Do antidepressants heal your brain and reduce risk of future depression?
February 20, 2020 1:57 AM   Subscribe

Considering going on antidepressants again, but really wasn't a fan of some of the side effects (I tried a couple). Before I go back to the doctors, can anyone point me to useful resources on the short(ish) term use of antidepressants (1-2 years) and the longer term effect this can have?

My doctor explained antidepressant use to me as a way of protecting the brain from stress (I've had like five years of trauma) and letting it heal, so that I could eventually come off and feel better naturally. He also said it would help me do the things I needed to to be well like take exercise etc.

So I took antidepressants for about eight months, then came off, and had the worse time ever. Brain zaps for months, crying all the time, very depressed (it's difficult to parse this with other life events to some extent as there was a lot going on and I was looking after a terminally ill parent, but before coming off I was generally much calmer about it and not crying a lot - in fact I was a bit numb, which I didn't like).

I'm having a really hard time again and kind of desperate for solutions (and don't seem to be able to keep up consistent exercise or meditation, which I know would help). I also think I have gotten into some extremely unhealthy thinking patterns which feel almost indelibly printed on my brain. Are there any studies that suggest that if I take antidepressants this can be helped in the longer term, even if I come off?

From what I've seen, info online seems to contradict what my doctor said. One study said antidepressant usage was like putting weight on a spring - as soon as you stop, the brain springs back and overcorrects - plunging you back into depression (this was my experence) - and also they stop you being able to regulate your neurochemistry in the longer term.

Has anyone else looked into this? I might try harder on the exercise and meditation if there is indeed no proof that antidepressants are not just a sticking plaster (of course a sticking plaster is still very helpful in extreme situations, and I don't judge anyone for wanting this effect. I just don't think I do).

Oh and I also know I can try different antidepressants for different effects if I do try them. I was on SSRIs before, am thinking maybe Wellbutrin although concerned this will make me very anxious - which I already am (I'm probs more anxious than depressed most of the time).
posted by starstarstar to Health & Fitness (15 answers total) 7 users marked this as a favorite
Antidepressants are linked to brain plasticity (specifically, to growing new neurons in the hippocampus, an area related to learning, memory, and counteracting depression). And short term use is also linked to increased bone density in animals.

So yeah, short term use could be a “sticking plaster“ that also continues to benefit you after it is removed.
posted by hungrytiger at 2:26 AM on February 20, 2020 [3 favorites]

Here is a slightly less wonky article about SSRIs and neuroplasticity. (Exercise is thought to encourage the brain to change, too.)

(Also, with regards to the meditation, I really like the app 1 Giant Mind, which teaches a TM-type technique that is a LOT easier to adhere to than many other styles of meditation, and which was of great comfort to me during a rough period, and is also 100% free. The graphics are cheesy, but it works.)

I hope you feel better soon.
posted by hungrytiger at 2:41 AM on February 20, 2020 [12 favorites]

When you came off them last time, did you ramp your dose down slowly over a couple of months or did you just stop?

I've heard lots of medical advice that says just stopping is perfectly fine for the SSRIs with longer half-lives, like fluoxetine; I've never once heard that from somebody who has actually done it, doctor or otherwise. Everybody I know personally who has quit an SSRI suddenly (me included) has been through quite a nasty month or two afterwards.

Ramping down slowly, on the other hand, is generally reported as having a quite manageable intensity of negative effects.
posted by flabdablet at 3:25 AM on February 20, 2020

Thanks Hungry Tiger - will check that app out! I really don't want to go on anything I don't have to.

Flabdablet - I actually ramped down extremely slowly, over a number of months, which seemed to mean brain zaps and other associated symptoms for a long time!
posted by starstarstar at 3:48 AM on February 20, 2020

I remember reading about a major study that looked at how effective antidepressants are, and it said that therapy is equally effective. I can't speak from personal experience but think that what you'd learn in therapy would also help in the long term.
posted by pinochiette at 4:11 AM on February 20, 2020

I thought antidepressant for the shorter term were mostly used to help you get on your feet again, have enough bandwith for therapy and other things to become healthy again.
posted by LoonyLovegood at 4:12 AM on February 20, 2020 [1 favorite]

If you're depressed for reasons, that is feelings about who you are in relation to others and the universe, these reasons aren't going to disappear because you take pills. Typically these emotions are unformulated or unthought about because they make you feel even worse. E.g. if you feel unlovable, all a pill can do is lower the volume on it. If that enables you to behave differently and thereby collect new evidence that contradicts and thus revises the feeling, it can have lasting effects but in practice, pills alone usually don't do this.
posted by Obscure Reference at 5:42 AM on February 20, 2020 [7 favorites]

I don't have any articles for you and I'm not a medical person, but I've taken antidepressants and Have Opinions About Them.

I think the ideal use case for antidepressants for chronic depression or anxiety is to reduce the lows enough so you can get functional enough to get into therapy and work on underlying issues and healthier thought patterns. Thinking healthier is something you need to be taught, or learn, and is not something you can count on happening automatically by taking pills. Unhealthy thought patterns cause and deepen trauma, while healthy ones pull you out and let the trauma heal.

You should also find a medical practitioner you trust to manage your medications, and then do what they say. Lots of communication with them is key. Going down the rabbit hole of becoming an expert on medications, like in this scene from Silver Linings Playbook, is not good. Yes, you should be educated on what you're taking, but when you're in the depths of mental illness, you are not in a good place to think about that objectively.

Good luck and I hope you feel better.
posted by bright flowers at 7:24 AM on February 20, 2020 [6 favorites]

If you're still feeling down, you really should be taking something. Bear the following in mind:
  1. Antidepressants work best alongside therapy. When I have done them together in the past, I was always able to overcome my problem and eventually get off the drugs. Lately for, as you put it, Reasons, I have only been taking the pills, and though it had the initial uplift I needed things have not really improved. Be sure to get some therapy.
  2. SSRI experience varies widely with the consumer, and what works for one person can be a nightmare for another. There are dozens of choices, all different. (I eventually wound up with Welbutrin, which mediates neurotransmitters other than serotonin, but I understand it works only for 45% of the people who try it). It's important to let your doctor know about the problems you had, and to take something more effective and less deleterious next time.
Good luck, and feel better soon!
posted by ubiquity at 7:28 AM on February 20, 2020

For what it's worth, I'll also give a shout-out to bupropion (Wellbutrin) vs SSRIs. Tried Celexa & Prozac, had the side effects you mention (general numbness, brain zaps), plus loss of libido. I get none of that on bupropion. About the only negative side effects I get are a slight headache, and drinking alcohol is a lot less fun (which isn't really a bad thing at all, right? You're not supposed to drink on it anyway). For me, it's activating, gives me enough oomph to do the things I need to do to take care of myself. I do not tend toward anxiety, though, so ymmv.

I initially started taking it while doing therapy, for Reasons, now I take a low dose only during the winter to combat SAD. It took me...awhile, to just accept this as a tool that keeps me from really plummeting down. I taper off in the spring, out of an abundance of caution, but haven't noticed any relapse effects.

Best of luck.
posted by Bron at 7:53 AM on February 20, 2020 [2 favorites]

I've used antidepressants on and off and over the course of my adult life, mostly SSRI's. I feel that they were quite effective in rescuing me from serious depressive episodes. I write 'feel' because there was no control study version of me to compare my results to, so no way to know whether I would have eventually recovered if I hadn't taken the drugs. It's also impossible to know how long it would have taken me to recover without drugs, assuming 1) the drugs were actually efficacious and 2) I was going to recover. In the acute pain I was in, time-to-recovery mattered a lot to me. So, recovering one to two months earlier was huge.

There are studies that show minimal, if any, difference in recovery rates for those who take antidepressants vs. those who do not. There are also studies that show the opposite. But your question isn't really about whether they work - it seems that you believe they have helped you - but whether they can provide a longer-term boost to resiliency that is sustained even after stopping them. I'm inclined to say 'yes' based on my personal experience. That's if you can get past the protracted withdrawal period.

I took Prozac for about 2 years in my mid-thirties and then tapered after being recovered from depression for about a year. I don't recall any withdrawal symptoms other than mild brain zaps. Maybe about a year after my stopping Prozac, my spouse became ill with the disease that would kill him 5 years later. Over the next 5 years, I supported him through the grueling illness and treatments, raised one child, became pregnant with a second child, gave birth to that child, buried my spouse while she was still an infant, started life as a single parent while deeply grieving, and began to rebuild my life after the worst of the grief lifted. I did this without antidepressants.

Did my earlier antidepressant use give my brain some sort of protection against what should have been a soul-crushing depression due to life circumstances? Or, had I become more resilient due to talk therapy, family and community support, and just generally learning better coping skills? I don't know. I'll never unravel the skein of what worked and didn't work to keep me healthy during that incredibly difficult time.

Now to the present. I took my last Cymbalta dose three weeks ago. This was after 10+ years and one unsuccessful attempt to wean 6 years ago. Both withdrawals were an intense, miserable experience. My withdrawal symptoms have included the physical - dizziness, nausea, insomnia, appetite disruption - and the psychological - extreme irritability, anxiety, intrusive thoughts, sadness. Because these symptoms came on abruptly and dramatically after dropping my dose below 10 mg, I credited them to the withdrawal and not a return of the original depression that put me on the drug in my mid-forties.

There is tons of anecdotal evidence to support this. I spent a lot of time seeking validation of my experience at (Be warned: like all online communities that are formed around a negative experience, the stories are extreme and posters tend to point to antidepressant withdrawal as the singular cause of their pain and decreased functioning.) I've found the experiences shared there to be quite consistent, particularly the description of mental symptoms and how they are immediately improved by reinstating the drug. This was my experience as well during my first attempt at withdrawal. I was better - and I mean completely normal after weeks of mental and physical turmoil - within one hour of restarting Cymbalta. If that was the placebo effect, it was one helluva an effect.

I am starting to feel better but I'm not fully recovered from withdrawal. The intrusive thoughts around violence and crime are particularly distressing. I'm realizing that I have to do a better job of avoiding triggers, i.e., news and entertainment that will trigger these thoughts. Intense exercise and meditation are helping. It's hard as hell to meditate, particularly when I am feeling agitated and sad, but I do find that the simple act of sitting down to do it confers some benefit.

I know that my brain was incredibly resilient while I underwent the trauma of my late thirties, early forties. I just don't know why. I am counting on my brain to be restored to its natural, healthy state after withdrawal is complete. It's done it several times before and it's already showing its ability to heal now. Brains get better. The key is knowing how much suffering to tolerate before deciding that you need a Plan B, i.e., returning to medication, talk therapy. I recommend putting a date on the calendar that is one to two months out - if you can tolerate your current state that long. If not, make it 2 weeks. Then, re-evaluate at that point. Are you better, even marginally? Are you worse? If you're feeling the same will you consider that a 'win' of sorts and then put another 2 weeks on the calendar? In other words, monitor your state intentionally, and evaluate at each calendar milestone how you want to proceed.

This internet stranger sees you and knows your pain. There is no right choice. You are doing the best you can and you have the right to decide at each point in your journey what resources to deploy while you help your brain heal.
posted by MissPitts at 8:41 AM on February 20, 2020 [5 favorites]

As a therapist (IANYT) if you struggle with dysregulation, it can make it hard to learn new coping skills to get out of a funk (or out of a crisis) if your brain chemistry is way out. I work with lots of folks with eating disorders, and they struggle to engage in CBT when their neurotransmitters and other hormones aren't doing what they're supposed to be. People do it, but it's harder.

There is something to be said for activation theory for mild to moderate depression and anxiety. If you are able to, act as if you are happy and non-anxious. Being active and social and acting as if you are not depressed works well for people with mild depression. If you are not able to do this, it's possible you need a bio-chemical boost.

Trauma can make the parts of your brain that sense danger over-sensitive to stress and impede longterm coping. If you've undergone trauma, you may have a "broken smoke detector" and be interpreting non-dangerous things as dangerous and scary. It is hard to stop this on your own once it starts. It is true that if you are in a loop where you are constantly feeling triggered, you are being exposed to more hormones like cortisol and adrenaline than are particularly good for your brain or the rest of your body. Meds could give you a vacation and a reset, so that you can stop having this reaction to stress and fix your smoke detector.
posted by unstrungharp at 10:06 AM on February 20, 2020 [11 favorites]

I'll chime in with anecdotal information re: bupropion and anxiety. I tried and didn't respond well to multiple SSRI meds many years ago. Too flattening, too restless-intensifying, too whatever. Bupropion didn't do this to me, and didn't make my anxiety worse either. I also stopped it cold turkey and didn't notice a rebound effect but I'm not recommending that to anyone.
posted by crunchy potato at 10:22 AM on February 20, 2020 [1 favorite]

This research is controversial, but some studies suggest that taking antidepressants can actually worsen long-term outcomes. Here's an excerpt from an article about the subject:
Now Antidepressant-Induced Chronic Depression Has a Name: Tardive Dysphoria

Three recently published papers, along with a report by a Minnesota group on health outcomes in that state, provide new reason to mull over this question: Do antidepressants worsen the long-term course of depression? [...]

Although this concern first surfaced in the late 1960s and early 1970s, when a handful of psychiatrists expressed concern that antidepressants were causing a “chronification” of the disorder, it was in 1994 that Italian psychiatrist Giovanni Fava, editor of Psychotherapy and Psychosomatics, urged the field to directly confront this possibility.

He wrote: “Within the field of psychopharmacology, practitioners have been cautious, if not fearful, of opening a debate on whether the treatment is more damaging [than helpful] ... I wonder if the time has come for debating and initiating research into the likelihood that psychotropic drugs actually worsen, at least in some cases, the progression of the illness which they are supposed to treat.”
Here's a reference to one of the papers cited above: "Tardive dysphoria: the role of long term antidepressant use in-inducing chronic depression", by El-Mallakh RS, Gao Y, and Roberts JR. Medical Hypotheses. 2011 Jun;76(6):769-73.
posted by alex1965 at 4:36 PM on February 20, 2020

also they stop you being able to regulate your neurochemistry in the longer term.

My brain is not your brain. I tried one anti-depressant many years ago and could not handle the side effects. More recently I tried a very low-dose anxiety medication that worked for quite a while and then stopped working. I have had health anxiety since I was 10 years old. I got my ADHD diagnosis in my 40s. But I have also been depressed for virtually my entire adult life. Sometimes it was a deep depression but usually it was kind of like having a low-grade fever. I could tell how severe it was in part by how frequently I had suicidal thoughts, which I understood correctly was not something that I wanted to act on but as simply bad information my brain would send me when I was feeling powerless or unhappy or whatever.

In December my doctor recommended I start a new antidepressant because increasing the dose of the anxiety medication had intolerable side effects for me. He said this new medication had relatively milder and fewer side effects. I waited out the headaches, mild dizziness, and nausea for two weeks and then started feeling something new and unfamiliar. I wasn’t sad all the time as my default. I no longer had thoughts of suicide once or twice a week. I started skipping, literally, the way I did years ago for no reason at all but that I wanted to. I was in the kitchen singing the other day, which I do when I’m happy but not in any kind of planned way, and realized that I was happy. Happy enough. Let’s call it content.

I just got back from spending 4 1/2 weeks with my dying dad. It was sad; I cried on occasion as people do when they are sad. But I was not constantly bursting into tears. I was not mired in regrets about the past. I was not terrified of the future. I did a good job of advocating for my dad and also taking care of myself. Before I left to see my dad, I was the most productive I have been in literally years. I find myself wondering if this is what normal feels like for many people. I feel really blessed to be on a drug that is working well for me after an entire adulthood of being chronically depressed. I do not believe that my brain in particular is capable of regulating my neurochemistry in a healthy way. Because it had more than 60 fucking years to do that and failed utterly. As it turns out, I need ADHD medication and this particular antidepressant in order to be my best self. Which is not to say an enhanced self. Just the person I would have been all these years if my brain had not been sending me signals to be depressed.

The mind and the brain is a great book filled with science that was a challenge for me to read but talks about the problems of antidepressants. I strongly feel that people who don’t want to be on them and don’t need to be on them should avoid them like the plague. But for me, a cloud has been lifted in a short time. I have no idea how I will feel if I stop taking the antidepressant. But I honestly don’t see any reason to stop taking it as long as it’s working.

Medication is hard. It is true that I have suffered because I did not have an anti-depressant until now that worked for me; it is also true that some people never find a medication that works for them. I don’t think there is a definitive answer to your question. I really want there to be a definitive answer to your question and to all the other questions so many of us have about these powerful drugs. I hope you find the support you need to feel better. I spent many years and thousands of dollars in therapy that was helpful in lots of ways. But in my case therapy never resolved my chronic depression. It helped me in lots of ways but in terms of depression, the benefits were always temporary.
posted by Bella Donna at 3:14 AM on February 21, 2020 [3 favorites]

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