Should I give up on antidepressants?
March 20, 2011 6:48 PM   Subscribe

Should I give up on anti-depressants?

I've been depressed and anxious for much of my adult life (I'm 35 now). There are periods that are better, some that are worse, right now I feel like I'm in one of those extended bad times and I can't seem to find a way out of it. The past couple of years have been rocky. I had a major break up and lost a job within the last year.

From the outside looking in, most people would describe me as a calm, grounded, smart, interesting person. I guess many of us who suffer from depression get very good at hiding for fear that we won't be liked otherwise. I feel like there's nothing to look forward to in life. I go through every day just trying to get through it, and lately, I've been having a lot of trouble getting through. I wake up and immediately think "when can I go to sleep again". I'm so tired of living like this... I'm not thinking of suicide, never have, but I need some hope that I can do something to change this.

I've been seeing a new psychiatrist for the past four months or so. I don't find him very helpful, and I've been on and off Effexor, Lexapro, Wellbutrin, Prozac, and now Cymbalta. Nothing has helped. I also take Ambien for sleep, which has started to be ineffective, and Ativan 1.5 mg a day (which recently I've started upping on my own). None of this helps, and I feel like I'm overmedicated and feel hopeless that any med will actually work for me.

I know the whole exercise, keep a consistent sleep pattern, socialize, eat better, advice, and I'm sure it can help. But how do you get to a point where you feel hope for the future enough so that you have the energy to commit to those things?
posted by anonymous to Health & Fitness (26 answers total) 10 users marked this as a favorite
I've been seeing a new psychiatrist for the past four months or so. I don't find him very helpful, and I've been on and off Effexor, Lexapro, Wellbutrin, Prozac, and now Cymbalta. Nothing has helped.

Nothing has helped because you haven't been on them long enough to know if they helped. 5 different meds in four months is a ridiculous and your psychiatrist should know better. Some medications can take months to show positive results. You seriously need to find a new psychiatrist and one that isn't going to throw a new med at you each time you walk in the door. I've been there and it sucks.

I know the whole exercise, keep a consistent sleep pattern, socialize, eat better, advice, and I'm sure it can help. But how do you get to a point where you feel hope for the future enough so that you have the energy to commit to those things?

I've suffered from depression for most of my life and I can tell you that a healthy diet helps a lot. It doesn't cure it by any means, but it makes it a lot easier to deal with. Eating healthy really isn't more of an effort energy-wise, it's just about making different choices. Memail me if you want to talk.
posted by MaryDellamorte at 7:03 PM on March 20, 2011 [3 favorites]

I know the whole exercise, keep a consistent sleep pattern, socialize, eat better, advice, and I'm sure it can help.

Does that mean you're actually following it? Medicine is just one tool that you use. It must be paired with conscious thinking and attempts to break through past patterns, along with things like exercise, better food, and better sleep. You say you are having trouble falling asleep, but then say that the first thing you want to do when you get up is go to sleep again. That sounds like a pretty serious sleeping problem to me.

Are you getting therapy along with medicine? Also, you might look into group therapy for a while. Sometimes just changing around how you are getting help can trick your brain into responding better.
posted by Deathalicious at 7:11 PM on March 20, 2011 [1 favorite]

I don't know your location and if other psychiatrists are available to you, but if you don't have confidence in your current one, please see if you can find another.

I've had anxiety and depression in tandem like you, and also took Ativan and SSRIs concurrently. I am not a doctor nor a therapist, but my own psychiatrist encouraged me for a long time to get off the Ativan (which he had not prescribed--GP had), as he insisted it (and other benzos) can really contribute to depression. (The research supports him, btw.) He kept saying, "It works against the [SSRI I was taking]." I did not want to believe him, but eventually I got off Ativan and my mood really lifted.

Various SSRIs are supposed to act similarly, but in real life they seem not to. A lot of people ride on what I call the "SSRI-Go-Round" before they find the right one for them. The anxiety community has had a lot of good things to say about Celexa and Lexapro.

Positive life changes are also so helpful. You do have some control over the things that trigger or hinder you. For instance, I have cut out sugar and I must exercise, or I just don't feel as well as I can. You can find your combo of things like that and then you will be contributing positively to your own well-being.

Good luck, and please MeMail me if you'd like!
posted by sister nunchaku of love and mercy at 7:20 PM on March 20, 2011 [1 favorite]

I am not the OP, but it's not entirely clear to me from the post whether the OP tried all 5 of those antidepressants with the new psychiatrist in this span of 4 month or whether some of those were tried with a different psychiatrist. It is within the realm of possibility that someone could give all of those meds a fair shake (6 weeks or more each) with no overwhelming success.
posted by needs more cowbell at 7:38 PM on March 20, 2011 [5 favorites]

Make sure you have been screened for physical problems that can cause depression (Thyroid issues, for example). Most of the main culprits can be ruled in/out with a simple blood test.
posted by uniq at 7:51 PM on March 20, 2011

Are you seeing the psychiatrist for talk therapy, in addition to meds? If meds don't seem to be helping (i also found it unclear like cowbell whether you had been switching a lot in the past four months or over a longer time...), maybe you need something besides medication.
posted by Tandem Affinity at 7:52 PM on March 20, 2011

I would encourage you to keep trying. Finding the right meds sucks, no doubt, but if you think you could be helped, it's worth it to keep going.
I would talk to your doc about the upping of your own Ativan usage, tolerance to Benzos builds up quickly and it's a tough habit to shake (trust me).

I'd also chat with your doc about the Ambien. I've had close friends who have been on Ambien long-term and have noticed some mood disturbances related to it. Also, to second what Sister Nunchaku, both Ambien and Ativan are CNS depressants, and anything that depresses your nervous system can also depress your mood.

Keep up the battle. I wish you the best.
posted by aloiv2 at 7:52 PM on March 20, 2011

But how do you get to a point where you feel hope for the future enough so that you have the energy to commit to those things?

You don't, at first. You do those things in spite of how you feel, and in doing those things, you feel better, and it becomes a snowball effect. If you wait around for hope or energy or commitment to show up, they won't. You have to create them. Depression says you can't, you don't feel like it, everything is horrible. And you can say, yeah, so what, fuck you, I'm going to do it anyway.

I am NOT making light of your struggles, or judging you. I have lived through it for many years. I still suck at making good decisions wrt diet and exercise. But I have learned to distinguish the voice of depression and anxiety from my real voice, and I can tell the depression voice to STFU. I have a choice, and it's because I took action when I didn't feel like it.

About the medication - none of the SSRIs worked for me (made me dizzy and nauseous) but I was prescribed Lamictal for anxiety, which is also a mood regulator, and it is awesome.
posted by desjardins at 7:56 PM on March 20, 2011 [12 favorites]

Feel free to MeMail me as well. I'm familiar with the subject both professionally and personally.
posted by dephlogisticated at 7:57 PM on March 20, 2011

Why don't you go off the meds? Not all at once, and not without supervision, but it may be that you ARE overmedicated. I was mis-medicated and over-medicated for a while. I was in your situation and quitting the meds, and quitting drinking, was the best thing I did for myself.

It took 4 or 5 months to go completely off everything and things didn't get better right away, but I'm a much happier person now than I was when I was on them.

I'm not saying it will work for you, this is just a data point.
posted by TheBones at 8:02 PM on March 20, 2011

As others have mentioned, although SSRIs work in similar ways, some people seem to find some work better than others. That being said, I was part of a major depression study and one of the PIs was a pretty well-known, respected psychiatrist who is also well-published. Despite the above, he believed that if an SSRI didn't work for you, that it was a waste of time to try a whole bunch of similar antidepressants in the same "family." After having only moderate success with Effexor and Zoloft, he put me on desipramine, an older TCA antidepressant that isn't prescribed much anymore since SSRIs have become the antidepressant of choice. It wasn't a miracle drug, but it worked far better for me in than the SSRIs with fewer side effects (I really had trouble sleeping with the effexor no matter when I took it and zoloft worked for a couple of months and then nothing. I did a total 180 and ended up just as or even more depressed as when I started on it). I'm not saying that desipramine would work for you, but if you tried a bunch of SSRIs that haven't worked, maybe it's time for your psychiatrist to think outside the box a little bit more and try something else.

Also, the study that I was part of ultimately found that antidepressants alone weren't nearly as effective as antidepressants + cognitive behavior therapy. Are you getting any type of therapy or just taking the antidepressants?

Hang in there. I totally relate to depression sapping all of your energy so that it is extremely difficult, if not impossible to do the things that you know that you should be doing to feel better. I'd argue that despite what someone said above about making healthy food not being that a big a chore, when I'm really depressed, just getting to the grocery store wears me out, let alone prepping, cooking and then doing the requisite clean up afterwards. That being said, if you can afford it make sure to have some healthy prepared meals on hand as well as easy healthy snacks that can even sub as meals if needed. My go-to is Greek yogurt, with granola, honey and fresh (or frozen) fruits or berries.

Hang in there! Feel free to memail me.
posted by kaybdc at 8:18 PM on March 20, 2011 [2 favorites]

Mod note: From the OP:
I was on Effexor when I started with the new psychiatrist, and in the four months with him I've tried Wellbutrin (stopped after 2 weeks because it made me extremely anxious), Lexapro (stopped after 6 weeks), and now Cymbalta (8 weeks and not helping). The Prozac I had taken in the past and it didn't help, as well as Celexa.

I have also been seeing a therapist for the past 2 years and lifestyle changes - well, I try them and then give up. How does one get motivated to do them when you feel like nothing will change this? I don't think meds are a cure all, but I hoped that I would get some relief to be able to put the other changes into place...
posted by mathowie (staff) at 8:26 PM on March 20, 2011

How does one get motivated to do them when you feel like nothing will change this?

Again, you don't get motivated. Motivation will not show up at your door. You do the right thing in spite of not feeling motivated. I don't really care how I feel at 7 am tomorrow morning, I'm going to get out of bed. The act of deciding to do something and following through on it is the important thing. That's what helps me overcome depression, not just the actual fact of eating better or whatever.
posted by desjardins at 8:44 PM on March 20, 2011 [7 favorites]

I have also been seeing a therapist for the past 2 years and lifestyle changes - well, I try them and then give up. How does one get motivated to do them when you feel like nothing will change this? I don't think meds are a cure all, but I hoped that I would get some relief to be able to put the other changes into place...

Try. Just try. "Ever tried? Ever failed? No matter. Try again. Fail again. Fail better."
posted by dogrose at 8:50 PM on March 20, 2011 [3 favorites]

What's the rest of your life like?

Here is how it worked for me: My persistent (feared life-long) on and off depression didn't lift until I changed the circumstances of my life, including many key relationships.

posted by jbenben at 9:05 PM on March 20, 2011 [1 favorite]

I second the "get rid of the Ativan" advice. With doctor support, of course. Those things really aren't for depression related anxiety. Benzos and the like just turn the volume of the anxiety down and perversely give the anxiety more room to grow.

I figured out something that works for me, and might work for others. I was having trouble sleeping, and happened upon the supplement 5-htp. I tried it. It did nothing. I tried taking it in the morning. I felt AWESOME. Not high, but merely "right". Ready to tackle the day, hey, I better not start that next Solitare game because otherwise I might be late getting out the door for work, don't forget to pay the electric bill at lunchtime.

That lasted for about three hours, and then I crashed into pillow-punching, frustrated misery.


1- Don't take 5-htp.
2- Serotonin IS my problem, and the problem isn't that my brain doesn't use it right, but that I just don't have enough of it.
3- Eat more protein.

Makes a HUGE difference. YMMV.
posted by gjc at 9:15 PM on March 20, 2011

I don't have depression, but I have bipolar, which also need medication. I took seven or eight mood stabilizers before I found the right one, three anti-psychotics and four different anti-depressants. I have finally - after five years of "this isn't working" -- found the right combination that makes me a working member of society. What I'm saying is, don't give up. When you find the right one, it makes all the difference in the world.

As for motivation, I just kept this in mind (my circumstances were/are probably different than yours) -- no one's going to do things for me, so I have to do for myself no matter how hard it is. There were/are times when I don't want to get out of bed, but I have to, because I can't do anything from my bed and things need to be done. It's as simple as that, for me anyway.
posted by patheral at 9:21 PM on March 20, 2011

What got me through the testing of different meds was the CBT counselling I'd received years before in counselling. No matter how smart we may be, humans are never free of cognitive distortions. Having a workbook or just taking a set amount of time each day to do some self-monitoring and analysis of thoughts forces you to think just a bit harder about the assumptions and emotions behind the self-talk. Even if you consider yourself a very self-aware person, there'll be some surprising revelations when the self-talk is put to the test.

I too have been on a handful of different meds; it can be frustrating (and if SSRI withdrawal occurs, downright scary) to wait for the right combination to be found. I've known family members who took years before finding the right 'cocktail' of anti-anxiety and antidepression meds. One of my relatives also had to add an anti-nausea drug due to interactons between all the meds. From what my doctor tells me, this kind of prolonged search for the magic mix is uncommon but not rare. Hang in there.

Ditto on what MaryDellamorte said about diet. I find it can make my anxiety much worse when I've eaten badly several days in a row. And of course diet affects sleep, which affects mood too. Life balance is a bit more precarious when living with depression.

Also, I agree with kaybdc about trying several drugs in a family. After having little results and a really bad time coming off Effexor (venlafaxine), I was very reluctant to try Pristiq (desvenlafaxine). A modified version of the same drug, why have the hassles? It turned out to be much more effective for me. It's unfortunately the state of medicine today that you never know (and neither does your doctor) what drug(s) will work for your depression 'till you try.
posted by Hardcore Poser at 9:23 PM on March 20, 2011

I just noticed what gjc put about protein, and wanted to chime in and agree. Specifically in the morning. Ten o'clock crashes are guaranteed when my breakfast is light on the protein. It's like clockwork.

Bleah, just looked at my first comment and noticed the word 'counseling' in there twice. Clearly I need to take my own advice and get to bed. Good night, best of luck!
posted by Hardcore Poser at 9:32 PM on March 20, 2011

An important specific factor that may be overlooked in the effort to address the overall arc of your depression: an increase in actively suicidal thoughts is a known possible side effect of Cymbalta. While all anti-depressants carry this risk, Cymbalta has been documented as producing a greater incidence of suicide attempts in clinical trials. I personally know a woman with a long history of depression who became actively suicidal on Cymbalta, whose concerns that her new med regimine might be connected to the notable increase in suicidal thoughts were dismissed because of her history of depression, and whose very pressing suicidal ideation vanished when (against her therapist's wishes) she ceased taking the medication. It's hard to tell when you have a long history of depression, but there is a very good chance you might not actually feel as deep in the misery as you do right now were it not for the influence of Cymbalta.
posted by tigerbelly at 9:33 PM on March 20, 2011 [1 favorite]

I'm sorry to hear that the antidepressants you've tried haven't helped. However, that doesn't mean that NO antidepressant will help. I encourage you to keep trying them, with a shrink you trust and who shows compassion for you. It takes persistence, but the potential payoff is immense.

Be sure to tell your shrink all of the meds you are taking (especially in light of comments above about Ambien and Ativan). Also, you might try taking a little vitamin B-6 daily. Maybe 10 mg to start, to see how it goes. B-6 is involved with synthesis of nerotransmitters, including seritonin, and I found it makes a big difference for me. Of course, YMMV. Best of luck with this.
posted by exphysicist345 at 9:40 PM on March 20, 2011

With regards to meds: Maybe you just haven't found the best one for you. Try even similar meds. I was switched from Effexor to Pristiq when it came out (because that is what they had free samples of). Pristiq is a metabolite of Effexor - that is, everyone who takes Effexor makes Pristiq in their bodies. But something wasn't right because I had an awful, awful year on Pristiq and finally insisted on being put back on Effexor (and am now doing great). So even really similar medications can affect you differently. Keep trying!
posted by IndigoRain at 11:28 PM on March 20, 2011

Loss of motivation and hopelessness are symptoms of depression. "Just do it" and "Try" are often not strong enough to overcome this illness and you shouldn't feel bad if that isn't working.

If you've been seeing the same therapist for two years have you received cognitive behavioral therapy? That is usually a time-limited treatment.

I applaud you for sticking it out for so long and for continuing to search for a solution rather than giving up. So there is some fight in you; depression does not own you. It is quite possible that you have treatment-resistant depression. There are alternatives to anti-depressants, and your psychiatrist should know about them. You've got to fight for your health with whatever strength you have.

If you don't have another appointment with the psychiatrist soon, call and make an emergency appointment (being in an extended, deep depression in spite of medication and therapy calls for action on the part of those trying to help you). When you see the doctor, stress that none of the medications have helped and the depression has drastically interfered with your functioning in life. Sometimes they don't really seem to take us seriously and they see so many like us; you have to let them know you're serious about it and that may push them.
posted by Danila at 12:34 AM on March 21, 2011

I hear you on feeling overmedicated; I've been in places where I felt like my shrinks were just trying to deal with symptoms and not overall maintenance of feeling like a normal human being. Anti-depressants can help you get out of the hole, but for me anyway it felt like they didn't do a good job of keeping me out of the hole and learning how to stand on my own. I strongly feel a lot of people do need regular medication to deal with their depression and that is OK too.

(I had similar reactions to many of the drugs you mention taking. Feel free to memail me if you want. I am currently not taking any meds, doing great and it wasn't due to "lifestyle" changes, more like just finally taking charge of where my life was going. ) It can be really exhausting looking for that one medication that's going to set you down on your feet long enough to keep walking and you deserve a good psychiatrist/therapist to see you through it. Is your therapist digging at the deeper issues that are keeping you depressed? Are you sifting through those issues or just drifting along? Good luck to you, you deserve all the best for yourself.
posted by Wuggie Norple at 3:17 AM on March 21, 2011

Maybe you could try tackling the depression and anxiety issue through the back door by thinking of them as secondary effects to bigger problems in your life such as lack of excercise, lack of mental stimulation, poor diet, poor sleep, and ill relationships. Maybe start by treating the poor diet and lack of excercise. Think of those as the biggest thing "wrong" with you. Find some sort of group that meets weekly to discuss healthy eating, home cooking, how to use stuff from the produce and meats departments to make yummy, etc. Take an excercise class that meets weekly at a community college - yoga, strength training, some sort of dance, whatever seems interesting or whatever fits your schedule. Focus on those problems. See if after 2 months or so you can make better choices in regards to food and alot your time better so that you have some physical activity in your day, even if it's just walking to the post office.

Once you tackle those to a point where you feel you can maintain your new habits, then make lack of mental stimulation the biggest things that's "wrong" with you and set out to learn about something that interests you or just something you have no clue about. Continue tackling such lifestyle issues and maybe the preoccupation with becoming a better you will make the depression a distant memory. A bored mind and body is an unhappy mind and body.
posted by WeekendJen at 12:55 PM on March 21, 2011

Try working more actively with your therapist on anxiety and depression issues. Try CBT.
Exercise makes you feel significantly less crappy in general, the same with better food, and anything that will make you feel better is worth it.
Being healthy makes things considerably easier to deal with and when getting through the day is a chore, you want to make things as easy on yourself as you can.
posted by provoliminal at 5:52 PM on March 21, 2011

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