Do you deal with major depression without drugs?
November 26, 2013 8:07 AM   Subscribe

I've been off Effexor cold turkey for about five days. I think the worst of the withdrawal is over. My doctor's office is not calling me back about refills. Should I keep trying to get some more or should I try to go it alone?

I've been diagnosed with major or clinical depression since I was about 15 or 16 (I'm 30 now). Since then, I've been on Wellbutrin, Prozac (I think), some other stuff, Celexa and most recently, Effexor. My doctor changed my prescription from 40 mg / daily of Celexa to 37.5 mg / daily of Effexor about 4 - 6 weeks ago. I immediately noticed a marked improvement of my mood and productivity, but also felt jittery and a little obsessive about small, inconsequential things.

I ran out of Effexor maybe Monday or Tuesday. (I put my all my pills and vitamins in a little weekly pill thingy.) By the time I noticed it on Friday, I simultaneously noticed that there were no prescriptions on the bottle. I have a follow-up appointment scheduled for next week (a "one month" follow up turned in to two months out given my doctor's schedule).

I had a terrible weekend of apparent withdrawals. Flu-like symptoms, chills, anxiety, careening emotions, severe dizziness, fever and nausea. (I'm 99% certain it wasn't the flu, since I got a flu shot.) I realized what was going on halfway through Saturday. A few years ago, I had a surprise withdrawal from Celexa and had similar withdrawal symptoms, except that escalated to full-blown hallucinations. It was terrifying. I think knowing that is all that helped me keep my shit together over this past weekend.

I started calling my doctor's office today. I left two voicemails for the nurse describing my symptoms and asking for the prescription to be called in. I never received a call back from the office or the pharmacy.

At this point, I think the withdrawal symptoms have passed and I feel much better. I'm pretty pissed at my doctor's office, even though it's my fault I let the prescription run out.

I don't really want to go back on Effexor, or any other antidepressant. I've spent my entire adult life on these things. They work for a while, then I can't get out of bed so the name and dosage changes for a few years. Hiccups like this cause me to lose huge blocks of time spent shivering under the covers and freaking the hell out. I've also gained a significant amount of weight over the years that I suspect is related (eight pounds since starting Effexor, dislike).

On the plus side for not leaving a third voicemail with my doctor, I'm about to start a new job and move to a new town. I say this is a plus because although the transition is stressful, I believe that my current work situation (in a town I dislike, working for family that I dislike in a profession that stresses me out and depresses me) is a major contributing factor. Nearly all the specific contributing factors will be absent from my new job. On the other hand, I'm educated enough to know that depression is a chemical medical thing that people can't just control with will power and a Pollyanna attitude.

Do you deal with major depression without taking prescriptions? If so, how so? I know you are not my doctor. But if you do it, how do you do it? What specific tools do you use to keep an even keel and, beyond that, to thrive? Is it possible?

If nothing else, what can I do to deal as well as possible until my refills get called back in?
posted by anonymous to Health & Fitness (22 answers total) 8 users marked this as a favorite
For most drugs you can go to your issuing pharmacy and say, "I am out of [drug] and my doctor hasn't called in a refill yet" and get a 3 day supply to hold you over while they try to contact the doctor. Take your old pill bottle in as backup, but if they were the ones that filled it in the first place they should be able to do it.
posted by phunniemee at 8:11 AM on November 26, 2013 [13 favorites]

You might also have better results requesting a refill from the pharmacy and having them be the ones to contact the doctor's office.
posted by something something at 8:19 AM on November 26, 2013 [4 favorites]

I'm really sorry you're going through this. I understand your desire to not be on antidepressants. Unfortunately, I don't have much advice on how to deal without them.

My tiny suggestion is that you call the pharmacy to see if they have the prescription. My doctor's office doesn't always follow up when I call to ask for a prescription refill. I've gotten really freaked out in the past because I was out of medicine X, only to discover that it was waiting at the pharmacy the whole time.
posted by Shohn at 8:19 AM on November 26, 2013 [3 favorites]

You should stay as you are for now. Find a new doctor in new town and have a series of appointments where you talk aboutbyour history and your wishes try true to manage this another way.
posted by Lesser Shrew at 8:20 AM on November 26, 2013 [2 favorites]

Oh, and for what it's worth in an emergency situation (I was traveling, over the holidays, and put my pills in some checked luggage that got lost--STUPID IDEA, DON'T DO THIS), I was able to go to a non-issuing Walgreens over the course of several days and get three separate 3 day supplies. Pharmacists generally really want to help you. That is your best next step.
posted by phunniemee at 8:20 AM on November 26, 2013 [1 favorite]

The other option is to go to the Minute Clinic in the CVS, or any other Doc-in-the-box. Bring your bottle and explain that you need a refill. A visit is usually about $35, and they'll be more than happy to help you out!

Don't wait until the holiday weekend to take care of this. W/D from anti-depressants is a bad, bad idea.
posted by Ruthless Bunny at 8:36 AM on November 26, 2013

Do you deal with major depression without taking prescriptions? If so, how so? I know you are not my doctor. But if you do it, how do you do it? What specific tools do you use to keep an even keel and, beyond that, to thrive? Is it possible?

I wouldn't call my depression major, but I generally manage it without medication. Unfortunately, this question is just not something that can usefully be answered on an Internet forum like this. Sometimes it's possible, for some people, in some circumstances. For some people it's never going to be possible. You need to have a good relationship with a mental health professional that you trust to even begin making these kinds of decisions.
posted by Rock Steady at 8:45 AM on November 26, 2013 [1 favorite]

Get a new doctor and explain your concerns about anti-depressant side-effects and /or ineffectiveness and let them analyze the issue and try to find a new meds balance or a weening off method with other supporting features.

And just to beat the dead horse, Do You Exercise?
posted by WeekendJen at 8:45 AM on November 26, 2013

When I have called the pharmacy, requested a refill, and found out that I was out of refills, the pharmacy would also call the doctor on my behalf to request more refills. And when my doctor was being crazy, I would just go to his office and make him deal with me.

I think it's possible to deal with major depression without antidepressants. It's also possible to heal from a broken arm without intervention by/from a medical doctor. It's definitely possible to give birth without painkillers. But given all of the wonderful advances in modern medicine, I don't understand why you would want to do any of those things.

Your doctor sounds like a butthead. Find a doctor who isn't a butthead. And if you decide to pursue life without antidepressants, please take care of yourself. If you find yourself slipping, go to a doctor. Don't mess around with stuff like that. Good luck.
posted by kat518 at 8:47 AM on November 26, 2013 [3 favorites]

After multiple years and rounds with Celexa and Zoloft (with assistance from the anti-anxiety Ativan for sleeping) I have been off all drugs for around a year now. So it is possible and if that's a goal you have then you should definitely work towards it and give it a try. You can always go back to the pills, and there's not necessarily anything wrong with that. But I totally understand the desire to see if you can manage without medicine and all of the side effects -- and I'd lump the hassle of getting refills into the undesirable side effects category).

That said, I have to agree with earlier comments and say you might want to avoid a cold turkey approach.

Why it worked for me: I had been very stable for many months, and somehow the life upheaval around the birth of my first child hadn't rocked me. That was a clue to me that I was ready -- even with all the sleep deprivation (which had in the past been a major trigger), I was holding it together and feeling pretty great. So I talked to my doctor and we gradually stepped down the doses until I was not getting a therapeutic amount. Then I just stopped taking it. I never even noticed the change. I told loved ones what was going on so they could help spot red flags or behavior changes and support me as needed.

So my questions for you are: how do you know you are ready for this? Do you have a support network that will help you make good decisions if things start to swing in the wrong direction? Can you now, or is there a time coming up in the future where you can focus on this transition and make it work?

Depression is tough but you can find a way to manage it. This transition should feel great -- it shouldn't feel like the flu. Go into it with full awareness and bring some supporters along who can help you watch your brain. Maybe that can happen now, but maybe you can spend some time planning to make this go as smoothly as possible so you can avoid getting on a drugs rollercoaster.

Good luck! Feel free to message me if you want to talk further.
posted by cubby at 8:48 AM on November 26, 2013 [3 favorites]

My doctor actually prefers that we call the pharmacy and get them to request the prescription refill.
posted by telophase at 8:49 AM on November 26, 2013

I totally support people who want to get off psych drugs but Effexor is a notoriously harsh withdrawal and cold turkey can put people in the hospital (and since you already have a history of hallucinations from antidepressant withdrawal, even more reason to be careful.) Personally, I'd take the other commenters' advice on ways to get an emergency supply of drugs and plan to taper off antidepressants instead of cold turkey.

But that's not really what your question is about. I was also diagnosed with major depression as a teen and told I would need drugs for the rest of my life. Looking back, I was in a horrible family situation and dealing with normal teen angst stuff and the antidepressants induced some pretty severe anhedonia and fatigue that my psychiatrist just attributed to my "chemical imbalance." The thing is, psychiatry is far from an exact science and no one really understands how antidepressants "work" and they can definitely make some people MORE depressed. Anyways, when I decided to get off the drugs 8 years later, after the nightmare withdrawal symptoms went away, I found I was able to find pleasure and joy in relationships, nature, and exercise at a level that didn't exist when I was on the drugs. So for me, enjoying my life is way, way easier off the drugs. You were a kid when you started these meds, you've been on them a LONG time, and it's very possible you'll find your core, unmedicated self is way healthier than you assume. It's possible avoiding depression might not be a big challenge. It's been true for me and several friends who were medicated as children or teens and stayed on the drugs long term before getting off them.

Some more things that have helped: lots of exercise and paying attention to how diet and recreational drugs affect my mood. Also, I really like this free guide to coming off psychiatric drugs - might be something for you to check out.

Good luck!
posted by horizons at 9:05 AM on November 26, 2013 [5 favorites]

I'm 32 and have been taking antidepressants for Major Depression (actual MDD, the kind where I'm either fine or face down in a ditch - not low grade dysthymia) for 14 years.

I tried to go off a few years back. I tapered off Effexor to prepare for pregnancy, and thought I'd try going without rather than switching to something new. Within a week, I was well on my way to a depressive episode: crying in the bathroom at work, picking fights with my partner, having panic attacks about leaving the house... I switched to Zoloft for the pregnancy, but that eventually stopped working - leaving me in a zombie esque state.

I'm back on Effexor and pregnant again and the increased risk to the pregnancy is something my OB and I have agreed is reasonable so that baby (and my toddler son) has a sane mother. My experience in Major Depression and taking these drugs is exactly the same as the drugs I take to control my epilepsy: I find out exactly how much I need them once I stop. When I'm on it, or just tapered off and feel ok, it's easy to think I could just quit. And then... the depressive episode inevitably starts and it reminds me why I needed to take them in the first place.

YMM of course V, but as someone who has been in a very, very similar position my advice would be to talk to your new doctor when you move and have a new prescription ready. You don't *have* to take it, but if you do start sliding into full on depression... at least you won't have to then try and call the doctor, which at that point is like trying to raise the Titanic.

Best of luck to you.
posted by sonika at 9:13 AM on November 26, 2013 [1 favorite]

If you go the pharmacy route, I also recommend talking to the pharmacist and describing exactly what happened to see what they recommend about the course of medication.
posted by nicodine at 9:38 AM on November 26, 2013

I'm similar to you in the sense that I was first diagnosed with depression around 15 and am now 30. During high school and college, different doctors put me on a variety of drugs to help combat my depression. NONE of them worked. I quit Effexor (ten years ago) cold turkey, and I remember it was two weeks of straight hell: body aches, sweats, nausea, etc. Definite withdrawal symptoms. I agree, I don't think you had the flu.

The last time I took any sort of medication for depression or anxiety was in 2006. Since I had tried at least 17 different pills in various dosages and combinations and none of them helped at all, I didn't see the point in continuing to flood my system with the stuff, and since none of them had helped, I suspected that depression--or at least my depression--wasn't just chemical. From 2006-2010, I was moderately to severely depressed, but surviving on my own, no pills. In 2010-2011, I feel I hit a type of rock-bottom. I wasn't actively trying to kill myself (as I had in the past) but was actively trying to destroy my life--friendships, my relationship, my band. I realized I didn't want to lose those things, and it was the first time in my life I felt like if I wanted to save myself, I'd actually have to work for it. It wasn't a lost cause, as I used to think (because thinking there was nothing I could do about my depression was the easy route to take). I'd have to be responsible, and I'd have to learn to change my thoughts and my behaviors.

I went to a psychologist with the intent to learn how to help myself, not just appease my parents (as in the past). He gave me Feeling Good, which is recommended all over the place here. It opened my eyes to the notion that emotions are thoughts, and if you can control your thoughts, you can control your mood. That helped enormously.

This isn't completely a success story. I'd say I'm still depressed, but nowhere nearly as bad as I was. I have bad moments, they last hours or days instead of weeks or months. I also have good moments--days or weeks--instead of never, like before. But I also haven't found the perfect balance of thougt-control yet. In wanting to keep the depression at bay, I've kept a tight rein on my thoughts, so a lot of the time, I'm sort of just walking around numb, my mind full of other people's songs instead of my own thoughts. It's better than feeling bad, but it's not the best for my personal creative projects. I'm working on learning to control the filter and let some of the good thoughts live while still screening out the bad. I definitely feel I've been on an upswing overall for a while, and it's all without pills (and also without my psychologist; I stopped going to him almost a year ago). I believe we can do this ourselves, but it takes a lot of work.
posted by dearwassily at 10:51 AM on November 26, 2013 [2 favorites]

I am not you, but if I stop taking psych meds for a few days I start to think, man I would be so much better off not taking these ever. Then I resume my treatment and realize that wasn't such a good idea.

It sounds like you have thought this out, but I recommend getting some Effexor back into your system until you are stabilized before deciding that you are done forever. Also, working with a doctor to taper yourself off, and managing symptoms. Quitting SSRIs and similar drugs is difficult physiologically and it is worth it to take the time to do it right.
posted by tweedle at 10:55 AM on November 26, 2013 [1 favorite]

Eh, I would be cautious about putting the Effexor back into your system without first talking to a doc about the best way to ramp back up. Your poor body has already been through withdrawal hell...yanking it back to full-throttle dosage might trigger a whole 'nother set of re-up adjustment issues.

Your doc isn't getting the job done for you, so I would consult with a psychiatrist. Pay out of pocket if need be. Spend big if need be to get someone on your treatment team who takes this stuff seriously and will be there for you.

And yes, for some of us, it is absolutely possible to thrive off of medication, even after a lifetime of major depression and anxiety. For me, it was all about diet, exercise, no booze or recreational drugs, and finding a later-life career that doesn't stress me the hell out. My life is better by an order of magnitude compared to when I was on meds and in therapy, but I know better than to suggest that it's possible for everyone, or anyone in particular (e.g., you).
posted by nacho fries at 11:18 AM on November 26, 2013

I am not you, and I am not any kind of doctor. But I have managed major depression without meds for about 5 years now. And uh, it's not the greatest idea, even for me and here I am talking about it. If this is a long term goal for you, it should be done with a doctor's supervision.

The key for me--who knows what it would or wouldn't be for you--is to know, reeeeeeeeallllllly know, my triggers and danger zones, and ruthlessly work to eliminate these things from my life as much as possible.

I know that long commutes are bad for me, especially in the winter when they are in the dark both ways. I have structured my life to have no commute, apart from a short occasional commute which so far I have handled okay. This has various upsides and downsides and is only even possible because I'm a lucky bastard, basically.

I know that certain types of relationships and people are bad for me. I do not engage with those relationships or people anymore. This meant ending some very meaningful connections cold-turkey, and it was not fun nor was it easy.

I know that if I behave in certain ways they will become a spiral of dysfunction and self-loathing. So I must be very mindful about what might seem like minor shit to other people (did i go to the gym today? is an essential mental health question for me, not an elective option).

It took me most of the last 5 years to work these things out, though, and I was a completely non-functioning wreck for at least 1 of those years, maybe 2. It's hazy. I broke a lot of relationships and fundamentally altered, for the worse, several others. (And maybe wrecked my career? time will tell...).

Not to be undertaken lightly or on your own. Cannot repeat that enough.
posted by like_a_friend at 11:27 AM on November 26, 2013 [2 favorites]

I do not manage major depression without meds but I do manage another serious condition without meds and that condition frequently causes depression -- a fair number of people with my condition are on antidepressants because of this other condition leading to depression. I have made a lot of dietary changes. I have read some articles which link food chemistry to depression. I mostly avoid those foods anyway because they worsen my medical condition. I have found that some of them can trigger depression in me.

Cold turkey is hard. For some drugs, it is very, very hard. I got off eight prescription drugs by making dietary and lifestyle changes first so that I had less need of drugs. I got off steriods in part by starting a different drug first, one that was easier on the body. It was several years before I finally got off this new drug, after tapering down gradually for a long, long time.

I think the lifestyle changes you are making look promising for making long term positive changes which may help you get off and stay off drugs. The one time I successfully went off a drug cold turkey was when I moved to a different place and that reduced my exposure to allergens. My first three days in the new place were spent in severe withdrawal and I never took antihistamines again.

So I think the changes you are making may help you make a drug-free life work if that is what you want but I think the odds are very poor that you can successfully transition in this particular manner just because your meds ran out. I had two failed attempts to get off steroids cold turkey, one of which landed me in the ER. Then I got the info I needed, started a different supporting drug and began tapering off steroids and finally succeeded. So, yes, I think it canbe done. No, I don't think this is the way to do it.

I am much happier and healthier without drugs but it took me years to gradually get off the drugs I was on and I had LOTS of support from various sources. I don't think a single AskMe begins to provide the kind of support you need to make this a successful transition.
posted by Michele in California at 4:04 PM on November 26, 2013

Mod note: This is a response from an anonymous commenter.
I have gone through periods of managing my depression without meds. Usually I'm okay for a while and then I gradually start noticing what a drag it is to be alive and what's really the point of anything anyway.

I did go through a period of having a really hard time managing things with very limited health insurance and no coverage for name brand wellbutrin, and so currently I'm self medicating with Sam-E, which is actually used as a prescribed antidepressant in some European countries, and inositol, which has showed some promising results for anxiety and depression. For whatever combination of pharmaceutical and placebo efficacy, they seem to hold me pretty well. They're both pretty expensive though, and not a bargain except compared to trying to buy name brand drugs without Rx insurance. I still don't love being dependent on something, but I like that I am more fully in control of my supply, and I also find that going off for a couple days when traveling or whatever doesn't seem to do any harm.

You're in a tricky place because the new job sounds promising but also like a not so great time for experimenting.

Good luck!!
posted by cortex (staff) at 4:09 PM on November 26, 2013

I have had depression for most of my life, and have never been on meds.

I did, however, start seeing a therapist two years ago, and it was extremely helpful. She gave me The Chemistry of Joy, and I follow the recommendations within religiously. It has helped tremendously.
posted by RedEmma at 6:06 AM on November 27, 2013

From time to time I watch and listen to Robert Sapolsky talk about depression, and it helps.
posted by theora55 at 2:29 PM on November 27, 2013

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