Should I try antidepressants even if my mental health is improving?
June 16, 2024 7:21 AM Subscribe
The doctor said after 15min of chatting that she doesn't give therapy sessions, that i should go in nature more, pet my dogs more, and take Sertraline for my mild depression. That I probably just don't respond to stress as good as an average person. I've never been prescribed ADs before.
Hi, I gathered my courage and went to the psychiatrist. I went to the one with plenty of high reviews that rarely takes new patients.
My challenge is that years ago my psychotherapist diagnosed me with ADHD (inattentive). It explained a lot. I've always struggled with paying attention as I have constant paralel streams of thoughts in my mind and it resulted in being forgetful, hyperfocusing,making good impression at first at work and afterwards underperforming. I create disorder very quickly, can't keep my house clean easily. I managed to compensate somehow with some exercises, but no miracles there.
I could still somehow live with it, i guess, but ever since my beloved cat passed away, i noticed massive worsening. It happened shortly i got rid of my violent boyfriend, so I didn't have plenty of time to celebrate. But it was a real gut punch, I started forgetting everything everywhere, i have memory gaps, i couldn't get my diet back together (could eat only sweets, everything else made me sick) and got hooked on sugar. It was really a challenge.
A few weeks after that, a colleague started giving me support, it helped me tremendously. We became romantically involved and for several months it has been going great, he moved in together recently. I've never felt more loved and respected my entire life so my mental health started increasing.
Which brings me back, the queue has ended and my meeting with psychiatrist was due a few weeks ago. I went there and explained her the situation. I briefly mentioned also my abusive parents, cheating ex bf and abusive drunk ex bf, as well as harmful thoughts a few years back for which i haven't searched for help.
The doctor said after 15min of chatting that she doesn't give therapy sessions, that i should go in nature more, pet my dogs more, and take Sertraline for my mild depression. That I probably just don't respond to stress as good as an average person.
Now, I am living in Eastern Europe and have my doubts about healthcare here, especially mental health is not the best. I read side effects and I am terrified of giving it a shot. I have easily irritated stomach, need to take BC pills for my probably endometriosis, and I am not sure if the benefits could possibly outweigh the risks. I am doing much better now despite my grief and the ADHD(-like symptoms), while I'd be happy to get rid of them, I'm just terrified.
Does anyone have any experience?
Hi, I gathered my courage and went to the psychiatrist. I went to the one with plenty of high reviews that rarely takes new patients.
My challenge is that years ago my psychotherapist diagnosed me with ADHD (inattentive). It explained a lot. I've always struggled with paying attention as I have constant paralel streams of thoughts in my mind and it resulted in being forgetful, hyperfocusing,making good impression at first at work and afterwards underperforming. I create disorder very quickly, can't keep my house clean easily. I managed to compensate somehow with some exercises, but no miracles there.
I could still somehow live with it, i guess, but ever since my beloved cat passed away, i noticed massive worsening. It happened shortly i got rid of my violent boyfriend, so I didn't have plenty of time to celebrate. But it was a real gut punch, I started forgetting everything everywhere, i have memory gaps, i couldn't get my diet back together (could eat only sweets, everything else made me sick) and got hooked on sugar. It was really a challenge.
A few weeks after that, a colleague started giving me support, it helped me tremendously. We became romantically involved and for several months it has been going great, he moved in together recently. I've never felt more loved and respected my entire life so my mental health started increasing.
Which brings me back, the queue has ended and my meeting with psychiatrist was due a few weeks ago. I went there and explained her the situation. I briefly mentioned also my abusive parents, cheating ex bf and abusive drunk ex bf, as well as harmful thoughts a few years back for which i haven't searched for help.
The doctor said after 15min of chatting that she doesn't give therapy sessions, that i should go in nature more, pet my dogs more, and take Sertraline for my mild depression. That I probably just don't respond to stress as good as an average person.
Now, I am living in Eastern Europe and have my doubts about healthcare here, especially mental health is not the best. I read side effects and I am terrified of giving it a shot. I have easily irritated stomach, need to take BC pills for my probably endometriosis, and I am not sure if the benefits could possibly outweigh the risks. I am doing much better now despite my grief and the ADHD(-like symptoms), while I'd be happy to get rid of them, I'm just terrified.
Does anyone have any experience?
I have been taking Sertraline for about 10 years and you won't pry it off me. It has smoothed out my moods and reduced my irritability, making life so much easier for me and my family. I can enjoy life without worrying or getting exhausted by depressing thoughts and anxiety.
Try it for 4 to 6 weeks. I hope it works for you.
posted by Enid Lareg at 7:35 AM on June 16 [6 favorites]
Try it for 4 to 6 weeks. I hope it works for you.
posted by Enid Lareg at 7:35 AM on June 16 [6 favorites]
Just want to say that whether or not you decide to take the meds, you don't need to be at rock bottom or desperately unhappy before it's worth taking meds.
It's totally valid to take meds even if you've felt worse in the past, or are improving.
I say this because it sounds as if you have been through some really rough times and I suspect your "doing OK right now " might seem like "Oh wow that was a tough time" with a bit more perspective in the future.
posted by Zumbador at 8:04 AM on June 16 [13 favorites]
It's totally valid to take meds even if you've felt worse in the past, or are improving.
I say this because it sounds as if you have been through some really rough times and I suspect your "doing OK right now " might seem like "Oh wow that was a tough time" with a bit more perspective in the future.
posted by Zumbador at 8:04 AM on June 16 [13 favorites]
I took it for a while and it was somewhat useful, I guess. I stopped after a year or so once I’d addressed some of the underlying reasons why I was depressed & anxious at that time. It’s not a miracle cure, but it has its uses.
TBH I like your doctor’s other advice better.
posted by rd45 at 8:08 AM on June 16
TBH I like your doctor’s other advice better.
posted by rd45 at 8:08 AM on June 16
Another huge fan of Sertraline, here. It is life changing, for sure. But! For me it doesn’t really treat depression at all. It treats my anxiety, which is wonderful, and allows me to do a lot of the things that can help combat my depression, but for me at least the depression is a different beast. It’s kind of like the two issues of anxiety and depression (let’s just set aside my mysteriously complex other neurodivergence for the sake of brevity here) are two big rhythms in my life. Sometimes they both align and it sucks especially, sometimes the anxiety really isn’t there but I am so super depressed. Sometimes it’s the flip of that, I have anxiety out the wazoo but I’m not depressed at all, can enjoy things and feel happiness and get motivated and have energy, it’s just the anxiety gets in the way. Most of the time it’s not so extreme for either issue, and I am just wrangling with a low level of both.
When shit happens, like when my cat died, I can feel the sertraline working. It’s fascinating. It’s like my body is primed to do all the anxiety things but there is a soft barrier keeping me from tipping into it. Or like, I can actually put a conscious stop to my ruminating thoughts. I can still be deeply sad or worried or furious or whatever else, but I am able to feel those ways and still do stuff like eat food, speak in complete sentences, not hurt myself, etc, and when the shit is resolved I have way less of what you might call a hangover - I can experience bad things and manage to do other things the next day. Then because I didn’t traumatize myself on top of the bad shit, I don’t get triggered by innocuous things or memories of it. It doesn’t always work perfectly but it is a hell of a lot better than life without sertraline.
The thing is that I’m not super sure you are the best candidate for it. There is a huge world of psychiatric drugs out there and it kind of sounds like you would do better on something else, maybe something specifically intended to help with depression, or that plays well with ADHD, or something else you could bring up to your doctor. For most people, sertraline can be a pretty safe drug to try when dipping your toe into the ocean of brain meds, but it is only a first option of many. I think your doctor was very dismissive of you and that sucks. If you need to stick with them because of a lack of options, I would ask them about the different kinds of meds that are available in your country and the kinds of things that are specifically good for, and hopefully you can work together with them on finding something that helps you.
I do think it is valuable to pursue medication even if your mental health continues to improve. Think of it like preventative medicine. Yes, sometimes meds are like crutches, they support you when your body can’t. But other times they are like stretching or eating leafy greens. They contribute to your ability to handle things as they come, help you stay flexible and endure problems.
posted by Mizu at 8:16 AM on June 16 [9 favorites]
When shit happens, like when my cat died, I can feel the sertraline working. It’s fascinating. It’s like my body is primed to do all the anxiety things but there is a soft barrier keeping me from tipping into it. Or like, I can actually put a conscious stop to my ruminating thoughts. I can still be deeply sad or worried or furious or whatever else, but I am able to feel those ways and still do stuff like eat food, speak in complete sentences, not hurt myself, etc, and when the shit is resolved I have way less of what you might call a hangover - I can experience bad things and manage to do other things the next day. Then because I didn’t traumatize myself on top of the bad shit, I don’t get triggered by innocuous things or memories of it. It doesn’t always work perfectly but it is a hell of a lot better than life without sertraline.
The thing is that I’m not super sure you are the best candidate for it. There is a huge world of psychiatric drugs out there and it kind of sounds like you would do better on something else, maybe something specifically intended to help with depression, or that plays well with ADHD, or something else you could bring up to your doctor. For most people, sertraline can be a pretty safe drug to try when dipping your toe into the ocean of brain meds, but it is only a first option of many. I think your doctor was very dismissive of you and that sucks. If you need to stick with them because of a lack of options, I would ask them about the different kinds of meds that are available in your country and the kinds of things that are specifically good for, and hopefully you can work together with them on finding something that helps you.
I do think it is valuable to pursue medication even if your mental health continues to improve. Think of it like preventative medicine. Yes, sometimes meds are like crutches, they support you when your body can’t. But other times they are like stretching or eating leafy greens. They contribute to your ability to handle things as they come, help you stay flexible and endure problems.
posted by Mizu at 8:16 AM on June 16 [9 favorites]
Nthing also seeking therapy if that's an option for you, but --
Are you already treating your ADHD with meds? If not, have you considered medicating your ADHD first, instead of starting with the depression? Very often, the root cause of ADHD leads to problems in your life, which lead to anxiety and depression. If you treat the ADHD, the anxiety and/or depression usually also improve! If they don't improve *enough*, then you can look at treating them with meds as well.
Unfortunately some doctors are really uneducated about ADHD (which it sounds like yours might be if they're recommending antidepressants before treating the ADHD at all). Your doc also just sounded awful and dismissive in general. Is it possible for you to see a different psychiatrist in your health system? Unfortunately, you sometimes have to try a few before you find a good fit.
What ADHD meds are available in your country?
I personally find a combo of a low dose of Vyvanse and a low dose of guanfacine really helpful. But everyone is different, and unfortunately you (with a good psychiatrist's help) just have to try a few different meds until you find something that works for you.
Fortunately, for stimulant ADHD meds at least, you should know very quickly if a particular formulation/molecule is helpful for you or not. I tried short-release Adderall first because of how health insurance works in the U.S. and hated it so much I didn't try anything else for a year; I wish I'd known that there was a process, and that for stimulants that process can honestly be pretty fast! (Unlike some meds you have to take for 3 months to see effects.) I also tried a higher dose of Vyvanse and that make me anxious, so we went back to the low dose which is pretty dang helpful, and added the non-stimulant guanfacine to it instead.
If the stimulants don't work for you, you can try combination therapy (what I'm doing: a stimulant and a non-stimulant), or various other non-stimulant ADHD meds.
ADHD is typically very treatable, and treating it can really improve mental health and quality of life. I'm definitely still an ADHDer with treatment, but certain things that were a huge struggle before are just *easy* with medication (like sitting still and staying focused while working at a desk).
Best wishes to you! Feel free to PM me with any questions.
posted by cnidaria at 8:16 AM on June 16 [11 favorites]
Are you already treating your ADHD with meds? If not, have you considered medicating your ADHD first, instead of starting with the depression? Very often, the root cause of ADHD leads to problems in your life, which lead to anxiety and depression. If you treat the ADHD, the anxiety and/or depression usually also improve! If they don't improve *enough*, then you can look at treating them with meds as well.
Unfortunately some doctors are really uneducated about ADHD (which it sounds like yours might be if they're recommending antidepressants before treating the ADHD at all). Your doc also just sounded awful and dismissive in general. Is it possible for you to see a different psychiatrist in your health system? Unfortunately, you sometimes have to try a few before you find a good fit.
What ADHD meds are available in your country?
I personally find a combo of a low dose of Vyvanse and a low dose of guanfacine really helpful. But everyone is different, and unfortunately you (with a good psychiatrist's help) just have to try a few different meds until you find something that works for you.
Fortunately, for stimulant ADHD meds at least, you should know very quickly if a particular formulation/molecule is helpful for you or not. I tried short-release Adderall first because of how health insurance works in the U.S. and hated it so much I didn't try anything else for a year; I wish I'd known that there was a process, and that for stimulants that process can honestly be pretty fast! (Unlike some meds you have to take for 3 months to see effects.) I also tried a higher dose of Vyvanse and that make me anxious, so we went back to the low dose which is pretty dang helpful, and added the non-stimulant guanfacine to it instead.
If the stimulants don't work for you, you can try combination therapy (what I'm doing: a stimulant and a non-stimulant), or various other non-stimulant ADHD meds.
ADHD is typically very treatable, and treating it can really improve mental health and quality of life. I'm definitely still an ADHDer with treatment, but certain things that were a huge struggle before are just *easy* with medication (like sitting still and staying focused while working at a desk).
Best wishes to you! Feel free to PM me with any questions.
posted by cnidaria at 8:16 AM on June 16 [11 favorites]
Related to my previous comment, here's a good video resource on medicating ADHD: ADHD Medication Management, by Dr. Dodson.
Also, if you do have ADHD, I think it's really important to learn about Rejection Sensitivity Dysphoria (RSD), a major but often overlooked part of ADHD. (At least, it was really important for me!) Dr. Dodson also has a couple more videos about RSD specifically and emotions in ADHD generally.
And finally, here's a TikTok on medication management in folks with dual ADHD and autism, in case that applies to you (or to someone else reading this <3)
posted by cnidaria at 8:26 AM on June 16 [3 favorites]
Also, if you do have ADHD, I think it's really important to learn about Rejection Sensitivity Dysphoria (RSD), a major but often overlooked part of ADHD. (At least, it was really important for me!) Dr. Dodson also has a couple more videos about RSD specifically and emotions in ADHD generally.
And finally, here's a TikTok on medication management in folks with dual ADHD and autism, in case that applies to you (or to someone else reading this <3)
posted by cnidaria at 8:26 AM on June 16 [3 favorites]
Seconding that psychiatrists are medical doctors you generally go to for diagnoses and meds, and therapists are people you go to for non-drug approaches. Doctors tend to do what they know and see things through the lens of their specialty.
I'm someone who tends to have crappy side effects with drugs so I'd probably be on the more cautious side. (That's not the case for everyone!) It's worth thinking about whether anxiety and/or depression are generally issues for you, or if you think they're situation-dependent.
One thing I've learned is that if I'm going to take meds, I need to do it with a doctor who will be accessible and responsive within a reasonable timeframe if the side effects prove serious and I want to end or change the prescription.
posted by trig at 9:44 AM on June 16 [2 favorites]
I'm someone who tends to have crappy side effects with drugs so I'd probably be on the more cautious side. (That's not the case for everyone!) It's worth thinking about whether anxiety and/or depression are generally issues for you, or if you think they're situation-dependent.
One thing I've learned is that if I'm going to take meds, I need to do it with a doctor who will be accessible and responsive within a reasonable timeframe if the side effects prove serious and I want to end or change the prescription.
posted by trig at 9:44 AM on June 16 [2 favorites]
Antidepressants (and SSRIs in particular) are drugs that, for better or worse, mess with your brain chemistry. And unlike many popular brain-affecting drugs, antidepressants are something you take regularly, something that has a persistent, long-term effect on your brain; they're not like caffeine or psilocybin that wear off after a few hours. Again, this isn't inherently bad, but they are no less of a drug than any other, and should be treated with the same kind of respect as any other drug that affects your brain.
Personally, I would not start using them without a significant reason; they're not something I would toss onto an already-successful regimen "just for funsies", so to speak.
Moreover, if you're having issues with ADHD, if you were to use some kind of mind-affecting drug long-term, I would very much not recommend an SSRI as the first one to try. Even in the realm of "anti-depressants", bupropion tends to be more commonly recommended, and more generally, stimulants (e.g. adderall, modafinil, etc) tend to be much more effective for ADHD symptoms.
posted by etealuear_crushue at 11:29 AM on June 16
Personally, I would not start using them without a significant reason; they're not something I would toss onto an already-successful regimen "just for funsies", so to speak.
Moreover, if you're having issues with ADHD, if you were to use some kind of mind-affecting drug long-term, I would very much not recommend an SSRI as the first one to try. Even in the realm of "anti-depressants", bupropion tends to be more commonly recommended, and more generally, stimulants (e.g. adderall, modafinil, etc) tend to be much more effective for ADHD symptoms.
posted by etealuear_crushue at 11:29 AM on June 16
Are you already treating your ADHD with meds? If not, have you considered medicating your ADHD first, instead of starting with the depression?
Yes, I would absolutely make sure you are treating ADHD with meds first before using meds to treat anxiety/depression. I got diagnosed with depression/anxiety before being diagnosed with ADHD. I tried so many meds, and none of them helped me. But starting on ADHD meds was literally life changing.
posted by litera scripta manet at 5:02 PM on June 16 [1 favorite]
Yes, I would absolutely make sure you are treating ADHD with meds first before using meds to treat anxiety/depression. I got diagnosed with depression/anxiety before being diagnosed with ADHD. I tried so many meds, and none of them helped me. But starting on ADHD meds was literally life changing.
posted by litera scripta manet at 5:02 PM on June 16 [1 favorite]
Some more anecdata- I was on Zoloft to help my (post partum) depression - I am now on the journey of ADHD diagnosis, because although I wasn't depressed/anxious my executive function was still woeful.
I'm off the Zoloft now after six months, but therapy has been so helpful. So, so helpful, before, during and after the medication.
posted by freethefeet at 12:15 AM on June 17
I'm off the Zoloft now after six months, but therapy has been so helpful. So, so helpful, before, during and after the medication.
posted by freethefeet at 12:15 AM on June 17
ADHD experts (Barkley, Hallowell et al) do recommend that ADHD is addressed either before or at the same time as other mental health treatment. If you "don't respond to stress as good as an average person", that's fully in line with having ADHD, which is at heart a regulatory disorder.
I'm guessing, based on my own experience, that your cat was part of a critical coping strategy, which is why you saw such worsening symptoms after you lost them. I know that when I lost my dog a few years ago, not only was I grieving, it felt like I forgot how to manage any part of my life, because I had been relying on the schedule created by filling her needs to get my own needs met. Regular mealtimes, bedtime, exercise--all that went out the window without an external source of motivation.
Even though it may have seemed a little dismissive, spending time in nature and having positive physical interactions with animals seem to have quite a lot of both scientific and traditional, anecdotal evidence for increasing health outcomes in humans.
As for the sertraline, your concerns are reasonable, and it's definitely worth asking your doctor in advance about how long they would want you to try this med to see if it works, and what you should do if you take it and start getting bad side effects. Some SSRIs you can quit immediately, some you have to slowly taper off. Doctors tend to have "go to" meds that they prescribe almost as a default, but if you don't want to risk taking something that you're stuck with for three months before you can determine if it's working and then have to take another month to taper off of, that's totally your right as a patient and they should be able to work with you on that.
posted by radiogreentea at 8:42 AM on June 17
I'm guessing, based on my own experience, that your cat was part of a critical coping strategy, which is why you saw such worsening symptoms after you lost them. I know that when I lost my dog a few years ago, not only was I grieving, it felt like I forgot how to manage any part of my life, because I had been relying on the schedule created by filling her needs to get my own needs met. Regular mealtimes, bedtime, exercise--all that went out the window without an external source of motivation.
Even though it may have seemed a little dismissive, spending time in nature and having positive physical interactions with animals seem to have quite a lot of both scientific and traditional, anecdotal evidence for increasing health outcomes in humans.
As for the sertraline, your concerns are reasonable, and it's definitely worth asking your doctor in advance about how long they would want you to try this med to see if it works, and what you should do if you take it and start getting bad side effects. Some SSRIs you can quit immediately, some you have to slowly taper off. Doctors tend to have "go to" meds that they prescribe almost as a default, but if you don't want to risk taking something that you're stuck with for three months before you can determine if it's working and then have to take another month to taper off of, that's totally your right as a patient and they should be able to work with you on that.
posted by radiogreentea at 8:42 AM on June 17
If your attention and focus suddenly got worse at a time you can pinpoint, I wouldn’t be sure that’s the ADHD worsening. Did your quality of sleep change? Birth control pills - did they change around then? The trauma and grief alone could do it (especially if that’s affected your sleep).
One recent review found that SSRIs don’t work the way they’ve been theorized to work: https://www.nature.com/articles/s41380-022-01661-0 . (There’s vigorous discussion about this. Some say “ah but yes they do work! Maybe in a different way”. If they do, when they do, it’s unclear how they do. That’s true for most psych meds though tbh. Lithium works brilliantly for a portion of people with bipolar and how that happens is still unknown. Still, SSRIs still work only a little better than chance and only for severe depression. Exercise outperforms ADs by far per multiple studies
https://www.bmj.com/content/384/bmj-2023-075847
If you’re not at the point where exercise is impossible, I would really focus on that.)
There’s a lot of discussion lately about how SSRIs impact sexual drive.
Myself, I couldn’t handle the emotional numbness, flat response to the arts, and loss of creativity. It took me ten years to cry again (for any reason). My drive to create basically doesn’t exist. Impossible to say how much life situation and time passing factor in, but yeah not crying at all for ten years, I think is strange and it was wholly unlike me (as I was all my life) prior to the meds.
I had the opportunity to try stimulants on an empiric basis for presumed ADHD and didn’t want to do it because I already live with heart palpitations. Have a sib who has classic ADHD and he sometimes goes without medication, relying instead on coffee and the coping mechanisms needed with or without meds.
If I were in your shoes, I would keep looking for a therapist, especially one versed in helping survivors of abuse, and maximize everything health related (focus on sleep, exercise, good diet, and definitely any hormonal or other health conditions). And maybe ask a doctor about the recent worsening of focus etc.
Your title says your mental health is improving, I hope this continues. You’ve been through a hell of a time, that is a human experience that I would argue is worth feeling through and understanding.
posted by cotton dress sock at 9:57 PM on June 17
One recent review found that SSRIs don’t work the way they’ve been theorized to work: https://www.nature.com/articles/s41380-022-01661-0 . (There’s vigorous discussion about this. Some say “ah but yes they do work! Maybe in a different way”. If they do, when they do, it’s unclear how they do. That’s true for most psych meds though tbh. Lithium works brilliantly for a portion of people with bipolar and how that happens is still unknown. Still, SSRIs still work only a little better than chance and only for severe depression. Exercise outperforms ADs by far per multiple studies
https://www.bmj.com/content/384/bmj-2023-075847
If you’re not at the point where exercise is impossible, I would really focus on that.)
There’s a lot of discussion lately about how SSRIs impact sexual drive.
Myself, I couldn’t handle the emotional numbness, flat response to the arts, and loss of creativity. It took me ten years to cry again (for any reason). My drive to create basically doesn’t exist. Impossible to say how much life situation and time passing factor in, but yeah not crying at all for ten years, I think is strange and it was wholly unlike me (as I was all my life) prior to the meds.
I had the opportunity to try stimulants on an empiric basis for presumed ADHD and didn’t want to do it because I already live with heart palpitations. Have a sib who has classic ADHD and he sometimes goes without medication, relying instead on coffee and the coping mechanisms needed with or without meds.
If I were in your shoes, I would keep looking for a therapist, especially one versed in helping survivors of abuse, and maximize everything health related (focus on sleep, exercise, good diet, and definitely any hormonal or other health conditions). And maybe ask a doctor about the recent worsening of focus etc.
Your title says your mental health is improving, I hope this continues. You’ve been through a hell of a time, that is a human experience that I would argue is worth feeling through and understanding.
posted by cotton dress sock at 9:57 PM on June 17
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In your shoes I would find a psychologist/therapist from your home culture (video chat if you need to) and start with that. After talking to them you should be in a much better position to decide if antidepressants are the right path.
N.B. Antidepressants and therapy have a much better result than either of them alone, but if therapy helps you can probably skip the antidepressants and their annoying side effects.
posted by Tell Me No Lies at 7:32 AM on June 16 [7 favorites]