looking for mr. psychopharmaceutical

September 27, 2006 2:56 PM

how do you know when you're on the right antidepressant?

I've been on effexor for... two and a half weeks, and while I'm noticing differences in the way things are, they're not the differences I wanted to effect. I realize I might be being hypercritical or expecting too much or needing more time, but regardless: when and how did you know that whatever you're on was the right thing to be on?

posted by anonymous to health (27 comments total)

I think you need to give it more time, but when I started on an anti-depressant I noticed a marked improvement in my general mood, motivation, and outlook. So I'd say you know you're on the right one if it makes you feel better. If it's not making you feel better after another week or two, tell your doctor. Lots of people have to try several before they find the right one. IANAD, YMMV.
posted by ludwig_van at 3:06 PM on September 27, 2006

You aren't depressed?
posted by Big_B at 3:11 PM on September 27, 2006

Why don't you tell us how you're feeling different?
posted by lemur at 3:16 PM on September 27, 2006

I was told to give it full month, and quit if things get significantly worse.
posted by KirkJobSluder at 3:19 PM on September 27, 2006

Be weary of Effexor. I was prescribed it but went off it after a week after I found this online petition. Of course it is only anecdotal evidence, but there are quite a number of signatures. Your case is definitely different from mine or anyone else's. All I'm saying is, if you have serious misgivings about what Effexor is doing to you, give some thought to switching to something else as there is a risk you could become addicted.
posted by pcameron at 3:56 PM on September 27, 2006

The other question is: why are you on the drug? Sometimes these drugs are prescribed for reactive depression (depression after a major loss, for example). In which case, I would say no anti-depressant is for you.
The other use is for major depression. In this case antidepressants elevate mood above that of the placebo in about one out of five cases.
Also, three weeks is the minimum time I would give it to have its depression lifting effect.
posted by dances_with_sneetches at 4:05 PM on September 27, 2006

I have been on a bunch of different antidepressants. Effexor was the last one I tried, and it definitely didn't work for me. I discontinued after about a week....though beware, you should really taper off of it (I believe I took a half dose, then a 1/4 dose, then nothing, over three days).

Your doctor and/or the info that comes with the drug should have told you the time to wait for the full effect to kick in, but with Effexor, I believe that you're already well on your way. Sounds like you need to revisit the shrink and ask for something different. In my experience, they're pretty good about working with you to find the right drug.
posted by bingo at 4:07 PM on September 27, 2006

It's trial and error. Everybody's different. Kirkjobsluder is right. Give it about a month (unless you feel like its making you worse). If you don't like Effexor, there are plenty of other alternatives to try. Don't be shy about asking to switch.

Don't worry. Depression can be successfully treated.

And one more time, if you think effexor is making you go downhill, go see your doc ASAP.

FWIW, I lasted about 2 days on lexapro (my head hurt so bad that I though I was having a stroke). Zoloft worked out just fine.
posted by bim at 4:12 PM on September 27, 2006

Seconding the suggestion to be careful with Effexor. It has taken me the better part of this year to come off of a lower dose (150mg/day), and withdrawal sucks. Badly.

But how do you know if it's working? Well, what has depression been keeping you from doing--sleeping, eating, sex, hobbies? If you find yourself thinking about doing the stuff you did when you know you were feeling better, you're probably on the right track. (For a weird example, my sense of smell seems to dull when I get depressed. Therefore, if I have the presence of mind to really enjoy the smell of fresh cookies, or newspaper ink, or rain on a dusty road, etc., I'm probably doing OK.)
posted by Vervain at 4:12 PM on September 27, 2006 [1 favorite]

People's reactions to different antidepressants vary all over the map. In some cases it can take as long as 6 weeks before there's any clinical effect.

There are also radical differences in terms of necessary dosing. Some people react strongly to low doses; others may need much higher doses. And for every drug there are people who don't respond at all except by suffering side effects. (And they all have side effects.)

Treatment of depression is as much art as science. No one really knows what it actually is, and no one really understands how the drugs affect it. Most of the drugs used to treat depression affect the background levels of the three monoamine neurotransmitters, but no one knows why that makes any difference.

And it's a clinical fact that some drugs work for some people but not for others.

What you do need to know is that there are few cases of miracles, of drugs which you start taking and suddenly feel like a new man. Some people do get that kind of effect, but it's not the norm. And you are probably not the best person to judge whether the drug is helping you; one irony of antidepressants is that if they're effective they can initially make you feel worse subjectively for a while. That's because the clinical effects are uneven, and one early effect is a general increase in motivation without an improvement in mood.

Be patient, and rely on your therapist.
posted by Steven C. Den Beste at 4:21 PM on September 27, 2006

A psychiatrist once told me that if your antidepressant is working, if you feel like more like yourself. I have read articles and interviews on the subject, and people say, "once the right drug kicked in, I felt like me again."

Another way: take a depression quiz like this or this. Try to answer as you would have before starting the medication. Then answer the questions again periodically to see what improvements have come about in your mood.
posted by wryly at 4:22 PM on September 27, 2006

Antidepressants work differently on everyone. Effexor in my experience is more a 'numbing' effect; you don't care so much about anything. You're not as depressed, but you're not as motivated either. It can be very subtle. Don't expect "Yay! Happiness!" but you may find the pits are not as deep.

Standard warning: The withdrawl symptoms are a BITCH; this is not a nice drug. If you really -need- it, give it a try, but be careful. I'd say give it a month, perhaps two, and then see how you feel AND, ask your friends and family if they've noticed anything different about you. When you're on Effexor, you may not notice the changes.
posted by Rubber Soul at 4:28 PM on September 27, 2006

Steven C. Den Beste is right on target. While Effexor has a reputation for significant withdrawl problems as does Paxil it clearly does not mean you will experience it. You have not been on it for a significant period of time and you can be transferred quite easily to another drug. The petition which was previously mentioned has 11,000 + signatures. There were 19 million prescriptions for effexor in a recent year--perhaps 1 1/2 million to 3 million different people. Effexor is a very useful drug for hundreds of thousands of people. Iif it does not work there probably 30-40 other antidepressants. Stick with it for a month and good luck.
posted by rmhsinc at 4:52 PM on September 27, 2006

I didn't notice any changes in mood until about a month in (the first month was spent getting over side effects). The changes for me were VERY gradual over about 3 months until things stabilized. It was like all of the sudden, I realized that I felt better, that I had more energy, slept better, my mood was much less extreme than it used to be. Of course, YMMV - it really does depend on the reason you started in the first place.
posted by echo0720 at 5:04 PM on September 27, 2006

A psychiatrist once told me that if your antidepressant is working, if you feel like more like yourself.

I have to say that I passionately disagree with this. For chronically depressed people who have been that way most of their lives (that is, the people who could really use antidepressants the most) - and I count myself among these people - the recognizable feeling is that you *don't* feel like yourself. In fact, it's a cliche for depressed people to take themselves off their meds because 'I don't feel like myself anymore.' The arc of Billy in Six Feet Under is a very realistic illustration of this that really hit home for me.
posted by bingo at 5:10 PM on September 27, 2006

I have never felt better using antidepressants (paxil, zoloft, prozac, wellbutrin, lexapro--I've tried a few) but my mom swears by effexor. She loves it and thinks it really helped her get over her depression. She's still on it, though--she starts getting dizzy if she misses her dose by one day, so she's not ready to withdraw *at all*.
posted by chelseagirl at 6:07 PM on September 27, 2006

I would have to agree with bingo about not feeling like yourself when ADs are working. For me, I have bad judgement when I'm really depressed. Everything seems much worse than it actually is ('catastrophizing' is the term I believe). For example, if I ask out a girl and she politely turns me down it seems like the end of the world even though my mind knows it's not a big deal; I just wasn't her type (and she was probably flattered I asked). After years of depression, this type of thinking becomes normal to you. When you finally get help with ADs and\or therapy you start to realise how "other people" must feel.

I would give it a couple of more weeks at least unless the side effects are really bad. Sometimes you feel a little strange while your body\mind adjusts to the drug. If you decide to stop taking it, slowly decrease the dosage. You'll probably still feel some withdraw but it might not be as bad. Tell your doctor the exact side effects you want to avoid and he\she can choose a better AD for you. Zoloft made me tired all the time and gain some weight, so my doc switched me to Wellbutrin which tends to have the opposite effect (and the Zoloft withdraw was pretty bad).

Also, if you've been depressed for a very long period of time you might want to see a therapist if you haven't already. ADs are not a magic bullet for people with chronic depression. You still need to change your habits and thought process which takes time and work. Be patient. There are some good books out there like Feeling Good and Undoing Depression that give some techniques for recognizing and changing the things that keep you depressed.
posted by bda1972 at 7:43 PM on September 27, 2006

ADs are a crapshoot, as you'll have gathered at this point in the thread. They work for some people, not for others, and they make some people flip out. Some people can't take any. For others one does it when all the others won't. Some people feel completely restored, others just get a little help up out of the tar. What they aren't is "happy pills". Side effects can be very different for different people too. Withdrawal, when present, sucks. I went cold turkey and just about shot lightning out of my follicles and eyeballs. I tried just about all of the SSRIs and not a one worked for me aside from numbing my soul to where I couldn't feel anything at all. But that's me. Like others have said, give each one a try, but if it hasn't worked after a while, do speak up and ask for a change. Don't do what I did and get stuck in months and years of "dose tinkering". More of this, more of that, add this, drop that, substitute this to counteract the effects of that other. Arrrgh. Take advice, but take control.

Also, to add to bda1972's book recommendations, please don't forget Mr. Hiroyuki Nishigaki's classic handbook, How to Good-Bye Depression: If You Constrict Anus 100 Times Everyday. Malarkey? or Effective Way?. Because, as this wise sage tells us, "If you don't know concentration which gives you peculiar pleasure, your life looks like a hell."
posted by kookoobirdz at 10:13 PM on September 27, 2006

Reiterating that drugs affect everyone differently. I got off Paxil with no problem, and Effexor has been a fantastic drug for me.
posted by IndigoRain at 1:41 AM on September 28, 2006

Just wanted to chime in that not everyone has problems tapering off Effexor. I was able to taper off an extrememly high dose of Effexor XR, under my doctors supervision, with none of the withdrawal symptoms I've read about.

That said, do not try to go cold turkey. I also experience problems when I miss my dose - the key is to taper off.

I felt better after about a month on my highest dose of XR. That was after trying Serzone, regular Effexor, and lower doses of XR. As others have said, I knew I felt better when I felt like myself again.
posted by xsquared-1 at 4:30 AM on September 28, 2006

Honestly, for me, the surest sign that an antidepressant was working was that I'd find myself thinking "Wow, I've started feeling better all by myself. Life isn't so bad. I can stop taking these pills now."

YMMV.
posted by nebulawindphone at 5:14 AM on September 28, 2006

Compare how you feel now to how you felt before you were taking the med. What's worse? What's better? What's just changed? Are the symptoms you're most concerned with better or worse? Do other people notice a difference? What kinds of differences are they noticing? What can you do now that you couldn't do before? What seems easier, harder, the same? What did you tell yourself you would do "when I'm not depressed?" Have you done it? Why not? Is that because the medication is or is not working?

These are the questions you need to ask yourself and answer in order to answer your own question. Mood doesn't exist in a vacuum, or, it may, but people tend to mostly talk about it in terms of how it affects life. The question with any form of psychotherapy, medication or talk, is "Is this helping me to change my life for the better?" If you focus on that question the minutae of whether or not the medication is working precisely as advertised may be easier to see behind.
posted by OmieWise at 5:47 AM on September 28, 2006

Steven C. Den Beste is right on target.

Those who have seen me on the blue may be surprised by this, but yes, he's exactly correct. I was able to stop taking Effexor with no trouble whatsoever.

Effexor did help, but it really helped by turning down the gain, so that the "pits weren't so deep", as someone mentioned above. It also meant that the hills weren't very high.

The reason I stopped was that it was seriously affecting my quality of sleep, leaving me with a massive problem with constant sleep deprivation, which was destroying me. Your mileage *will* vary.
posted by eriko at 6:12 AM on September 28, 2006

I've had depression since I was in my early teens (for 10 years or so, up and down, better and worse), and I knew my pills were working when I "felt like myself again." Every day was a good day: I could get out of bed easier, I was actually motivated to go to class and do my school work, to go to the gym. My mind was finally quiet. I can't explain exactly what that meant, but my mind wasn't racing, I felt almost serene, but there was more to it then just that. I remember thinking wow, this is how it's supposed to be. Obviously, my "medicated" self isn't the same as my "depressed" self, but I don't feel like it is a "false" self.

I agree that you need to give your meds at least a month to kick in. Sometimes you can tell within a month if they definitely work or definitely don't, but that's certainly not always going to happen.
posted by good for you! at 6:41 AM on September 28, 2006

Effexor worked great for me, but the side effects were nuts-- nightsweats, really psycho bad dreams, sexual side effects-- ugh.

And DO NOT go cold turkey if/when you get off. Taper the Effexor down and then take a tiny dose of prozac for two weeks to avoid days and nights of shakes and vomiting. Soooo ugly. Don't be the hero, Johnny.
posted by orangemiles at 7:40 AM on September 28, 2006

I know Effexor works for some people, but it was my understanding that SSRIs are first-line treatment: Celexa/Lexapro or Prozac, as they are the best tolerated, and by some accounts, most effective. But, whatever...
posted by Frankieist at 3:19 PM on September 28, 2006

I'm also taking Effexor (after trying Lexapro) and it took about a month to really kick in. I'd give it a full month, unless you're feeling worse, to make sure it's the right/wrong antidepressant.

Please remember - antidepressants are NOT "happy pills", they are designed to make you feel like yourself. I still have lows but they're not nearly as bad as they had been (some crying, but no suicide ideation).

As other people have said, do NOT go off of Effexor without your doctor's supervision. You may not have side effects, but chances are you will. I'm on a fairly low dose (75mg) and if I miss one dose, I feel it by noon of the morning I should have taken it.
posted by deborah at 8:26 PM on September 28, 2006