Depression or personaity flaws?

September 14, 2007 1:42 PM

How should I feel if my antidepressants are working?

I've had moderate depression for about 15 years. I had some therapy and medication, and was in hospital for a while, when I first became depressed, but not since.

This year, because of other things in my life, my depression has got too much to deal with, so I saw my GP and have been on 20mg citalopram (Celexa in US - I'm in the UK) for three months.

I'm sure the drugs are having some effect, as my constant thoughts of suicide and self-harm feel a bit removed from me. But I still feel that life is something to get through rather than to enjoy, feel unmotivated, hate myself and find it very hard to do anything except work, lurking on Metafilter and sitting around. (For instance, the kitchen's currently got a week's worth of empty dog food tins sitting on the counter waiting to be moved three feet to the bin.)

What I don't know is whether this laziness and lack of ambition is about my character rather than depression; should I expect antidepressants to help with these things, or do I need to find other ways to solve them? I would appreciate advice on this, as I'm trying to decide whether to request a higher dose of citalopram.

Before anyone suggests therapy - I do realise I might benefit from it, but it brings its own problems and I'd rather sort out the drugs first. And I have a copy of Feeling Good, but am too lazy to read it.

posted by anonymous to health & fitness (24 comments total)

There are no markers or milestones, but it sounds to me like you are not seeing the improvement you should after three months and you should discuss this with your doctor. It may be that you need to ramp up to a higher dose or another drug entirely. (Though if the side effects of yours are livable it's best to stick with that.)

I have found that there is just a sense that you're on the right path. It's like someone opens the curtains a bit and lets in light and you start to have a good day now and then. You start to want to do things that make you feel good again, rather than know they'll make you feel good but not be able to do them.

And I totally understand where you're at about therapy, but you don't need to have a certain level of medicinal affect before therapy will help. Maybe the fact that you're not open to it yet is another sign that the meds aren't doing what they need to. I promise you that therapy takes your mood places that meds on their own most likely never will. Especially CBT. Good luck.
posted by loiseau at 1:52 PM on September 14, 2007 [2 favorites has favorites]

My personal experience has been that antidepressants have not had much of a direct effect on apathy or lack of motivation.

If you can see a specialist rather than a GP, they may do a better job of possibly finding something that might help a bit more, or at least helping you ascertain the limits of psychiatric drugs' helpfulness for you.
posted by needs more cowbell at 1:54 PM on September 14, 2007

Oh - and the inability to move the dog-food tins is not just a sign of a bad personality. It *never* is. You are still in the thick of depression. Please do mention these things to your doc at your first opportunity.
posted by loiseau at 1:54 PM on September 14, 2007

(For instance, the kitchen's currently got a week's worth of empty dog food tins sitting on the counter waiting to be moved three feet to the bin.)

If this is true, then this isn't lazy, is sounds like part of the overall problem, and this suggest that maybe the drugs aren't doing what or everything they should. I'm not a doctor/shrink/psychologist person, however. I would talk to your doctor about the drugs. I once heard a saying that "lazy is a sickness". It isn't a personality trait.
posted by Pastabagel at 2:17 PM on September 14, 2007

yeah, i don't think this is laziness. you should talk to your doctor about your dose and/or switching meds.

also, you might try some cognitive therapy. if you have been depressed for so long, you very well may have developed some coping mechanisms/learned helplessness/and other bad habits that may have kept you alive while you were ill, but which may hold you back once you're feeling better (like a limp--you might favor an injured ankle while it heals, but if you continue to walk like that forever, you'll end up hurting your back and be even more disabled). instead of talking about your feelings, this kind of therapy addresses behaviors.
posted by thinkingwoman at 2:21 PM on September 14, 2007

I'm on the same drug, same dose (but I take several other medications). I *think* it works, but I can't really tell. I've been on other SSRIs before, and it's hard to judge your feelings from one day to the next, especially since hindsight is NOT 20/20 (read "Stumbling on Happiness" for why). I suggest keeping a diary of your feelings for the day. Not a long entry (I kept mine in my appointment book, as an example). Just some words about significant feelings of the day. Maybe rate your happiness/sadness on a 1-10 scale.
posted by nursegracer at 2:25 PM on September 14, 2007

I would probably label that as more than moderate depression, honestly, just from the obvious red flags in the post. And, of course, meds + counseling tend to work better (in most situations) than just meds alone. Generally, when I was on a med I liked, it took several months for me to really start feeling even a little better. People around me, however, claimed to notice improvement pretty much around the first month mark. Do you take your meds when you are suppost to? Missing a few days/week doesn't really help build up the concentrations of beneficial stuff.

Standard disclaimer: Not a doctor, psychologist, chemist, psychiatrist, ect, ect. Take all advice as a good solid opinion.
Good luck!
posted by Jacen at 2:25 PM on September 14, 2007

It sounds like you need an higher dosage or to change medications all together. It's good that you no long think about suicide, but that's really not enough.

Hating yourself for being lazy is clinical indicator of depression. People who aren't motivated to do anything, don't really worry about it (like George Bush). But when you clearly realize laziness is making you unhappy about who you are, it's a sign that you've moved up from suicide to self harm.

My doctor was very insistant that I need to conquor depression before I could get socially and physically healthy. Perhaps I could have skipped the medication, but it really helped getting the right dosage of the right stuff.
posted by gesamtkunstwerk at 2:38 PM on September 14, 2007

You either need a higher dose or a different ad.

You WILL gain back motivation when the depression is properly treated.
posted by konolia at 2:39 PM on September 14, 2007

When I was going through my depression, I would notice people laughing and smiling about whatever makes people laugh and smile and I would think to myself, "What is so humorous about that?" I knew the antidepressants were kicking in when I was able to laugh with others. Another point was when I was able to be angry--before that I was numb--couldn't feel anger nor express it.
posted by wafaa at 2:40 PM on September 14, 2007

It feels a lot like waking up from a strange dream.

You're still asleep.
posted by idiotfactory at 2:52 PM on September 14, 2007 [2 favorites has favorites]

I second many of the suggestions here: go back to your doctor, try to keep a journal rating your mood [or aspects of your mood] from 1-10, and try cognitive therapy.

My HMO made me do the scale of 1-10 thing on a form every 2 weeks, and after a few months my therapist said "bad news" and I knew and said "I've been doing too well haven't I, they aren't going to approve more sessions." But it was OK, I knew I was doing better.

Cognitive therapy was HUGE for me. I never really felt like any of the ad really helped me beyond a baseline amount. But specific therapy really helped in a way that other therapy never did.
posted by Mozzie at 2:58 PM on September 14, 2007

I was on Celexa a few years ago, and truly felt better. :) More recently, the depression returned, and I went back on Celexa. I felt better, but not "all the way better." I wasn't crying all the time, but I still had no motivation to do anything. My GP sent me to a psychiatrist who ADDED Wellbutrin to the mix. That did the trick. See if your GP will refer you to a psychiatrist for a more expert opinion.
posted by clh at 3:33 PM on September 14, 2007

Everybody's different-- some react better to some drugs than others. And sometimes depression is misdiagnosed, or another problem isn't detected (you have depression plus something else, but the "something else" hasn't been diagnosed, so the drug for depression helps the depression but you're still miserable from the "something else").

So my experience is anecdotal, but here goes: I realized that the drugs were working when everyone around me seemed to stop being so goddamned annoying, when having to stop at a red light didn't make me want to punch the windshield, when having to stop and tie my shoes didn't elicit a rush of existential despair, when I could read more than two lines without wondering, "why don't I love to read anymore?"

And for what it's worth, Celexa made me physically ill and so sensitive to light I wore sunglasses to walk down the street at night. I switched to Zoloft, which made me feel lots better, but has some weird sexual side effects. I've heard good things about a new one-- Cymbalta (sp?). My wife switched to it from Zoloft and says it's great.

At any rate, good luck to you-- depression is very real, and I hope you find a treatment that works.
posted by Rykey at 4:21 PM on September 14, 2007

20 mg is a mild dose. Tell you doctor you're not noticing improvement and want a higher dose. If that doesn't show improvement after a couple of weeks, think about trying something else. You will notice if your antidepressant is working, believe me.

I've been on citalopram and cymbalta, and I found that plain ol' prozac (fluoxetine) worked best for me. There's a ton of stuff out there, and different drugs work for different people.

Good luck. And I highly recommend reading Feeling Good. Break it down and read just one page a day if the whole book looks overwhelming.
posted by tejolote at 4:50 PM on September 14, 2007

Are you taking any other medications? Any benzodiazephines, for instance? (Valium, Xanax, Klonopin, etc.) Long-term use of benzos can leave you feeling unmotivated, depressed and fill-in-the-blank.
http://www.benzo.org.uk/
posted by Gerard Sorme at 6:18 PM on September 14, 2007

My mother said going on antidepressants was like "getting rid of a headache you didn't know you had."
posted by olinerd at 7:26 PM on September 14, 2007

I've had quite a bit of experience in this matter. And I find it bizarre - to the point of being totally aghast, really - that after 15 years of depression, you are still getting your meds from a GP.

Um...at the list of stating the very, very, oh my god so very obvious: stop doing that. Go to a specialist.
posted by bingo at 8:51 PM on September 14, 2007

amen bingo. GPs don't work on your teeth- they send you to a dentist. Wouldn't you rather see a mental health doctor?

Psychiatrists are MDs, by the way.
posted by Rykey at 9:14 PM on September 14, 2007

An anecdote from the time I was on Paxil for a few months: I was at Boston Market restaurant and the corn they had there was so. God. Damn. Yellow. It was like they had applied a highlighter to the corn. I couldn't stop talking about how yellow it was for several days. My friends got really tired of it.

If the corn in your life is suddenly hyper-yellow, your antidepressants may be kicking in.
posted by kindall at 9:31 PM on September 14, 2007 [1 favorite has favorites]

I have no idea about the particular med you're taking, but..... what olinerd said (and Rykey too). It's more about what's lacking than a major change that you can notice.

Allow me to be an optimist and suggest that you're making some progress at least. The food tins may be partially a result of deeply embedded habit. You've had 15 yrs or so of training and habit development under less-than-optimal circumstances. You should expect to find that some of your behaviors need work. I'm not saying it's easy to change them....

So, here's another vote for visiting with a qualified therapist. Yes, it has it's problems and I have no idea about your particular circumstances. However, I'll suggest that you do whatever it takes (including risking financial ruin) to make it happen. Or drive 100 miles/km to another town or whatever to stay under the radar if that's your thing. Meds PLUS therapy will yield better results than meds alone. I'm not a doctor or statistician or whatever but that's my story and I'm sticking to it.
posted by powpow at 11:19 PM on September 14, 2007

This question you've asked is an impossible one to answer, or maybe it's just that the answer will be a little bit different for everyone. Not only that, but the answer might even be different for YOU if you were to ask it at a different point in time.

As yet another person with plenty of experience with severe depression, antidepressants, inadequate mental health care providers, etc., I will echo others and say that it does sound like a competent doctor will likely prescribe you a higher dose of what you're currently on. S/he will have you come in after that to evaluate if the medication's working, and will make adjustments as necessary.

For many people, finding the right combination/dose of antidepressants is a time-consuming and frustrating process. Keep at it.

From a broader perspective, I've learned that it's a very good idea to pay attention, as you currently are, to how you feel when taking x med at y dose. Over time, you'll have more experience with these medications (if you take them long-term) and you'll have more points of comparison that you can use to determine whether they're effective, and to what degree. You might even try keeping notes on this (I've never done that, but looking back wish I had.)

With more severe depression (which your question suggests), it can be especially difficult to figure out whether you're still depressed. Keep in mind that it's not a black and white thing, for one. Also, I've found that coming out of depression can be so gradual that it's hard to notice changes except over a very long period of time (it seems like that's what's happening with you right now). Sort of the opposite of what it's sometimes like to slide into a depressive episode - you don't even realize what's happening until you're deep into it. For me, depression is, more than anything else, insidious.

Think back to how you've felt at various points in your life (both depressed and not), and then think about how you feel now. Maybe this will help you get an idea about just how depressed you are. Can you remember a time when you know you weren't depressed? Did it feel like this? If not, then you are probably still depressed, but maybe moderately rather than severely. In my experience, it's all too easy to accept that as a state of being, because I'm so relieved to feel even slightly better than I did when things were really bad. Try not to get acclimated to this half-depressed way of being, though.

You're not lazy. I understand how easy it is to believe that, especially when you're feeling sort of better after feeling really bad - "since I'm not depressed anymore, the fact that I'm still not doing basic tasks must mean I'm lazy." But this isn't true...remember that depression isn't black/white! You're not lazy. Keep seeking out help until you've found help that is helpful for you. It's not anything close to an overnight process (sadly). I'm so glad you're feeling better than you were. Keep going...
posted by splendid animal at 12:35 AM on September 15, 2007

While suicidal thoughts feeling "a bit removed" is a certain improvement over "raging full force," no, your medication is not serving its purpose and you should be discussing changing your treatment approach with your doctor. Don't make any decisions about meds or change what you're taking without supervision. Since you are not receiving actual therapy alongside medication you should consider it, and yes I know you've explained why you don't want to right now but it's worth considering that it doesn't sound like you have any decent reason not to be in therapy: it sounds to me like you are just avoiding confronting your problems.

No, what you're describing is not a personality flaw, it is a classic description of serious depression. A book won't cure it, and neither will a pill. You need ongoing treatment including therapy.
posted by nanojath at 1:05 PM on September 15, 2007

When I got up to the right dose of the right med, I said "Oh my god, this is a fucking miracle drug." I'm not sure if that's an experience that's available to everyone or not, but it's worth looking for.

I say try something else.
posted by longtime_lurker at 8:56 PM on September 15, 2007