Any hopeful stories about antidepressants?
March 17, 2023 5:15 PM   Subscribe

For mental and physical health reasons, I will likely be starting an antidepressant in the next week or so. I'm nervous about side effects, withdrawal symptoms, and the whole thing generally backfiring while I'm already in a precarious state.

I tried prozac a few years ago -- it helped some of my physical health issues (the tl;dr of which is that anxiety makes my gut and ability to swallow go haywire), which is why I want to try another one, but the side effects of prozac (constant fatigue) were kind of insidiously life limiting, and in retrospect I think it blunted good emotions along with bad, resulting in a very 'easy' year to live through that I remember little of.

I accidentally went down an internet rabbit hole of people complaining about meds that did more harm than good, and since I'm at a stage where I don't really have much choice but to try them again, I'd like to hear about good experiences people have had, if possible.

And potentially some tips for interacting with the prescriber when it comes to side effects, if you have any. I always heard people may need to shop around for the 'right' antidepressant, but my last prescriber didn't really want to hear a word about me ever getting off the meds, whether to try another one or not, and I struggle to advocate for myself when SSRIs are so slow acting that it's difficult to tell if the way you feel IS a side effect or not, especially if your prescriber may feel strangely motivated to believe it isn't.
posted by space snail to Health & Fitness (16 answers total) 1 user marked this as a favorite
SSRIs have been remarkably effective for me. I started them about 20yrs ago - on them for about three years, off for about two, then on them continuously since. I went off them to see if I really needed them and learned that I reallllllly did. For me, the benefits hugely outweigh the mild side effects. I was suicidally depressed both before I went on them and for the latter year of being off of them. I have still had some difficulties with mental health while on SSRIs, but it’s just a whole different situation - nothing like what it was for me without them.

I was on Zoloft (but the generic) at first, then when I restarted them I went with Celexa (also a generic) on my provider’s recommendation. Later I switched back to Zoloft because I was planning to get pregnant and there’s more data on Zoloft during pregnancy (and I did stay on it for two pregnancies and during nursing, which was fine). No real difference between to two for me. If you want to try a different SSRI than the initial one, you may be able to cross taper - that’s what I did when I switched.
posted by maleficent at 5:33 PM on March 17

And any competent provider should listen to you about side effects and be willing to try a different SSRI if the first option doesn’t work for you! I’m sorry you had such a negative experience with your prior provider, and I hope you have access to someone who will really listen to you.
posted by maleficent at 5:35 PM on March 17 [2 favorites]

I had to go through a bunch and they’re not a perfect solution and I still get anxious/depressed but ultimately they made a whole life that never seemed possible not just possible but right within reach. Don’t give up ❤️
posted by raisindebt at 5:40 PM on March 17 [5 favorites]

Wellbutrin has worked and continues to work great for me -- I was supposed to be on it for six months for situational depression, and I ended up just staying on it because it regulates my depression and anxiety so well, as it turned out.

I think interacting with your provider about side effects going well depends more on the provider in general than the topic. I live in a large city and my provider is my primary care doctor at one of those "boutique" customer service oriented medical chains, and their whole brand is to listen to the patient.

But in general, some things to keep in mind (which might or might not be new to you because you have experience with prozac).

For some people generics work just as well as brand medicines

Not all generics are created equal

Generics can and do have different bioavailability than brand medicines, and this can be especially true with time release medications (when a patent for a medication becomes publicly available, that is for the medicine itself, not the time release mechanism -- those get reverse engineered by generic producers and aren't always as good as the original)

Some antidepressants come in extended release formats, and for some people that works better

It can take a few weeks for the side effects to go away -- and sometimes the dose needs tinkering with, and sometimes switching to brand can smooth things out -- keep that in mind.

As I am sure you know, people who have had bad experiences are more likely to post on the internet about them than people who have had no problems.

I totally relate to you being nervous about it -- I am always nervous about any new medication, and I was super nervous about an antidepressant, but it has been totally fine and very helpful.

Good luck!
posted by virve at 5:50 PM on March 17 [2 favorites]

I don't have a story of having to shop around, but I've been on fluoxetine for 14 years and have zero regrets. I started taking them for PPD, when I was very uncharacteristically feeling worthless and like everyone hated me. At my first appointment with my prescriber a few weeks later I remember expressing genuine shock at the idea that most people feel like this all the time--happy and sad and angry and all, but without a simmering rage that is just barely held in 100% of the time. Like, I thought that was normal until it went away. I would never want to go back.

So yeah, it's not a flashy story so I don't tell it often, but it has been so easy with very minimal side effects (I found swallowing felt weird for about two months, but not bad enough to stop, and it went away). I suppose my sex drive decreased, but it is still well within acceptable levels. (Possibly that also relates to having had a kid around the same time, which was a big lifestyle change.)

Anyway, it's not just all horror stories. I hope you find your treatments. Good luck.
posted by gideonfrog at 5:56 PM on March 17 [3 favorites]

Here’s my good experience: I’ve been on an SSRI for about 2 years and the biggest change is that I no longer feel frantic to incorporate self care. I exist and I feel fine and I still run and hike and bike but it no longer feels like I NEED to do these things to feel okay.
posted by yes I said yes I will Yes at 6:02 PM on March 17 [1 favorite]

I am not a psychiatrist, but have worked pretty extensively with psychiatrists as a social worker.

Yes, it's common for people to find that the first anti-depressant they try doesn't work for them, or has difficult side effects. It really is frustrating when you have to do some trial-and-error with different meds and dosages to find something that works well. But there are a lot of different meds available now; and their mechanism of action is only somewhat well understood, so it can take some time and experimentation.

But the combination of medication, which can give you space to be able to breathe, and therapy (in whatever form: formal talk therapy, mindfulness/meditation, finding ways to support and comfort yourself) is worth pursuing -- depression is a treatable disease, and I strongly encourage you to find mental health professionals who will help you find out what works for you. It might mean asking your primary care doctor to try some other things, it may mean asking for a referral to a psychiatrist who has more specialized training in the field. Brains are weird and complicated and we are still learning what will work well for different people to help them feel better.

You deserve to be happy. You deserve to have hope.
posted by tivalasvegas at 6:35 PM on March 17 [4 favorites]

I've had pretty much nothing but good experiences with SSRIs, which I have taken at three different points in my life, the first two times for a year or so each, and most recently for the past several years. The first couple of weeks have tended to be a little rough mostly in terms of sleep disruption - Prozac made me jittery for a couple of weeks and Celexa made me darn near narcoleptic for the first few days. In both cases messing around with the time of day for taking the meds helped a lot, and then within a couple of weeks that side effect was gone. I have no other noticeable ongoing side effects.

One thing that did happen with the most recent round of taking meds was that, perhaps because this time around I was being prescribed for anxiety as well as depression, I was given a small script of low-dose Ativan to take up to twice a day if needed for the first - month or so? I don't actually remember the timeline. But the idea was that sometimes the first few weeks of a new SSRI can be difficult, and can even increase anxiety, and so a short course of a companion medication to help smooth that phase was what that psychiatrist recommended. I was surprised by that and don't know if it actually helped, but it didn't hurt, and if anything was sort of just a security blanket - knowing I *had* a fallback medication helped my anxiety so much I hardly ever actually got so far as taking it. I don't know if that's standard practice now or just a particularly helpful shrink, but if you're offered the option, I'd take the benzos.

When I have stopped taking SSRIs it has been easy, with zero withdrawal issues.

I consider myself very lucky to have an apparently really good and easy response to SSRIs so of course YMMV, but for me they were life-changing when I was in my twenties, are a helpful component of my self-care situation now, and I'm glad they've been available to me.

The medication merry-go-round has been much more of a thing for a close friend of mine and it's a frustrating thing to go through - but even he did eventually settle on a med that works well for him and has been on a stable dose and doing well for many years now.

I hope you find yourself on the "easy, minimal side effects, and getting the good effects you want" end of the spectrum.
posted by Stacey at 6:37 PM on March 17

Best answer: Since you said you'd be starting in about a week, I'm assuming you've already picked someone to work with on this. But if not or for future thought:

The best experience I had with a prescriber was when I met with a psychiatrist who, upon reviewing my history, understood that I had tried a lot of medications/combinations of medications before and was really engaged in creating a plan with me like -- how long I'd try something, what options we had on the table, what side effects were simply no-gos, how others could be managed, etc...

Although we weren't ultimately successful with medication, the process didn't make me shut down on the idea of revisiting the idea in the future. So that's what I'd be looking for -- that kind of collaboration.
posted by sm1tten at 6:46 PM on March 17 [3 favorites]

Best answer: I tried Sertraline in 2018 for a month or so, couldn't get over the nausea. Told my family doctor, who then switched me to Bupropion. I took it for 2-3 months, felt like it wasn't really doing anything, so I stopped. I stopped cold turkey without telling my doctor. No I'll effects, but in retrospect maybe I should've told them my plan in case a taper period was required.

Fast forward to late 2022. We've all lived though all the COVID stuff. I had a new job that was very stressful, and a new people manager role which compounded the stress. My volunteer gig for our condo strata council (homeowners association for you US-ians out there) was 4+ hours a week. I had no hobbies left, no energy to do anything anyway, other than scroll Tiktoks and reels. I was crying after work almost daily, and checking our bank account constantly, wondering when I can quit working (it's not like those $ values are going up every hour!)

So finally called my same family doc, and he went through the assessment questions again, as he does each time I talk about my depression. He suggests going back on Bupropion because I didn't have side effects four years ago. "But I didn't really feel like it worked last time?" He said, "Well sometimes people think it's not working because they were on the road to feeling better anyway with counseling and lifestyle changes. But it could have helped before and you just didn't know it was from the meds, too." Ok, fair enough. They prescribed 3 months supply and I was supposed to check in 1 month later.

Within one month it was a pretty dramatic change. I wasn't crying everyday anymore. I was joking around, work was still stressful but felt manageable. I could focus more on what to do, rather than how terrible everything was. After 3 months I asked if I could go higher on the dosage to see if I could get to "happy" from just "mostly ok." So now I'm on a double dose, again supposed to check in 1-2 months later. A few days ago I was excited to plan a meal for guests who would come over for brunch. That hasn't happened in months! So yeah, definitely working. And still no side effects (no dizziness, no trouble sleeping). Guess Bupropion works for me, after all!

So how to deal with your doctor who won't listen? At your first appointment, ask two questions: How can I tell if it's working? For the side effects, what severity level would be "not ideal but still tolerable" vs "unacceptable, need to switch." Write the answers down.

Next time if you want to switch your meds, tell them that you are experiencing the "unacceptable" level of side effects, describe how it affects you and your life. Basically parrot their words back to them. If they say, "No, that's ok, you stick with it," then you can say, "But when I started these meds you explicitly said if I experienced A, B, C, that is not OK and I should switch."

PS the above is based on Canadian health care system
posted by tinydancer at 6:49 PM on March 17 [5 favorites]

Too much SSRI positivity in this thread that will get you down if they don’t work well for you!! The SSRIs I tried made me feel similar to your prozac experience, and everyone’s other favorite Wellbutrin made me feel a way that I can only approximate with the phrase “psychotically aggressively anxious” both times in my life I had the pleasure of trying it. BUT after trying many many MANY other non-SSRI options, my doctor landed on something that worked for me (lamotrigine and a small dose of Abilify) and I’ve been stable for like 6 years now. It was brutal to go through so many meds and feel messed up in a different way every month or so for the ones that didn’t work, and in some cases be pretty sure it was going to be constantly terrible after only like 1 week but still have the doctor telling me to be patient and stick it out to be absolutely sure that the side effects wouldn’t mellow out (in some cases they totally did!). An insane grueling era of my life but ultimately it was so so worth it for me.
Switch psychiatrists if you can and need to, I did and went hard on researching patient reviews of doctors available to me and was able to find someone willing to listen to me and be “creative” with trying things.
Various SSRIs had different “flavor profiles” for me so maybe a different one of those will work better for you than Prozac, but if not there are a tooooon of non-SSRI things out there, new stuff is coming out all the time, and when you consider that you can have different combinations of things and high or low doses there are just so so many options and they are not all different variants of “blunted feelings” I promise!! I’m rooting for you!! Memail me if you want to chat in more detail about this crap!!
posted by crime online at 7:29 PM on March 17 [1 favorite]

Try it. Don’t like it? You can stop.
posted by Miko at 10:13 PM on March 17 [1 favorite]

The hardest part for me was getting through two weeks of headaches and feeling sick. I have health anxiety, which makes it really hard to keep taking something that has side effects immediately because my brain tries to convince that I am taking something that is going to kill me. But I stuck it out, and the anti-depressant that I thought I did not need (but did, according to my psychiatrist, who thought maybe it would be good if most of the dark thoughts went away) worked well for me after those first two week.

Many years before I had tried Prozac. Years after that, I was on something for my anxiety that was helpful until it stopped being helpful. At the moment, my anti-depressant seems to keep me from a deep depression and holds much of my usual anxiety at bay. I have been on it for three to four years now.

If it stops working, I will try other meds because it is clear that without them my life is too dreary. I do have friends who have never found an effective medication despite the best efforts of their health pros. Mental health treatment is still kind of a crap shoot. I hope your treatment story has a happy ending.
posted by Bella Donna at 6:58 AM on March 18

Another recommendation for bupropion (Wellbutrin) which is a norepinephrine–dopamine reuptake inhibitor (NDRI) rather than an SSRI and doesn’t have some of the more notable side effects common to SSRIs such as sexual dysfunction and loss of libido, emotional blunting, fatigue, etc.
posted by slkinsey at 8:50 AM on March 18

My winning combo is Zoloft and Remeron (mirtazipine). It took years of trial and error and over a dozen different meds, but it was either that or give up and die. Now I'm stable to the point that I take my pills and don't have to worry about it any more. Just refuse to give up and advocate for yourself (loudly if need be) to get the care you need.
posted by storminator7 at 11:25 AM on March 18

Although SSRIs didn’t work for me, they were a first step in a treatment algorithm that ultimately lead to something that works (at least for now).

Treatment keeps me where I am today - alive, employed, full belly, comfortably housed. Being mentally unwell is unsafe, finding something that works can be life affirming.
posted by shock muppet at 1:09 PM on March 18 [2 favorites]

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