To what extent should I expect anti-depressants to help motivate me?
November 19, 2024 4:12 AM Subscribe
I'm new to taking an SNRI and I'm feeling great, but I also feel like I need to get over the final "hump" of taking better care of myself. Do I need to consider increasing my dosage or am I actually just a bit lazy?
The last few years have been rough, for all the reasons you might imagine. I've had a few periods when I kind of "woke up" and got my life together a bit, losing my pandemic pounds, exercising regularly, eating better, etc. I've found myself feeling better, but usually something "bad" will happen and throw me off my game and then I lose all those good habits. Frustrated with this endless cycle, I finally talked to my doctor who was very helpful and understanding and put me on Effexor in September.
Overall, my experience had been great! My endlessly swirling thoughts have nearly stopped, I've been able to handle some stressful situations without even reading them as "stressful," and I've barely experienced any side effects (despite my many hours of panicked Googling before I started the drugs....).
However, while I feel great and regret not starting at least a few decades ago, I think I had expected that I would also by now start to feel like I have the motivation to get back into my better habits so that I can feel EVEN better. Behaviour-wise, I'm still sort of living with my depression habits, even though I don't feel depressed. I waste too much time on the internet. I don't spend enough time playing guitar or crafting. I snack more than I need to. And so on....
My doctor thinks I should consider increasing my dose a bit (I'm on 75mg at the moment). But I guess I'm not sure how much of this is a "me" problem or a dosage problem? I don't want to increase my dose if fundamentally it's up to me to clear the last mile of my mental health journey with just a bit more discipline. On the other hand, if bumping up my dose slightly could be the thing that tips me over into being able to sustain those better habits, then I would like to know!
Three relevant points, first: my doctor acknowledged that I am newly perimenopausal and so that definitely is toying with my body and brain chemistry. The second thing is that the event that led to me stopping my workout routine most recently was a flooded basement. It was not remotely catastrophic, but it's taking forever to get the basement fixed up so I've lost all my workout space and equipment and we're all living on one floor and I MISS MY SPACE so much and definitely have told myself, "it's ok.... just wait til your house is back together and then you can start over." Make of that what you will! Finally, I do have a therapist who is sort of helpful and I'm still doing my anxiety exercises and stuff and seeing some progress, just to pre-emptively answer that question. Neither doc nor therapist have concrete advice on this topic and say that it's simply "up to me" whether I want to increase dose or not...
The last few years have been rough, for all the reasons you might imagine. I've had a few periods when I kind of "woke up" and got my life together a bit, losing my pandemic pounds, exercising regularly, eating better, etc. I've found myself feeling better, but usually something "bad" will happen and throw me off my game and then I lose all those good habits. Frustrated with this endless cycle, I finally talked to my doctor who was very helpful and understanding and put me on Effexor in September.
Overall, my experience had been great! My endlessly swirling thoughts have nearly stopped, I've been able to handle some stressful situations without even reading them as "stressful," and I've barely experienced any side effects (despite my many hours of panicked Googling before I started the drugs....).
However, while I feel great and regret not starting at least a few decades ago, I think I had expected that I would also by now start to feel like I have the motivation to get back into my better habits so that I can feel EVEN better. Behaviour-wise, I'm still sort of living with my depression habits, even though I don't feel depressed. I waste too much time on the internet. I don't spend enough time playing guitar or crafting. I snack more than I need to. And so on....
My doctor thinks I should consider increasing my dose a bit (I'm on 75mg at the moment). But I guess I'm not sure how much of this is a "me" problem or a dosage problem? I don't want to increase my dose if fundamentally it's up to me to clear the last mile of my mental health journey with just a bit more discipline. On the other hand, if bumping up my dose slightly could be the thing that tips me over into being able to sustain those better habits, then I would like to know!
Three relevant points, first: my doctor acknowledged that I am newly perimenopausal and so that definitely is toying with my body and brain chemistry. The second thing is that the event that led to me stopping my workout routine most recently was a flooded basement. It was not remotely catastrophic, but it's taking forever to get the basement fixed up so I've lost all my workout space and equipment and we're all living on one floor and I MISS MY SPACE so much and definitely have told myself, "it's ok.... just wait til your house is back together and then you can start over." Make of that what you will! Finally, I do have a therapist who is sort of helpful and I'm still doing my anxiety exercises and stuff and seeing some progress, just to pre-emptively answer that question. Neither doc nor therapist have concrete advice on this topic and say that it's simply "up to me" whether I want to increase dose or not...
I see very little downside to giving an increased dosage a try, given that you're not having rough side effects now. It sounds like the worst case scenario is likely that you see no difference, and know you need to try something else - and that will be valuable knowledge to have.
posted by Stacey at 4:48 AM on November 19 [5 favorites]
posted by Stacey at 4:48 AM on November 19 [5 favorites]
Are you still on your starting dose? I stuck to my relatively low SSRI dose for years longer than I should have, and then spoke with a psychiatrist specifically about my med options and she point blank told me to double it, and that nearly all of the things I was concerned about were things that were classic indicators that I would benefit from an increased dosage. She was 100% correct, it really worked on exactly the things that my lower dose wasn’t helping with.
I’m not on Effexor so am unfamiliar with the side effects of changing dosage. If after doing some research and thinking back on when you first started taking it, you suspect there will be minimal side effects, that I say go for it. The only way to know if it will work is to try it out. You also could benefit from a combination of meds or different ones all together - it’s pretty unusual for people to stick to the same ones they try from the start the whole time. There’s nothing wrong with trying different dosages or types as suggested by your care team.
And please, try to put aside the laziness talk. Depression is not caused by a lack of hard work, nor is it cured by an excess of it. Dosing is different for different people, too. If a 250 pound person had a headache and they only took a children’s Tylenol, would you tell them they just need to work harder to make their head stop throbbing? Ideally, medicine is one aspect of address mental wellness holistically - there’s also social and familial activities, introspection and spiritual things, engaging with nature, being present in your own body - but medicine can help us do all of those other things. And some medicines are ineffective depending on the dose.
posted by Mizu at 4:53 AM on November 19 [5 favorites]
I’m not on Effexor so am unfamiliar with the side effects of changing dosage. If after doing some research and thinking back on when you first started taking it, you suspect there will be minimal side effects, that I say go for it. The only way to know if it will work is to try it out. You also could benefit from a combination of meds or different ones all together - it’s pretty unusual for people to stick to the same ones they try from the start the whole time. There’s nothing wrong with trying different dosages or types as suggested by your care team.
And please, try to put aside the laziness talk. Depression is not caused by a lack of hard work, nor is it cured by an excess of it. Dosing is different for different people, too. If a 250 pound person had a headache and they only took a children’s Tylenol, would you tell them they just need to work harder to make their head stop throbbing? Ideally, medicine is one aspect of address mental wellness holistically - there’s also social and familial activities, introspection and spiritual things, engaging with nature, being present in your own body - but medicine can help us do all of those other things. And some medicines are ineffective depending on the dose.
posted by Mizu at 4:53 AM on November 19 [5 favorites]
First thing: if this SNRI is Venlafaxine (also known as Effexor) be extremely careful when changing dosage. It's known to cause very unpleasant withdrawal symptoms very quickly as it's got such a short half life in your body. In other words, the drug doesn't stay in your body for a long time, which is why you can start getting withdrawal even if you're only a few hours late with a dose.
Don't increase the dosage unless you are very sure you need to, because decreasing it can be tough. Definitely don't change the dosage either up or down unless you're being advised by a psychiatrist (not a GP) who has experience with this medication. Ask me how I know!
Withdrawal symptoms include headaches, nausea, brain zaps, and dizziness.
About motivation, I found that both SSRI and SNRI decreased my motivation. I've seen some theories that they mess with your brain's dopamine system, and dopamine is necessary for regulating your motivation / executive function.
I would highly recommend not changing your medication at the moment, but using other methods to help you motivate yourself. Read up about the Compassion Based Therapy's different emotional regulation systems and try to use methods other than fear based ones to motivate yourself.
Notice when you're trying to scare yourself into action, or shame yourself (like, right now, totally stop ever using the word "lazy" again). Talk to yourself as if you were a small, stubborn, sensitive child that you care a lot about. "Ok I see you don't want to do x. You're tired! Totally understandable. Life SUCKS sometimes. Would it help if we did it this way, or that way?"
Find the friction points that are stopping you. For example, I have a hard time starting my daily exercise routine if I first have to put on special clothes. So I just do it in whatever I'm wearing. Make doing the thing as easy as possible.
posted by Zumbador at 5:20 AM on November 19 [15 favorites]
Don't increase the dosage unless you are very sure you need to, because decreasing it can be tough. Definitely don't change the dosage either up or down unless you're being advised by a psychiatrist (not a GP) who has experience with this medication. Ask me how I know!
Withdrawal symptoms include headaches, nausea, brain zaps, and dizziness.
About motivation, I found that both SSRI and SNRI decreased my motivation. I've seen some theories that they mess with your brain's dopamine system, and dopamine is necessary for regulating your motivation / executive function.
I would highly recommend not changing your medication at the moment, but using other methods to help you motivate yourself. Read up about the Compassion Based Therapy's different emotional regulation systems and try to use methods other than fear based ones to motivate yourself.
Notice when you're trying to scare yourself into action, or shame yourself (like, right now, totally stop ever using the word "lazy" again). Talk to yourself as if you were a small, stubborn, sensitive child that you care a lot about. "Ok I see you don't want to do x. You're tired! Totally understandable. Life SUCKS sometimes. Would it help if we did it this way, or that way?"
Find the friction points that are stopping you. For example, I have a hard time starting my daily exercise routine if I first have to put on special clothes. So I just do it in whatever I'm wearing. Make doing the thing as easy as possible.
posted by Zumbador at 5:20 AM on November 19 [15 favorites]
While I also think you should MILDLY up your dosage, I don't totally agree with everyone who says there's no downside to upping your dosage. There can be! For instance, as you go up on Effexor, you may be more likely to feel interactions with coffee, or lack of sleep, or all kinds of random things. You may feel speedy or weird or otherwise off. However, you can recognize that and go back down.
My experience is that Effexor and others (LOVE Effexor!) don't eliminate habits. Effexor doesn't drive you to the gym while you're rebuilding your basement. Effexor doesn't change what food you buy at the store. It might do a ton of other things but it's not going to manage your calendar or your relationships.
The fact of the matter is that right now you feel pretty great! You're competent, you're facing difficult tasks, you're not laying in bed all day, and you're not sobbing yourself to sleep.
These are competencies built day by day. Why don't you let go of the bigger picture, and make some plans for today, and see how they go? What one bad chore, and one fun thing, and one piece of exercise, do you want to do today? Tomorrow you can worry about tomorrow.
posted by RJ Reynolds at 5:20 AM on November 19 [10 favorites]
My experience is that Effexor and others (LOVE Effexor!) don't eliminate habits. Effexor doesn't drive you to the gym while you're rebuilding your basement. Effexor doesn't change what food you buy at the store. It might do a ton of other things but it's not going to manage your calendar or your relationships.
The fact of the matter is that right now you feel pretty great! You're competent, you're facing difficult tasks, you're not laying in bed all day, and you're not sobbing yourself to sleep.
These are competencies built day by day. Why don't you let go of the bigger picture, and make some plans for today, and see how they go? What one bad chore, and one fun thing, and one piece of exercise, do you want to do today? Tomorrow you can worry about tomorrow.
posted by RJ Reynolds at 5:20 AM on November 19 [10 favorites]
Co-sign RJ Reynolds. Behaviors gonna behave; your brain chemistry (at least on an SNRI) does not dictate your behaviors - you still do. (Very glad the medicine has helped so much!! That’s great.)
BTW - not to be that guy, talking about therapy even thought you already mentioned you’re in it - but your therapist may be kind of a dud? Maybe not, but you mention them as “sort of helpful” and unwilling to really engage with you on your own self-motivated quest to adopt healthier habits…?
A sort of helpful therapist is a godsend when you’re in crisis or a long doldrum. They’re not great when you’re looking to go from tolerable to thriving. It is annoying to start from scratch with a new one, but I made the leap to a better aligned therapist early last year after a few years of very meh appts, and it’s been night and day for personal growth. A really helpful therapist will absolutely be able to actively support you in healthy behavior modification.
Do you want your co-pay going towards someone who has basically let you know “I’m not really interested/capable in helping you beyond your current plateau” or would you like to spend that time and money on someone who meets you where you’re at now? Food for thought.
posted by seemoorglass at 5:38 AM on November 19 [3 favorites]
BTW - not to be that guy, talking about therapy even thought you already mentioned you’re in it - but your therapist may be kind of a dud? Maybe not, but you mention them as “sort of helpful” and unwilling to really engage with you on your own self-motivated quest to adopt healthier habits…?
A sort of helpful therapist is a godsend when you’re in crisis or a long doldrum. They’re not great when you’re looking to go from tolerable to thriving. It is annoying to start from scratch with a new one, but I made the leap to a better aligned therapist early last year after a few years of very meh appts, and it’s been night and day for personal growth. A really helpful therapist will absolutely be able to actively support you in healthy behavior modification.
Do you want your co-pay going towards someone who has basically let you know “I’m not really interested/capable in helping you beyond your current plateau” or would you like to spend that time and money on someone who meets you where you’re at now? Food for thought.
posted by seemoorglass at 5:38 AM on November 19 [3 favorites]
FWIW, to answer your question, antidepressants don’t directly “motivate” you. What they can do is lift the barriers keeping you from acting/engaging, thus indirectly allowing motivation. Antidepressants won’t push you through the door, but they will crack it open for you.
posted by Thorzdad at 6:11 AM on November 19 [4 favorites]
posted by Thorzdad at 6:11 AM on November 19 [4 favorites]
I have nothing really helpful to add here other than to say I am going to have this exact conversation with my doctor next week, so you're not alone in this, and I appreciate the answers.
posted by jacquilynne at 6:36 AM on November 19 [3 favorites]
posted by jacquilynne at 6:36 AM on November 19 [3 favorites]
It helps to think of anti-depressants as literally that: something that fights depression. Removing that obstacle is wonderful, but after that you’re on your own.
Of course depression is not a binary thing and it’s possible that upping the dose will help clear up something that remains. But that’s all that anti-depressants are intended to do.
I'm still sort of living with my depression habits, even though I don't feel depressed.
Whether at this dosage or another, this is the real challenge you now face. You have not only the physical habits, but also ways of thinking about yourself that have been become ingrained.
By all means stop and celebrate your new freedom, but you still have a ways to go. If you do anything long enough it becomes a habit, and you’ve been thinking and acting in unhealthy ways for a long time.
posted by Tell Me No Lies at 7:00 AM on November 19 [2 favorites]
Of course depression is not a binary thing and it’s possible that upping the dose will help clear up something that remains. But that’s all that anti-depressants are intended to do.
I'm still sort of living with my depression habits, even though I don't feel depressed.
Whether at this dosage or another, this is the real challenge you now face. You have not only the physical habits, but also ways of thinking about yourself that have been become ingrained.
By all means stop and celebrate your new freedom, but you still have a ways to go. If you do anything long enough it becomes a habit, and you’ve been thinking and acting in unhealthy ways for a long time.
posted by Tell Me No Lies at 7:00 AM on November 19 [2 favorites]
As someone who was on Effexor some years ago and am still having side effects long after going off the drug (fortunately minor and merely annoying and distracting), I would strongly advise against upping the dosage.
The antidepressant is making you too happy and relaxed to care about self-care. If you up the dose you may end up caring less. It's likely having an anti-anxiety affect on you. Now if anxiety had been blocking you from doing self-care the drug you are on might help. But chances are you motivated yourself to do self-care habits earlier out of anxious restless desperation. I gotta do something to feel better! You couldn't bear the trapped in a rut sensation, and clawed your way out. Now that you no longer have the bottomless pit to escape, it can be hard to motivate yourself to change out of your pajama bottoms, let alone put on hiking boots and stormy weather running gear.
I think the Effexor is probably making you every so slightly sleepy - you're just that much more relaxed and comfortable that it takes a little extra effort to get moving.
It's a trap to think of yourself as still following your depression habits. If you are still following those habits, then it wasn't the depression keeping you from exercising. Of course there are lots of reasons why people don't exercise ranging from social and performance anxiety, to it feeling crappy for them physically when they do exercise, logistical difficulties, strongly wanting not to spend the time taking up pursuits that would displace doing things they actually enjoy, etc. I think you'd be better off figuring out what other reasons might be sapping your motivation to exercise.
I think you can additionally think about what motivates you do the things that you do work on steadily and which you excel at. What gives you the surge of satisfaction and pleasure? And then see if you can figure out a way to exercise so that it triggers the same surge of satisfaction and pleasure you get from doing the activities you do enjoy.
posted by Jane the Brown at 7:15 AM on November 19 [1 favorite]
The antidepressant is making you too happy and relaxed to care about self-care. If you up the dose you may end up caring less. It's likely having an anti-anxiety affect on you. Now if anxiety had been blocking you from doing self-care the drug you are on might help. But chances are you motivated yourself to do self-care habits earlier out of anxious restless desperation. I gotta do something to feel better! You couldn't bear the trapped in a rut sensation, and clawed your way out. Now that you no longer have the bottomless pit to escape, it can be hard to motivate yourself to change out of your pajama bottoms, let alone put on hiking boots and stormy weather running gear.
I think the Effexor is probably making you every so slightly sleepy - you're just that much more relaxed and comfortable that it takes a little extra effort to get moving.
It's a trap to think of yourself as still following your depression habits. If you are still following those habits, then it wasn't the depression keeping you from exercising. Of course there are lots of reasons why people don't exercise ranging from social and performance anxiety, to it feeling crappy for them physically when they do exercise, logistical difficulties, strongly wanting not to spend the time taking up pursuits that would displace doing things they actually enjoy, etc. I think you'd be better off figuring out what other reasons might be sapping your motivation to exercise.
I think you can additionally think about what motivates you do the things that you do work on steadily and which you excel at. What gives you the surge of satisfaction and pleasure? And then see if you can figure out a way to exercise so that it triggers the same surge of satisfaction and pleasure you get from doing the activities you do enjoy.
posted by Jane the Brown at 7:15 AM on November 19 [1 favorite]
If you are still following those habits, then it wasn't the depression keeping you from exercising
I could not disagree more with this perspective.
posted by Tell Me No Lies at 7:32 AM on November 19 [9 favorites]
I could not disagree more with this perspective.
posted by Tell Me No Lies at 7:32 AM on November 19 [9 favorites]
I experienced a remission from my depression one year, and everything got easier. Self-care, leaving the house, interpersonal situations, cleaning. I grew a lot and it felt like my depression was no longer weighing me down. I’m not saying upping the medication would give you this. Just that the lack of motivation you feel could well be lingering depression.
posted by mai at 8:43 AM on November 19 [1 favorite]
posted by mai at 8:43 AM on November 19 [1 favorite]
You've struggled to manage a chronic illness without treatment for many years. You're not lazy, you need time to adjust and re-evaluate your habits in a non-judgemental way. Including your own self-judgement! We all want to feel good and be healthy, but it's very unhealthy to label yourself as 'lazy' and blame yourself for what are, in the grand scheme of things, very normal habits that many people have and that do not prevent a happy, healthy life. ( Check out "Laziness Does Not Exist" by Dr. Devon Price.) And, yes, maybe an increase in meds is called for. It's extremely normal to have to tweak medication dosage, especially in cases where your illness was not caught early.
Despite what the self-help industry likes to promote, changing habits and routines is actually extremely difficult. The brain automates behavior into habits because it's energy saving; when you change habits you not only need to allocate energy to laying down new neural connections, but also extra energy on top of that to erase the existing ones. Think about it like a commute--you do the same drive every day for years, then your office moves across town. Suddenly your boring commute takes a lot of mental energy: you've got to figure out your new route, maybe you need to leave the house at a different time, you need to learn new traffic patterns, new roads, etc. And if you're distracted one day, you find yourself driving to the old office instead of the new one, on auto pilot.
That's the kind of inertia you fight every time you change a habit--and the brain resists it, obviously. The brain is spending huge amounts of energy just keeping you alive, it's already invested energy into encoding a bunch of survival strategies that clearly work, and it makes no sense to randomly change them. This is what "lifestyle change" actually means. It was super easy to alter your exercise habit when your workout space flooded, right? You can change your habitual commute when the office is literally in a different place; if you moved to another country your diet would change to the foods that are available there; when the electricity is out it's easy to go to bed early, etc. So the question is really how much time and energy are you willing to spend to change your habits, and what in your environment are you willing to change--permanently--to support new ones.
It can be done, and each individual will find some things easier than others, but it's unreasonable to expect your self to spontaneously change while all the other material conditions of your life stay the same.
posted by radiogreentea at 8:43 AM on November 19 [5 favorites]
Despite what the self-help industry likes to promote, changing habits and routines is actually extremely difficult. The brain automates behavior into habits because it's energy saving; when you change habits you not only need to allocate energy to laying down new neural connections, but also extra energy on top of that to erase the existing ones. Think about it like a commute--you do the same drive every day for years, then your office moves across town. Suddenly your boring commute takes a lot of mental energy: you've got to figure out your new route, maybe you need to leave the house at a different time, you need to learn new traffic patterns, new roads, etc. And if you're distracted one day, you find yourself driving to the old office instead of the new one, on auto pilot.
That's the kind of inertia you fight every time you change a habit--and the brain resists it, obviously. The brain is spending huge amounts of energy just keeping you alive, it's already invested energy into encoding a bunch of survival strategies that clearly work, and it makes no sense to randomly change them. This is what "lifestyle change" actually means. It was super easy to alter your exercise habit when your workout space flooded, right? You can change your habitual commute when the office is literally in a different place; if you moved to another country your diet would change to the foods that are available there; when the electricity is out it's easy to go to bed early, etc. So the question is really how much time and energy are you willing to spend to change your habits, and what in your environment are you willing to change--permanently--to support new ones.
It can be done, and each individual will find some things easier than others, but it's unreasonable to expect your self to spontaneously change while all the other material conditions of your life stay the same.
posted by radiogreentea at 8:43 AM on November 19 [5 favorites]
In my experience I'm not bursting into sobbing tears and having spontaneous breakdowns any more and I don't do some of the physical stuff I did to myself under stress very much any more after going on meds. But I still don't have super motivation to do heavy duty industrial cleaning, either. It's a lot of work and effort, I have to figure out How To Dispose Of Things Properly, and I know darned well I'll still have giant mess and continue to make more giant messes even if I put all that work into it, because I can't figure out where to put stuff in small space and if I put it Away and Out Of Sight, I lose it entirely. Meds can't solve that one.
So I don't think it really helps with "motivation," per se. My current level of motivation is setting up boxes to throw things into that I should probably get rid of, like shoes that hurt my feet, all the broken electric blankets (all electric blankets stop working after I've had them for a few days and probably need to be driven to the landfill), stuff like that. Maybe I'll do more of that when I'm sitting home alone every night, we'll see.
posted by jenfullmoon at 8:44 AM on November 19 [1 favorite]
So I don't think it really helps with "motivation," per se. My current level of motivation is setting up boxes to throw things into that I should probably get rid of, like shoes that hurt my feet, all the broken electric blankets (all electric blankets stop working after I've had them for a few days and probably need to be driven to the landfill), stuff like that. Maybe I'll do more of that when I'm sitting home alone every night, we'll see.
posted by jenfullmoon at 8:44 AM on November 19 [1 favorite]
I'm coming at this from an ADHD perspective because we have these struggles as well, and ADHD is also a disorder of serotonin, norepinephrine, and dopamine so the overlap is significant.
So an SNRI works by slowing the breakdown of serotonin and norepinephrine (also called noradrenaline). This is way oversimplified but I think of serotonin as executive function, norepinephrine as nervous system responsiveness, and dopamine is reward (or, if you want to rabbit-hole this, "motivational salience").
In the world, most people find that if they've got a decently-functional neurochemical soup to work with, habits and motivation and such are still hard - there wouldn't be multiple billion-dollar industries banking on that fact - but at least feasible, where for most people it's incredibly difficult to impossible if they're short on any of these 3 main players. None of these chemicals are likely to drag you into the gym by themselves, but they should make it much easier to complete the task when you attempt it, and they should make it easier to imagine success, which is a key indicator in achieving success.
But real talk: only a very privileged slice of the population organically "feels like" doing stuff. You CAN manufacture some of that feeling by recognizing its value - like, I know people who hate going to the gym but really hate how they feel if they don't, so they do. This is where you have to harness your own dopamine to work for you: you can learn to love having a clean sink or a made bed or food to eat or being well-regarded at work even if you don't adore the process of getting there.
Even though it's technically about housekeeping, I highly recommend KC Davis's book How to Keep House While Drowning, to help reframe your thoughts around doing the things that take care of you. Getting thrown off your game is natural, it's gonna happen no matter what, and one of the places antidepressants are supposed to help is your resilience: your ability to get back on the horse every time you fall off.
I call these reframings and strategy adjustments "lifestyle changes" that should go hand-in-hand with medication, and I think you should stay at your current dosage and put a month or three - get past the holidays and get back to lengthening days - into the lifestyle changes and see how that goes.
You may also want to consider discussing HRT to smooth perimenopause. I was dealing with this during the 45th presidency and my mental health was very very bad and I almost didn't make it, and I'm really sorry I didn't help myself with hormonal support.
posted by Lyn Never at 9:01 AM on November 19 [6 favorites]
So an SNRI works by slowing the breakdown of serotonin and norepinephrine (also called noradrenaline). This is way oversimplified but I think of serotonin as executive function, norepinephrine as nervous system responsiveness, and dopamine is reward (or, if you want to rabbit-hole this, "motivational salience").
In the world, most people find that if they've got a decently-functional neurochemical soup to work with, habits and motivation and such are still hard - there wouldn't be multiple billion-dollar industries banking on that fact - but at least feasible, where for most people it's incredibly difficult to impossible if they're short on any of these 3 main players. None of these chemicals are likely to drag you into the gym by themselves, but they should make it much easier to complete the task when you attempt it, and they should make it easier to imagine success, which is a key indicator in achieving success.
But real talk: only a very privileged slice of the population organically "feels like" doing stuff. You CAN manufacture some of that feeling by recognizing its value - like, I know people who hate going to the gym but really hate how they feel if they don't, so they do. This is where you have to harness your own dopamine to work for you: you can learn to love having a clean sink or a made bed or food to eat or being well-regarded at work even if you don't adore the process of getting there.
Even though it's technically about housekeeping, I highly recommend KC Davis's book How to Keep House While Drowning, to help reframe your thoughts around doing the things that take care of you. Getting thrown off your game is natural, it's gonna happen no matter what, and one of the places antidepressants are supposed to help is your resilience: your ability to get back on the horse every time you fall off.
I call these reframings and strategy adjustments "lifestyle changes" that should go hand-in-hand with medication, and I think you should stay at your current dosage and put a month or three - get past the holidays and get back to lengthening days - into the lifestyle changes and see how that goes.
You may also want to consider discussing HRT to smooth perimenopause. I was dealing with this during the 45th presidency and my mental health was very very bad and I almost didn't make it, and I'm really sorry I didn't help myself with hormonal support.
posted by Lyn Never at 9:01 AM on November 19 [6 favorites]
(Disclaimer: I am not a doctor, therapist, or counselor, just someone who has been dealing with mental health crud on and off for my whole life.) In your position I would say yes to increasing the dosage, for two reasons:
1. I've had a few periods when I kind of "woke up" and got my life together a bit, losing my pandemic pounds, exercising regularly, eating better, etc.
This to me indicates that depression is what's stopping you from doing these things. If that weren't the case - if these were more like things you'd never done before but envisioned that a post-depression version of you would be doing - I would say to spend more time in therapy working through why you feel you need to do these things or why you have such a close association between diet/exercise and "getting one's life together". And you can still do that too, for what it's worth. But this does sound more like a classic situation where depression is getting in the way of your usual habits, hobbies, and passions.
2. My doctor thinks I should consider increasing my dose a bit (I'm on 75mg at the moment) [but says] that it's simply "up to me" whether I want to increase dose or not
I think you might be reading your doctor as ambivalent, but I'm reading them more as giving you autonomy over your own health and body, which makes me like them already. A medical professional who knows your medical history and has your chart is making this recommendation, and they're a lot more qualified than any of us.
posted by capricorn at 1:48 PM on November 19 [1 favorite]
1. I've had a few periods when I kind of "woke up" and got my life together a bit, losing my pandemic pounds, exercising regularly, eating better, etc.
This to me indicates that depression is what's stopping you from doing these things. If that weren't the case - if these were more like things you'd never done before but envisioned that a post-depression version of you would be doing - I would say to spend more time in therapy working through why you feel you need to do these things or why you have such a close association between diet/exercise and "getting one's life together". And you can still do that too, for what it's worth. But this does sound more like a classic situation where depression is getting in the way of your usual habits, hobbies, and passions.
2. My doctor thinks I should consider increasing my dose a bit (I'm on 75mg at the moment) [but says] that it's simply "up to me" whether I want to increase dose or not
I think you might be reading your doctor as ambivalent, but I'm reading them more as giving you autonomy over your own health and body, which makes me like them already. A medical professional who knows your medical history and has your chart is making this recommendation, and they're a lot more qualified than any of us.
posted by capricorn at 1:48 PM on November 19 [1 favorite]
Peri = a cornucopia of reasons to not have energy or motivation.
#1 issue to address: SLEEP. If you’re getting less than 7 hours, you’re operating at 60-70% of your capacity. When I get 7 or Jesus 8 I am a completely different person. Waking up **feeling** ready to go naturally brings things to do to mind. (These are precious days to me!).
I don’t believe anyone is “lazy”. Period. Something is blocking energy that’s it.
If that is an issue, you and your doc have got to be detectives to figure out why 8 hours isn’t happening. Could be hormones, could be nutritional deficiencies, could be a side effect of the medication itself. Or sleep apnea
If you’re getting sleep but still feel fatigued that’s another issue, got to look into that. Anemia and other issues can cause it.
Don’t put everything down to psych stuff, there’s a whole body there
posted by cotton dress sock at 7:01 AM on November 20 [1 favorite]
#1 issue to address: SLEEP. If you’re getting less than 7 hours, you’re operating at 60-70% of your capacity. When I get 7 or Jesus 8 I am a completely different person. Waking up **feeling** ready to go naturally brings things to do to mind. (These are precious days to me!).
I don’t believe anyone is “lazy”. Period. Something is blocking energy that’s it.
If that is an issue, you and your doc have got to be detectives to figure out why 8 hours isn’t happening. Could be hormones, could be nutritional deficiencies, could be a side effect of the medication itself. Or sleep apnea
If you’re getting sleep but still feel fatigued that’s another issue, got to look into that. Anemia and other issues can cause it.
Don’t put everything down to psych stuff, there’s a whole body there
posted by cotton dress sock at 7:01 AM on November 20 [1 favorite]
I have been on Effexor for long periods of time, including multiple dosage changes and a very long taper off. I say this to demonstrate that I'm fully aware that changing the dosage of Effexor in particular is not trivial AND to recommend you give it a try.
posted by In Your Shell Like at 7:25 AM on November 20
posted by In Your Shell Like at 7:25 AM on November 20
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