Have serotonin, what now?
July 25, 2010 7:44 AM   Subscribe

After more than a decade of poorly treated depression, I have started taking anti-depressants. I'm already starting to feel better. Other than taking the pills regularly and not expecting instant miracles, what specific things can I do to maximise the positive effects of my new brain chemistry? When you started taking anti-depressants, what else did you do to change your life for the better?
posted by anonymous to Health & Fitness (22 answers total) 30 users marked this as a favorite
Therapy, exercise, surrounding myself with new, positive people.
posted by sweetkid at 7:47 AM on July 25, 2010 [1 favorite]

I stopped constantly doubting and double-guessing myself, which was one of the major symptoms of my depression. The meds helped stop my brain from bringing up doubts all the time, but I was the one who had to stop and think "no, that decision was the right thing to do because I am an intelligent human being with experience and common sense." Eventually, it became second-nature to believe what I did was the right thing, and my self-confidence problems started dissipating.
posted by griphus at 7:50 AM on July 25, 2010 [3 favorites]

Exercise every day, eating more fruits and vegetables, also tried to stay away from situations with people that effected me in a negative manner or if I had to be in that situation I was better able to deal with it because of the pills. Also taking the time each day to do something enjoyable, like going to a bookstore and reading or being out in a beautiful park.
posted by lynnwilson120 at 7:52 AM on July 25, 2010

acknowledging random bouts of sadness as normal, valid feelings.

once you start treatment for depression and you begin to feel better, feeling sad or dissatisfied can feel weird - almost like you're afraid you're slipping back into the pit of despair. but i find that acknowledging my feelings and understanding them makes me feel much more comfortable.

congratulations on your progress!
posted by gursky at 8:14 AM on July 25, 2010

The way that SSRIs work in your brain is really interesting - basically, they allow receptors in the brain to bathe in serotonin much longer than they would otherwise. I don't remember the details, but essentially what this does is opens your brain up to learn new thought patterns, rewriting the old, destructive ones.

The metaphor that's stuck with me for this is a snowy ski hill in winter - when you're depressed, it's easy for your thought patterns to get stuck in ruts, like skiers following the same paths down over and over, and the more times a path is used, the more ingrained it becomes. Serotonin is like a fresh snowfall, so you can create new paths. So, think of everything you do over the next few months as a new path, and reinforce the good ones as much as possible. Eventually, you won't have to default to the old ones anymore.

(This book touches on the subject and is generally fascinating - The Brain that Changes Itself.)
posted by ella wren at 8:20 AM on July 25, 2010 [5 favorites]

One small tip is: watch your intake of other chemicals. Particularly caffeine! (I would assume alcohol as well.) It can affect you in whole new ways--maybe good, maybe bad!
posted by RJ Reynolds at 8:41 AM on July 25, 2010 [1 favorite]

Developed better sleep habits. I now get up at the same time every day, even on weekends. Sleeping in on Sunday is one of life's great pleasures but if I do that it throws off my sleep schedule for the whole week and ends in a cycle of insomnia/oversleeping and feeling like crap every morning. I find if I oversleep, I don't feel more rested and I get the heavy, dull, head-stuffed-full-of-cotton-wool feeling that was one of my depression symptoms. I'm not a morning person by any stretch of the imagination but getting up and getting my day started in the morning helps frame the rest of my day in a more positive light.
posted by atropos at 8:41 AM on July 25, 2010 [2 favorites]

big amen to gursky's comment. our brains are designed to handle a wide variety of emotional states. resist the temptation to follow modern western culture's brainwash attempts to get you to be ecstatically happy all the time. there's a lot to be said for satisfaction and contentment, but rich living doesn't come from constant ecstasy.

I 'lived' with poorly-treated depression for over a decade (all of my 20's). some short dalliances with SSRI's but not more than 6 - 12 mos, then I bailed, for one reason or another. now I'm in my mid-30's and have been on meds regularly for the past 3-4 years, and I'm never going back. amongst many things I give major creds to having stayed on meds, for the fact that was able to maintain (and feed) a relationship long enough for it to bloom into marriage, and parenthood (both of which previously seemed inconceivable).

the point of all that is to say: stick with it. yes, it's possible to feel some effects within 4-6 weeks as they say, but for me it took several months, or longer, for fundamental, long-lasting shifts to happen.

other things that have been a big, big help to me:

- be smart about your diet. eat enough, but don't overeat. the process of digestion takes a lot of resources away from your brain, overeating can be a big drain. watch the sugar / caffeine quick-fix; learn how to provide a steady supply of energy to your brain. learn what foods are good to you, and which are not.

- get into a normal sleep schedule. consider your circadian rhythm. give this time. remember, everyone's is different.

- cut down on alcohol, or at the very least, get the hell away from binge drinking, and move towards a more regular and disciplined consumption pattern (i.e. a beer on Thurs, a beer on Fri, rather than 5 on Saturday night). if you're taking medication, you've made a decision to regulate the levels of certain brain chemicals -- to build a new baseline. if you're constantly fucking with that baseline -- creating peaks and troughs -- then you are wasting your time and money. note also, don't worry that you're never going to be able to drink again. trust me :-)

- be smart about your diet.

- exercise, even if the smallest amount. those days when you just can't get out of bed or get out of the house, just try a walk around the block. doesn't have to be brisk (although there's heaps of evidence that regular intense exercise can do wonders for the mood centers) but enough to get the blood pumping around your body, get your mind lubricated. hell, even if you just make sure you get up and putter around your home, that's often way better than staying in bed.

- habits form over time. breaking habits takes time too. they say that establishing a new habit takes at least two weeks.

- be smart about your diet.

- research has indicated that medication + therapy is more effective than either one of those alone. don't be afraid to shop around for someone who works for you (as long as you're someone who's able to be honest with him/herself about your own responsibility for this endeavour). just like any other professional, there are good therapists and there are therapist that just don't work for you, and then there are some who are utterly incompetent. this is an area where you can afford to be choosy.

- confide in a friend. for the longest time, I was paranoid about any friends or family members knowing about how I was depressed (and anxious etc.) now I look back at that earlier me and just shake my head.

be good to yourself. don't give up. remember, the night is always darkest before dawn.

and... be smart about your diet. :-)
posted by armoir from antproof case at 8:57 AM on July 25, 2010 [4 favorites]

p.s. feel free to meta-mail me, even with 'dumb' questions. along these lines: you may be utterly shocked to find out how may people around you have similar struggles. the pool of knowledge is vast. don't be afraid to drink from it.
posted by armoir from antproof case at 9:01 AM on July 25, 2010

Here's my story of recovery from depression. Best wishes to you. You're doing the right things.
posted by netbros at 9:17 AM on July 25, 2010

All of the above! And don't feel obligated to tackle them all at once. Some of them will come on their own.

The biggest thing anti-depressants did for me was along the lines of what griphus, gursky, and ella wren are talking about: I learned to recognize stress and bad moods for what they were and not let them pin me down. It was like I'd had a worksheet with a series of "I feel ______ because ______" statements to fill out, and I was starting to fill them out with "I feel irritable because I slept badly last night" or "I feel neglected because my friend canceled on dinner plans" instead of a constant stream of "I feel like a horrible person because I am."

I wouldn't wish depression on anyone, but I feel lucky for having had the opportunity to fight depression and come out ahead, because I've learned so much about myself in the process. I wouldn't have been able to do it without medication. So, congratulations, and may you continue to work your way up!
posted by Metroid Baby at 9:22 AM on July 25, 2010

My anti-depressant has done wonders for me. It did start making me feel a little better within weeks but I continued to improve over the course of several months.

I've discovered that the meds provide me with a basic state of non-depression but in order to feel really good I also need to exercise every day and take fish oil. I also feel less run down in general if I limit sugar and fast food.
posted by Serene Empress Dork at 9:32 AM on July 25, 2010

I got a cat. Now, my depression has not been too severe, but ever since moving for my job I've been incredibly lonely, and short of changing who I am in order to fit in (no thanks) that's not going to change. But Seriously, having this living creature who depends on me, and loves me has been really helpful. My doctor wanted me to get a dog, because the exercise of walking it would help, but I'm often away on weekends so that was a no go.

My mom also suffered from depression... I think like you, untreated for a very long time, and frankly not recognized by the family because it was status quo for her, and she hid the worst of it from us. She finally listened to her doctor about vitamins, particularly vitamin D and Fish Oil. She also started tanning. She also took up archery, which not only gave her exercise, but a new group of friends and goals. AND she started eating better.

I know that's a lot of changes, but it was a big snowballing effect for her. She started weighing herself with the Wii Fit and didn't like seeing the numbers tick up, so she started to eat better. She liked an archery game so she tried the real thing. The better food gave her more energy to do the archery, the exercise helped improve her mood, the positive changes helped her decide to take her doctor's advice about supplements... etc, etc.

Now she's in a better place physically and mentally than she ever has been. I'm still working on it, but I've never been as low as I was before I went to the doctor and got help.
posted by Caravantea at 10:08 AM on July 25, 2010 [1 favorite]

Exercise! Cycling and weightlifting, specifically. Rediscovering dormant passions, reengaging in the esoteric art of socializing, exploring my town and community - just rejoining the human race in general and getting curious about the world I hadn't been participating in.

Congratulations on your recovery and best of luck maintaining and building upon the momentum you've already gathered!
posted by EatTheWeek at 10:22 AM on July 25, 2010

As I've mentioned elsewhere, depression affects every aspect of your life. As a result, real recovery involves making changes to every aspect of your life. The strategy I've found most helpful is to constantly experiment to see what makes me feel better. Things that have worked for me include:

-exercise more
-learn how to meditate
-find opportunities to socialize
-get a cat
-eat more fresh fruits, vegetables and nuts
-take fish oil/flax seed oil capsules
-cut back on carbs, sugar, alcohol, and processed foods
-take up a new hobby

This may look like a daunting list, particularly if you are just starting on the road to recovery. Start small with the changes you make to your life, maybe just one or two at a time. See what difference those changes make. If they work, try to incorporate them into your daily routine, otherwise try something else.

Above all, be patient with yourself. Habits take time to change. Every positive change you make will make a difference, and the changes will build on each other.
posted by oozy rat in a sanitary zoo at 11:08 AM on July 25, 2010

Here are a few basic recommendations from personal experience.

*Exercise- It's a bit of a catch-22 if you are depressed it's usually hard to find the motivation to exercise. I found some meds helped make it easier to exercise, so I hope that yours helps.

*Study Up! Read the wikipedia article about whatever medicine you are on. Read several discussion boards written by people who are or have been on the medicine that you are on (both positive and negative). You might have a great doctor that covered everything about it with you, but more than likely you will learn some things to look out for as far as side effects go. All the anti-depressants are very different in how they affect different people, so don't think it's all or nothing for the one you are on.

*Do Not Stop w/o you Dr's supervision!!!!! Anti-depressants can make you feel crummy and the side effects can wear on you and you can reach a point where you doubt it's helping you at all anymore. It is super important that you keep a clear head on this issue. Do not ever abruptly stop your meds! If you are going to stop them talk to your doc about how and when to do it.

These were the biggest issues that popped into my head after reading your post. I hope that you are effectively treated by your meds and completely recover from your depression. Have a great day!
posted by gibbsjd77 at 11:38 AM on July 25, 2010

I have a little abbreviation that I use to help me remember all the things I should strive to be getting every day, MS. STREEP:

M - Medication
S - Sleep

S - Socialization (time with friends, phone calls, being out in the world)
T - Therapy (or therapeutic activities like CBT thought records)
R - Relaxation
E - Exercise
E - Eating well
P - Pleasure
posted by Colonel_Chappy at 12:50 PM on July 25, 2010 [1 favorite]

Yeah yeah, eat right, exercise, all that, all of that is good advice for everyone. My advice?

Get out of the house and stimulate the brain with things that are not completely familiar. People who are depressed tend to fall into a rut, work, home, sleep, work, home, sleep. And not much beyond that. I'm not saying to throw yourself into a social whirlwind and go partying, but break the rut if you've gotten into one. Even going to the store at a different time of the day (if you usually go in the morning, go in the afternoon or evening) can create a different experience. Then it's not a very big step to try different things,

It helped me.
posted by patheral at 1:09 PM on July 25, 2010

I quit smoking pot. It is essential to eliminate or severely curtail the use of alcohol and drugs to make the most of recovery.
posted by crazycanuck at 1:30 PM on July 25, 2010

Start doing CBT exercises on my own, and work on changing some life-long habits (time management, socialization, organization, housework, etc.) Get involved in a stimulating social group or passion. Maybe do some reading on philosophy or spirituality to fill your reserves of hope in the meaning of life.

Doing this stuff can give you new skills that will bolster you if/when the depression comes back at any point.

I would also highly recommend arranging for the pharmacy to deliver your med refills if possible, or figure out a foolproof plan for getting your refills on time. One little missed refill can engender a HUGE crisis -- withdrawal effects can start quickly, and not only be physically uncomfortable, but can result in feeling horribly depressed/suicidal. And if you have a tendency to depression to begin with, you're also more likely than other people to avoid or forget little errands like this.

It's also a good idea to create a SPECIFIC contingency plan in case of a recurrence:

-Like, make a list of the bare minimum things that need to get done in your life, and troubleshoot ways to get them done as EASILY as possible in the event of an emergency (order takeout from that one place, get groceries delivered, hire a cleaning service you like temporarily, ask someone close to you to help with meals/errands.)

-Notify anyone living with you or in close contact with you that, in the future, if X happens (talk about suicide, self-harm), they must do Y (call 911 and get you to the hospital immediately, get pills and knives and dangerous things out of the house.)

-Keep numbers for crisis line, your psychiatrist/doctor, or a therapist you can book an appointment with on short notice in an easy-to-find place.

Sorry to focus so much on the just-in-case-it-comes-back, but this has been my experience.
posted by Ouisch at 4:20 PM on July 25, 2010

When I first started taking the anti-depressant that helped me, I too was really thrilled with the difference. Once I had months of stability under my belt, I started to doubt the meds because even though I was now stable (no suicidal thoughts, much less anxiety, able to enjoy things again), I wasn't what I thought I would be once the depression was gone. Years of depression had done a number on my life, and treating the depression will change your life, but it won't fix it. So I went off the meds for a while and finally saw the difference. I was hopeless, irritable, and miserable within weeks.

So first I would caution you not to start thinking the meds don't matter as the months go by and the awfulness of the depression becomes hazy. And don't expect the meds to fix everything. If depression made you anti-social and unable to maintain friendships for years, then the medicine won't bring your old friends back, and it won't tell you how to grease the wheels with new people. If the depression made it impossible to think about the future in a positive way, that doesn't mean the medicine will tell you what you should do with your life. For me, the future was a chasm of hopelessness when I was depressed because I didn't see how things could ever change. Now I do feel I have a future, but I went so long not making plans that I don't really know what to do with my life now that I have it back.

With all that in mind, one of the things I had to do once the meds made my mind better was pay heed to my physical health, which had gone neglected. When I was depressed I wouldn't even take allergy medication because I just couldn't care enough about myself no matter how miserable. Now I've had to learn to listen to what my body is saying and to take care of myself, because I deserve it.

Something else I did was hire a life coach to help me use my unique skills and personality to create the kind of life I want for myself. I did this before the depression was completely gone, but it still helped immensely. I was years behind everybody else (or so it seemed). I didn't know myself as the non-depressed Dani. Being depressed had become a huge part of who I thought myself to be. The life coach helped me with discovering myself and what I really want.
posted by Danila at 4:38 PM on July 25, 2010

I started biking, and found a hugely enjoyable good-for-me activity. It turns out I love it and it's another non-drug thing in my life that makes me happy. Find your special new activity you would've been too scared to try before.
posted by paddingtonb at 8:49 PM on July 25, 2010

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