Whether or not to take antidepressants
June 19, 2012 12:58 PM   Subscribe

Is using antidepressants to get over depression triggered by a breakup a good idea?

THIS IS LONG, SORRY! (Not sure if these details are relevant or not, but if you jump to the last 3rd of the question you can find the actual questions I'm asking, under "so what I want to know is" )

I went through a pretty bad breakup several months ago, and it messed me up pretty good. I've had several long term relationships, but this was the most serious by far, and after the breakup I went into a pretty deep depression for the first couple of months. I'm a grad student. I needed to keep working, so I went to a therapist for the first time in my life, and this was helpful, to a point. When I started seeing my therapist, I was having a hard time getting through a day, and I couldn't really focus on or work on anything. He helped me with this, but after about 2 months of therapy, where I had been making some progress, I had 2 weekends in a row where I was essentially stuck on my couch, unable to do anything, caught up in regret about the end of my relationship. I knew this wasn't normal, so when I saw my therapist later that week I asked if it might be time to try antidepressants. He agreed to refer me to a GP for a prescription.

It took me a little over 2 weeks between that visit with the therapist and when I could get in to see my GP, and in that time, for whatever reason, I started to do a bit better. I was at least able to get my work done, and didn't have any episodes where I was so depressed I couldn't function. When I met the GP, I told her that I thought I could probably get by without a prescription for antidepressants. She told me she understood, but that if I changed my mind, to contact her and that she's write me a prescription right away. (she was going to write a prescription for celexa, which my sister is currently on and tolerating well)

It's now been about 4 or 5 weeks since I asked my therapist about antidepressants, and I haven't had any other episodes where I have been unable to function because of depression. I'm not happy though. At best, most of life is a fairly joyless exercise, I put one foot in front of the other and try to get through the day. I'd been very busy with school, which helped to take my mind of things a bit, but that's now ended for the summer, and I still miss my girlfriend a lot. We lived together, and I wake up every morning, by myself, feeling a very palpable sense of loneliness and loss.

I'm also fairly pessimistic about my chances of finding a relationship to replace this last one. I'm pretty picky, and rarely find women I'm interested in dating. I just turned 30, and feel like my chances to meet people are also dwindling. Like I said before, I had a lot invested in this relationship, and the thought of ever getting back to that point again seems kind of inconceivable, and thinking about this, which I often do, makes me sad.

I also know, that wallowing around being sad and feeling sorry for myself accomplishes nothing. Feeling sad so often is counterproductive, and it also just sucks! I am trying the other things; getting exercise, staying busy, trying to be social, etc, but it's having limited results. So, I'm considering trying out an antidepressant, in the hopes that it will help me feel a bit more positive about life, but having a hard time deciding whether or not it's actually a good idea.

So what I want to know is:

I'm essentially sad because of one thing; the end of my relationship If we were still together, I'd probably be pretty happy right now. That won't happen though, and that is making me sad, and I feel like I'll continue to be sad about this for a long time. I think I've processed a lot of the lessons that I needed to learn from this relationship, so at this point the sadness and regret don't seem to serve any purpose other than making my life fairly miserable. Is this kind of problem something people uses antidepressants to deal with? Does it work?

If I do decide to try an antidepressant, could I be setting myself up for a setback if I then decide to go off the antidepressant? I know they sometimes have side effects. I'm probably ok with doing a trial run, if I know that I can stop and not be in a deeper hole if I decide to go off the meds. I don't want to get into a situation where I'm dependent on a drug, especially if it has nasty side effects.

What else should I think about when making this decision? My therapist and gp didn't give me any strong advice on this. If I think I need it, I can get it, and if I don't then they're fine with me not using one. At this point, I don't need meds just to function, I can do that already, but I am not thriving. I'm not very happy, and I don't see this changing anytime soon.

I know you are not my doctor, therapist, etc, but if you could give me any suggestions about the pros and cons of antidepressants, or anecdotes about how they did or did not help get over the depression caused by a breakup, I'd appreciate it.
posted by tokaidanshi to Human Relations (20 answers total) 7 users marked this as a favorite
What else should I think about when making this decision? My therapist and gp didn't give me any strong advice on this.

There should be a plan in place before you take medication -- why you're taking it, how long you plan to take it, what to watch out for w/r/t side-effects and so on -- and there doesn't seem to be one. Go see an actual psychiatrist, not a GP. GPs are notoriously shitty when it comes to managing psychiatric medication, and I'm not surprised you have so many questions after your meeting.
posted by griphus at 1:20 PM on June 19, 2012 [3 favorites]

Is this kind of problem something people uses antidepressants to deal with?

no. as someone who has been diagnosed as having been clinically depressed (and been on anti-depressants for a number of years), been through two major depressive episodes, and diagnosed with dysthymia, this sounds like normal post-break-up sadness to me—not anything that needs to be addressed with anti-depressants. i broke up with someone last year (we had considered ourselves engaged, albeit informally) and it took me a good six months to get over feeling sad and thinking about him every day. i still think about him briefly, a few times a week and when i do, i still feel sadness and anger. this kind of thing requires time, not anti-depressants.
posted by violetk at 1:31 PM on June 19, 2012

You've got two things going on here. You're mourning a relationship, which is depressing. But you're experiencing a depressive episode, which may be helped by taking an antidepressant.

Just because you had something sad happen to you doesn't mean you don't have depression!

I'm on Celexa, 20mg for anxiety and I really like it. I didn't think I needed anything either, I was just having a panic attack every so often. I was also terrified of bridges, overpasses, underpasses, driving in the dark...you get the idea.

When you're depressed you don't think clearly. It's not about wallowing in misery necessarily. Depression is an emotion, but it's also a condition of your brain chemistry. Your sadness may have triggered an endorphin, seritonin shortage, whatever.

We don't have a way to calibrate this stuff in the brain yet, so we experiment with drugs. Go to your GP and seek a low dose of something (I recommend Celexa) and see if it helps. If it does, YAY! If not, then you can cross it off your list.
posted by Ruthless Bunny at 1:31 PM on June 19, 2012 [1 favorite]

Go buy this book, right now. Read the first 50 pages, and do the exercises. Most good bookstores will also have a copy; it's cheap. This book will help you identify the cognitive distortions that are impacting your mood, and behavior. The book (entitled "Feeling Good") provides a very easy way to identify and cope with these distortions. Some very simple exercises are suggested, and you should go through them; it will take only a few minutes every day. Once you get a grip on how to deal with your cognitive distortions, you will start to feel better. (btw, even non-depressed people encounter these distortions; it's just that when one is stress, distortions can appear to be "reality", but they are essentially nothing more than a *distorion* of reality, keeping you from functioning at your fullest.

You are going through a hard time, and your crisis has caused a LOT of your thoughts to become distorted. That means thoughts about your future, you ability to retain a relationship; your ability to ever feel joy again, and so on. These are all thoughts; thoughts are neuro-chemical events that result in a cascade of psycho-physiological happenings that cause you to think in distorted patterns.

This is what is so insidious about depression; your distorted thoughts are taken by you at face value. And why not? They are your thoughts, arrived at through reasoning, so why shouldn't you think that your negative feelings (that result form these thoughts( aren't true. Guess what, all your negative thoughts are a lie. There is no self-created conspiracy by your brain, it's just that your brain (like millions of others) may be more susceptible to certain stresses, than others. Your cognitive distortions (they tend to cascade in some people, who are under stress) seem true, but they are not.

All that said, I strongly urge you to get that book, or find yourself a really good cognitive therapist. Maybe both are in order. You are worth it!

One more thing: if you find that all this is just too much to handle, and that you are completely immobilized, maybe drug therapy is for you. The book I recommended has a large section on antidepressants at the end of the book; that section is somewhat dated (the rest of the book is current). Talk to a good cognitive therapist or psychiatrist about this. Many psychiatrists work in tandem with cognitive therapists.

Last, if you are ever bothered by thoughts or plans to hurt yourself over any of this (or anything else), *immediately* get yourself to an emergency room. Depression is insidious, painful, and debilitating. It's nothing to be ashamed of. Take care of yourself! You are on the road to recovery!
posted by Vibrissae at 1:36 PM on June 19, 2012

Seconding cognitive therapy.

Your concerns about set-backs, and side-effects are somewhat warranted. (I say this as someone who's been on antidepressants for many years, and who doesn't regret that decision.)

Part of what's keeping you miserable is your beliefs about your poor prospects. Does your therapist specialize in cognitive & behavioral therapy? It's way faster than e.g. psychodynamic approaches, and I reckon would suit your situation better too.
posted by feral_goldfish at 1:40 PM on June 19, 2012

Yeah, I mean, sure, drugs, but I would also first take a hard look at my diet. Make sure I'm exercising my ass off. Laying off the booze. Finding new friends, things to do. Buckling down at work. Try all that first.
posted by thinkpiece at 1:43 PM on June 19, 2012 [3 favorites]

there is a free online cognitive therapy tool moodgym, which is supposed to be really good. I agree with vibrissae that it sounds like you may be under some cognitive distortions that it could help sort out.
posted by 5_13_23_42_69_666 at 1:55 PM on June 19, 2012

One of the reasons antidepressants have meh success rates is because people use them to medicate sadness rather than depression, imo. Similarly, one of the reasons antibiotics have meh success rates is that people use them to treat viral infections rather than bacterial infections.

In other words, I'd start with a psychologist or other therapist to see whether they assess you as having reactive or endogenous mood issues. They can refer you to a psychiatrist for meds if you think that's a good idea.
posted by Sidhedevil at 2:07 PM on June 19, 2012

Whoops, I am trying to read an iPad in wrist braces, so I scrolled past where you were doing just that. Sorry for the noise; I autoflagged.
posted by Sidhedevil at 2:09 PM on June 19, 2012

Response by poster: Hi all,
Thanks for the feedback. I've actually tried moodgym, and yes, it is really good. I'm aware of the pattern of distorted thoughts, and it's something I'm working with. It's what's helped me to get from the stuck to the couch phase to the being able to go about my day phase. I'd like to get past that to doing better than just getting by, and that's where I'm getting stuck. I guess I probably just need to give it more time.
posted by tokaidanshi at 2:18 PM on June 19, 2012

One of the reasons antidepressants have meh success rates is because people use them to medicate sadness rather than depression, imo.

i agree completely. ppl conflate sadness and depression, and i think in large part, that's why it can sometimes be difficult for those suffering from clinical depression to be taken seriously by those around them. from what you've described, you had a break up, you were devastated for awhile, hid out, and awhile later, it got better enough that you were functional again, albeit still sad. as i'd said before, this is pretty standard for what happens after break-ups and i just don't see that this would warrant going on anti-depressants. meds aren't going to somehow miraculously make you feel better, e.g. "happy". they will just make you functional—which is where it sounds like you already are. what will help you is to continue to go about your life, engage in your coursework, hang out with friends, meet new people, work out, start a new hobby, etc. you don't needs meds for this; you just need time to heal a broken heart.
posted by violetk at 2:20 PM on June 19, 2012

My mother was put on antidepressants by her doctor after the death of my father. She herself says it was the worst thing she did because they simply made her numb and coming off them she still had to face the fact she hadn't grieved properly and in the end it took her almost 3 years to get to a good place again. The meds didn't make her happy, they made her numb, they actually took one of the most caring people I know and made her not care for anyone around her anymore.
What finally helped my mother was getting off of the pills, finding a therapist and dealing with her sadness and grief.

Having said that she had no other mental health problems and her doctor basically put her on them as she was diabetic and her grief was making her eat the wrong food and making her blood sugar crazy and he was trying to help that situation with pills as doctors are want to do.

Remember while the feelings after a breakup suck, seriously, seriously suck, the things that led to the break up don't go away if numb yourself and pretend it didn't happen. I know it won't make you feel better but the whole I am sad and I can't see it ending feeling is how the end of a serious relationship feels. Maybe you could just keep moving the appointment off until a later date or maybe even get the prescription so you can fill it if you really do end up depressed and need it, knowing that you have it to turn to if you need it might help you keep going on without it.
posted by wwax at 2:26 PM on June 19, 2012 [1 favorite]

Interesting question. I've always been personally scared of antidepressants both for the side effects and for horror stories about withdrawal symptoms. That said, as a therapist, I've seen how much difference they have made for my clients, and I do recommend the pills when things seem particularly bleak for them. It's one of those issues I'm constantly unsure about.

I will say this though, from what I understand, they really take the edge off and help you feel some space in which to do the emotional work that needs to be done to heal. Sounds like the edge is largely off for you already, but that doesn't mean they can't still be helpful. Most side effects do seem to be reversible, and there's just no need to unnecessarily suffer. But do go through a psychiatrist either way - someone who knows what to watch out for with going on and tapering off. These are chemicals in your brain, after all, and there are some truly unpleasant stories about going off these things.

Maybe more importantly, have you tried mindfulness meditation? Look into an MBSR or MBCT class around you, maybe. It's more work, but it can be a lifelong healing practice.
posted by namesarehard at 3:37 PM on June 19, 2012

I just noticed I answered much more definitively with a 'consider antidepressants' to a guy three days ago who said he's just divorced and unable to function. The difference, for clarification: the inability to function. You sound like you're over the worst of it, so it wouldn't have been the first thought.
posted by namesarehard at 3:42 PM on June 19, 2012

I had 40 mg of Celexa added to 300 mg Wellbutrin for anxiety. I was also very sad about my health situation on top of the anxiety it added. It took almost 6 weeks for the Celexa to properly kick in -- keep this in mind. I yawned excessively for much of that time. But I've been adjusted to it now for a couple months and it has changed my life. Things that I was anxious about for years, but became used to and thought were normal no longer make me feel anxious. I find it easier to make decisions. I am very happy to be taking it. It has helped me more than I realized I needed to be helped.

But I also see a psychiatrist trained in psychotherapy once a week. And I had to tough out nearly two months before I reaped the promised benefits. Antidepressants may be helpful for you -- it may be that underlying anxiety/depression are making it difficult for you to process this break-up and sadness right now -- but understand that if you do decide to go on one it a) may take quite some time to perceive the effects and b) may take some time to find the right drug. What works for me may not work for you. But there truly can be benefits and it is an option to explore with your doctor or psychiatrist (if you have one).
posted by Felicity Rilke at 6:24 PM on June 19, 2012 [1 favorite]

Best answer: tokaidanshi: I've actually tried moodgym, and yes, it is really good. I'm aware of the pattern of distorted thoughts, and it's something I'm working with. It's what's helped me to get from the stuck to the couch phase to the being able to go about my day phase. I'd like to get past that to doing better than just getting by, and that's where I'm getting stuck. I guess I probably just need to give it more time.

I strongly urge you to buy or borrow the book I recommended ("Feeling Good", by David Burns)! the book is based on solid research, and is NOT just author opinion. There is hardly a better thing you can do for yourself. There is a whole chapter in the book on on how to deal with "do-nothingism". It starts on page 81. You can borrow this book from and decent public library; it's about $10, in print. I strongly urge you to read the first 30-50 pages, and then read the do-nothingism chapter.

The insidious thing about depression is that distorted thinking *appears* as normal thinking to the depressed person.

Giving your current state more time may very well work. However, taking steps to counter your cognitive distortions (it's not difficult; it just takes persistence) will get to where you want to go, faster, and better inoculate you from similar, future scenarios (if they happen, which I hope they do not).

Get better! You are on your way!
posted by Vibrissae at 6:47 PM on June 19, 2012 [2 favorites]

Incidentally, if you ever do decide to take anti-depressants, be sure to accompany that with therapy. Drugs are far more efficacious when combined with therapy. There is solid research to prove that. Try the book, first.
posted by Vibrissae at 6:49 PM on June 19, 2012

Try The Depression Cure. Doing mainly the med portion now, and doing better. After a few days of walking the dog, even better. I have to do it in pieces or it won't be done. Good luck!
posted by littleredwagon at 7:31 PM on June 19, 2012

I've been on anti-depressants for most of my life, but I have (more than one) serious diagnosed mental illness, so take what I'm about to say with that in mind.

While there is a difference between normal sadness and clinical depression, it's certainly not impossible for true clinical depression to follow a loss--death, divorce, etc. I can't tell you if you're truly depressed or not--that's up to you and your providers to figure out. What I can tell you about is my personal experience with anti-depressants and how they did (or didn't) work on my depression.

When I'm on an anti-depressant that works, there are two kinds of relief they provide: One, I can actually get up the motivation to do things like clean, grocery shop, or do dishes. The "numbness" many people describe is what allows this to happen. But, in my experience, it's not numbness. It's relief. Relief from crying over Geico commercials, from wallowing in self-destructive thoughts and general self-hatred, from the pain of taking in oxygen and breathing out carbon dioxide. I don't know many people who think that people with physical pain should just suck it up and deal, and so I don't appreciate those who seem to think that emotional pain should be endured when there's a way to ameliorate it as part of a treatment plan. To that end, I don't recommend getting anti-depressants from GPs. See a psychiatric nurse practitioner or psychiatrist instead and do your program--cognitive behavioral therapy, dialectical behavioral therapy, whatever.

Two, anti-depressants moderate my emotional response to crises. If I am depressed and NOT taking an anti-depressant, I might have an emotional meltdown if my pharmacy doesn't have my prescription ready or if a guy cuts me off on the highway. With the anti-depressant I still have emotions--they're just not as likely to cause me to break down or slide even deeper down the slope of dysfunction.

But anti-depressants aren't that awesome long-term, in my experience. The side effects are significant and withdrawal can be seriously problematic. I've been trying to get off Celexa for two years, but no matter how slowly I try to do it I suffer from weird brain buzz sensations, a sense of disconnectedness from the universe, extreme nausea, dizziness, and anxiety. It's also stopped working--I've got Prozac Poop-out, so I'm basically taking it because I can't tolerate the withdrawal symptoms, particularly when I'm already depressed. But in the past, when I took them on a more temporary basis to get me past a crisis, they were extremely helpful.

I agree with everyone recommending books, CBT, etc. Learning effective coping mechanisms is something I think everyone should do, depressed or not, and a lot of these programs teach skills that seem obvious once you're exposed to them and work wonders when you practice them. Sometimes taking an anti-depressant can motivate you enough to give a shit about working a program by reminding you that it is possible to get through a day without wanting to be dead.

Good luck, and I hope you feel better soon, truly.
posted by xyzzy at 11:08 PM on June 19, 2012 [1 favorite]

This is a problem known as situational depression or adjustment disorder. As you can see from the WebMD link, it is "sometimes treated with medication" but "usually treated with psychotherapy."

Note: "adjustment disorder is short-term, rarely lasting more than 6 months."

I'm a doctor, and I can tell you that when people go to doctors for depression, they get antidepressants - doesn't matter what the details are. To a person holding a hammer, everything looks like a nail. If I were you, I'd forego the meds and try other solutions first.
posted by treehorn+bunny at 11:22 PM on June 19, 2012 [5 favorites]

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