We Need Words of Encouragement
January 13, 2015 8:38 AM   Subscribe

On anxiety and medication for the modern man.

Mr. dactyl is not a mefite, but he is a fan of getting real-time answers on the green. After a lifetime of self-medicating his severe anxiety AND a very tumultuous year (death of his grandfather, step-grandmother, father, my severe depression during pregnancy, and the birth of our child) things have reached a breaking point and he has agreed to start taking 10mg of celexa.

Talk therapy is in our future, but the events of this weekend constituted a medical emergency, pretty much. I think he feels a failure for being depressed, and I think he's pretty damn scared right now. He was there for me during the second trimester when I literally cried for days on end and could not be left alone; I want to shepherd him through this process but I am not a medical professional and can only speak from my own experience. (I too self-medicated for years, or stopped taking meds every time I felt better, only to spiral back down.)

Please tell us (he will be reading) how anti-depressants/anti-anxiety meds have changed your life for the better. How did you deal with side effects? How many switches/dosages/changes before you found the right drug? How long before you felt "better"? How is your life different? You can also link us to old threads, but one thing I am curious about is CURRENT answers, as these drugs keep evolving.

Things we don't need to hear: scary stories (he is being monitored), "try marijuana" (we do!) diet/exercise/sleep stuff (he is a chef and runs daily; but we have a newborn so shit is fucked, if you'll pardon my French.)

Thanks MeFi!
posted by polly_dactyl to Health & Fitness (17 answers total) 28 users marked this as a favorite
Best answer: I think he feels a failure for being depressed,

My husband has been working through his anxiety and depression over the last few months, and it was a real eye-opener for me how different depression is in men and women. He had a hard time admitting that depression was part of what was going on, and this book I Don't Want to Talk About It was really helpful for him in learning about how depression affects men, and how many men are depressed without ever realizing it (admitting it to themselves) or ever addressing it, which I think went a long way towards helping him not feel so much shame over it. Sorry, yes I know you asked about meds and a book's not a drug, but it was a great jump-start for my husband's entrance into talk therapy, gave him groundwork for making new connections between health, emotions, and mental health, and made it way easier to talk about this stuff with the therapist.

Oh, and words of encouragement: Yes, it will get better! It took several months, but my husband went from almost non-functional to doing better than in the 10 years I've known him. He's feeling better about himself, which cascades into a better relationship, me feeling better, all sorts of improvements. I'll be thinking good thoughts toward the two of you.
posted by aimedwander at 9:00 AM on January 13, 2015 [2 favorites]

Best answer: A little more than a year ago, I realized that while I could control my anxiety issues with a low carb diet and an hour or two of vigorous exercise per day, that wasn't always practical -- because the times when I'm under the most stress are the times when I have the fewest resources to devote to such lifestyle management factors. And so I asked my doctor for what I call a "break glass in case of emergency" prescription, for four 0.25mg Xanax. Literally four pills, in the tiniest strength they make them in. Having that medication available is like the pressure release valve on a hot water heater; I take them very thoughtfully because I only have 4 of them, but I know that they will break the back of my anxiety in 20 minutes or less, and so it makes it easier for me to try other things first (meditation, jumping jacks, deep torso pressure, etc). I refill that prescription on average once every three or four months, that's how rarely I need it. But once I had it? My panic attacks went from two or three times a week to, well, once or twice a month. Just knowing it was there made it easier for me to work my way out of the anxiety.

Xanax was the third psychoactive medication I was prescribed. Previously, I'd been on Prozac, with a switch to Zoloft after several years when I was trying to conceive my second child. Both of those medications were astounding -- the black stone of misery that had been in my chest for as long as I remembered just evaporated, like fog in the sun. I could just. . . be. . . happy. They didn't interfere with my creativity (in fact not being depressed and anxious made it much easier to go out and do artistic things), they didn't change my personality, and while I realized later when I went off them that they WERE suppressing my libido, they weren't doing it anywhere near as much as being anxious and depressed was. I was on those medications for about ten years, and now I'm not on them any more, and my life is pretty great.

I should point out, in no way did any of these medications make it unnecessary to do other work to fix my shit and be happy. But it made that work actually be effective -- it meant that I made progress, that I was able to see what I needed to fix and fix it. It wasn't a magic bullet by any means, it just made my efforts to get better much, much more productive.
posted by KathrynT at 9:03 AM on January 13, 2015 [5 favorites]

Best answer: I recently went on anti-depressants, which I kind of resisted doing because I really badly wanted to be able to handle everything in my life without help. Spoiler alert: that was not a good decision. I was also on them briefly when I was twelve. Then it was Celexa and Remeron; currently I am on Zoloft.

When I was twelve, I don't recall any medication issues at all; both of them worked fine for me on the first go, with no side effects that I remember clearly. The overall effect felt like coming out of a fog; I felt like I was able to focus for the first time and I improved a lot of stuff about my life that made them unnecessary a year or so later.

More recently, I went back to a psychiatrist because I was not handling a lot of life stressors well at all, and I felt I needed a leg up to tackle those issues and get myself back on my feet. I tried Wellbutrin first; it turns out that this exacerbated the crap out of my anxiety. I felt like I was constantly hyperventilating for about a month, even after dropping my dose, and when I realized that the Wellbutrin was causing me to break out in huge itchy hives all over my body I went off it. After that, I tried Zoloft, which has worked much better for me. It took about six weeks to see any positive effect from it, although the side effects kicked in pretty quickly. However, for me the only really annoying side effect is that I've lost a lot of appetite, so I've had to construct workarounds to make sure I eat properly. I've also had some side effects in the way of sleeping a little more shallowly than I used to, but that's dealable.

Positive effects: again, it's like a cloud has been lifted. This time, it hasn't been quite as total a result, and I actually may need to check in with my psych about adding something for the anxiety. But it's MUCH better than it was before I started on the Zoloft. I can think again, and I can focus without getting into the brainfoggy panicking, where I wind up just freezing and staring ahead while I try to get my emotions under control. It was so worth doing, and I'm glad I did. It doesn't have to be a forever thing--although you should expect to be on them for at least a year--but it can be a really useful leg up so that you can work on reducing anxiety in other ways as you go. For me, antidepressants work really well at breaking a nasty cycle and let me get moving again.
posted by sciatrix at 9:08 AM on January 13, 2015 [2 favorites]

Best answer: Speaking as a 38 year old male who has been diagnosed since about age 12, the process evolves through life. There are people who need meds forever, and those who don't. Some have side-effects, just like antibiotics. Most of what is important is finding the right doctor, i.e. one that isn't about pushing pills but is looking to improve his quality of life.

I currently see a doc who focuses on anxiety and find that focusing on that aspect of my treatment is covering the depression too... and maybe be a trigger.

I've always been able to function under medication, and in some cases function better than I could without the medication. I'm one who will always need medications, and will always advocate for them in tandem with CBT (Cognitive Behavioral Therapy). Your husband should consider both, even though the latter can be tough and scary. You'd be surprised at how helpful it can be. Mefi mail me if you'd like more info.

Wishing you both clearer skies.
posted by Draccy at 9:10 AM on January 13, 2015 [2 favorites]

Best answer: It's hard to move from mj to something else for managing anxiety because a lot of the positive self-talk surrounding marijuana (and I have used it occasionally, I am not an anti-mj person) is all about how it's a natural way to relax. Moving to medication feels like moving to something "unnatural" but realistically it's the same thing in a way that is easier to monitor, easier to keep track of, under the supervision of a medical professional and in a way that is less likely to lead to fuzzyheaded stoned-feeling escapism (not that there's anything wrong with that!)

My anxiety is mild and it got bad after my father died. Terrible sleeping, a lot of grouchy unhappiness and hating life. I had, in the past, gotten a prescription for occasional benzos (lorazepam) that were like my reset-button for terrible times and I took them a bit more frequently. Like KathrynT my usual approach to anxiety is lower the caffeine, do more exercise, eat better food but that won't always be an available option and this was something that would predictably get the squirrel out of my head so I could be me.

And that was the biggest thing I learned. That the anxiety was, could be, external to me and not an essential indivisible part of who I was. Once I got to experience myself-without-anxiety and got rid of some of my go-to anxiety reducing tics, the more I learned about myself and how to recognize anxiety and be mindful of it without giving in to it. I learned how to sleep better. I enjoyed life more. The meds were a small part of that but they gave me the tools to help do that.

I'm pretty lucky in that I didn't need much and my doctors have been supportive. But it was a huge lifechanger for me. It's become my mantra here that one of the things they don't tell you about anti=-anxiety meds is how hard it is to start taking them (you will be afraid of them, you will beat yourself up over it) but that's the anxiety parasite trying to keep itself alive. Fuck that guy.
posted by jessamyn at 9:14 AM on January 13, 2015 [9 favorites]

Response by poster: This is already awesome, thank you guys! I am going to wait until later to mark best answers because I have a feeling there will be quite a few.

Re: xanax, benzos are a problem for him -- and actually the comment about finding the right doctor is spot on, because this one was an ER/trauma doc and tried to push klonopin on him, which he refused and asked for celexa, because that is what I am on.

Thank you for the kind thoughts and the honesty! I always can count on the green... :D
posted by polly_dactyl at 9:16 AM on January 13, 2015 [1 favorite]

Best answer: Well, I am still married because of my spouse's medication. And he calls it his "staying alive pills". My new bullshit insurance has made it less easy than it used to be, but I'll eat ramen to afford it if I have to.

He's been through maybe three flavors - the first was Wellbutrin, and it was fine but eventually the mild side effects seemed dramatic to him and he did that thing where he figured he was all better and could stop. Going back on after being off, he just didn't get the same effectiveness, so he switched to something else I can't remember for a while. Which he quit because he was unemployed (I wasn't consulted). I presented an ultimatum and he ended up with a doctor who picked Cymbalta, and that has been good, with minimal side effects (missing one will make him a little nauseated, but in an "oh blerg, forgot my pill" way, not like "get a bucket!").

Each time has been roughly the same in that within about two weeks he could definitely tell something was different but I couldn't. At four weeks things were obviously better, by six weeks we've both kind of forgotten how bad it was.

I can tell by your phrasing that you think of medication as a big scary thing that should only be undertaken in the gravest of circumstances and needs to be apologized for and mitigated by talk therapy, but I feel like if you're not feeling well and science has found ways to help many people not feel so bad, not trying it is self-defeating.

It's not a permanent radical option that can't be reversed, and if Celexa doesn't work (but it's a really common first-try medication because is so often does work) there are other things, and if he doesn't like it he can stop and do something else. Talk therapy is fine for learning coping skills, but when you are physically biologically having symptoms you really have to treat those before you can get very far with coping skills.

It's okay to take medicine when you're sick. It's not because you're weak or bad. One cannot actually physically pull themselves up by their own bootstraps - all you can do with bootstraps is put your boots on. Take the boots, put them on, see if they result in less glass in your feet. It's a smart thing to do.

You are probably right that he feels shame - depression does that, it's not just socialization. Treat it like a symptom, like you would regard a cough with a cold, and make sure you're not perpetuating these ideas that good people don't take medicine or good men don't get depression. That's absolutely what depression whispers in your ear, and secrets and silence are dangerous, so don't let it be a terrible secret.

We go at it in a super-practical way in our house - when I can tell he's doing especially poorly, I walk him through the checklist: are you taking your medicine? Did you just get it refilled (there was one month where we both wondered if he got a bad batch, because he was taking it but getting all the symptoms of abruptly stopping), are you sleeping, do you need to reconsider your caffeine schedule etc. He's not very good at self-care, and I have to help him figure it out sometimes. This is just a puzzle to solve as best we can with the tools at hand, not a personality defect to be suffered.
posted by Lyn Never at 9:18 AM on January 13, 2015 [3 favorites]

Polly, I'm on klonopin, and it's not awful. There were a few days that I was numb, but once that faded it became a great help to me. Just two cents!
posted by Draccy at 9:24 AM on January 13, 2015 [1 favorite]

Best answer: When I finally filled and took an SSRI prescription in the midst of a long, anhedonic summer of suck, it began to kick in over the first week or two, but I still felt like I had plenty of depression under the surface. But suddenly it felt like there was a surface again. That made a ton of difference in my ability to try to change other things in my life. I don't take SSRIs currently, but I feel like they made a fast & substantive contribution in my personal mental health quagmire when nothing else was really working.
posted by deludingmyself at 9:24 AM on January 13, 2015 [1 favorite]

We keep emergency klonopin in the house. I can't imagine taking it on any kind of routine basis but it's been a real boon in social anxiety tailspins and the occasional can't sleep/rabbit brain issue.
posted by Lyn Never at 9:51 AM on January 13, 2015 [1 favorite]

Best answer: This is a timely question for me, because I'm about to celebrate the one-year anniversary of Prozac pulling me out of the total nervous breakdown that I experienced last year.

So here's the story - I've had a kind of low-grade health anxiety since college. I tended to treat the transient pains and bumps that we all experience from time to time as symptoms of something, and focus on the with a lot of anxiety. This usually ensured that they wouldn't go away (fun fact: if you poke an enlarged lymph node every day to check if the swelling has gone down, the swelling will never go down). Still, usually all it took was a visit to the doctor to calm me down - at that time I mostly always thought I had cancer, and it was pretty easy for doctors to tell me that I didn't have it. What I had never done was seek treatment for my anxiety. I was especially wary of medication, because I thought it would make me mentally less sharp, and, as I would later learn, my sense of myself as the smartest guy in the room was both very important to me and a huge contributing factor in my hypochondria.

So around November of last year I had one of these episodes. This time, however, when I did my usual ill-advised googling, I didn't come up with cancer, I came up with ALS. That started a downward spiral that had me barely holding on for a couple of months. I did strength tests every day. I would obsess over whether I could push up harder with one of my feet than another. I would sit and watch my muscles twitch. My girlfriend (now fiancee) got us tickets to watch the Thanksgiving parade from her office overlooking the route, but I didn't really see that much, because I was reading ALS forum posts on my phone. It was very hard to focus at work. I went to see a neurologist, who told me there was no way I had it, and somehow, even that wasn't enough this time. I barely slept, I didn't go out - basically every day involved getting up, going to work, and then making it through the day until I got home. My personality completely changed; I went from the fun guy at the office to the silent guy at the office. I left my company holiday party an hour early. My girlfriend was as supportive as one can be, but she was getting tired of always talking about whether or not I felt weak, and I don't blame her. Finally, the panic attacks started coming over and over again, and my girlfriend talked me into going to the ER. I left with a three day course of ativan and an appointment to see a psychiatrist.

The ativan helped almost immediately, giving me my first restful night of sleep in a month. It allowed me to function while my psychatrist found the right dosage for me. Turns out is 50 mgs of Prozac. It's sometimes hard to remember what life was like for me then. The best way I can describe the change that the Prozac made is that a few weeks after we found the right dosage, my girlfriend turned to me and said, "you're back!" That's the way it felt to me too, like I lost myself, and like the Prozac gave it back to me.

It doesn't take away all of my anxiety or anything, and I still get stressed out like anyone else. But it absolutely changed my life for the better, and it's scary for me to think about what might have happened to me if I hadn't tried it.
posted by Ragged Richard at 9:58 AM on January 13, 2015 [9 favorites]

Oh, and as per your update, I can see why the ER doc was pushing for klonopin. It works well as a short term thing because it basically sits on top of your adrenal system and doesn't allow you to panic. Even if it's not for you in the long term, a doctor will often prescribe it and have you carry it around as a security blanket. I haven't had a panic attack in a year, but I still keep a couple of ativan in my bag, just in case.
posted by Ragged Richard at 10:00 AM on January 13, 2015 [1 favorite]

Best answer: I used to be on Celexa a few years ago. I resisted any help for a long time (the whole "I failed at dealing with my problems" bullshit a lot of people believe for way too long). Before Celexa, I spent most of my free time hiding in my apartment, avoiding calls and texts, ditching plans with friends at the last minute and stuff like that.

Celexa didn't fix me or my problems. What it did do was make things a little easier. All of the sudden, I didn't feel so worried any more. That bit of comfort allowed me to start making small changes for the better. That relief snowballed and now I am a busy, happy, active person. I'm still anxious but boy do I manage it better. Exercise and physical activity is key. I have Ativan for days when I'm really anxious but I almost never get to that point any more.

I don't take Celexa any more. It killed my libido when I was on it and the withdrawal was brutal when I finally did taper off (under doctor's supervision) but it was completely and totally worth it and I would go on it again in a heartbeat if I felt like I needed to. Good luck to Mr. dactyl!
posted by futureisunwritten at 10:03 AM on January 13, 2015 [1 favorite]

Best answer: I went through a couple of medication shifts in the process of finding out what worked for my anxiety: a couple of instances of adjusting up from lower doses to higher ones, and a couple of meds that had to be switched out because they did nothing (Abilify) or crashed me deep into depression (can't remember which this one was, sorry). Ultimately I ended up on Pristiq and Lamictal. I didn't notice a dramatic change--I think in part because there was so much fiddling about that things altered slowly--but between the medications and pretty intensive therapy, I went from nonfunctional to tolerably functional over the course of a few months.

Last year I dropped both meds due to insurance shenanigans, and at first I was fine, but after a few months I went off the rails again. I went back on the Lamictal and exchanged the Pristiq for Effexor (my insurance wouldn't cover the Pristiq; too expensive). And this time the change was dramatic. Literally within a couple of days the anxiety was *gone,* and I felt better than I had in ages. These days I'm doing a ton of writing and feeling much more capable of getting things done; I also have the mental space to be able to actually use my coping skills from therapy when I do get a little overstressed. I had intense resistance to taking medication at the very beginning of my process, but it definitely helped me, and these days I'm pretty accepting of the fact that I likely will have to stay on the meds to keep my equilibrium. It's worth it!!

It may take a while to get the right combo and dosages sorted out. And definitely don't be afraid to push back against your doctor or find a new one if you don't feel that they're addressing your concerns, or even if you're just not comfortable with them!
posted by velvet_n_purrs at 12:54 PM on January 13, 2015 [1 favorite]

Best answer: I took an SNRI (Venlafaxine aka Effexor, 150mg time-release OPD) for a year. TL;dr version: It made a huge positive difference and my only regret was not seeking medical help sooner.

I saw a difference in about two weeks, and was massively improved by about week six. Meds can work, but they take time and in a lot of cases several attempts to get the medication and the dose right. Don't get discouraged, and be patient -- but don't be afraid to switch doses, meds or even doctors if you're not getting a good result.

There were side-effects, but (at least in my case) these were enormously less of an embuggerance than being miserable 100% of the time for no rational reason. Missing a dose was not fun -- google "brain zaps". Stopping absolutely required tapering off the dose. I had a slight loss of libido, and gained some weight.

But on the plus side, the pills took me from "unable to enjoy anything and unmotivated to do anything" to actual functional living human person. It was about 95% making what had previously seemed like insurmountable problems clear as the irrelevant trivia they actually were. That left about 5% having the energy and drive to actually do something about the genuine sources of stress and anxiety.

Before pills, it was like I had a record playing 24x7 in my head going over all the (wildly unlikely) scenarios of what was going to go wrong and everything would be ruined forever. After, I could get stuff done, feel good about it, and start the next day in an incrementally better mental place than the day before.

> I think he feels a failure for being depressed, and I think he's pretty damn scared right now.

I've been in that place. That's a big part of why I'm writing this here where future employers might read blah blah etc.

Depression shouldn't have a stigma. If you have too much or not enough of some chemical in your brain, that is no more your fault than if some other random body part didn't work. It isn't a moral failing. It isn't a consequence of bad life choices, excess, laziness, weakness of will or lack of discipline. It's genetics and chemistry.

But depression *lies*. It creates fake problems where none exist. It makes real problems seem bigger and closer. It makes solutions seem hard and unlikely and far away. That's not real -- that's the disease changing your perception, because that's what it does.

Those people you think will judge you and reject you for having depression? Most of them don't actually care. The ones who do care will support you. It's very hard to believe this because *depression lies*.

It is scary. But it gets better. Science can help fix this.
posted by sourcequench at 1:39 PM on January 13, 2015 [4 favorites]

Best answer: OMG - We JUST DID THIS. Like, this very exact thing. Our baby is 16 weeks and Dad's been on Lexapro since my third trimester.

My husband's father is bipolar and was, to cut a long story short, a crap dad. Needless to say, my husband had a lot of childhood issues to work through, anxiety around becoming a father (to a son!) himself, and had some buried preconceived notions about medication (despite working in mental health services; his primary experience was of his father on many very very hard drugs).

My husband spent my entire pregnancy in therapy. It helped until he plateaued early in my third trimester and then had a panic attack at work (he cried in front of high-school aged patients > it was bad). He made an appointment with the therapist and his GP, got diagnosed with GAD and got a prescription for Lexapro. When we talked at home about his GAD and the actual thought processes he'd been trying to ignore (and not sharing with me) I was kind of shocked - I can't believe he waited as long as he did // my brain definitely does *not* do that to me!

So you start on a low dose of Lexapro and work up, and he initially felt kinda crappy and then levelled off and felt better. He started feeling better maybe, oh... two weeks in? Ultimately, he ended up upping his dose from the introductory 5mg to the very very standard 20mg + 30-40 min of power walking (fast heartbeat + sweat inducing) most days (often he takes the baby in the pram so... extra exercise!). He feels SO MUCH BETTER. He's himself again, a better partner, a better dad, etc. The only side effect has been some slight weight gain (which worries *him* but frankly, on his solid 6'3" frame I can't tell).

Right before Christmas (great timing, eh?) he had his prescription filled at a different chemist, got a different brand of generic, and immediately we both noticed it "wasn't the same". He moped, was cranky, etc. He went back to his old chemist after the holidays, got the old generic he's used to, and immediately felt better again within days.

Your husband is an absolute champion for Taking Care of Things and Doing What Needs Done. He's setting a great example for your child. He's being a great dad and partner.

Classic of course but... if you cut yourself, you'd put a band-aid on, right? This isn't different.
One of the things that really helped my hubby feel better about the whole thing was listing everyone we knew who had a mental health diagnosis of some sort and been in therapy/on meds at some point (it ended up being almost everyone we knew). Life is hard - and modern life is really hard, and babies are hard, and he's had a hard year! Totally normal.

My husband ALSO got a sleep study done, was diagnosed with mild sleep apnea, and fitted with a hardcore mouth guard to stop him snoring/grinding teeth/etc. Personally, I can see my moods and ability to cope shift in direct correlation to how sleep deprived I am to an extent that's actually super scary. I'm 100% sure that if I'd had a "hard" (colicky, fussy, crying) baby I'd have had PND. I got super lucky with a healthy easygoing baby, and still - after a few wakeful nights I'm suddenly despondent, crying, hate everything, and super anxious about whether the baby is "OK". If you guys aren't sleeping much yet, this is probably adding to it and is an element that will not last forever. If there's ANY way for one or both of you to spend the occasional night in a different room getting a full nights sleep DO IT. It makes a huuuuge difference. Sleep deprivation is no joke - it's a form of torture and will literally drive you insane.

So, we have a 16 wk old. God, Newborns are SO HARD - do not underestimate this! Shit absolutely IS fucked. Watch TV and eat take out - cop out of as many things as you can. Ask for help, take people up on any offers to help. Know that things change soooo much, especially around 10 weeks, and then rapidly after that (my kid at about 14 weeks). Don't underestimate how much a little positive feedback from kiddo helps. Things get better. SO much better. Hang in there!

MeMail me if you/hubby want to vent/chat to me/my hubby about mental health stuff, baby stuff, or anything at all! HUGS
posted by jrobin276 at 1:51 PM on January 13, 2015 [4 favorites]

Response by poster: You guys are amazing and I'm soooo glad I asked this question. Two pills in and he is a changed man. I am in stunned shock and it seems like everything he has been trying not to feel is coming out now.

I can tell by your phrasing that you think of medication as a big scary thing that should only be undertaken in the gravest of circumstances and needs to be apologized for and mitigated by talk therapy, but I feel like if you're not feeling well and science has found ways to help many people not feel so bad, not trying it is self-defeating.

I felt this way until pregnancy, when Shit Got Real for me. I am dealing with issues with my distant and neglectful mother. Now it seems easy to advocate for meds but the truth is I was seriously unstable a few short months ago.

If you guys aren't sleeping much yet, this is probably adding to it and is an element that will not last forever. If there's ANY way for one or both of you to spend the occasional night in a different room getting a full nights sleep DO IT. It makes a huuuuge difference. Sleep deprivation is no joke - it's a form of torture and will literally drive you insane.

Our girl is 13 weeks and sleeps like a champ (sometimes)! Now that we have started on this journey we can attend to his sleep apnea, psoriatic arthritis, and childhood trauma.

Thank you so much everyone...!
posted by polly_dactyl at 2:11 PM on January 14, 2015 [1 favorite]

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