Dysthymia and antidepressants--what should I ask my GP?
October 4, 2010 3:52 PM   Subscribe

After years of resisting antidepressants, I don't think I can go on without them.

(Anon because of some details about my family.)

I come from a long line of depressed people. My father had a nervous breakdown shortly after I was born and spent a year out of work, just sleeping on our couch. Eventually he was diagnosed with extreme anxiety and depression and has been on several heavy-duty drugs ever since. Other family members have committed suicide, been diagnosed bipolar, and are alcoholics and drug addicts. We even have a convicted pedophile and some religious fanatics in the mix. So the deck was probably stacked against me to begin with.

Luckily, I'm not that bad. I just seem to have a chronic case of the blahs. I can laugh and have fun, but I suspect that my level of "normal" is below the norm. I have a ton of hobbies that I would like to focus on, and things I want to do with my life, but I can't seem to muster up the energy or enthusiasm to do them. There's a constant stream of negativity ("Why bother? You're not good at this anyway") in my head. I'm tired and often feel sad or fearful for no reason. I sometimes have panic attacks in the morning and I seem to have developed a bit of social anxiety. It takes me forever to get things done and sometimes even doing the dishes seems overwhelming. In my dark moments, I just feel hopeless, like I have no joy in my life. In the past I've tried to fix this with therapy, but I feel like there's a wall I can't break through. It's just become so easy to feel bad.

So, I think I need to bite the bullet and ask my GP for drugs. In fact, I have an appointment tomorrow. After reading a little bit about my symptoms, I think it would be classified as dysthymia. I know everyone reacts to drugs differently, but has anyone else with similar symptoms had more success with one SSRI than another? Is there anything that I should remember to bring up with my GP?
posted by anonymous to Health & Fitness (13 answers total) 14 users marked this as a favorite
You probably want to check the forums at CrazyMeds if you haven't already (as far as med experience goes).

...and, um, be prepared to try a few until things get sorted out. The first one (or two) you try may not work for you, in which case there are others. Additionally, just in case you were worried about this, you may not have to take them for life. Some folks get permanently better after a while.
posted by aramaic at 4:08 PM on October 4, 2010 [2 favorites]

I was certain that my depression was 'just' depression, because i'd been in therapy for my PTSD for 2 years and I felt like I should have been 'over' my crappy childhood already.

Turns out I also have ADD, which was exacerbating my depression in a vicious wheel of suffering. So, tell your GP everything you've told us here, and maybe keep a journal of your activities and thoughts between now and your appointment.

It might help your GP to see that you get angsty before the weekend, or socially anxious more on the first of the month, or, you know, whatever is true about you. (specific thoughts - not just 'was anxious' but 'worried that nobody would come to my birthday party and instead they're at a bar around the corner together saying mean things about me' and if you're imagining what those mean things are? Include them too.)

Good luck, and remember that if the side effects if a med are unpleasant, you can switch. I'm emvarassef to admit that I was bothered by one for months before I piped up about it. Learn from my mistake.
posted by bilabial at 4:11 PM on October 4, 2010 [1 favorite]

I'm trying to work my way out of some similar things. I have had a decent amount of therapy, though, which is where I would suggest you start. If it is too expensive and/or you don't have insurance, many graduate psychology/psychiatry programs have clinics where they charge on a sliding scale. Drugs may be a good idea, but what I have learned is that you still need to re-learn how to think.

I have been reading and working through the Feeling Good Handbook, which sounds ridiculously cheesy but has some excellent tips and exercises. It's rooted in Cognitive Behavior Therapy (CBT), which claims that misguided, automatic thoughts 'create' our moods -- and that we can change our thoughts. Thoughts like 'Why bother? You're not good at this anyway'. Antidepressants can definitely help, but they will not re-frame your thought patterns, which have been developing since you were a child.
posted by imalaowai at 4:11 PM on October 4, 2010 [2 favorites]

I was on zoloft for several years. They helped. Eventually I went off them and I still feel much better than I did before. One thing my therapist told me was that the drugs can help you re-channel new ways of thinking/feeling so that when you go off them later you don't necessarily just fall back into the way you felt before. I also continued talk therapy for a bit while on the zoloft. That helped too because I was able to talk about things without worrying they'd trigger a downward spiral. But. Getting started is tricky. I had to undergo 3 weeks of pretty spikey anxiety before my system settled down. It's a very good idea to continue seeing your therapist for at least a month or two so he/she can help you monitor the drugs and see if they are right for you. I might not have stayed on them without the support, and I'm really glad now that I did. I also knew that if the side effects during the adjustment phase got to be too much my therapist was there to help me assess so things didn't get dangerous. I experienced a small drop in libido and a small amount of weight gain...nothing serious, and I was enjoying myself so much more in general that it didn't matter.
posted by aunt_winnifred at 4:11 PM on October 4, 2010

Is there anything that I should remember to bring up with my GP?. Full disclosure of symptoms, brief but thorough and accurate family history, any allergies, past medicines that worked/did not work, accurate accounting of alcohol/recreational drug use. Other medication you are taking. A brief and accurate medical history. Any other physical symptoms whether you think they are related to the depression/anxiety or not--weight change, sleeping habits, libido, energy level, aches/pains, etc.
It really helps to make an outline of these issues and have them available. The key is complete candor, accuracy, succinctness ( you do not need to tell long stories, over explain or apologize). State specifically why you are there and that you believe that antidepressants (probably a SSRI) would help. While most SSRIs are closely related they all have slightly different actions. Here is the MOST IMPORTANT THING--if they are prescribed do not get frustrated if they do not work as quickly as you would like and GET THROUGH the side effects. The side effects will most likely subside in 10-14 days. Give the medication at least 6 weeks to work--if there is no change then you can start playing around with the dosage and consider a different drug. If there is no improvement after 60 days you should ask for a referral to a psychiatrist--it takes patience but the right dosage or combination will work. I do not think there is any one that it better or worse--they will probably start you on the ones with the fewest side effects although some of the older ones (prozac/paxil) are quite good and many are now generic. If lethargy is a predominate symptom they may prescribe and SNRI or supplement your SSRI with a SNRI to minimize some of the side effects. Good Luck and Patience
posted by rmhsinc at 4:19 PM on October 4, 2010

Like you say, everybody reacts differently, but you could ask your doctor about what kinds of side effects you might encounter with the various drugs. These can range from weight gain to decreased libido. Or your libido might increase; you never know.

But that's where the other questions come in: how long should it take before you start to feel different? When should you book a follow-up appointment to discuss the results & maybe change the medication or dosage? Are there any support lines or similar that you could call while the changes are taking place? What else can you do to monitor how things are going (eg a mood diary)? Are there any other more holistic steps you can take to feel better - eg diet, exercise, acupuncture, CBT, relaxation techniques etc?
posted by UbuRoivas at 4:20 PM on October 4, 2010

has anyone else with similar symptoms had more success with one SSRI than another?

That's really the wrong way to go about picking an SSRI, because what works best for you and what works best for me will typically be different even if our symptoms are similar. You just have to try things out.

That said: sertraline kicks in about twice as fast as fluoxetine, and paroxetine tends to cause more side effects than either.
posted by flabdablet at 4:35 PM on October 4, 2010 [1 favorite]

there is research that suggests that medication works faster than talk therapy, after a few months their effectiveness is about even, talk therapy does a better job of preventing relapses after you quit and that for most people a combination is the most effective.

If you really don't want to do talk therapy then I strongly recommend you buy a copy of Feeling Good mentioned above and work your way through the book. Most people won't commit the time and effort to actually doing the exercises but they do work if you do them.
posted by metahawk at 5:09 PM on October 4, 2010

I would heavily recommend (from experience) building a relationship with a therapist first. Find one you really like. Take your time, look around, don't stick with one until you know they are the right one for you. Go in and tell them that you are feeling this way and that you want to feel better. They may help you work through it with CBT, they may recommend you see a psychiatrist.

If you do see a psychiatrist (and I would recommend seeing a psychiatrist and not getting a script from your gp) make sure you trust them. I have had some REALLY BAD psychiatrists, so before you start on anything, make sure you talk to your therapist (if you get one), or even get a second opinion.

You will probably go through a couple of different meds until you find one that works. There are some crazy side effects out there and everyone reacts differently to all medications. Also, just because you find one that works now, doesn't mean it will be as effective in a year or 2.

I cannot stress enough that you will have to be your own advocate here, hence trying to get a therapist involved. Actually if you could find a pyschotherapist who can also prescribe, I would recommend this above all.
posted by TheBones at 5:38 PM on October 4, 2010

I really agree with TheBones about being your own advocate through this process -- and also that there are some REALLY BAD psychiatrists out there (though don't let that scare you too much; there are lots of awesome ones as well).

It sounds like you have really analyzed your situation and your emotions and are able to take a step far enough back from yourself to get the general idea of what's going on. You should definitely stay confident about that. I was in a situation where I knew I was very depressed, though also frequently impulsive, and was misdiagnosed as bipolar and put on lithium and an antipsychotic. I was shocked when they put me on those drugs -- I knew myself, and knew I had never once had a manic episode. I was also very scared to be on two drugs with such potentially serious side effects. But no matter how much I told them that, they kept me on those drugs. Eventually I got a different doctor who said, 'why the hell are you on these drugs???', took me off them, and put me on an antidepressant. And it worked (though I did lots of work in therapy as well). Looking back now, I know I should have been more assertive with what I knew about myself and my experiences.

So yes, I would definitely say the moral of the story is to be your own advocate. You know yourself. If a Doctor is clearly not listening to you, say so, and find a new doctor.

Unless you are hearing voices. Then listen to the doctor.
posted by imalaowai at 8:31 PM on October 4, 2010

Ask about side effects.

Ask what happens if you need to stop. Do you need to taper or can you stop cold turkey.

Ask if there's a difference between the generic and the brand name. Insurance will want you on the generic, but I've had to fight for the brand name of one drug (Wellbutrin) because I found the generic less effective or consistent (my pdoc backed me on this one and said that he had heard similar complaints about it, I forget the exact thing he said though). I don't know if this has changed, since that was a few years ago. For other drugs I have taken, the generic was fine.

Find out your insurance coverage regarding the drug.

Ask if there are any concerns regarding medications, cold medicines, herbs, supplements, foods, etc that you should avoid while on that drug, or avoid within a certain range of dosage time (also check drug interactions online).

Maybe have your vitamin d levels checked (is it sunny where you are?) and your thyroid?
posted by mbird at 9:47 PM on October 4, 2010

It's not biting the bullet. Would you refuse antibiotics for an infection? No? Than why would you refuse antidepressants for depression? Given your family history you're not responsible for your depression anymore than your bipolar relatives are responsible for their manic phases.

Take them. It's not a life sentence. And if you don't like the side effects of one, try another (and if you don't like the sexual side effects of SSRI's ask for Wellbutrin/Bupropion, it works on a totally different mechanism than SSRI's).
posted by Ndwright at 9:55 PM on October 4, 2010

Seconding Aramaic, Rmhsinc and Flabdablet.

It's really a case of "suck it and see", while considering a) whether you feel better OVER TIME with an antidepressant, b) whether you're noticing any side effects, and c) whether the side effects suck worse than how you felt before you started taking this particular medication.

Rinse and repeat as necessary.
posted by MadMage at 3:41 PM on October 7, 2010

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