothing. Think of this as one final round of trying to hold yourself up by your own bootstraps, help is on the way, you're putting on your oxygen mask, try to flip some of this dread of doing the thing into back-patting for doing the thing - you are taking a positive action for yourself and your kiddo and your business because what you were doing before wasn't working.
It may be scary, and it might even be a little bit hard, but it's hard-trending-positive instead of hard-trending-negative, and you're underestimating the power of that.
And always remember you're fighting a real battle here: your anxiety doesn't want you to do this. It will tell you anything it can to talk you out of this. You may have to just take a leap of faith that the anxiety is wrong and try the advice of someone who went to school for the better part of a decade for this instead, for an interesting change. Your anxiety wants you to believe that all side effects are dire and catastrophic and unmanageable, when most people mostly find them slightly annoying and often temporary or intermittent.
Talk to your doctor about this. Be willing to trust them a little bit more than the voice of your anxiety. Remember that most people are glad they did.
posted by Lyn Never at 9:17 AM on June 18, 2021 [11 favorites]
In all likelihood, on the other side of this you too will be a person who says, "eh, it wasn't a fantastic couple of weeks but it wasn't the end of the world either." Like, you will probably have an experience you wouldn't recommend to anybody for fun but will consider it worth it to have gotten to a better place with a full dosage giving you all the benefits.
You say you don't have any leeway for things to get worse, but I have bad news about how much benefit you're getting from doing nothing. Think of this as one final round of trying to hold yourself up by your own bootstraps, help is on the way, you're putting on your oxygen mask, try to flip some of this dread of doing the thing into back-patting for doing the thing - you are taking a positive action for yourself and your kiddo and your business because what you were doing before wasn't working.
It may be scary, and it might even be a little bit hard, but it's hard-trending-positive instead of hard-trending-negative, and you're underestimating the power of that.
And always remember you're fighting a real battle here: your anxiety doesn't want you to do this. It will tell you anything it can to talk you out of this. You may have to just take a leap of faith that the anxiety is wrong and try the advice of someone who went to school for the better part of a decade for this instead, for an interesting change. Your anxiety wants you to believe that all side effects are dire and catastrophic and unmanageable, when most people mostly find them slightly annoying and often temporary or intermittent.
Talk to your doctor about this. Be willing to trust them a little bit more than the voice of your anxiety. Remember that most people are glad they did.
posted by Lyn Never at 9:17 AM on June 18, 2021 [11 favorites]
For me alcohol was 90% of my sleep problem. I replaced it with kava in the evening for relaxation, and a low dose of melatonin before bed. Seems to be working so far, except for a runny nose which may be related to the kava. Keeping the morning cup of coffee, though.
(Obviously YMMV and IANAD, consume kava responsibly under the care of your local kava bartender)
posted by RobotVoodooPower at 9:32 AM on June 18, 2021 [1 favorite]
(Obviously YMMV and IANAD, consume kava responsibly under the care of your local kava bartender)
posted by RobotVoodooPower at 9:32 AM on June 18, 2021 [1 favorite]
Check your MeMail.
posted by Medieval Maven at 9:34 AM on June 18, 2021 [1 favorite]
posted by Medieval Maven at 9:34 AM on June 18, 2021 [1 favorite]
I've seen someone wise in AskMe, and I think it was probably jessamyn, point out previously that getting anxious about taking anti-anxiety meds is kind of part of the picture, because... well, you've got anxiety. And it loves to glom onto anything it can. That doesn't mean it's a bad idea to take them. The best time to start taking them was a few weeks ago, the second best time is now.
The tricky thing is that everyone's experience varies so it's always hard to advise other people, but my experience has been that most times, that kind of 'being able to knuckle through and do the stuff that's really demanded of you' ability you're already deploying, will continue and help you get through side-effects too. It's amazing how much of a normal front it's sometimes possible to put up even when there's chaos going on inside. Especially - IME - when you know that this time the chaos is part of your healing and so is probably finite - a much more manageable prospect than feeling like you're on a downhill slope into worsening, unmedicated MH problems. You can continue to shelve all but the most necessary tasks in your life, but this time in the knowledge that, in a few weeks' time, you'll probably be feeling better.
That doesn't mean that you have to put up with hell - if you feel the side-effects are pushing beyond your ability to cope with the necessary tasks in life, you call the doctor, come off the meds, and try a different one.
Best of luck - you're doing the right thing.
posted by penguin pie at 9:50 AM on June 18, 2021 [5 favorites]
The tricky thing is that everyone's experience varies so it's always hard to advise other people, but my experience has been that most times, that kind of 'being able to knuckle through and do the stuff that's really demanded of you' ability you're already deploying, will continue and help you get through side-effects too. It's amazing how much of a normal front it's sometimes possible to put up even when there's chaos going on inside. Especially - IME - when you know that this time the chaos is part of your healing and so is probably finite - a much more manageable prospect than feeling like you're on a downhill slope into worsening, unmedicated MH problems. You can continue to shelve all but the most necessary tasks in your life, but this time in the knowledge that, in a few weeks' time, you'll probably be feeling better.
That doesn't mean that you have to put up with hell - if you feel the side-effects are pushing beyond your ability to cope with the necessary tasks in life, you call the doctor, come off the meds, and try a different one.
Best of luck - you're doing the right thing.
posted by penguin pie at 9:50 AM on June 18, 2021 [5 favorites]
I was also coming in to say that my feeling is that you sound in pretty rough shape already and the benefits of medication are probably going out outweigh any potential side effects. Nthing everyone who said to openly and overcommunicate this to your doctor as that will factor into what drug they choose, what dosage to start you on, etc.
Also I'm just a sample size of one but "a basket case for a week" was definitely not my experience at all, it took two full weeks before I even noticed anything happening at all (my mouth was drier and I was suddenly drinking way more water: a good thing, for me!) and I noticed larger (positive) changes that the meds were working as expected right at the 4-week mark. I would suspect you're much more likely to notice small changes happening gradually than any major shift that would suddenly put you completely out of commission with no warning.
Best of luck. You're doing a good thing for you (and your family!) by pursuing this! Hang in there!
posted by anderjen at 9:52 AM on June 18, 2021 [2 favorites]
Also I'm just a sample size of one but "a basket case for a week" was definitely not my experience at all, it took two full weeks before I even noticed anything happening at all (my mouth was drier and I was suddenly drinking way more water: a good thing, for me!) and I noticed larger (positive) changes that the meds were working as expected right at the 4-week mark. I would suspect you're much more likely to notice small changes happening gradually than any major shift that would suddenly put you completely out of commission with no warning.
Best of luck. You're doing a good thing for you (and your family!) by pursuing this! Hang in there!
posted by anderjen at 9:52 AM on June 18, 2021 [2 favorites]
Definitely talk to your doctor, but here's my anecdata: I was in a similar situation as you (anxiety and not sleeping making it worse, and too much going on in my life). My dr. prescribed gabapentin (off label) to help in the immediate term, and lexapro to help in medium/long term. The first night I took gabapentin I slept like BABY which helped immensely. I hadn't slept like that in months. I started on the lexapro as well, which takes a few weeks to take effect. I did have some small (non-mental-health) side effects, but it did not make me a basket case in the least. I only ever felt better after the gabapentin and lexapro. But definitely talk to you doctor, and don't be scared to give it a shot. Even if you are a basket case for a few days, that's a very short time, and its better than being an almost-basket case for the indefinite future. Good luck!
posted by sillysally at 10:01 AM on June 18, 2021 [1 favorite]
posted by sillysally at 10:01 AM on June 18, 2021 [1 favorite]
Oh, and I should add that I put off trying anxiety medication for five years because of fears exactly like the ones you are describing (also feelings like I "should" be able to muscle through with exercise and sunshine and laying off caffeine and yada yada). One of my biggest regrets is that I didn't start way sooner. I know we only begin something when we are ready to begin, but it was in every way a far less disruptive and more beneficial experience than I could have ever imagined and I wish I had known I didn't need to be so scared of it and that better days were definitely ahead.
posted by anderjen at 10:03 AM on June 18, 2021 [6 favorites]
posted by anderjen at 10:03 AM on June 18, 2021 [6 favorites]
Unfortunately, choosing the right anti-depressant is still something of a trial-and-error process. SSRI's theoretically all work the same, but they each come with their own set of side-effects and sensitivities. My child and I take different SSRI's because what worked for him was a nightmare for me, and vice versa. Welbutrin (which actually inhibits the reuptake of norepinephrine and dopamine, not serotonin) has fewer sides (and I personally love it), but a shrink told me it only works for 40% of those who try it.
All that said, the right anti-depressant can be a life saver. Definitely tell your prescriber about your previous bad experiences. And then be sensitive to what's going on inside you when you start a pill on a reduced dose. Many of the common sides go away after a week or so, and some can be ameliorated during that period with other drugs, such as anti-nausea drugs, or even just a bit of yogurt. The important thing is to be aware and let your prescriber know what's happening.
Good luck!
posted by ubiquity at 10:15 AM on June 18, 2021 [1 favorite]
All that said, the right anti-depressant can be a life saver. Definitely tell your prescriber about your previous bad experiences. And then be sensitive to what's going on inside you when you start a pill on a reduced dose. Many of the common sides go away after a week or so, and some can be ameliorated during that period with other drugs, such as anti-nausea drugs, or even just a bit of yogurt. The important thing is to be aware and let your prescriber know what's happening.
Good luck!
posted by ubiquity at 10:15 AM on June 18, 2021 [1 favorite]
I've been on or tried a whole bunch of ADs of various families and with one exception (which was, in hindsight, a totally inappropriate medication for me) I've never had more than mild symptoms. In all cases things had gotten intolerable enough that not doing anything felt riskier than potential side effects. And as another commenter noted if you do feel worse, you can stop and you'll go back to your baseline nearly immediately (you won't have been on it long enough to have withdrawal symptoms). Not sure if this has come up, but short-acting anxiety medications (eg Klonopin) can be incredibly effective on an as-needed basis. Likewise sleep meds, although both have their own risks and side effects. Neither is a substitute for an AD but for me, just knowing that I have anxiety meds at hand in case things suddenly spiral is itself reassuring. (For reference I am your age and currently on a combination of an AD and a mood stabilizer, which work well together.)
posted by weirdly airport at 10:25 AM on June 18, 2021 [3 favorites]
posted by weirdly airport at 10:25 AM on June 18, 2021 [3 favorites]
Talk to your doctors about this.
But also, as people have said, meds affect everyone differently.
As an anecdote, when I started taking Wellbutrin the immediate effect was that I had A! LOT!! OF!!! ENERGY!! Like, I barely needed to sleep the first day, and was the most productive, in terms of writing, than I have ever been in my entire life. Honestly, I think back to those first few days as a teeny tiny insight into what it must be like to be on speed, and I understand how people get addicted to amphetamines. It was amazing. I now know to expect a slight uptick in energy and happy mood if I change my dose, that quickly settles down again in a few days. But otherwise I have no long or short term negative side effects.
This is definitely not everyone's experience. And honestly, there is no way for you to know how your body is going to react until you try it. But know that for many people, even a few days or a couple of weeks of weirdness and disruption are worth it, for the ultimate feeling of being less miserable all the time.
posted by EllaEm at 10:40 AM on June 18, 2021 [1 favorite]
But also, as people have said, meds affect everyone differently.
As an anecdote, when I started taking Wellbutrin the immediate effect was that I had A! LOT!! OF!!! ENERGY!! Like, I barely needed to sleep the first day, and was the most productive, in terms of writing, than I have ever been in my entire life. Honestly, I think back to those first few days as a teeny tiny insight into what it must be like to be on speed, and I understand how people get addicted to amphetamines. It was amazing. I now know to expect a slight uptick in energy and happy mood if I change my dose, that quickly settles down again in a few days. But otherwise I have no long or short term negative side effects.
This is definitely not everyone's experience. And honestly, there is no way for you to know how your body is going to react until you try it. But know that for many people, even a few days or a couple of weeks of weirdness and disruption are worth it, for the ultimate feeling of being less miserable all the time.
posted by EllaEm at 10:40 AM on June 18, 2021 [1 favorite]
Anecdata: 44 years old, recent fairly amicable divorce. I went on 20mg Paxil to quell my acute daily panic attacks (it did, 100%). My appetite went down for about a week, and my little guy down south just absolutely went into hibernation for about 2 weeks. Absolutely zero other symptoms, psychological or otherwise.
Another fear I had is that an SSRI would somehow dull me or that I couldn't lose my panic without losing some kind of imaginary "edge". Nope. Absolutely not the case for me. I feel like exactly the same me except without the panic attacks and anxiety.
My general message to most folks thinking about going on an SSRI is absolutely try it, like, yesterday. I pay something like $3 a month and my life is markedly better with few to zero downsides.
posted by ftm at 11:02 AM on June 18, 2021 [3 favorites]
Another fear I had is that an SSRI would somehow dull me or that I couldn't lose my panic without losing some kind of imaginary "edge". Nope. Absolutely not the case for me. I feel like exactly the same me except without the panic attacks and anxiety.
My general message to most folks thinking about going on an SSRI is absolutely try it, like, yesterday. I pay something like $3 a month and my life is markedly better with few to zero downsides.
posted by ftm at 11:02 AM on June 18, 2021 [3 favorites]
Like everyone says- side effects are very personal. I had a super hard time starting on a SSRI: the physical side-effects had me basically incapacitated, even on a baby dose. Turns out I'm just super sensitive to things that mess with serotonin.
Bupropion (wellbutrin) was much better. I believe it generally has an easier to deal with set of side-effects, although one of those can be increased anxiety. YMMV!
Sounds like maybe you could benefit with trying some anti-anxiety meds before antidepressants?
Whichever way you go, make sure you express your needs to your doc, and if they aren't on board with going super slow, or dialing back immediately if warning signs start appearing, then consider finding another doctor.
posted by Jobst at 11:19 AM on June 18, 2021 [1 favorite]
Bupropion (wellbutrin) was much better. I believe it generally has an easier to deal with set of side-effects, although one of those can be increased anxiety. YMMV!
Sounds like maybe you could benefit with trying some anti-anxiety meds before antidepressants?
Whichever way you go, make sure you express your needs to your doc, and if they aren't on board with going super slow, or dialing back immediately if warning signs start appearing, then consider finding another doctor.
posted by Jobst at 11:19 AM on June 18, 2021 [1 favorite]
Yes, you should obviously talk to your medical team about meds. If you need more help, this could be a go to.
But also, meditation. Meditation consistently shows relief on par with meds, and there are nearly no negative side effects. It seems like you're doing the diet and exercise things that can help before meds. I would also consider throwing in meditation in case that is the boost you need to get closer to normal whole you deal with this hard time. If you are truly worried about the meds, it could be an alternative to try first.
posted by Kalmya at 11:24 AM on June 18, 2021
But also, meditation. Meditation consistently shows relief on par with meds, and there are nearly no negative side effects. It seems like you're doing the diet and exercise things that can help before meds. I would also consider throwing in meditation in case that is the boost you need to get closer to normal whole you deal with this hard time. If you are truly worried about the meds, it could be an alternative to try first.
posted by Kalmya at 11:24 AM on June 18, 2021
Hi, I went on a med for the first time during pandemic and had almost no side effects.
I did feel an immediate benefit from taking a forward step: acknowledging that I had a broken brain and I was taking physical action (swallowing a pill) to try all available means to mend it. Because the med was “doing the work” I also got a rest from anxious rumination that I was supposed to help myself through internal methods requiring time energy and willpower (meditation, CBT, unrealistic exercise regimes), and that reduced a lot of anxiety and shame. None of this had to do with the contents of this pill, just what the pill represented.
Negative effects were a few days of light fuzziness, then nothing. After about ten days symptoms of numbness, depression and feelings of panic decreased to almost normal. I was employed full time and was parenting kids (at home) and did not miss any work.
As work and school pressures have decreased, and also scores of people are not dying in my community daily, I just started tapering off last week and can report no side effects for going off as well.
I’ll memail you with an offer to give you more specific details if you like, my demographics are quite similar to yours.
posted by sol at 11:24 AM on June 18, 2021 [1 favorite]
I did feel an immediate benefit from taking a forward step: acknowledging that I had a broken brain and I was taking physical action (swallowing a pill) to try all available means to mend it. Because the med was “doing the work” I also got a rest from anxious rumination that I was supposed to help myself through internal methods requiring time energy and willpower (meditation, CBT, unrealistic exercise regimes), and that reduced a lot of anxiety and shame. None of this had to do with the contents of this pill, just what the pill represented.
Negative effects were a few days of light fuzziness, then nothing. After about ten days symptoms of numbness, depression and feelings of panic decreased to almost normal. I was employed full time and was parenting kids (at home) and did not miss any work.
As work and school pressures have decreased, and also scores of people are not dying in my community daily, I just started tapering off last week and can report no side effects for going off as well.
I’ll memail you with an offer to give you more specific details if you like, my demographics are quite similar to yours.
posted by sol at 11:24 AM on June 18, 2021 [1 favorite]
+1 for this being something your doctor can help you with, for example by starting out at a low dosage and ramping up to the therapeutic dosage as tolerated.
There's no 100% guarantee that you won't experience a really unpleasant side effect, but I'll also share my own experience that starting up a new SSRI definitely does not lead to being a "basket case for a week". Dry mouth, slight hazy feeling, maybe a bit of headache—but no big mood swings or panic attacks, no negative impact on cognition, no drowsiness to the point of not being able to drive or stay awake during the day, etc. In other words, nothing that put my ability to perform my regular activities and responsibilities at risk.
Let me also give a gentle reminder that if you are not getting enough restful sleep, you are not performing at 100% capacity now. It sounds like you are doing okay with keeping up with your basic responsibilities, but also that your anxiety is having a serious impact on your quality of life. Medication (especially combined with therapy, lifestyle support, etc that you are already doing) can help you feel a lot better than you are now.
posted by 4rtemis at 11:33 AM on June 18, 2021
There's no 100% guarantee that you won't experience a really unpleasant side effect, but I'll also share my own experience that starting up a new SSRI definitely does not lead to being a "basket case for a week". Dry mouth, slight hazy feeling, maybe a bit of headache—but no big mood swings or panic attacks, no negative impact on cognition, no drowsiness to the point of not being able to drive or stay awake during the day, etc. In other words, nothing that put my ability to perform my regular activities and responsibilities at risk.
Let me also give a gentle reminder that if you are not getting enough restful sleep, you are not performing at 100% capacity now. It sounds like you are doing okay with keeping up with your basic responsibilities, but also that your anxiety is having a serious impact on your quality of life. Medication (especially combined with therapy, lifestyle support, etc that you are already doing) can help you feel a lot better than you are now.
posted by 4rtemis at 11:33 AM on June 18, 2021
I went through a horrible period as a young adult where I was put on many different psych meds because the medical community misunderstood what was happening with me. SSRIs, mood stabilizers, antipsychotics, and more.
I bring that up to say that going through all of that, not once would I say that side effects were so awful I wouldn't have been able to work. I was in college at the time and was still able to function for school. I just also had emotional numbness, or jittery feelings, or weight changes, etc. I eventually weaned off all the medications with my doctor's awareness.
Because of the above fiasco, I resisted getting back on meds for a long time. But my anxiety was pretty debilitating and I did the non-pharmacological things. It wasn't enough. I realized I probably still had some depression too. I started back on bupropion as that was the best antidepressant for me. And I asked to try buspirone for the anxiety. I'd heard of it but never tried it. I didn't want to take more addictive anxiety meds regularly and I knew the SS/SNRI class was a nonstarter. Buspirone doesn't work for everyone but it's worked great for me with basically no side effects even in the beginning.
I'm very glad I chose to start medication again. I was doing "ok" before, but I was also white knuckling my way through life. I get the anxiety. It's about control. And you already have out of control things happening. But more than likely your doctor can help design a plan with minimal risk. The sooner you make the appointment the sooner you can stop white knuckling your way, too. (IANAD, TINMA)
posted by crunchy potato at 12:49 PM on June 18, 2021 [2 favorites]
I bring that up to say that going through all of that, not once would I say that side effects were so awful I wouldn't have been able to work. I was in college at the time and was still able to function for school. I just also had emotional numbness, or jittery feelings, or weight changes, etc. I eventually weaned off all the medications with my doctor's awareness.
Because of the above fiasco, I resisted getting back on meds for a long time. But my anxiety was pretty debilitating and I did the non-pharmacological things. It wasn't enough. I realized I probably still had some depression too. I started back on bupropion as that was the best antidepressant for me. And I asked to try buspirone for the anxiety. I'd heard of it but never tried it. I didn't want to take more addictive anxiety meds regularly and I knew the SS/SNRI class was a nonstarter. Buspirone doesn't work for everyone but it's worked great for me with basically no side effects even in the beginning.
I'm very glad I chose to start medication again. I was doing "ok" before, but I was also white knuckling my way through life. I get the anxiety. It's about control. And you already have out of control things happening. But more than likely your doctor can help design a plan with minimal risk. The sooner you make the appointment the sooner you can stop white knuckling your way, too. (IANAD, TINMA)
posted by crunchy potato at 12:49 PM on June 18, 2021 [2 favorites]
Hi, I'm bipolar and I've been on so many drug trials I can't remember them all. The one uniting factor, though, is that *you can stop taking them any time* if you get put on something new and it makes things a lot worse. I'd say that 75% of the time a med change isn't horrible, it's just something like dry mouth. But the thing is with pills, if your doctor puts you on Drug A and you take it for four days and can tell you're getting miserable, you can call your doctor and tell them and stop taking it. It's not like a depo injection that will take a long time to wear off, and as someone mentioned above, you won't have been on it long enough to have withdrawal symptoms.
I know it's scary. I've recently had to have my meds adjusted and I was not looking forward to it. But it's also not as bad as your anxiety can tell you it is. I don't think you need to not make plans because you think you'll have a week of being a basket case. It's usually MUCH subtler than that, and if it's not, that's a talk-to-your-doctor-immediately issue and you will usually be told to stop or adjust your dosage.
Good luck! I often find that when a new med starts working, I realize I was much worse off than I thought I was, and that the meds help way more than I thought they would!
posted by fiercecupcake at 1:08 PM on June 18, 2021 [2 favorites]
I know it's scary. I've recently had to have my meds adjusted and I was not looking forward to it. But it's also not as bad as your anxiety can tell you it is. I don't think you need to not make plans because you think you'll have a week of being a basket case. It's usually MUCH subtler than that, and if it's not, that's a talk-to-your-doctor-immediately issue and you will usually be told to stop or adjust your dosage.
Good luck! I often find that when a new med starts working, I realize I was much worse off than I thought I was, and that the meds help way more than I thought they would!
posted by fiercecupcake at 1:08 PM on June 18, 2021 [2 favorites]
Response by poster: Thanks everyone!! You have *really* changed my thinking about this a lot!!
posted by LambSock at 4:57 AM on June 19, 2021 [1 favorite]
posted by LambSock at 4:57 AM on June 19, 2021 [1 favorite]
Definitely talk to your doctor about a med that can help in the short term with sleep and potentially anxiety attacks that you can take along with something longer term like SSRIs. SSRIs can take a few weeks to kick in, and sometimes the first thing to kick in can be side effects (which often go away for a lot of people in a few weeks). '
It is completely reasonable to worry about sleep being interrupted, and I would say any decent doctor would understand that sleep is a top priority. If you're sleep deprived, everything else can easily spiral. And insomnia is a common complaint I'm sure for doctor's to deal with, so definitely bring this up with them!
Also, you're not alone. I definitely go through some version of "OMG what if this med makes me even worse, what if it changes me forever, what if it makes my anxiety worse, maybe it's not that bad and I'm better toughing it out without meds, what if I'm making this whole thing up" and on and on and on. As already mentioned above, this is just another manifestation of your mental health symptoms. Talk to your doctor about these fears!
Good luck!
posted by litera scripta manet at 6:01 AM on June 19, 2021
It is completely reasonable to worry about sleep being interrupted, and I would say any decent doctor would understand that sleep is a top priority. If you're sleep deprived, everything else can easily spiral. And insomnia is a common complaint I'm sure for doctor's to deal with, so definitely bring this up with them!
Also, you're not alone. I definitely go through some version of "OMG what if this med makes me even worse, what if it changes me forever, what if it makes my anxiety worse, maybe it's not that bad and I'm better toughing it out without meds, what if I'm making this whole thing up" and on and on and on. As already mentioned above, this is just another manifestation of your mental health symptoms. Talk to your doctor about these fears!
Good luck!
posted by litera scripta manet at 6:01 AM on June 19, 2021
Response by poster: Thanks for all the replies! For anyone checking in later: I started the meds (Wellbutrin 150mg). As I write this: Five days in, and no real side effects that I can notice.
posted by LambSock at 4:32 AM on July 2, 2021 [3 favorites]
posted by LambSock at 4:32 AM on July 2, 2021 [3 favorites]
Response by poster: Just back, later, for anyone watching this later, to update:
I started on Wellbutrin, 150mg, about 4.5 weeks ago. I had no negative side effects at all. I am definitely experiencing really marked improvement in my anxiety and depression. It's great! Not all better, but very different.
Here is one tip I want to share that no one told me: It has helped a lot that I track my symptoms and moods. I think at first, on the meds, I thought "I dunno, maybe these are working, maybe they are not. I mean, I don't feel *that* great". But then when I looked over my tracking sheets, I could see much clearer patterns: Like, there are still bad hours/days on the meds, but they happen *much* less often than before, are less intense, etc. I'm not sure I'd be able to see that as clearly without some tracking.
I think the positive effects started at 2.5 weeks or so. Now, at 4.5 weeks, I'm in a really different place than I was when I started. I'll likely be increasing my dose from 150mg to 300mg, to see if that helps further.
I am so, so glad I decided to take these meds. I want to offer my thanks to those who posted here, and my encouragement to those who are nervous (like I was) about starting.
posted by LambSock at 9:28 AM on July 30, 2021 [2 favorites]
I started on Wellbutrin, 150mg, about 4.5 weeks ago. I had no negative side effects at all. I am definitely experiencing really marked improvement in my anxiety and depression. It's great! Not all better, but very different.
Here is one tip I want to share that no one told me: It has helped a lot that I track my symptoms and moods. I think at first, on the meds, I thought "I dunno, maybe these are working, maybe they are not. I mean, I don't feel *that* great". But then when I looked over my tracking sheets, I could see much clearer patterns: Like, there are still bad hours/days on the meds, but they happen *much* less often than before, are less intense, etc. I'm not sure I'd be able to see that as clearly without some tracking.
I think the positive effects started at 2.5 weeks or so. Now, at 4.5 weeks, I'm in a really different place than I was when I started. I'll likely be increasing my dose from 150mg to 300mg, to see if that helps further.
I am so, so glad I decided to take these meds. I want to offer my thanks to those who posted here, and my encouragement to those who are nervous (like I was) about starting.
posted by LambSock at 9:28 AM on July 30, 2021 [2 favorites]
LambSock - that's brilliant news. Well done for getting yourself this far *high five* and thanks for updating with the good news.
posted by penguin pie at 9:33 AM on July 30, 2021 [2 favorites]
posted by penguin pie at 9:33 AM on July 30, 2021 [2 favorites]
Response by poster: Wanted to post another update, a few weeks later, just for anyone checking in on this thread later wanting anecdotes:
A few weeks later now. I have increased my dose from 150 to 300. Things are *so* much better. It's really remarkable. Of course, it's hard to know for sure how much of this is attributable to the meds directly, but my impression is that they are a big part of the story. I went from "Most of my days are pretty terrible most of the time with brief moments of reprieve" to "I have lots of days that are endurable" to "Most of my days are actually pretty great". It's a really amazing difference: Being me feels *completely* different now than it did three or so months ago.
I'm someone who's more prone to anxiety than to depression. I was worried Wellbutrin would contribute to anxiety, but it has not. I was worried it would interfere with my sleep but it has not: I'm sleeping great for the first time in ages.
I have not had any negative side effects at all that I have noticed. One possible side effect is: Often I feel bit stimulated/activated, sort of like the effects of caffeine. I find this generally pleasant. I'm also not sure if that's the effect of the meds or just general excitement about some fun stuff in my work and life.
A few more tips to share with anyone reading this: I find it helpful to track mood, but also to look at other indicators: I think before I was sure if the meds were working, numerous friends and co-workers remarked that I seemed to be myself for the first time in a long time. I was more productive at work. I was able to resume my full exercise routine, where I'd previously not been able to find the motivation. Looking for indicators like this can help. In my case: the improvement has been incredibly dramatic, but also very gradual- I'd say a gradual ramping up improvement over 8 to 10 weeks.
I feel very lucky and grateful for this change. And grateful for all the folks on this forum. It asked multiple questions here about decisions around meds, and the responses were *tremendously* helpful.
posted by LambSock at 6:52 AM on September 6, 2021 [1 favorite]
A few weeks later now. I have increased my dose from 150 to 300. Things are *so* much better. It's really remarkable. Of course, it's hard to know for sure how much of this is attributable to the meds directly, but my impression is that they are a big part of the story. I went from "Most of my days are pretty terrible most of the time with brief moments of reprieve" to "I have lots of days that are endurable" to "Most of my days are actually pretty great". It's a really amazing difference: Being me feels *completely* different now than it did three or so months ago.
I'm someone who's more prone to anxiety than to depression. I was worried Wellbutrin would contribute to anxiety, but it has not. I was worried it would interfere with my sleep but it has not: I'm sleeping great for the first time in ages.
I have not had any negative side effects at all that I have noticed. One possible side effect is: Often I feel bit stimulated/activated, sort of like the effects of caffeine. I find this generally pleasant. I'm also not sure if that's the effect of the meds or just general excitement about some fun stuff in my work and life.
A few more tips to share with anyone reading this: I find it helpful to track mood, but also to look at other indicators: I think before I was sure if the meds were working, numerous friends and co-workers remarked that I seemed to be myself for the first time in a long time. I was more productive at work. I was able to resume my full exercise routine, where I'd previously not been able to find the motivation. Looking for indicators like this can help. In my case: the improvement has been incredibly dramatic, but also very gradual- I'd say a gradual ramping up improvement over 8 to 10 weeks.
I feel very lucky and grateful for this change. And grateful for all the folks on this forum. It asked multiple questions here about decisions around meds, and the responses were *tremendously* helpful.
posted by LambSock at 6:52 AM on September 6, 2021 [1 favorite]
This thread is closed to new comments.
posted by LambSock at 8:42 AM on June 18, 2021