Do I really need these drugs to feel better?

February 25, 2009 12:50 PM

Help me have a conversation about anti-depressants with my doctor.

I am a 30 year old (physically) healthy male. I recently finished my doctorate and now work at another academic institution. While most of my PhD experience was quite pleasant (even the writing), I did very little for the last year (mostly because I was so stressed out by the job search process). Thankfully I had written much of my dissertation by then so being under productive didn't matter too much.

While it was acceptable to procrastinate so much during grad school, doing so on a postdoc (I feel) is pretty much career suicide (my boss expects me to have a publication from my new project by May). These days I go to work around 10 am, browse metafilter and a few other blogs, get coffee, print some papers, and then try to work in a coffee shop and do more of the same. Honestly I get less than an hour of work a day. This comment resonated with me very strongly. I immediately saw my GP and told her about my issues. My goal was to get her to refer me to a therapist who could identify my motivational issues. Here's what happened:

She did refer me to a therapist [still waiting on insurance approval] but she also prescribed an anti-depressant. She has me on 10 mg of Lexapro for a year. I rarely take prescription meds (last time was 6 years ago for a week; I've always had great insurance) and so I didn't know what to make of this. I've been on the meds for a week and have had nasty nasty side effects (jaw pain, stomach pain, dry mouth, sexual side-effects). I called her office and they told me to cut back to half a pill a day until I see her next (Friday). The side effects are still just as bad.

Here are my questions:

a) Given the side effects I am experiencing so early on, I fear that being on it for a year will simply make it very hard for me to get off the drug. Googling around even brings up a book for sale on how to get off of Lexapro without really nasty side effects. Has that been your experience? It is possible that my position may lose funding (California budget crisis) later this year. I really do not want to be in bad shape simply because these prescriptions are so expensive.

b) Should I just tell my doc that I would rather wait to meet with a therapist and try to work out my issues. If my therapist still thinks I needs these meds, then I'd be happy to take them again (possibly something other than this one). Is that appropriate to suggest?


What should I do?

posted by anonymous to Health & Fitness (20 answers total)

See, this is a common problem with anti-depressants and other psycho-active meds: GPs prescribe them at the drop of a hat without making any serious attempt to resolve patients' issues without them.

I wouldn't have started them at all. Your GP, though legally qualified to prescribe any meds she wants, probably has no formal psychological training beyond a few med school classes. Talk to your therapist. Talk to a psychiatrist. Talk to someone who will work with you to reach the best result for you without meds before automatically jumping to meds, especially if you think you're having a bad reaction.

I'd stop taking the pills altogether. You aren't a suicide risk. The worst that can happen is that your therapist thinks that the meds really will help and you have to start them again next week.
posted by valkyryn at 1:04 PM on February 25, 2009

I'm not a doctor, but personally I would talk to a therapist prior to starting that class of meds (for depression), since a therapist's specialty is those types of disorders compared to a GP. I would be worried about being misdiagnosed and taking the wrong thing.

For example, you didn't explain more symptoms, but if you have a hard time focusing you could be ADHD and it was "hidden" due to your ability to focus on the easy goal-oriented situations you were placed in during your undergrad and grad studies. Now that you're in a more open-ended scenario, you're having a hard time getting down to business in a less structured environment. So Lexapro is not going to help you at all.

But in the end I'd worry about taking the wrong thing and never solving the problem - especially when a lot of meds come with undesirable side effects.
posted by JibberJabber at 1:06 PM on February 25, 2009

Some doctors sometimes assume people showing up at their office expect to be prescribed a magic pill to make things better. They have seen that there's frequently no point in trying other stuff first, because people won't do it, so might as well go straight to the medications.

I find that starting the conversation with "I'm not expecting to walk out of here with a prescription that is going to fix this, or anything like that..." before going into the details of the problem helps a lot. I've found my doctor quite willing to discuss and negotiate the treatment process once it's apparent I'm actually interested in that process rather than a quick fix.

Which is not to say there's anything wrong with medication--for a lot of things that is the right answer. You just want to make sure the doc isn't making an incorrect assumption about your willingness to try other types of treatment first.
posted by FishBike at 1:16 PM on February 25, 2009

Go see a real doctor, one with training in the field. I was in a similar position, and lexapro helped, but man, its definately not an easy discussion to have, nor is it an easy path to take. I was on Lexapro 10mg, and I remember the side affects. That being said, I am here today because of that medication. Best of luck to you.
posted by Heliochrome85 at 1:22 PM on February 25, 2009

Yeah, therapist before medicine. The therapist will help you figure out what's wrong and why, and then make a diagnosis and formulate a treatment. In some cases, this means medicine, and she or he will then recommend you to a specialist who will work with you in getting the right med at the right dose. In other cases it does not require medicine, and being on a drug, any drug, without the practitioner understanding =exactly= why they're prescribing it for their patient seems unwise to me.

Is it really depression... or anxiety? ADHD? Low energy from a bad diet or working hours that mess with your circadian rhythms? A sensitivity to flourescent light? (Don't laugh, I had a teacher in HS who had to wear rose-tinted prescription glasses - without them he'd get irritable and distracted due to low-grade migraines.) Lexapro won't help with any of that.

It probably is garden-variety depression (hoofprints mean horses, not zebras), but I'm not qualified to say that for certain without the opinion of an accredited expert to back it up. Neither are most GPs.
posted by Slap*Happy at 1:41 PM on February 25, 2009 [1 favorite]

I suffered from depression while in my Master's program and was prescribed Lexapro. Like you, I do take medication much- not even vitamins. On Lexapro, however, within a week (more quickly than I've been told it's supposed to work) I felt that a "wall" had lifted from me. It was a major, positive change for me. I did not have negative side effects, but everyone's body is different. I quit Lexapro cold turkey when I left the state to enter a doctoral program. I didn't have the money to continue treatment, plus I thought I would use my new beginnings as a way to make a break from my depressive past. I had no side effects from stopping Lexapro.

A few months later I got into eating raw foods in an attempt to lose weight (someone earlier said that salads are acidic; that is only if you choose acidic foods for your salad). I was astonished when, after a few weeks, I experienced had the same depression-lifting effect that I'd had when taking Lexapro. Now, I don't know if the all-raw (I ate produce- not meats, by the way) regimen that did the trick or if the removal of processed, mass-produced foods did it, but I was thrilled to have found a "natural" way to lift my depression.

I wish you luck!
posted by Piscean at 1:44 PM on February 25, 2009 [1 favorite]

Myself included, many people I've spoken to about Lexapro have had a bad experience. Zoloft or prozac is better. And that doctor doesn't know what he is doing, because 10 mg is probably not going to do much at all.
posted by metamush at 2:42 PM on February 25, 2009

I'm sorry, what does this mean? Honestly I get <>This comment resonated with me very strongly.

I feel like I'm missing a piece of the story, but it looks like others get it. What am I missing?
posted by sweetkid at 2:58 PM on February 25, 2009

sweetkid: He had a quote or more content in there between the <> that doesn't display because I'm guessing Coldfusion strips is as a non-valid tag. I flagged it as an HTML display error, but have no idea if it can be restored from the DB.
posted by cjorgensen at 3:11 PM on February 25, 2009

IANAD.

I think it's a little weird that your GP prescribed an antidepressant. I would see a psychiatrist - a therapist with an MD who can talk to you and has experience with your kind of problems. A good psychiatrist is a blessing.

Also, I've been on Lexapro, and it helped me tremendously. However, in my very unprofessional opinion, it seems like a strange drug to give for motivation problems - it's more of an anxiety medication. Once you see a therapist and if you do decide to go the med route, you might want to ask him/her about Wellbutrin.

FWIW, although I would definitely see a therapist first, I would keep an open mind about meds. A lot of people don't get the help they need because of preconceptions about antidepressants that aren't necessarily true. Good luck!
posted by walla at 3:36 PM on February 25, 2009

I'd stop taking the pills altogether.

Be careful just stopping the pills cold turkey, though. Lexapro can do (not so) funny things.
posted by inigo2 at 3:53 PM on February 25, 2009

Mod note: Fixed formatting error in the post.
posted by cortex (staff) at 3:55 PM on February 25, 2009 [1 favorite]

A couple of things:

-It often takes 1-2 months for these sort of medications to start working properly, so most prescribers are reluctant to change meds quickly. It's too bad that the side effects don't wait that long.

-All the research I've found indicates that the majority of MD's don't necessarily know how to prescribe these kinds of drugs effectively. A psychologist or a Licensed Marriage and Family Counselor (LMFT) are great for therapy purposes, but ideally they would then refer you to a psychiatrist who can prescribe meds if that is in fact what you need. You may or may not need meds, and the best way to decide is in concert with a therapist and a psychiatrist.

-NOTE: Though some psychiatrists are also skilled therapists, they often do not specialize in therapy and instead leave that to the psychologists, therapists, and such. (Psychiatrists go through more schooling, but shouldn't be considered MD's)

I have a wealth of information on this subject, so if you have more specific questions feel free to send me a message!
posted by Evanstruth at 4:04 PM on February 25, 2009

Evanstruth, why do you say psychiatrists are not medical doctors? They have been to medical school, and then do psychiatric residencies.
posted by Houstonian at 4:16 PM on February 25, 2009

Agree with "therapist, not GP." Psychiatrist, to be specific. You might or might not need meds, and you might be having a nasty reaction to the Lexapro.

Zoloft or prozac is better. And that doctor doesn't know what he is doing, because 10 mg is probably not going to do much at all.

You can't possibly know that, unless you're the physician examining this patient. Even then, there could be a bad reaction.

Psychiatrists go through more schooling, but shouldn't be considered MD's

...except that they are MDs.
posted by Rykey at 4:27 PM on February 25, 2009 [1 favorite]

My experience with Prozac for a few months and Zoloft for about 4 months for depression when I was in undergrad is that: it lifted me above "the wall", but then two more walls appeared on both sides (sad/happy) keeping me in this zombie zone of no emotion.
posted by wcfields at 5:35 PM on February 25, 2009 [1 favorite]

Not only am I not a doctor, but I've never taken an antidepressant of any kind. So really, I don't know what I'm talking about. Except that I AM an academic. And frankly, what you describe sounds like, well, being an academic during a bad spell. It's hard to start a new project. It's hard to recover/move on from grad school. It's hard to research and write, day in and day out, without other tasks that count as work. Sorry; I'm assuming that you're on a nonteaching post-doc? People struggle while on leave, particularly during the early part of their careers--when they don't have a backlog of 9 unfinished drafts of stuff that's been piling up over the past several years of teaching. Some people procrastinate egregiously, and behave a lot like you describe. Being a full time thinker, without someone (your advisor) looking over your shoulder, is not easy for a lot of people.

I am not endorsing any of this or telling you that it is OK. You DO need to suck it up and get some work done. I'm just telling you that it may not be depression (again, not a medical doctor). You need to experiment with work locations and routines, and do the stuff that works. 2 hours at home first thing in the morning with no internet? An hour on and then an hour off? Some kind of exercise program? Music? E.g. I have music that I only listen to when really trying hard to write (no other type of work: not refereeing, not admin, not grading, not writing lectures.) I put my headphones on and listen to loud techno without vocals. Hey; it works for me. It's like going underwater.

All that said, what am I doing right now? I'm supposed to be writing a new talk, and I'm..... posting to metafilter. Sigh.
posted by kestrel251 at 6:02 PM on February 25, 2009 [2 favorites]

Go to a shrink who writes prescriptions for less than a year at a time.

I mean, seriously.
posted by bingo at 7:26 PM on February 25, 2009

Not a doctor, etc. but if it was me, I'd call the doctor and ask if it was safe to just quit taking the Lexapro since you haven't been taking it very long and you're having so many problems from side effects. There are so many anti-depressants out there, it doesn't make sense to take one that makes you feel bad when you could be switched to something else.
Waiting until you've gotten a therapist's or psychiatrist's opinion on if a anti-depressant is helpful sounds intelligent to me.

This wasn't part of your question but these are a few simple things I do when I'm in the same kind of situation you're in where I'm having a lot of trouble getting anything done. Feel free to ignore them if you want but they've helped me.

One thing I've found helpful for getting more done when I've been goofing off too much is to make myself to some work for a set time period and then I reward myself with watching TV or internet. Maybe you should try switching your surfing habits and work first, then read a blog, work some more, get to read the next blog. It's too easy to spend all your time surfing if you don't set up some kind of schedule.

I'm also a big fan of if a task seems overwhelming, break it down into smaller tasks until you can start making some progress. Sometimes I feel like I should be able to do it all in one go and start feeling bad about myself but I try to look at it as if I keep doing a little at a time, whatever it is will eventually get done. If I just put it off, nothing gets done. It helps me motivate myself.
posted by stray thoughts at 8:58 PM on February 25, 2009

And that doctor doesn't know what he is doing, because 10 mg is probably not going to do much at all.

What.

OP: yes, the MD with the magic pen (but not necessarily much psych training) and the therapist who has experience in counseling should talk to each other. An MD does not automatically make someone a moron, but the way GP practices are structured (45 minutes for a first visit, less for subsequent ones) does not jive well with getting to understand someone's mental situation and thinking carefully about what they need.
posted by a robot made out of meat at 4:30 AM on February 26, 2009