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November 20, 2005 7:50 PM   Subscribe

I want an antidepressant that makes me less ballistically ANNOYED at the world...

I know that I have low-level depression, and have for probably 15 years or so. I'm considering asking my MD and therapist to think about an antidepressant for me. Wellbutrin has worked pretty well in the past and might again, but I wanted some of those sweet AskMe personal anecdotes about a specific requirement I have of an anti-depressant.

I'm finding that in the past year or so, I am constantly, almost distractingly annoyed. Like, on-edge, ready to snap, can't deal ANNOYANCE. I'm 35 and I feel like a crotchety old 75 year old man.

Any little thing causes me to just SEETHE and rant and rave - bad driving, loud noises, people chewing, going throught the metal detector at the airport, dogs barking, bad grammar, babies crying, pedestrians, cashiers, crappy service, people giving me plastic bags when I ask for paper....seriously, all of these stupid things make me want to shoot someone. It's getting worse all the time, and it's exhausting. I AM ANNOYED AT EVERYONE AND EVERYTHING. It's different than my usual "blue cloud" depression - it's anger and impatience like I've never felt. My life is one big eyeroll and sigh.

So...uh, is there a particular kind of (or name of) anti-depressant that might take the edge off this? Something that would help me just LET SHIT GO that doesn't affect me and just deal with the world like a normal person? It's ridiculous - my friends are starting to get sick of me.
posted by tristeza to Health & Fitness (35 answers total) 3 users marked this as a favorite
tristeza, You may very well be depressed. However, what you describe could also be an anxiety disorder rather than a clinical depression. Do you have a tendency to worry? In fact, just look at this page and see if it's not closer to what you're experiencing as opposed to symptoms of clinical depression. Your irritability sounds like it is definitely on the high side which sounds, to me, more indicative of high anxiety. Sometimes it is a very tricky diagnosis and many doctors will treat you with an anti-depressant anyway. But getting the right diagnosis is critical to long-term treatment and decisions regarding medication.

posted by Independent Scholarship at 8:11 PM on November 20, 2005

I should also mention that GAD can occur with depression as well. It's just that your description seemed more like symptoms of anxiety.

posted by Independent Scholarship at 8:14 PM on November 20, 2005

I've just come off a similar period ... the irritability and general impatience were really mounting, my wife was getting bugged, and I was feeling like a jackass a lot because my general sense of reserve was just gone.

I got a counselor and started working through a lot of emotional stuff I'd just been deferring ("reserved," it seems, is sometimes another way to say "repressed").

I also went on lexapro after several weeks of counseling, and with my therapist's and a nurse practicioner's concurrence that I've probably spent most of my adult life suffering from dysthymia, which is a sort of depression

In terms of side effects, I can't say there have been many. My need to sleep for an hour in the afternoon regardless of how much sleep I got the night before is pretty much gone, unless I'm just really under-rested. My sleeping's gotten better and more regular in general. There was a period of sleepiness that was a little hard to cope with in the first three weeks, but it dissipated pretty quickly. I certainly haven't felt particularly manic or wound up, though it has been easier for me to stay on task, even with stuff I don't ordinarily want to do for long.

It's been a very good experience for me. A lot of personal maintenance stuff I always let slide because I'd just slip into a braincloud or decide it wasn't worth bothering with is a lot easier for me to do. I've continued with counseling because I want to use the leg up the medication gives me to tackle stuff I'd never bothered to address before, and hopefully undo some of the depressive cycle I found myself in.

I'd say counseling first, though, before looking for meds. Lexapro has definitely improved my general mood and demeanor, but for the symptoms you're describing, just going to a counselor and figuring out where the irritability and anger were coming from fixed the part that made me hard to be around.
posted by mph at 8:20 PM on November 20, 2005

I am on Celexa, and when I forget to take it for a couple days, I feel EXACTLY the way you describe. Maybe your dose is too low.
posted by clh at 8:22 PM on November 20, 2005

Wellbutrin is what helps me with similar irritability issues. In the past, when I've gone off it, I get the same exact feelings. With wellbutrin, I don't. I've also used rational-emotive behavioral therapy and cognitive behavioral techniques to help, but Wellbutrin works better and is much easier. I still use the REBT/CBT positive self-talk, but I find that both *together* is ideal for my particular patterns of irrational thinking.

(You don't have to see a therapist to use REBT or CBT. There are some great books and a lot of free stuff about both online. However, if you can afford it and it's something you are willing to try, a cognitive behavioral therapist can sometimes work wonders.)
posted by acridrabbit at 8:32 PM on November 20, 2005

Thanks for the answers so far. I just want to clarify in case it wasn't already:

- I *am* in therapy, have been for about 5-6 months
- I am NOT currently on anti-depressants, and haven't been for about 5 years
posted by tristeza at 8:36 PM on November 20, 2005

Your post reads like you're not taking Welbutrin right now, but FWIW, what you describe sounds exactly how I felt on Welbutrin. I don't know where I'm trying to go with this, but I thought it was worth mentioning.
posted by crabintheocean at 8:36 PM on November 20, 2005

(sorry, posted same time as you)
posted by crabintheocean at 8:37 PM on November 20, 2005

I was on Zoloft (200 mg, which is high) for about 6-8 months. It was such a godsend for me that I was sorry I waited until I was 28 to finally see a doctor about going on meds. While I was on it I had a spell of migraines with vomiting which interfered with the absorption of the medication, but I didn't realize it until I experienced the withdrawal symptoms. The only way to describe it would be that I wanted to rip my skin off and run around as a skeleton. There have been times since where I've said "I need to go back on meds" but nothing short of a breakdown would make me risk experiencing that again.
I did wean off the meds and didn't have those problems, but to me, it's just not worth the risk of it. If you're at the point where you do want meds and you are in counseling, don't limit yourself just to antidepressants. There could be other things that could be used in your situation.
On preview: Apparently my stance on this isn't clear - I can't tell if I'm for or against it. So basically, just be fully aware of the risks.
posted by TTNoelle at 9:09 PM on November 20, 2005

Paxil handled my depression best but shortened my (already severely challenged) attention span to nil. Can't- address- an- envelope- from- start- to- finish nil. Plus, getting off it was a BITCH.

Zoloft was pretty good in treating the depression, but really made me crave alcohol in an insane way. Which is odd, because I am the child of two alcoholic parents (both of whom died prematurely from drink) which reactionarily makes me as close to a teetotoler as you're going to get. Which brings me to....

Wellbutrin, which handles the depression only so-so but seems to have none of the unpleasant side effects.

C'mon Tristeza! We're in Seattle! It's been fogged in for several days! The monorail just got voted down and the new Grocery Outlet down the street was tagged over the weekend. Between that and light deprivation, we've earned the right to be bitchy, doncha think?
posted by DawnSimulator at 9:14 PM on November 20, 2005

I think the anti-depressant you're looking for is called "marijuana."

If you choose to self-remedy, you will wish to visit Overgrow. There are people who take the medicinal approach seriously and it makes for interesting reading.

Oh, and since it looks like you're in Seattle, this is a very viable solution. Probably find it growing in your back yard...
posted by five fresh fish at 9:20 PM on November 20, 2005

Whatever you do, I would recommend not taking Effexor -- I've read that the withdrawal is fierce if one were to try to stop taking it.
posted by Handcoding at 9:26 PM on November 20, 2005

I have heard that good ol' Prozac is good for irritation. I will second the "stay away from Effexor"; withdrawl is hell and furthermore, it may change you into someone your 'real' self would not like.
posted by Rubber Soul at 9:50 PM on November 20, 2005

I've had similar irritability issues, and I second the thought that this might be anxiety rather than depression. CBT can be useful for both...and I also found that hard exercise (not just walking) helped me be less grumpy.

In terms of medicines, "the plural of anecdote is not data"...Personal anecdotes are cool, but keep in mind that unfortunately YMMV--a lot--in the effect that a particular antidepressant will have. Heck, specific antidepressants haven't even had the same effect on me as they have on my mother or cousin, and we're likely to have somewhat similar body chemistries. Effexor was great for me but did nothing for them, vice versa with Paxil.

That said, frequently doctors start you out with SSRIs, (which inhibits serotonin reuptake) because they have fewer side effects than other antidepressants (such as tricyclics). There are also SSNRIs (Effexor and Cymbalta) which inhibit both serotonin and norepinephrine reuptake. Wellbutrin is different from any of the above-mentioned, and inhibits the reuptake of dopamine and norepinephrine.

So, um, YNMV-Your Neurotransmitters May Vary.
posted by needs more cowbell at 9:56 PM on November 20, 2005

I personally went through the laundry list of anti-depressants with about the same results on each one: a mild increase in mood along with a severe increase in irritability. From depressed and calm to less depressed and raging in a few weeks! Whoo!

I finally found a nurse practitioner that thought outside the box a bit, theorized that I was sensitive to seratonin effecting drugs (most modern anti-depressants) and suggested that I try Topamax. Yes, it's a epilepsy drug, but it works well as a mood stabilizer as well. So I'm no longer depressed and calm, more middle of the road to happy and calm. This is a very good thing.
posted by ensign_ricky at 10:09 PM on November 20, 2005

One of the things that kept me from getting mental health help for a LONG time was that I was constantly angry and annoyed with everyone, rather than constantly sad.

That said, I've had a lot of luck with antidepressants that are prescribed for obsessive compulsive disorder, like Paxil and Zoloft. They have literally let me take control of my thoughts and choose what I want to focus upon.

When it comes to antidepressants, especially on the Internet, people who experience adverse effects are likely to be more vocal. If you have biological relatives who take antidepressants and are willing to share their experiences, that might be a more useful way to gauge potential side effects.
posted by gnomeloaf at 10:12 PM on November 20, 2005

when in comes to anger, what helps me is an aerobic workout (doesn't have to be sophisticated. can even be half an hour of walking) or writing it out.
posted by mirileh at 11:57 PM on November 20, 2005

Five Fresh Fish is correct.
posted by Goofyy at 12:51 AM on November 21, 2005

I tried Prozac for similar issues you described. I started on a low dose (10 mg) and it made my agitation so bad I never took my second and subsequent pills. Afterward, I found out that Prozac is a very activating antidepressant. If you try ADs again, look for one that is less activating as those are less likely to aggravate anxiety. Paxil is sedating but has its own issues related to its very short half-life. Lexapro is middle of the road on the activation scale and has relatively few side effects, so it would be a good candidate.
posted by rhiannon at 3:02 AM on November 21, 2005

Sounds like a case for Wellbutrin (barring a steady source of weed) Unlike the mainstays like Zoloft, Paxil, etc, Wellbutrin acts on the dopamine levels in your brain. It seems tailor-made for cases like yours.
Works for me, anyway.
posted by Thorzdad at 4:57 AM on November 21, 2005

I realize that your low-level depression is probably a chronic condition if you've had it for a long time, but have you ever gone through any sort of counseling? I tend to be annoyed in a similar way occasionally, and it's usually because I'm frustrated with my life -- I'm not feeling productive at work, I'm not making good use of my idle time, and both coming home and going to work seem like a chore.

If you're being critical of other people because of absolutely trivial things, what are you feeling about yourself? Do you get pissed off when you're driving and miss a turn, or even feel angry for oversleeping a few minutes? If you can talk to someone, who doesn't necessarily need to be a professional, and take a step back from your life to figure out what would make you happier, then maybe the small troubles of the world will fade out.
posted by mikeh at 7:31 AM on November 21, 2005

Prozac handled my depression so I've never seen any reason to go off it, though I only take it MWF these days and that's sufficient. Since it's got such a long half-life you can get away with doing that with prozac but not other ADs.

While I'm certainly more irritable and meaner off it, altering my reactions to the world was something that came after the medication. I used to have much more the situation/outlook that you do and for me not being that way started with not being that way. I liken it to the presumption in Pascal's Wager that by sufficient practice of a certain belief you achieve that belief. Less obtusely, negative behavior is self-perpetuating, particularly when it comes to perception. Once you think "geez, what an asshole" and start pondering what an asshole that person is, you solidify that perception that the person is, in fact, an asshole.

I think it's a long and constant effort to overcome that attitude but for myself I'd say it's been well worth it. I'm certainly happier now in my 30s than I was when I was prone to stew in irritation in my 20s.

Another little mental practice that's been helpful in achieving this outlook has been keeping it in my mind that everyone views their life with themselves as the central character and nobody casts themseles as the villan. They may be completely oblivious or rationalizing everything they do, but they still think they are "good." It's a lot easier not to be pissed off all the time when you realize "wow, they really think they're right." It opens up a whole other bunch of ways to be annoyed at folks but I think its a net gain in stomach lining.
posted by phearlez at 7:54 AM on November 21, 2005

I posted about this in this recent thread but I'll mention it again here: addressing my diet and use of caffeine and sugar really helped with my irritability. Just another thing to think about.
posted by teleskiving at 8:10 AM on November 21, 2005

I'm on Wellbutrin, and while I'm irritable both on and off it, I'm less irritable on it. And I've found that a consistent yoga practice helps curb that irritability to basically nothing, even when I'd otherwise be under stress. If I were not on Wellb right now I would see how much overall value I got from daily ashtanga alone, hoping to skip the drugs altogether.
posted by xueexueg at 8:19 AM on November 21, 2005

I've done a good many of the SSRIs and the SSNRIs and marijuana too. I recently decided to skip them all and try another approach. I am currently trying GTD, meditation and exercise.

It fails sometimes, for example when people linger on cell phones while on subway steps, but overall, I am slowly becoming more accepting of other people's actions, even when they inflect my own, and just dealing with it. It's tough and it may require going through the meds path.
posted by kingfisher, his musclebound cat at 8:55 AM on November 21, 2005

Effexor XR works pretty well. I've taken it and Lexapro both and both have their upsides and downsides. Alex mentions the withdrawal issues - I can speak from personal experience from both (although it is obviously anecdotal and subjective) that the withdrawal can be unpleasant, but it is also temporary. It does make you feel wonky, but you can gut it out. It's not debilitating. Your mileage may vary, yadda yadda....
posted by TeamBilly at 8:56 AM on November 21, 2005

If you want to read about some real life experiences with various anti-depressants, check out CrazyMeds.

I've been on Lexapro, (which eventually stopped working) and Zoloft, which really works well for me. Finding the right anti-depressant can take some trial and error, so find a good doctor who is willing to make med changes.
posted by Serena at 9:20 AM on November 21, 2005

Irritability is a common symptom of depression; in men, the young, and the elderly, it can actually be a more common symptom than an overt depressed mood.

My guess would be that anything that effectively treated the depressed mood would improve the irritability too, as they are pretty much two manifestations of the same underlying phenomenon. If I were treating a patient I would certainly proceed under that assumption; there aren't any meds I'd go to specifically, unless there were rage attacks that were causing violent behavior (and it doesn't sound like that's the case.)
posted by ikkyu2 at 10:28 AM on November 21, 2005

Consider simply "St. John's Wort". My father swears by it whereby he formerly had an anger and stress problem, but after taking it regularly noticed a stark amiability with people in situations that had normally stressed him greatly. It's an OTC herbal, not a prescription.
posted by vanoakenfold at 10:47 AM on November 21, 2005

I think the anti-depressant you're looking for is called "marijuana."

please, don't consider marajuana and especially don't self medicate if you do. it's difficult to know how strong street bought weed is and there are serious studies linking cannabis and psychosis in those susceptible.

get some professional advice from your doctor and a psychiatrist instead. they should be able to advise on alternatives to antidepressents too (like st johns wort and exercise, for example).
posted by tnai at 11:25 AM on November 21, 2005

i should probably add that if the doctor/psychiatrist do not advise (or even mention) alternatives and reach straight for the presciption pad after 5 minutes then they're not worth your time (but i probably don't need to tell you this). go and see another doctor/psychiatrist and get as much info as you can.
posted by tnai at 11:31 AM on November 21, 2005

Hey, all, thanks so much for the thoughtful, nice responses. I realize that anti depressants are not "one size fits all" but your insight is helpful. Oh, and regards to "self-medicating" - I'm down with that already and I'm STILL a raving beeyotch. :)

posted by tristeza at 1:17 PM on November 21, 2005

Prozac is all I've tried (twice for about 2 years both times) and it helped me a ton with both depression and irritability. Going off it was really easy too (meaning no crazy side effects as I tapered off).
posted by echo0720 at 1:30 PM on November 21, 2005

Is this a jonmc sockpupet?
posted by Paris Hilton at 9:40 PM on November 21, 2005

The world is louder and more irritating than it used to be -- the ubiquitous electronic chirp of cell phones being a prime example. Not to mention the loud conversations after the ring! I think people are more inconsiderate than they once were, and I think it's because our over-charged society keeps us running from one task to another, all of us just strung out almost beyond control.

That said, you've still got to cope with what's out there while maintaining your own sanity and not getting arrested for grabbing a stranger's cell phone and smashing it into tiny pieces before you run over it multiple times.

I take Wellbutrin and Effexor, which work okay. The "I hate people" mood still hits me sometimes, though. What helps me most of all when things get to be far too much is to retreat. The noise of modern life seems to be a big problem for me, so I drive without the radio on for a while, hole up at home with as few interruptions as I can arrange, and spend a weekend and as many weeknights as I can doing nothing - no TV, no radio, no books unless they're funny. I also try to eat well. After about a week of this, I can face (hear?) things again.
posted by Jaie at 2:15 PM on November 22, 2005

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