How do I follow through and take my Prozac as prescribed?
July 28, 2013 7:29 AM   Subscribe

I have untreated depression. It's starting to impact my work, family, and social life significantly. My primary care has prescribed 10mg of Prozac, but I still haven't taken it. How can I jump the gun and feel comfortable taking it, when health anxiety is also an issue?

I have tried CBT which significantly helped my health anxiety. Still, I can't get to the next step--taking the Prozac. My CBT therapist (who I am no longer seeing) recommended medication but couldn't prescribe it. I have taken Prozac in the past (about 8 years ago) with almost no side effects, and it did help my mood. I am seeing my PCP and not a psychiatrist to get the Prozac because I am on a waiting list for one, and my motivation is significantly impacted so I haven't brought myself to call around. I will have a follow up in another 5 weeks. Honestly, I meant to post this months ago but haven't felt the motivation to do it. I know I need to take the pills, but between the anxiety about what kinds of problems it could cause and my general lack of motivation, I am in the same place as I was a year ago, two years ago, three years ago. I have minimal support from friends and family. How can I get motivated to take it? What can I mentally tell myself to ease the wariness that I have with starting a medication? How can I, with a very limited support system and almost no motivation, get started on treating my depression?
posted by anonymous to Health & Fitness (19 answers total) 4 users marked this as a favorite
You could think: what I am doing now is not working, and I should therefore try a different course (taking the pills). You could reflect that this is not a permanent choice. If it does not help, or gives you problems, you can go off of the drug.
posted by thelonius at 7:43 AM on July 28, 2013 [2 favorites]

If your depression is significantly affecting your life in a negative way, then the risk of not taking the medicine outweighs your perceived risk of taking it. Prozac has been around for years and years and years and as far as I know, is generally safe and has minimal side effects. I've been on it for almost a year and I have not experienced any negative side effects, and it has helped my depression immensely.
posted by thank you silence at 7:46 AM on July 28, 2013 [1 favorite]

I spent years not on meds thinking that it was my fault and that I was lazy or unmotivated. I beat myself up constantly and it created a vicious cycle. I beat myself up; that made me more unmotivated; that made me beat myself up more; etc.

It was very helpful for me to understand that depression wasn't something I caused or could will my way out of. It was my body actually not functioning correctly, and it could be likened to someone with diabetes for example. So that's how I started treating my depression - it was me treating an illness.

More practically, I found it very helpful to incorporate taking my meds with something I already do every single day - brushing my teeth. Brush teeth, take pill. It felt less jarring when it was just part of the routine.
posted by frizz at 8:03 AM on July 28, 2013

The 1st is sometimes the hardest. Ask a family member to be with you as you take the 1st capsule. You're doing this for yourself, in the same way to put your own air mask on 1st - if you can't function well, you can't take care of others. Keep in mind that you're taking 1 Prozac. If it feels bad, you don't have to take it tomorrow. Give yourself a reward for taking it, even if it's something small, like a salted dark chocolate caramel. Rewards really work. Put it in your calendar, to reinforce that this is a task, and for the reward of accomplishing the task. Please come in to this thread to tell us that you took it, and we will cheer you on.
posted by theora55 at 8:04 AM on July 28, 2013 [2 favorites]

You need to just take it, worry about the consequences later. The consequences of doing nothing about your depression are worse. The pills have a known track record of helping you with minimal side effects.

I have gotten off eight prescription drugs. People routinely think I am some extremist anti-drug nutcase. But the reality is I was thrilled to finally get prescribed 8 drugs. Doctors were not taking me seriously or doing much for me before that. It was a turning point that helped save my life. Then years of withdrawal followed but I had those years because I was still alive.

It might make it easier to view it as a possible stepping stone or temporary stage, not necessarily a permanent commitment to be on meds for life. Since you don't like the idea of being on medication, start taking the prozac, get stabilized and functional, and then start doing research on how to treat the depression without the drugs. You can start by reading books on dietary alternatives like Potatoes not Prozac. I have also seen articles that link inflammation to depression and suggest olive oil and fish oil can play a role in combatting depression. Exercise is also well established as being more effective than a lot of the drugs.

You could try skipping the drugs and going straight to researching nondrug alternatives. But will you make those dietary and lifestyle changes on your own, without first taking the prozac? It takes months or years to fix your brain chemistry using diet and lifestyle changes. It also takes sustained, consistent effort. I doubt you can make the journey without first getting some quick fix meds into you, especially with little social support. My 12 year journey has been made with my oldest son playing both nurse and drill sergeant the entire time. You apparently do not have anyone like that in your life.

Take the pill. Decide what to do next after your brain chemistry is less screwed.
posted by Michele in California at 8:15 AM on July 28, 2013 [1 favorite]

I had a similar issue when I was first taking Lexapro. I was afraid of the rare horrible side effects that could happen to one in a million people, and it was paralyzing. So I ended up starting with very small bits of the tablets, and gradually increasing how much I'd take in a day. Right up until I was taking my full dose.

This is probably only possible if your Prozac is in tablet or liquid form, which it may not be. (Back when I took Prozac, it was a capsule.) This process did work for me, however. My anxiety about taking the pill dropped off significantly, once I got in the habit of regularly taking any of the pill at all. And whether it was a placebo effect or not, even the small bits of the Lexapro seemed to make me feel better, and that was motivating in itself.
posted by Coatlicue at 8:15 AM on July 28, 2013 [1 favorite]

Remind yourself that side effects are not permanent. If this pill ends up having side effects you don't like, your doctor will help you find another medication that works better and, most importantly, any side effects of Prozac that bothered you will just go away once you stop taking it.
posted by Margalo Epps at 9:01 AM on July 28, 2013 [1 favorite]

When we have been depressed for many years it becomes part of our personality, our comfort zone. It is scary to leave our comfort zone. Recognize this. Applaud yourself for your bravery in making good changes for yourself. Create a task list of at least 10 things that you have been needing to do that won't take more than 10 minutes per task. Every morning when you take your prozac, do one thing on the list. This physical act will reinforce your understanding that you are making changes in your life for the better.

Picture yourself a year from now, happy, doing something that you love. That is your goal. You will get there. You can do this. You are brave.
posted by myselfasme at 9:49 AM on July 28, 2013 [3 favorites]

I have never forgotten this comment, from Ghostride The Whip:

"Depression is a parasite, like a tapeworm that lives in your head. It doesn't want you to get treatment because it wants to keep living there."

For my money, this is the most useful way to think about the problem. Obviously your depression doesn't want you to see a psychiatrist! Of course it doesn't want you to post a question asking for help! And it sure as hell doesn't want you to take your Prozac.

Do it anyway, because fuck that.

(For extra points, draw a picture of your depression parasite and throw darts at it.)
posted by Mender at 10:03 AM on July 28, 2013 [10 favorites]

Put a pill on your desk next to a glass of water while you're on the internet, or beside you on the bedside table while you're doing your nightly reading or watching television.

Your thoughts will start wandering, you won't be able to concentrate and you'll start wishing these anxious feelings would end. You'll tell yourself, like you are now, that you really ought to start taking your pills, and will wonder for one or two seconds why on earth you haven't started yet.

Once you get to that short moment, before you start rationalizing not taking your meds, you need to act fast. Grab the pill, toss it into your mouth. Take the glass, drink, swallow. Repeat as necessary.
posted by ipsative at 10:35 AM on July 28, 2013 [1 favorite]

I have taken Prozac in the past (about 8 years ago) with almost no side effects, and it did help my mood.

Go open the pill bottle right this instant and take your pill. Not later. Put down the keyboard and do it right now.

No amount of rational argument is going to convince you to do this thing which you already know will help and already know works for you. So don't try to reason yourself into it. Just do it. Now.
posted by ook at 11:34 AM on July 28, 2013 [3 favorites]

Here's what I did.

I had a time in my life where my anxiety got really really bad and I went to seek treatment for the first time as an adult - I was prescribed medication, but like you, was way too scared to take it (I got onto the Googles and started reading about side effect like "brain zaps" and working myself into a tizzy.) So I never took it.

However, several years later, I had to fly for work. I hate flying, but I had no choice. I went and got prescribed a short term medication just for the flight. So I was kind of trapped, like, I was scared to take the medication, but I was even more scared to fly.

What I ended up doing was, in advance, taking a teensy, teensy bit of the first pill. Like it was nowhere near a half or a third of the pill, it was like a few crumbs. So I took that and I waited, and pretty much nothing happened, for hours.

Okay, so then I took a little bit more of the same pill. I slowly took more and more of it until I could feel the effects juuuuuust beginning to work. That was way less scary to me than taking a whole pill right away and just waiting to be hit with the full force of an effect you have never felt before.

With Prozac it'll be way way slower than that because I was taking something that was supposed to kick in within a few minutes, whereas Prozac kicks slowly in after weeks. You can start by crumbling up the pill like I did and taking a few crumbs the first day, and taking a few more the second day, and eventually getting up to half a pill, or a full pill eventually. Ask your doctor if they think there will be any harm in you ramping up your dose super super slowly. I doubt they will have any objection to it.
posted by cairdeas at 11:57 AM on July 28, 2013 [1 favorite]

What I ended up doing was, in advance, taking a teensy, teensy bit of the first pill. Like it was nowhere near a half or a third of the pill, it was like a few crumbs. So I took that and I waited, and pretty much nothing happened, for hours.

Okay, so then I took a little bit more of the same pill. I slowly took more and more of it until I could feel the effects juuuuuust beginning to work. That was way less scary to me than taking a whole pill right away and just waiting to be hit with the full force of an effect you have never felt before.

I pretty much do this to take medications I'm not familiar with. (I'm very afraid of side effects or allergies.) When I first started taking Celexa I was worried I shouldn't split the tablet up so I ended up finally hitting a moment where I said "screw this" and swallowed the damn thing.

I second keeping the pills (and some water) near you as much as possible. I still have hard time remembering to take my pills simply because they're in another room. Having the pill right there will help keep you from talking yourself out of taking it. And remember that you have taken this medication before and it helped.
posted by kassila at 12:08 PM on July 28, 2013

You have taken this pill before, thus the side effects are likely to be less.

Do a " thoughts record" about pill taking.

Choose a time that you can really stick to, otherwise it will suck to have the amount of drug in your blood stream fluctuating every day.

Depression lies!

You can take this step for your health!
posted by Heart_on_Sleeve at 4:10 PM on July 28, 2013

10 mg is a miniscule dose of this stuff. 20 mg is the standard dose. 10 mg is nothing. Seriously.

Fluoxetine (Prozac) is still, in my humble opinion, the most effective and best-tolerated of all the SSRIs. There is a reason why there are so many generic versions of this drug: it is pretty remarkable.

It will not break you permanently. It is not addictive. It easier to discontinue than most any other antidepressant currently available. It is very, very safe.

And it works.

It will give you a chance to right the ship while you figure out a more comprehensive plan for fixing what's broken (seconding the suggestion to take a deep, critical look at your diet and lifestyle).

But: get stable first, then figure out how to proceed.

Take the pill. You will be fine.
posted by rhombus at 5:16 PM on July 28, 2013 [2 favorites]

Coming from someone who really didn't want to get help, really didn't want to take anything, and whose wife threatening to drag him to the doctor and make him go:

Just take the damn pill. It really make things a lot better.

Something in your brain isn't right. That's not anyone's fault. It just happens. The pills fix that. Really simplified, but it's close enough.
posted by theichibun at 7:18 PM on July 28, 2013 [1 favorite]

Maybe it would help if you stopped thinking about this as being something that is, in the first instance, your judgement call to make. It's really difficult to make decisions about whether any given drug will help you in your condition, and that's one reason why health professionals exist - to make informed decisions for you. Personally, I work in healthcare, know a lot about healthcare, and always advocate being an active and engaged patient. However, I also think that a good rule of thumb is that if a doctor suggests something might help, all other things being equal, you should give it a try. If your therapist's judgement isn't enough for you, why not let your PCP give you advice on whether they think that Prozac is the right thing for you? They may or may not be great at treating depression - some primary care doctors are really good on mental health stuff - but unless they are obviously an idiot, they will probably have medical judgement that's at least a little better than yours. Make the appointment, but think of it as a 'what should I do' appointment, rather than a 'prescribe this please' appointment. And unless you come out of it thinking 'I will never let this asshole near my brain', you could probably do worse than give whatever the doctor advises a whirl. If it doesn't work, you can always go back to the doctor and discuss stopping/switching*. Venlafaxine aside, most antidepressants are pretty unproblematic to come off if you do it under a doctor's supervision.

Summary: be an engaged patient, but don't try to be your own doctor.

*Absolutely do not take antidepressants and then stop them suddenly on your own, without medical supervision. This is something that people often do, and it frequently ends badly.
posted by Acheman at 7:47 AM on July 29, 2013

If you're worried about the initial side effects, take them at night. I take mine before bed.
posted by luckynerd at 12:17 PM on July 29, 2013

I have similar concerns as you. When I finally decided to take the medicine and actually asked the doctor to prescribe it to me, I can't help searched "permanent side effect" and I was freaked out on how dangerous it is! so now I have a bottle of SSRI in front of me and I decided not to open it.

Actually more than 1o years ago when I was a teenager I had took Seroxat for a period of 1 year, but at that time I was living with my family and my mother prepared the med everyday for me. Although I had now idea about what I was doing, there was a supporting system there.

Now I live alone, I don't dare to do that, partly due to the vast amount of information available on the internet.
posted by pack2themoon at 7:30 PM on August 9, 2013

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