Should I Take Antidepressants For Seemingly Outside Causes?
April 5, 2014 10:26 AM   Subscribe

Trying to determine if I'm depressed enough to warrant the use of antidepressants. Chicken and the egg about the cause of depression.

I know, YANMD or Therapist. That said...

I've been seeing a CBT therapist for two years. I like her and I've learned a lot about combating negative thoughts, etc. and I've definitely seen a change in my thinking patterns. However I can't seem to shake out of this funk I'm in. The catch is that the funk is caused by external and situational factors. I started going to my therapist for help on coming out (age 27) and coping with that and anxiety from it. But while going to her I slowly slipped into depression caused by a nightmarish and unending string of bad luck and rejection in regards to finding a relationship that has left me and my emotions in a ragged heap of despair. It's as though the universe has a voodoo doll of me and it's repeatedly stabbing me in the chest. I've been repeatedly led on, rejected, crushed, and not once has my romantic interest been reciprocated. I'm turning 30 in a few days and I just have this unending thought stream that my life is like a nightmare.

I try to pick myself back up and go after someone else, but I keep getting smashed back down. I don't know how many times I can get back up, and I feel like all the rejection left me an emotional mess.

I feel so different than I used to be. I used to have my ups and downs, and I guess you could say I would err more on the melancholy side, but I used to be pretty happy go lucky. I'm so negative and sad now, strings of negative thoughts going through my head all the time. I see everything through a very pessimistic lens. The smallest things make me angry. I am becoming apathetic about things I was once passionate about. I have vague occasional thoughts of suicide (although no plans about it) and at the same time increasing anxiety about death and my health. I lost 10 pounds from stress in the past two years.

However I have a hard time just sitting by myself and relaxing. I often feel very distracted. I feel as though the only way to quiet my mind from rumination and obsessive thoughts is to have a beer or two. It gives me a moment's respite from the heaviness. I can't get the stuff done that I want to. I'm less motivated than I should be. God forbid you ask me to make a decision on something. My brain just feels scattered.

If you asked me to rate my overall mood for the last year (or two), I'd say "shitty". I've had the most crushing lows I've ever had in my life, and I can't seem to snap out of it.

The thing is, I don't lie in bed all day. I go out and I'm fully capable of having a fun day with friends. I've even made a lot of new friends throughout the past two years since this started. So I'm being very very social. I have good days. I am active. I have short bursts of productivity. So I still seem to be fairly functional.

I want to say that maybe if I'd stop getting rejected romantically then maybe this would go away. But perhaps depression is causing my reactions to these events to be way out of proportion.

I just feel like I'm turning into a cynical, bitter person.

My therapist has suggested antidepressants before, but I didn't want to take them. Now she's suggesting them again, actually for the third time. At first I thought it would go away on it's own, that I could weather the storm and things would eventually get brighter. Now I'm reconsidering because life keeps kicking me in the face, I feel like hell, and I'm tired of feeling like I'm going around with a storm cloud over me all the time.

But I worry about taking them, and I wonder if antidepressants work for such situations. Plus I hate taking medications in general. My therapist even said herself that depression does clear up on its own, and it would probably lift for me pretty fast if I found a good relationship. But who knows when that will be, and who knows if it's even going to help me much since all this negativity and sadness has been such a THING for me for so long.

Anyway my question is, would antidepressants work in a situation like this, and has anyone had a similar situation? I feel like the reason this is happening is because through sheer bad luck the same things are happening to me over and over again. I'm doing everything I can to break the cycle but I've been hurt more times than seems fair for one person. However, because this is why I'm feeling down, I don't know if an antidepressant is a good way to go. I wonder if I'm just overreacting to my situation, or if the depression is causing me to overreact. Classic chicken and the egg.

Obviously I will talk to my therapist more about this, but I'm just looking for anecdotal stories if perhaps anyone was in a situation similar enough to mine.
posted by anonymous to Health & Fitness (15 answers total) 5 users marked this as a favorite
I would say yes, you should try them. The first one might not work, and maybe it turns out that they don't help at all, but why not give it a shot? The thing is, sometimes you know the steps you need the take to pull yourself out of a hole, but when you're depressed, they just seem like So. Much. Work. that you can't even take the first one, let alone the subsequent ones. In my personal experience, the anti-depressants help on that level alone -- they can help you get unstuck and moving forward.

I understand the chicken/egg thing -- I've experienced it -- but I'd still urge you to give the drugs a shot. Think of it as taking antibiotics; you've got a bug right now, and your body needs some help fighting it effectively because it's affecting your health, even if your body could probably take care of it, eventually and way down the road, all on its own.

Best of luck, hang in there, and hugs.

And, it gets better!
posted by mudpuppie at 10:40 AM on April 5, 2014 [2 favorites]

Agree with mudpuppie. I WISH I'd taken antidepressants years ago when they were first suggested. The thing is: it's okay to need them.

I felt better after a beer or two as well, then after four or ten. You're already self-medicating.

I was functional as well until a crisis hit, and boy howdy do I wish I'd had some scaffolding like antidepressants to buttress me. You can hum along wih dysthymia for a while until something serious happens. I fell apart. Even though everything turned out for the best, it was tough.

I hate the thought of taking daily meds as well, but I waited until my 40's and I wish I'd done it sooner.

Good luck. I know it's tough.
posted by Punctual at 10:48 AM on April 5, 2014 [1 favorite]

But perhaps depression is causing my reactions to these events to be way out of proportion.

I don't know that it matters at this point. Metaphor time: there's the spark (the romantic disappointment) and then there's whether you are "a moist log" (someone with no pre-existing tendencies toward depression) or "a pile of nice dry kindling" (someone already depressed or prone to depression). But even a moist log will catch fire eventually. At this point, it sounds like the depression has caught fire and taken on a life of its own. Sure, you could wait for a romance to put out the fire, but since you're suffering so much now, why not call the fire department? Just like allergies can occasionally turn into a sinus infection, sometimes it isn't enough for the external harm to stop. And even with allergies, people take medicine to feel better while there's so much pollen in the air. I hope you feel better soon.
posted by salvia at 11:02 AM on April 5, 2014 [4 favorites]

I took them for four months and they effed up my metabolism such that 8 years later I still can not lose the enormous amount of weight I gained. I'm very active and do not eat processed food. Ever.

Totally not worth it if you deem this situational. Every time I like into the "science" of anti-depressants and the process behind how the FDA approves them (and other drugs), I feel rage.

You're better off with woo that (supposedly) doesn't work - biofeedback, meditation, yoga, acupuncture, regular therapeutic massage. Vitamins. Vitamins. Vitamins.

posted by jbenben at 11:02 AM on April 5, 2014 [8 favorites]

It's unlikely that you're going to get to a point in your life where you don't face any sort of romantic rejection -- that's just how the world works. Even if you entered into a great wonderful relationship, great wonderful relationships can end.

I say that not to be depressing, but because your definition of "situational" may not be realistic; getting to a point in your life where you never face any sort of romantic rejection is not the same as "Quitting a shitty job" or "Giving myself time to grieve my mother's death" or "Getting my feet back under me after a long-distance move." Plus, other people rejecting you is a situation you have no control over -- it's literally in everyone else's hands.

As you point out, what one can control in such a situation is one's reaction to it, and you said that you are too unmotivated, angry, apathetic, and depressed to do that work. You describe your life as a "nightmare" and are having suicidal thoughts.

By those criteria, I suspect that most health-care practitioners would diagnose you with moderate to severe depression (yes, even though you still have good days). The science is mixed on antidepressants for mild to moderate depression, but the worse the depression is, the more effective antidepressant medication usually is in treating it.

It sounds like you've been struggling without medication for a full two years, at least. You seem very self-aware, it sounds like you have a support network, it sounds like you've been doing the emotional and mental work you can to keep the depression at bay, and you've been in therapy. So you're doing a bunch of the "right" things, and you're still having suicidal thoughts, you're still unmotivated, apathetic, angry, and depressed, and your life is still a "nightmare."

When I've seen people in that situation, I find that not taking medication is actively making their depression worse, because they're developing a layer of self-blame for not "trying harder," even when they are trying harder than 90% of the population to have a fulfilling happy life. At that point, taking antidepressant medication can take off several layers of apathy, amotivation, suicidality, and anger, which means that the work one puts into one's life can actually have positive results, rather than continuing to feel like fighting in quicksand.
posted by jaguar at 11:18 AM on April 5, 2014 [7 favorites]

I'm so negative and sad now, strings of negative thoughts going through my head all the time. I see everything through a very pessimistic lens. The smallest things make me angry. I am becoming apathetic about things I was once passionate about. I have vague occasional thoughts of suicide (although no plans about it) and at the same time increasing anxiety about death and my health. I lost 10 pounds from stress in the past two years.

You are me twenty years ago - I tried anti-depressants and therapy, but what changed things for me were starting to eat well, exercising regularly, and getting enough sleep.

Short term, drugs may be helpful (I agree w/jbenben, for the most part, but have friends who appear to have been helped by them, if only by placebo), but if you aren't doing any of these things, it is worth making the effort. Six months of running three times a week, in particular, completely changed my life.
posted by ryanshepard at 11:27 AM on April 5, 2014 [7 favorites]

Your therapist's observation that your depression would clear up if you found a good relationship doesn't sit well with me at all; it seems like reckless advice. Relationships aren't a panacea, and your ultimate goal should be to feel mentally well on your own. Besides, successfully treating the depression first will help your ability to find someone who's right for you and to be a good, healthy partner for them.

Depression's response to different forms of treatment varies from person to person, and doesn't really depend on whether or not there's an identifiable cause. In many circumstances, treating the symptoms can better equip you to remedy the external situation.

Antidepressants have worked wonders for me, so of course I enthusiastically recommend them to others. But they don't work for everyone. Sometimes, what works is finding the right therapist, or exercising and eating well, or other lifestyle changes. I think it's worth it to try everything you can, and not to rule out medication. If you're not responding to therapy and having trouble with other forms of treatment, antidepressants can help those things stick better. (For example, when I've been deeply depressed, CBT hasn't done shit for me; medication helps get my brain to a healthy enough spot for it to work.)

You deserve to feel well, and it's generally a good idea to try multiple approaches when wrestling with depression. You can work on the situation and the symptoms at the same time.
posted by Metroid Baby at 11:27 AM on April 5, 2014 [6 favorites]

Your therapist's observation that your depression would clear up if you found a good relationship doesn't sit well with me at all;

I strongly disagree; if the OP is sad only because they are not in a good relationship, then of course it would go away if that changed. Unmet needs make people miserable--sometimes it really is that simple. Unfortunately it's also (mostly) out of your control.
posted by Violet Hour at 12:50 PM on April 5, 2014 [2 favorites]

You've given a lot of justification about why you feel rotten and depressed. Here's the deal - you don't have to justify it. Depression can be triggered by events, or just land like a plague of locusts on a sunny day. You deserve to feel happy, or at least not awful. Definitely try antidepressants, and try different ones if the 1st script doesn't work.

Exercise and sunshine/ nature also seem to help, so try them if you can.
posted by theora55 at 4:58 PM on April 5, 2014 [2 favorites]

Under your specific circumstances, antidepressants could help break you out of that cycle, and a temporary prescription now could save you from dipping into major depression later, perhaps.

BUT if you are concerned about having to take them for whatever reason, try the following first:

Walk for thirty minutes a day fairly briskly (or other exercise, a spin class would work here, a bike ride, whatever, as long as you will DO it)

Fish oil tablets

Getting out into the sun without sunglasses, as much as you can.

If you do these three things, in three weeks you should see a difference. If not, or if for whatever reason you can't, do the meds. Your therapy will work much better once you are out of the pit.
posted by St. Alia of the Bunnies at 6:49 PM on April 5, 2014 [1 favorite]

Scientific studies are even better than anecdotes to answer a question like this.

Check out this (rather old, but relevant) article:
"Comparison of pharmacological treatment response between situational and non-situational depressions"

I have access to the full text of this article. The upshot is that treatment with antidepressants worked equally well in both groups, whether they had situational or non-situational depression. There was also a third group that they called "probable situational depression" where it was more difficult to determine whether the depression would have occurred regardless of the stressful events in those people's lives - the antidepressants worked similarly in that group as well.

I don't think there's anything wrong with trying non-pharmacologic alternatives to medication either, but the way you're currently living sounds miserable, and I think anyone having thoughts of suicide (even if not with a concrete plan) should strongly consider any potential option for treatment.
posted by treehorn+bunny at 10:14 PM on April 5, 2014 [2 favorites]

These jumped out at me:

>I've had the most crushing lows I've ever had in my life, and I can't seem to snap out of it.


> The thing is, I don't lie in bed all day.

Just because you're "functioning" doesn't mean you have to endure crushing lows.
posted by morganw at 11:56 PM on April 5, 2014 [1 favorite]

If you decide to take antidepressants, don't forget there are different kinds of antidepressants out there. I never had much success with SSRI's (Prozac and Celexa are two examples of SSRI's), but Wellbutrin (a SNRI/SDRI) worked beautifully. (Celexa also gave me horrible restless legs at night.) Another friend had the same results - Celexa didn't work but Wellbutrin was a miracle cure. And Wellbutrin is not known for causing weight gain or for sexual side effects.

Different antidepressants work for different body chemistries. If your doc wants you to try them, you can do some research and ask to try Wellbutrin first (if you don't want a SSRI). I wish I had.
posted by Rosie M. Banks at 8:16 AM on April 6, 2014

I was quite panicky about taking anti-depressants initially, just like I was about seeing a psychologist and basically doing anything that (in my head) translated to failure to even be able to take care of myself. I also worried very much that they would somehow change who I was, make me into some kind of unfeeling robot. Much as I hated the rock-bottom parts of depression, I didn't want to stop feeling altogether.

But the thing is, sometimes you need help. You need a friend's advice, you need someone to teach you how to do something, you need a tool to help you do something tricky. Meds are just a tool to help you. For me, they haven't so much stopped me from feeling as they have made it harder for me to get trapped in a particular feeling. Instead of going round and round the mousewheel of doom, I feel sad. Sometimes I cry. I might dwell on it for say, half an hour. Sustaining it longer than that usually takes a concerted effort, and it's usually much easier to get distracted or just feel that the particular bit of sadness has run its course. Over now.

Other people have lots of success with exercise, sunshine, diet, etc. For me, meds worked. I was lucky enough that the first kind I tried (Lexapro, an SSRI) worked. But if you decide to go down the path of taking meds, it does not have to be a lifetime sentence and can really just be something else in your arsenal to help when the demons of depression have you backed against the wall.

One thing I would gently suggest: give the relationship-seeking a break for a bit. With every attempt you have taken a big risk, put yourself and your heart out there. You need time to recover. And it can be freeing just to say "okay, for the next 6 months, I'm just not going to try to get in a relationship!" Take the pressure off.
posted by Athanassiel at 8:59 PM on April 6, 2014

I also worried very much that they would somehow change who I was, make me into some kind of unfeeling robot.

Oh, that's a good point. If you end up on a medication that makes you feel like a robot or zombie, that's because you're on the wrong medication. As others have said, different medications have different effects on different people, and they're not necessarily very predictable, so you may have to try a few different ones to find one that works -- but you absolutely have the right (and, in my mind, the responsibility) to let your doctor and therapist know if any medication makes you feel apathetic or detached (or any other unpleasant feeling) for longer than the first few weeks.
posted by jaguar at 9:13 PM on April 6, 2014

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