February 29, 2012 8:24 AM   Subscribe

I have major depression. My therapist is pushing for meds like crazy and I am kind of scared. Several general questions about antidepressants inside.

I had my intake session with my first therapist last week, and she diagnosed me with major depression, which apparently has been going on for most of my life. She inmediately said I should continue doing therapy and supplement with meds, and I have a few questions.

- how did she decide I need antidepressants so quickly? shouldn't we try just therapy first?
- I know nothing about antidepressants: Are they going to make me a drone? Am I going to gain weight? Will I be addicted? Will I have to take them for the rest of my life? What if I lose my insurance, will I go crazy without them? do you have any specific recommendations?

I'm very nervous. My second appointment is tomorrow and she was singing the glories of meds last week, so I know she will go on tomorrow, and I wouldlike your stories, reassurance, warnings, etc.

:) Thank you.
posted by Tarumba to Health & Fitness (46 answers total) 12 users marked this as a favorite
My experience is that antidepressant meds do not make you feel better, they make you feel different. Its still up to you to convince yourself that the particular flavor of different they make you feel is better. YMMV.
posted by ackptui at 8:34 AM on February 29, 2012

Therapy + medical treatment has the highest positive outcome. I'm sure your doctor can explain and even cite relevant studies for you.

No. They do not make you a drone. Will you gain weight? Different ADs affect different people in different ways. Vague, I know. I'm on Wellbutrin which is known to cause people to lose weight as it's a stimulant. I tried prozac and it had poor side effects for me so I switched. You might need to do that a few times.

No, you will not become addicted to any AD off the top of my head. Ask your doctor. There CAN be withdrawal effects but you taper off slowly when you are coming off them. ADs are not always permanently necessary. That is why therapy + the AD is helpful.

Re insurance: many ADs are now generic and my grocery store pharmacy and wal-mart both offer them for $4 w/o insurance. Yep, $4 for a month.

Think of it this way: something in your brain isn't quite right. It is not your fault. You can't always bootstrap your way out of depression and the drugs will not take a knife to the old you, but rather let you (hopefully) overcome the irrationality of your depression. Because it is irrational to sit there all night and think apropos of nothing, I am a piece of shit and I deserve to die and nobody likes me and fuck this but I'm not going to do anything about it because what's the use and fuck this shit.

So yeah, I'm pretty glad I'm not depressed anymore, and so is the lady I'm seeing since I have the energy and will to do so, and my boss at my job since I have the energy to show up and generally everyone who interacts with me. And most of all me.

DEPRESSION is what makes you a drone. Fixing it will turn you back into the real you rather than vice versa.
posted by OnTheLastCastle at 8:35 AM on February 29, 2012 [18 favorites]

(I am a therapist, I am not your therapist, etc.) Therapists who are informed about current neuropsychological research know that, for Major Depressive Disorder, the treatment plan that shows the highest rate of success for people is therapy plus medication. I would guess that your therapist is tuned in to the fact that you may need more support than just talk therapy; if you feel uncomfortable about it, you are absolutely entitled to ask as many questions as you want or need to, and are absolutely entitled to make the choice for yourself. Her recommendation likely isn't a command or requirement for staying in therapy with her, it's a recommendation to try to help you (which is her job). Consider that her recommendation of meds could lead you to getting better all on your own and then dropping her because you feel better, so she probably doesn't have an ulterior motive.

Ask as many questions as you need to! But ask a doctor who prescribes medications. Therapists, unless they are MD-level psychiatrists or psychiatric nurses, do not have prescribing powers or the level of training that would be able to give you the level of information you need in your situation.
posted by so_gracefully at 8:36 AM on February 29, 2012 [4 favorites]

how did she decide I need antidepressants so quickly? shouldn't we try just therapy first?

Consider it the equivalent of walking into a physical therapist's office with a broken leg. Their training and education lets them know when this is something they can handle on their own or if medical intervention -- and keep in mind a psychiatrist in an M.D. -- is necessary as well. They can't force you to see a psychiatrist or take medication, but it would be irresponsible for a therapist to diagnose major depression and not suggest psychiatric help.

I know nothing about antidepressants

There are many, many different kinds of anti-depressants, each with their own mode of action, side effects, and so on. Some make you gain weight, some make you lose weight. Whether or not you become a "drone" is a really subjective thing but, no, generally that's more of a side effect of anti-convulsants/mood stabilizers and anti-psychotics (which have been prescribed for their anti-depressant qualities, in some cases) than traditional anti-depressants.

You may have to take them the rest of your life, you may not. It depends on what, exactly, is going on in your head and whether or not therapy is effective. No one here can tell you what's going to happen in the future. As an American you're probably used to having drugs directly marketed to you on TV and so on and you should know that there are two countries in the world where this is legal, and the US is one of them. Everywhere else has been smart enough to pass laws that say that the only person who should be telling you what medication you should take is a prescribing doctor. Any suggestions from the peanut gallery as to anti-depressants are irresponsible and should be disregarded.

If you lose your insurance, there are many options including public health assistance, paying out-of-pocket and so on. Absolutely worst case scenario is that you'll have to taper off of them (you can't just cold-turkey drop most anti-depressants) but, hopefully, regular therapy will have given you some insights and strategies as how to handle yourself while trying to secure insurance again. Addiction isn't really something to worry about with anti-depressants, but you do develop a physical dependency which is why you always taper off medication, as opposed to dropping it. In the United States, mental and physical health is, unfortunately, a privilege.

Crazymeds is a great place to learn about psychiatric medication. When you get a prescription from a psychiatrist, read up on it there before filling and taking it. Also, ask the psychiatrist a million questions. Every little worry you have, you can ask them because that's the service they're providing.
posted by griphus at 8:37 AM on February 29, 2012 [5 favorites]

Tell your doc all your concerns. If you really aren't ready to try meds, say so. She can't make you. Express your willingness to try talk therapy / journaling / regular exercise / etc.

Get a second opinion if you are still uncomfortable after tomorrow's appointment - she may not be the best therapist for you.
posted by bunderful at 8:38 AM on February 29, 2012 [1 favorite]

These are also all questions you should ask the therapist. If you get the brush-off or feel like she isn't taking your concerns seriously, find a new therapist. If your therapist is not the person who will be prescribing the meds, then ask to talk with the person who will before you start them.
posted by rtha at 8:38 AM on February 29, 2012 [1 favorite]

She decided you need antidepressants, because for most practitioners, these are the first line of treatment for depression. That's not necessarily a bad thing, and it's not necessarily jumping the gun, but you are very, very much allowed to say, "No, let's try therapy first."

As for people's responses to antidepressants...they vary. A lot. To the point where other people's advice is not really useful. What makes me feel like a drone, might fill you with energy. What makes you gain 20 pounds might make me lose my appetite. There are no hard and fast guides here. Lots of people do, in fact, feel a little sluggish, and lots do gain some weight. But then, lots of people have had their lives saved by them, so, you know, maybe a few extra pounds plus the energy and will to live, are a good trade!

You will not be addicted to antidepressants. There are some tranquilizers used for anxiety that can be abused and can possibly lead to addiction, but these are not the same as antidepressants. There are some antidepressants (SSRIs) that can cause withdrawal effects if you do not taper off them rather than quitting cold turkey, but those aren't addictive, they just need some planning if you're going off them. If you lose your insurance, you may be recommended other varieties of pills, some generic, some with coupons to drastically lower the payment.

I hope this isn't too vague, but the main thing to keep in mind is: Discuss, discuss, discuss. If she recommends a pill, get her to tell you her clinical experience with it. How long has she prescribed it? What are the common side effects? What are the uncommon side effects that cause people to drop it? What leads her to believe this particular pill is the right fit for your condition? What should you know ahead of time to help you be less nervous about taking it? You could even get the script for the med, and then spend a little time researching before you get it filled.

And, when I say 'researching,' I very specifically don't mean: "Obsessively read all the horror stories on the internet." For any given pill, you're going to find people who hated their experience on it, hold a grudge, or whatever, and they will write at length about their awful time on it. Don't get scared off by stuff like that--people are more prone to rant at length about problems, than they are to celebrate the successes.
posted by mittens at 8:39 AM on February 29, 2012 [5 favorites]

If you present with obvious, potentially debilitating, depression, a therapist will usually try to get you on meds in order to, at the very least, get you to a position where you can work on the therapy. Someone succumbing to deep depression simply has too many blocks in-place to make therapy work as well as it might.

Are they going to make me a drone?
Some might. Most of the modern anti-depressants don't. It's usually a "try one and see" effort.

Will I be addicted?
Not to the med, no. You might find that you prefer your new state of mind, though. YMMV as to whether you feel that's "addiction".

Will I have to take them for the rest of my life?
Maybe. If you've been more-or-less depressed most of your life, you might have to. On the other hand, if there was a precipitating event that brought on this sudden attack, maybe not.

What if I lose my insurance, will I go crazy without them?
Hopefully, you find one of the cheaper generics work for you. This will make it easier for you to keep up on your meds.

Do you have any specific recommendations?
If your therapist recommends Wellbutrin, have him argue with your insurance to get the brand version. My experience with the generic versions of Wellbutrin is that most of them are crap.
posted by Thorzdad at 8:40 AM on February 29, 2012

A lot of folks are helped by meds, a lot of folks are not. It's completely reasonable to want to try therapy prior to considering meds. The studies which suggest that meds, or meds plus therapy, are the best treatment are equivocal at best.

The most important thing about getting better from depression is having a good relationship with your treatment provider, this is true whether they are prescribing you medications or providing you with therapy.

Here is a previous comment I've written about getting the most out of therapy.

Therapists who are informed about current neuropsychological research know that, for Major Depressive Disorder, the treatment plan that shows the highest rate of success for people is therapy plus medication.

I'm informed about the current neuropsychological research, and I think the evidence is much more equivocal.
posted by OmieWise at 8:40 AM on February 29, 2012 [4 favorites]

My experience has been that it's really hard to tell if they're doing anything at all. No, they are not addictive; it is much better to taper off gradually than stop suddenly, to avoid headaches and nausea. You can choose to stop whenever you want to, as long as you taper off gradually. Regarding the issue of feeling disturbed by the thought of a drug that affects your brain: I regularly pay good money for alcohol to intentionally try to affect my brain, so I think the idea is not that disturbing; alcohol's effects are far more crude and noticeable, though.
posted by Paquda at 8:41 AM on February 29, 2012 [1 favorite]

Get a second opinion if you are still uncomfortable after tomorrow's appointment - she may not be the best therapist for you

Just to be clear - I'm not sure from your post whether you are just uncomfortable with meds or uncomfortable with her. If you're just worried about meds you can sort that out in conversation with her, but if you feel truly uncomfortable with your therapist and she doesn't listen to your concerns it's time to shop for someone else.
posted by bunderful at 8:41 AM on February 29, 2012

IANAD, but I am a nurse. I worked for many years in a psychiatric hospital. I have also suffered from depression and anxiety myself in the past, so I have some personal experience to draw from here (with Lexapro, FWIW). The standard of care for a person with major depression *usually* includes the use of antidepressant medication. There are different classes of antidepressants. Your health care provider should work with you to figure out which one will work best, but it's important to remember that sometimes there's a bit of trial and error involved. I know that can seem daunting when you're depressed, but I will tell you that if you hold on through the initial 3-4 weeks (average time it takes to judge whether or not a medication will be effective for you) it is possible that your quality of life will improve dramatically.

Antidepressant meds shouldn't make you a drone, and you certainly won't be addicted. Follow your provider's advice when it comes to dosage, what time of day to take the medication, common side effects, etc. Weight gain is not as big a problem with the most commonly prescribed antidepressants as it is with other classes of psychiatric drugs (antipsychotics, most notably).

What I really want to tell you is that this: an antidepressant's effect (optimally, when you're on the right medication for *you*) is dramatic but subtle: one day you will likely wake up and notice that things that seemed overwhelming or disinteresting seem doable and engaging. Some people do need to take medication long-term, while others eventually find they are able to successfully ween off. Talk therapy will help you, but if you've been depressed "for most of your life" the odds are excellent that medication can benefit you. Use all the tools at your disposal. It's understandable that you feel anxious about taking medication. Avoid online forums that are not scientific or evidence-based, but do spend some time educating yourself on this topic once you and your provider reach an agreement about which medication to try. Feel free to MeMail me if you like. I wish you the best.
posted by little mouth at 8:43 AM on February 29, 2012 [3 favorites]

Antidepressants such as SSRIs (selective serotonin reuptake inhibitors) are designed to affect the neurotransmitters (serotonin, dopamine, etc) in the brain that are responsible for mood. Different types of antidepressant medications affect these neurotransmitters differently, but the most common type which your therapist might well start you on is an SSRI type. Generally, antidepressants work by increasing the amount of neurotransmitters in the brain, usually by preventing them from being broken down or recycled in the brain. Many people find that taking medication has a fairly rapid effect on mood, and this, coupled with therapy to address underlying issues, is usually how depression is treated.

I've had two periods in my life where I've needed an SSRI medication for depression and for me it was a positive experience and gave me some clarity of thought so I could deal with other issues that were contributing to my depression. It can be a vicious cycle, depression; you feel like shit, you have no energy or interest in life, you're unhappy, you have no friends, work sucks, you're depressed, you feel like shit, etc. I found that the medication made me feel physically better very rapidly, and the knock-on effect of that was that I could make other changes I needed to make in my life that in turn increased my self-esteem and my outlook on the world - taking better care of myself physically, dealing with past issues in my early life, and ultimately making some sensible decisions about my life. I took antidepressants for 18 months the first time and about 9 months the second time (not including a 2-month tapering off). I would not hesitate to take them again, if I needed to.

There's no shame in taking antidepressants - you wouldn't think twice about taking medication every day if you were an insulin-dependant diabetic in order to regulate your insulin levels. This is no different, because antidepressants are designed to regulate a chemical imbalance in the brain.
posted by essexjan at 8:43 AM on February 29, 2012

Response by poster: Thank you for such complete responses - about the therapist, I really like her. She is kind, thoughtful and seems to be very empathetic. She seemed really concerned for me and I think that's what made her suggest meds so strongly. I think I needed someone to talk to and may have scared her with everything that was going trough my mind, so that's why she jumped to say YOU NEED MEDS!

I do like her. I'm just scared of the meds, but thanks to you, not so much anymore.
posted by Tarumba at 8:47 AM on February 29, 2012 [3 favorites]

I completely understand your hesitancy with regard to anti-depressants, as I've gone through similar things in the past. The short of it is that I would guess the reason she is suggesting meds so much is because for some people it really is a chemical issue that can not be completely taken care of by therapy. My best friend since high school has major depression and has tried coming off of them in the past thinking that she can regulate things herself, but when things get back she'll always come back to them because sometimes there is really nothing that you can control.

That said no they aren't addictive (if you are just taking anti-depressants of course), you will have some rebound symptoms if you try to quit them suddenly, but if you do not want to take them anymore you would strictly need to tapper off slowly and voila.

It shouldn't make you a drone. As long as you aren't taking a mood stabilizer or anything that is a sedative, you probably won't even notice that much of a difference, except that you feel better. Or at least when I start on Effexor XR that was the case.

I also did not gain any weight or anything like that.

I have had success with Effexor XR, and if you have any issues at all with anxiety as well it is something I would recommend. There are several different types of anti-depressants that are used typically, mostly the SSRIs (Selective Seratonin Reuptake Inhibitor) and the SNRIs (Seratonin Norephinephrine Reuptake Inhibitor). The SNRIs are the ones that can also help out with mild anxiety, but can be used strictly for depression as well, and my friend that I mentioned earlier has had a lot of success using Cymbalta which also falls into that category.

Overall I would say if your therapist is recommending it I would trust them for the most part. Unless they are a psychiatrist, they can't write prescriptions, and it wouldn't benefit them to try to force medication on you. Sometimes with chemical things like that you just have to take an approach from both directions to handle it. Best of luck :)
posted by Quincy at 8:48 AM on February 29, 2012

As you can see from what you're being told here, psychiatric medication is an inexact science. Some people have tried a bunch of medications and nothing work, some people got a good one right off the bat, most people probably had to switch between a few and then found the sweet spot. That's how it works; the same exact pill can have drastically different effects on different people. So if you start taking something and absolutely nothing is different after a few weeks, or if you feel worse, or if the side effects are too much, it is perfectly acceptable to ask to try something else.
posted by griphus at 8:48 AM on February 29, 2012 [1 favorite]

For the moment, consider the antidepressants as a temporary solution. No, they do not fix everything. But they will help you get to a point where you can clean up your life a bit. They'll help you recover the initiative you probably find yourself lacking right now.

As for your other questions... one of the biggest issues with antidepressants is that there are a lot out there and they all act differently. It is difficult to know what will work for different people. (You can't exactly take a measurement of a neurochemical imbalance, can you?)

You won't be a drone. You may find yourself a little bit blunted - highs not so highs, lows not so low - and if this is the case, you can talk to your doctor about trying a different medication. But you aren't going to lose emotions all together.

You might gain weight. You might lose weight. But that's a risk that lots of medications carry and should NOT be a short-term factor in whether you take them or not.

You won't be addicted, at least not in the way you are thinking. It is true that for most if you suddenly stop taking them you will have withdrawal symptoms. However, if you miss a dose, you aren't going to have cravings or shakes. You will not be tempted to sell yourself out for another pill. They are addictive like caffeine - yes, you get accustomed to them and function differently, but if coffee was unavailable you'd be cranky and sleepy and irritable for a couple days, then you'd adjust.

If you lose your insurance it will suck, but you won't "go crazy" without them. You may have another depressive episode, but there's no reason it would be worse than you're feeling now (assuming you taper off them correctly).
posted by maryr at 8:48 AM on February 29, 2012 [1 favorite]

I have major depression and I can't go without meds. I've tried it and the results were disastrous. I've tried the alternatives -- St. John's wort, vitamins, et c. This is anecdotal, of course, but I have never seen anyone seriously struggling with depression who was truly helped by anything except medication (and, of course, therapy!). Not that the alternatives do nothing, but they don't do enough. If you've got major depression, you probably really do need meds.

There is no med that works for everyone right out of the box. It can take a long time to find a medication that works, and in the meantime you have to deal with side effects, which tend to be the most pronounced when you start a medication. It's not that much fun being a guinea pig but when something helps, it helps. I can't even tell you how good that feels.

The downside is that most antidepressants are associated with weight gain in the long term. There is a medication for migraines called Topamax that seems to help people lose weight, but I don't know the details. (I'm not a doctor.)

All this being said, you sound a bit taken aback by your diagnosis. Not all counselors are good and this therapist may be wrong about you. Ultimately you are the only expert on you. Therapists who apply a lot of pressure do not tend to be the most useful. I had one who really pressured me to get electroshock therapy (now usually called ECT) and it was rather scary.
posted by gentian at 8:48 AM on February 29, 2012

OH! Finally, talk to your psychiatrist or GP about a vitamin regimen. You'd be surprised how many people have an easily-correctable vitamin deficiency that is making already bad depression that much worse.
posted by griphus at 8:51 AM on February 29, 2012 [3 favorites]

ackptui: "My experience is that antidepressant meds do not make you feel better, they make you feel different."

In my experience, they made me feel better. You know that nice feeling when the sun shines warmly on your face on a spring morning, when you're free do do whatever you want all day? I didn't know that feeling until I took Remeron.

I had gone to my doctor about depression and he said, "why don't you try this and see what happens?" There wasn't any pressure. It wasn't like I was going to suddenly turn into a different person and forget who I was. I just gave it a shot, and it worked.

The meds I took were not addictive, but for the first while, I had to sleep right after I took them. Other than that (and the cost) there were no side effects. It was all upside. When I stopped using them, many of the good effects lasted. I felt like I had been rewired (somewhat) to be more positive and self-motivated.

I probably would not have done it if I'd felt pressured.
posted by klanawa at 8:52 AM on February 29, 2012 [2 favorites]

I spent a year and a half refusing to take medication for depression and anxiety, because I was afraid of it, and couldn't see how it would help. Finally, I gave in. Now I'm full of regret that I didn't start sooner, because my life totally changed in just a few weeks. I feel like a real person again. For the first time in a long time.

I don't feel like a drone. I haven't gained any weight. I just suddenly was able to handle all the bullshit I couldn't handle before. Everyone is different, but my only real side effects so far have been sleepiness combined with insomnia -- a little weird, but manageable. Also a little spaceiness. Nothing dramatic.

If you don't like your doctor, feel free to find another one. But medication can save your life, so don't write it off just because you feel like the recommendation was hasty.
posted by Coatlicue at 8:56 AM on February 29, 2012 [1 favorite]

I'm not a doctor and I've never taken anti depressants. However I've seen psychologists in the past and my sister is a psychologist. Both my sister and my mom have been on anti depressants. For me, I'm not sure I'd ever wanna go on them. Perhaps as others have said, your problem may be simple for a doctor to see right away which is why she prescribed meds so quickly. While she may very well be right, if it was me...I would get a second opinion. I don't care what anyone says, medicine is not to be taken lightly and there's always a chance of side effects. I can't see why starting with therapy vs drugs wouldn't be safer or at least a more conservative approach. But I'm pretty anti drugs so you getting a skewed opinion. But I don't see how it could hurt to see another doctor before you decide to take meds. I'd even see a psychologist instead of a psychiatrist. At the end of the day, meds may be a great solution for you. They may change your life for the better. But before jumping into it, make an informed decision...get some other opinions and then decide based on everything you learn.
posted by ljs30 at 8:57 AM on February 29, 2012

I want to add one thing: it's really stupid that part of our "American Dream" is that you're so responsible for your own destiny that it is completely your fault if you're depressed. It's not though you have to want to get better. I know emotions feel personal and like we have all the control in the world over them, but that just is not true at all.

They're even finding that imbalanced bacteria in the gut causes depression so there's a whole hell of a lot going on in our bodies and it all impacts who we are.

Best of luck.
posted by OnTheLastCastle at 8:57 AM on February 29, 2012

What you want to do here is go to a psychiatrist (maybe one your therapist recommends, maybe one a friend/family member recommends) and tell him/her "Hi, my therapist thinks that I should be on antidepressants for x/y/z reasons. I'm a little worried about the whole thing for reasons a/b/c and I'd like to get some advice on the matter. What can you tell me?" Then, you thank the psychiatrist, tell them that you want to mull it over, and go home and think about it. Make sure that you feel you were treated with respect and that your questions were addressed in a topical manner, and make your decision. If you decide you do want meds or if you decide that you have more questions, make another appointment with the psychiatrist (unless they were rude the first time, in which case make an appointment with a different psychiatrist) and get your prescription/answers.

It's a process, and it's arduous, but it's worth it. Antidepressants do help some people some of the time. They helped me, and they help my mother, and they help a good friend of mine. I know they don't help everyone, and you are right to be cautious, but if you are really struggling or if you just want to see if you can get some improvement in your condition, it is certainly an avenue worth pursuing. But it's worth getting advice from somebody new, somebody who is specifically trained to know the answers to the kinds of questions that it sounds like you have. At the end of the process you will know you have made the right decision. Perhaps you decide antidepressants aren't for you, that the risks aren't worth it for the benefit you might get. Perhaps you decide to try one, or you try a few, and none of them do what you want in a satisfactory way. Perhaps you try one and get immediate benefits that change your whole life, or more likely a moderate benefit that is worth the downsides that come along with it. The decision is completely in your hands, but you deserve to go to somebody who can give you the most definitive answers possible to your totally legitimate concerns about this confusing and difficult topic, so that you can make your decision with as much confidence as possible and feel that you're taking the right path for you.
posted by Scientist at 8:59 AM on February 29, 2012

Congrats on seeking help and talking about your fears with us. It can be really hard to talk about depression, sadness and the fears that stop us from getting the right help and that's a horrible cycle to get stuck in.

I want to echo the professionals & others pointing out that drugs+talk are the best solution. Also, you're unlikely to have "scared" or "overwhelmed" your therapist with your story.

My personal experience with antidepressants (I've taken 3 different ones over the years) is that it's definitely possible to stop taking them without "going crazy". Forgetting to take a dose can be really uncomfortable, but that's a slightly different issue and not to be recommended. Also, the first drug you try might not work... and you can definitely try a different one if necessary.

I'd suggest that you may be less likely to lose your job if you can get your depression under control through drugs & talk therapy cuz it's possible that you won't think your job & life suck so badly.

Also, especially if you live in the northern hemisphere, consider increasing your vitamin D intake - this can help protect against cancer and improve mood.
posted by Heart_on_Sleeve at 9:04 AM on February 29, 2012

how did she decide I need antidepressants so quickly? shouldn't we try just therapy first?

If you're in dire straits, therapy is not likely to be effective. Therapy + meds is most effective. Meds fix broken brain chemistry. Therapy cannot fix broken brain chemistry.
posted by DarlingBri at 9:06 AM on February 29, 2012 [1 favorite]

Like Quincy and others, I have had magnificent success with Effexor. No "drone" stuff, no side effects, no weight gain, no nuthin' but my brain stopping trying to kill me.

The thing about psychopharmaceutical medication is that it's fairly empirical. You try it for a while, you see if it works or not, and that's how you know whether it works for you or not. It isn't something like insulin where your doctor can calibrate a dose based on bloodwork.

So this is frustrating, I get it. You have to be your own biochemistry experiment. But if it works, it can help tremendously.
posted by Sidhedevil at 9:11 AM on February 29, 2012 [1 favorite]

Anecdotal evidence: I saw a therapist for about a year at one point, and during my intake session, she asked if I'd be willing to take medication to help the process. I asked how it would help the therapy, and she indicated that it would be a light medication (to "take the edge off", I believe she put it) so I could concentrate more on the sessions and recovering, and less on the depression/anxiety I was feeling.

Initially, I was a bit opposed--what if I changed? What if I became something terrible, or worse--something I liked better? After expressing these concerns, but still being willing to take the meds, I was put on a mild dose of Celexa, experienced a few days of migraines, and then felt... better. Not perfect, but better. I actually felt that I could maybe, just maybe, start making a bit of progress toward fixing the things that made me sad/anxious.

And I did. It wasn't terrible. I had a more mild-to-moderate case, but I was ultimately glad I took a bit of medication to help me out.

It's not for everyone, but the counseling centers should work with you and monitor your medication to ensure that you aren't experiencing bad side effects, and adjust accordingly.

Good luck, I'll send many happy thoughts your way.
posted by Verdandi at 9:12 AM on February 29, 2012

If it helps at all, I started therapy almost five(!) years ago and my therapist recommended antidepressants/anxiety medication at our first or second appointment. at the time, I angrily told her that that was not for me and I would not consider it.

Six months ago, she tried recommending them again and this time I accepted. I really, really wish I had done it sooner. The therapy has helped tremendously but as DarlingBri said, medication actually takes a physical approach to the problem and fixes your funky brain chemistry. I feel like the therapy has given me good tools to deal with the anxiety and the fog of depression, while the medication lightens both and makes it easier to use the tools the therapist has given me.
posted by anotheraccount at 9:13 AM on February 29, 2012

IANAD or therapist. I have been on antidepressants for many years though, and they, in combination with therapy, have changed my life for the better. I was also hesitant to start them, and a therapist explained it to me like this - think of the medication like a diagnostic tool. If part of your depression is due to brain chemistry, and you take the medication, you'll feel somewhat better. The, you know that brain chemistry is a factor. If you don't feel better at all (after trying a couple, and giving them a chance to work), it might mean that brain chemistry isn't part of your depression. Hey, you've learned something useful!

For me, therapy gives me the ability to change my thinking patterns, but meds give me the capacity to feel better. I don't know if writing it out like that makes sense to you, but with therapy and without meds, I can change my thought patterns from destructive to healthy, but I still feel depressed, miserable, like crap. With meds and without therapy, I feel kind of okayish, but I still have destructive thought patterns. With both therapy and meds, I have healthy thought patterns, I feel better, so I can work on my healthy thought patterns, so I feel better, so I have better thought patterns, so it's a whole healthy cycle.

As for side effects like gaining weight: I have been on two anti-depressants, both SSRIs, Zoloft and Celexa. I haven't gained any weight on them. I have minor sexual side effects on a high dose of Celexa (it's harder to reach orgasm on my own, but not harder with a partner). It's not a big deal to me.

No, you probably won't need to take them forever, but you probably will for a while. Yes, you will have side effects if you stop taking them abruptly; you would need to taper off them if you decided to stop taking them. But - as mentioned upthread, several of them are $4 a month generics, so you could afford them without insurance.

Also: Just a SSRI alone wasn't enough for me. Celexa alone helps me, but what really, really helps is Celexa plus a very small dose of Abilify. A good psychiatrist will help you find the medication or combination of medications that works for you - many people with major depression need to try multiple meds or combinations of meds to find something that works for them.
posted by insectosaurus at 9:20 AM on February 29, 2012 [1 favorite]

i am someone who has been and who for some reason continues to be very resistant to antidepressants. i feel like i should be able to just fix the depression and anxiety without chemical help.

but i do not feel like i should just be able to fix my allergies or asthma or thyroid issues without chemical help.

which is dumb.

you sometimes just need the chemical help. sometimes forever, sometimes just until you are able to work through/past your issues.
posted by misanthropicsarah at 9:49 AM on February 29, 2012

Count me in as another enthusiastic supporter of antidepressants. They don't always work for everyone, and they do sometimes come with bizarre side effects, but when they work they are so worth it. It's just so nice to feel normal.

Here's the thing about antidepressants: they're just one tool in the arsenal. Other tools: therapy, exercise, eating well, getting enough sleep, sunlight, vitamins, rewarding hobbies, strong friendships, getting outside the house, a good work environment, a good home environment, pets, and so on. That's a lot of different things to futz with, and a lot of them take sustained effort; they're hard enough for anyone to do, and when you're sapped by depression, they're several orders of magnitude harder. Antidepressants can give you the boost to get the most out of therapy and tackle all the rest. For many people, they're the stable foothold to start climbing out of the pit.
posted by Metroid Baby at 9:50 AM on February 29, 2012 [1 favorite]

I gained 40 lbs in two months on (I think) celexa. I went off the meds immediately and finally kicked my lifelong depression a number of years ago by COMPLETELY changing my life and slowly getting rid of every relationship that caused me harm or disadvantage.

I was 120lbs. My metabolism seems almost permanently fucked. I'm still struggling 6 years later to lose the weight.

That was my experience.
posted by jbenben at 9:54 AM on February 29, 2012

If you're in dire straits, therapy is not likely to be effective. Therapy + meds is most effective. Meds fix broken brain chemistry. Therapy cannot fix broken brain chemistry.

I'm not at all opposed to meds, but I'm completely opposed to uninformed, incorrect, scare-mongering comments like this that paint meds as the only option. And I think disputing it matters since the question here is (at least in part) what are my options for treating major depressive disorder.

Therapy cannot fix broken brain chemistry.

Yes it can. Experiences change the brain, for good and ill. Meditation changes brain chemistry, trauma changes brain chemistry, therapy changes brain chemistry. Lewis Baxter, among others, has proved that brain chemistry changes based on therapy are very similar to those produced by SSRIs.

Meds fix broken brain chemistry.

To tell you the truth, I'm not exactly sure what this means. However, it seems to be predicated on the idea that "broken brain chemistry" causes depression. Usually this is used to refer to the Serotonin Hypothesis, which posits that problems in serotonin (a neurotransmitter) regulation lead to depression. There's a fair amount to recommend this idea, especially since taking medications that raise serotonin levels sometimes help to alleviate depression. The problem is that the hypothesis is contested, and of obvious interest to those who sell medications that raise serotonin levels (and therefore promote the hypothesis as the explanation for depression. This is a review, at the PLOS, about the hypothesis. Suffice it say, the hypothesis is not as well supported as it is promoted. Sure, SSRIs change brain chemistry, and makes some people feel better. So does cocaine. That fact alone says nothing useful about either the causes of depression or the best way to treat it.

Therapy + meds is most effective.

I said above that the studies on this are equivocal, and they are. There is a lot of evidence that the placebo effect is responsible for a large amount of the efficacy of SSRIs. There are many studies suggesting that once we account for the role of data shaping by pharmaceutical companies, SSRIs don't work significantly better than placebo. That does not mean they don't work, just that they are not a panacea. The "therapy + meds" approach is fine, for people who want to employ it, but the data has been challenged repeatedly, and if you look through the literature you'll see a rise in calls for "therapy + meds" at the same time that the efficacy of SSRIs really start to be challenged.

If you're in dire straits, therapy is not likely to be effective.

I don't know what the evidence is for this. What does seem to be true is that people with mild and moderate depression are helped less by medications than those with more severe depression. We don't know what the case is here. (Major Depressive Disorder does not mean the same thing as severe depression.) Therapy works well and quickly for most people. The brain change studies by Baxter I mentioned above saw those brain changes over just 10 session.

Let me reiterate: meds work well for some people. However, they are not the only choice, not necessarily the best choice, and can have adverse side effects that some folks find intolerable. To the extent that they work, they are fabulous. To the extent that people are bullied into taking them based on a bunch of talking points promoted by pharmaceutical companies and their paid researchers, that sucks.
posted by OmieWise at 10:07 AM on February 29, 2012 [8 favorites]

Some people use coffee to get up, face the day, get perspective, and focus; others use antidepressants. I hope I am not trivializing things when I say that my experience is that either or both can be very helpful (although of course these are very different chemical processes), and in my case both had the same side effects: occasional mild headache, occasional mild insomnia. I echo the sentiments above that that they helped me see that the obstacles I faced weren't overwhelming. Obviously when it comes to brain chemistry YMMV.
posted by Mr. Justice at 10:14 AM on February 29, 2012

There's no harm in doing your therapy without meds for a while. I did that for some months. My depression and anxiety were severe enough that I didn't get much out of therapy until after I was taking the right meds. By "right." I mean that the side effects were tolerable and the drug allowed me to enjoy some things.

Can you go in and say what you said here? "You're strongly encouraging me to take medication. I feel uneasy about that and I'd like to try therapy without drugs for a while. Are you willing to do that?"

See how you feel about her answer. If she's convinced that you can't make progress without pills, can you see someone else? I met with a few therapists before I settled on one of them. By the way, each of them gave the option of not taking drugs, even though I was very severely depressed.

One way you "get better" in therapy is that you develop the ability to deal with your anxiety as it affects your relationship with the therapist. Can you tolerate the anxiety that comes with saying you feel pressured and anxious about her recommendation? If so, say it out loud next time.

Ask yourself if it feels like she has respect for your fear and reluctance. If not, call someone else. You can even mention on the phone that the idea of medication makes you feel scared, and see what they say.
posted by wryly at 10:31 AM on February 29, 2012

What my psychiatrist said yesterday:

People who take anti-depressants rarely say they aren't depressed anymore. It can just help with the burden. We will go down a check list and they will be sleeping better, dealing with problems more efficiently, crying less, but when I ask if they are depressed they often tell me that they are still depressed.

Anti-depressants won't make you super happy. But they can help lift the burden and some of the negative affects of depression. It's up to you to find personal happiness and contentment.
posted by jjmoney at 10:53 AM on February 29, 2012 [1 favorite]

You don't have to take medication if you aren't ready for it or you feel you don't need it. In fact, they frankly might not be of much help to you if you're really resistant to taking them. Get a second opinion. Talk to an MD. Don't feel pressured to take any steps that you don't want to. You are the driver of your therepeutic vehicle, no matter what road it may take. The only thing I regret about my decision to take medication for my depression and anxiety i that I let my doctors talk me into things, which in my case led to a misdiagnosis and years of, frankly, crap.

My experience with anti-depressants is that they weren't helpful for me. I was not physically or psychologically dependent on them, I was using them in combination with therapy, some of them made me gain weight, some of them made me feel spaced-out. My brother, mtoher, and I have all taken the same medications with very different results between us. It's different for everybody, really.
posted by sm1tten at 10:54 AM on February 29, 2012 [1 favorite]

Another argument for jumping on meds as soon as possible is that it can take a long long time to strike the right balance. Some people get better in three weeks. For me it's been fifteen (long) years and I am still making adjustments. It's like a bartender trying to make the new hip drink. Maybe if I would have started earlier I'd be further along by now. It's the beginning of a long journey and you don't have to take anything for the rest of your life unless you and your doctor decide that it's a good idea to do so.

But, be very insistent on learning about side effects and withdrawal symptoms. This is where web research comes in handy in addition to medical advice. Since you are particularly concerned about these aspects of medication therapy you may want to visit a psychopharmacologist instead of relying on your talk therapist to prescribe medication. Although they should be coordinating with one another it's rare for one person to be super-fantastic at both the talk-therapy and the medication components of treatment.

Feel free to memail me if you want to chat.
posted by Saucy Intruder at 11:07 AM on February 29, 2012

therapy + meds.

when i was first diagnosed with major depression, my therapist immediately put me on celexa. it didn't make me happy. what it did was make me even, for lack of a better word. and able to get out of bed, not be crying non-stop for no apparent reason, and just able to get on with the business of life. i was on them for about two years until my therapist and i determined that i had come out of the deep episode. five years later, i went into another deep episode that rendered me so incapable of anything that i didn't even recognize that i needed the meds. there are days, weeks, months that are lost to me now bc of my depression before i got back on the meds (which i took for about three years) and was able to function close to normally again. and the therapy has ultimately helped me long term.
posted by violetk at 11:30 AM on February 29, 2012

Ten days after I started taking antidepressants, the black horrible stone in my chest lifted up and I was happy. Not ecstatic, not gleeful, not manic, not momentarily secure, just. . . happy. By myself.

I'd been in therapy for four years, which had stopped the nightmares and the deeply destructive relationship patterns and the self-injury and the insomnia and the panic attacks, but I was still spending about 2-3 hours a day just trying not to burst into tears. After Prozac? I didn't have to struggle not to cry, at all. Ironically, I found it much easier to be sad about things that were truly sad, like a relative's cancer diagnosis or 9/11. But I wasn't stumbling around trying to escape misery all the time.

The meds did not make me a drone. Once I didn't have to spend all that energy trying to shut out the lying voice in my ear, I was able to start making art again, make new friends, get back into making music professionally, and take my relationship to the next level. I got married, we had kids. I did gain weight, but my thyroid was also gently fucking itself over the same period, so I don't know that they're related.

In my second pregnancy, I found that my meds were making me throw up, so I stopped taking them. I've been off them for just about two years now, and I find that while I am definitely more labile than I was when I was on them, I am now not depressed. I got so familiar with what it was like to be happy that now I recognize when I'm drifting off that path, and I have so many good tools to address the situation that I can bring myself back on course relatively quickly. I was on meds, all told, for about nine or ten years, and it was one of the best decisions I ever made.
posted by KathrynT at 11:42 AM on February 29, 2012 [2 favorites]

Hang in there. Also http://www.crazyboards.org is another great resource with people who can relate and there's a sense of camaraderie and humor.
posted by mmf at 12:15 PM on February 29, 2012

Wowzers. There are a lot of responses to your question with a variety of answers.

However, I think the most important answer is for you to use your voice & talk openly with your therapist. None of us here can really tell you what is right for you.

Ask your therapist about why specifically she feels antidepressants would help you. Discuss your concerns about taking medication & whether therapy alone is a sufficient treatment for you at this time. Remember, a therapist writing a prescription does not mean you are required to fill this prescription.

If you decide to go on antidepressants, be sure to let your therapist know about side effect that concern you the most and ask her to choose one that is least likely to cause it. For example, if you are having personal relationship sexual issues, sexual dysfunction would be an unfortunate side effect. If your depression includes body/self esteem issues, weight gain may be side effect it is important to reduce the liklihood of. There is never a guarantee of these things, but each antidepressant has well known common side effects and your therapist should be aware. And be sure to taper off any antidepressant if you decide to stop taking them.

In times of depression, it can be really difficult to feel worthy of much of anything. But finding the right treatment plan is vital. Try to be your own advocate as much as you can. Best wishes to you.
posted by Kitty Cornered at 12:26 PM on February 29, 2012

I think the most important answer is for you to use your voice & talk openly with your therapist.

Yes, this. Let her know that you don't feel enthusiastic about meds right now. Tell her why. Ask her questions. This is all part of developing a relationship with her and building trust. There is no reason for you to run right out today and grab some pills. If you have been depressed for most of your life, and are not putting yourself or others in immediate danger, you can probably wait a few weeks before doing anything. You may find you aren't getting anything out of the therapy because the depression makes it feel pointless and hopeless. You may find that therapy alone is enough to make changes that improve your life. You may find that therapy takes you only so far and then the need for medication becomes obvious.

I have had both good and very, very bad experiences with anti-depressants. I had a fairly terrifying experience with meds in the 90s that placed me firmly in the anti-med camp for over a decade. More recently, I have benefited enormously--therapy and drugs literally saved my life--and strongly encourage anyone with a serious mental illness to give very careful consideration to how and whether drugs would help. I regret profoundly the 10+ years I went without treatment of any kind because I was so mistrustful of medication.
posted by looli at 9:26 AM on March 1, 2012

Therapy cannot fix broken brain chemistry.

Yes it can. Experiences change the brain, for good and ill. Meditation changes brain chemistry, trauma changes brain chemistry, therapy changes brain chemistry.

I've heard that brain chemistry changes can be detected empirically from cuddling, from reading a good book, and from laughing! Clearly, it is not "natural" to have brain chemistry be static and unchanging -- a person with unchanging brain chemistry would indeed be a "drone."

I therefore have nothing personally against changing brain chemistry (for the better) from either "natural" or "outside" methods. The important thing is to be in touch with yourself. Try eating well, exercise, sleep, etc. along with continuing the talk therapy, and note any perception of increased well-being that would indicate positive "brain chemistry change." If, after a while, there is no (or not enough) better feeling, then give a low dose of meds a try. These decisions are always yours to make.
posted by RRgal at 9:57 AM on March 2, 2012

Response by poster: Came back to report that I started taking Wellbutrin a couple of days ago. I don't know if it's the placebo effect, but I am quite pleased. I already feel a difference (nothing too extreme, just normalcy at last). The psychiatrist I was referred to was very thorough and I am still doing weekly therapy.

Thank you all. You have truly changed my life for the better.
posted by Tarumba at 6:59 PM on March 30, 2012 [6 favorites]

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