How to deal with depression
May 24, 2006 6:53 AM   Subscribe

My doctor wants to put me on anti-depressants, but I'm hesitant. What experiences do you have with them, and would you recommend dealing with the depression naturally or with the medication?

I have been suffering from occasional panic attacks, constant tiredness, anxiety, and insomnia over the last few years, and my doctor wants to put me on anti-depressants. I haven't been on them before, and am not quite sure what to expect. I've spoken to my sister, who is a pharmacist, and who has been on anti-depressants herself, but I thought I'd put it out there to see what you guys think...

So my question is this - would you try treating depression with natural treatments - such as counselling (which I am doing anyway) and exercise and other methods like that, or would you recommend going on the meds (not sure which medication in particular she would recommend for me)?

Any experiences about being on anti-depressants would be really good too.
posted by jonathanstrange to Health & Fitness (44 answers total) 7 users marked this as a favorite
This is a highly personal issue and its really never a good idea to get medical advice over the internet.

I will however give you my opinion. No matter how some people (doctors included) might make taking mind altering drugs seem trivial and commonplace... it is a serious issue. Anytime you take a drug that chemicals alters how your brain functions there are all sorts of things that can right or wrong.

I'd try making some lifestyle changes. Eat healthier, excercise at least a few times a week, get more sun, maybe take up a relaxing hobby like tai'chi.

Sure its always easier to just take a pill and if you -really- do need medication to get everything back in track don't let internets opinions change your mind... but taking medication is serious business. My father for instance takes a blood pressure and cholestorl controlling medication that has the potential to kill his liver. He -should- just cut back his hours at work a bit and spend more time relaxing/excercising... but he doesn't. Sometimes the best solution isn't the most expediant.
posted by JFitzpatrick at 7:09 AM on May 24, 2006

If you're hesitant about going on meds, and you aren't in a place where you're dangerous to yourself or others, why wouldn't you try exercise and diet modification before going on medication?

I've been on meds (Welbutrin) and I certainly don't have anything against them. But you sound like you're not crazy about the idea. I'd try exercising regularly, getting sun (not too much, but get yourself outside in the light for 15 minutes a day), and possibly diet modification (I found that my depression and motivation issues were greatly improved by limiting or cutting out my intake of carbs, and definitely by cutting out refined carbs (white bread and sugar)). If you're not in danger of hurting yourself, what's the harm? If it doesn't work, you can always go on meds later.

What is your doctor thinking about putting you on?

My personal experience is, as stated above, with Welbutrin/budeprion. I found that it increased my anxiety levels TREMENDOUSLY (I developed a real fear and sensation of zombies crawling out of the shower behind me) and made me extremely twitchy/jumpy. But, otoh, I was able to negotiate a 10K raise while on it and get out of the inertial funk that I'd been in for 5 years. I also lost 10 lbs and my libido was through the roof. But the anxiety thing was enough to make me go off and stick to diet, sun, and exercise as a treatment plan.

Good luck, whatever you decide. Lots of us have been there too. You're not alone.
posted by fuzzbean at 7:13 AM on May 24, 2006

I am on anti-depressants, and I still don't know how I feel about them on the whole. I no longer trust SSRIs, though I know that most anti-depressants out there are SSRIs. I was on Lexapro for about a year and a half, and it started off by just messing with my sleep schedule. When I had been on it longer and my general depression was more or less gone (though I should note that I was also seeing a counselor at the time), it made me feel really dulled. Not as if I had suddenly become dense, but as if the whole world was no longer crisp--all the edges blurred, and instead of being sad, I was just kind of apathetic. I didn't care about things very much, and that really bothered me.

I was put on it when it was pretty new, and the doc who prescribed it said there weren't any side-effects. It was only after I went off it that I found out that the joint pain I was having was probably from it (I am in my mid-20s with no arthritis or joint or bone issues otherwise, and the pain started while I was on it, and as soon as I went off it, it disappeared). Additionally, coming off the Lexapro was an absolute nightmare. I couldn't concentrate, I had terrible mood swings, spent a lot of time crying for no reason, and was incredibly dizzy. I know that SSRIs have helped some people, but my experience, and the things I've heard from a lot of my friends and family have really scared me off of them.

I also have experience with Wellbutrin, and I know others who do as well. I've heard nothing bad from anyone else who's on it, and personally, I don't notice any side-effects or dullness from it. Mostly, I feel normal--I have highs and lows, and I care about things.

With regards to anti-depressants in general, do your research on whatever is prescribed to you (if anything is) or anything your doc suggests. Each one affects people differently, but common elements like bad withdrawal are serious issues. Go into it with an open mind, but don't go into it without information, either.

That said, I really wish I had had some idea of natural methods of treatment that might have worked. Meditating made me calmer, but it didn't get rid of that core sadness. I don't know how accupuncture or more exercise might have helped.

Please don't think I'm advocating anti-depressants here--I simply hope that my experience might offer you another perspective. Even if you go on anti-depressants, I think it's important to keep seeing your counselor. The big idea lately is that the two together are the most effective treatment. But do what you think is right for you. Don't let someone push you into it or try to badger you until you give in. If you change your mind later, you can always go on the meds or change meds or go off the meds.
posted by monochromaticgirl at 7:21 AM on May 24, 2006 [1 favorite]

If you've already tried exercise and relaxation techniques and therapy, then sure. But if not, try it for a month or 6 weeks and see if it helps; this is as long as it would take for an SSRI to kick in, anyway.

On the other hand, since this has been going on for a number of years, it sounds like you may be in the "dysthymic" category--poor concentration, feelings of hopelessness, appetite changes, sleep changes, energy changes, and/or low self-esteem. So it may take longer for you to start feeling better, so perhaps an SSRI would be a good idea.

Either way, let's not look at taking the medication as "failure" on anyone's part; often medications are required to get a person to a place where exercise and talk therapy will help. Sometimes people are so low or their current mood is so stable that it takes a drug to get them out of it. (Studies show an SSRI plus psychotherapy is the most effective treatment for depression, I'm not sure about dysthymia.) And to JFitzpatrick: sometimes BP and cholesterol levels are so high that lifestyle changes alone will not get them to the levels we'd like Lifestyle is an important part, but it's not always the solo solution.

(Re: SSRI's, the main complaints people have are GI upset, headache, and the notorious sexual side effects, often longer time to achieve orgasm. Unfortunately the drug everyone asks for, because it lacks sexual side effects (buproprion) isn't a good choice for people that are having anxiety issues, as it tends to make people more anxious.)
posted by gramcracker at 7:21 AM on May 24, 2006

I was put on it when it was pretty new, and the doc who prescribed it said there weren't any side-effects.
Never trust a doctor that says this; all medications have side effects.

Each one affects people differently, but common elements like bad withdrawal are serious issues.
All SSRIs should be tapered off, except maybe Prozac because of its active metabolite in your body; stopping them abruptly will cause a post-SSRI syndrome with headache and feeling crummy.

(And buproprion is Wellbutrin.)
posted by gramcracker at 7:26 AM on May 24, 2006

This is all I can offer: I had very similar symptoms to those you described and a great antipathy to anti-depressants. Some cognitive-behavioral therapy + a fairly intense exercise regimen in a sport I love has resulted in me being happier than I ever was. It took a while though, something like a year. So I'm all for going non-drug first, but give it some time.

Caveat: I'm not sure how much of my sport-related cheer is from the exercise itself and how much from the things I've learned about myself while doing it.
posted by dame at 7:30 AM on May 24, 2006

I've been off on and off them a number of times. When used in conjunction with therapy (counseling, psychologist, etc.,) they can be a nice little bridge to help you through the rougher alone times until you learn to cope w/o them. I never experienced any side effects but that does vary from one person to another.
posted by KevinSkomsvold at 7:33 AM on May 24, 2006

A few years ago, after finally accepting the fact that I had depression for much of my adult life, I went to the doctor. Counselling helped a lot. I tried 3 different anti-depressants (can't remember which ones, but could probably find out) all of which made me feel so terribly ill that I had to give up on them. Blinding headaches were the main problem ... usually after a few days, but within 6 hours with the last one I tried, when I literally couldn't get out of bed. That experience made me realise that my brain didn't want to be messed with to that extent.

I went with St John's Wort for a couple of years. It seemed to help at first, but gradually reduced in effectiveness to the point where I'm not sure it was helping at all.

Earlier this year I started (for other health reasons) using ground flax seed in some foods ... e.g. in smoothies, or sprinkled on breakfast cereal. I noticed a quite significant improvement in my mood, so started researching what it might be. DHA is 'brain food' - deficiency of it is a problem for developing infants and children, but it's also believed to be one possible cause of depression.

Typically DHA can be found in fish-oil formulas, either pure oil, which many people might not enjoy, or capsules. I'm vegetarian so didn't really want to go that route, but luckily found a couple of vegetarian products that use DHA from algae sources. I tried one and it seemed to help a lot. I'm now trying the other 'super' version and I'm not convinced that it works as well for me so may go back to the other.

So, based solely on my experience, I'd consider trying DHA as a natural alternative before going on prescription meds. Cost may be an issue as it obviously wouldn't be covered by any insurance. The ones I take are about $1 (Cdn) a day. I suspect that fish-oil ones may be a lot cheaper.
posted by valleys at 7:39 AM on May 24, 2006 [1 favorite]

I've never been on meds myself, but I've had plenty of friends/family member who have, and here's what I've learned.

-- they can be life savers.

--they can have unpleasant side effects.

--they affect each person differently.

Hopefully this goes without saying, but if you try exercise (etc.) and you continue to feel depressed -- and especially if you feel suicidal or are unable to function -- then it might be worthwhile giving meds a chance.

Sometimes when people get into a really bad state, they can't make such judgements by themselves, so I hope you've discussed this with someone you trust and that they are ready to be there for you if necessary. I would tell them that you don't feel comfortable with drugs now, but that you might need some prodding in that direction should things get really bad.

MOST IMPORTANT: find a good doctor. Start looking NOW, while it's not mission critical. Many people need their meds adjusted for a long period of time, before they find exactly the right concoction/dose for them. You need a doctor who will be willing to stick with you for the course of this, someone who will see you regularly, monitor your moods, and adjust the levels of your meds until they're right.

If you go on meds, finding this doctor/not finding this doctor will make all the difference.

Finally, once you go on the meds, ask the same buddy who is -- hopefully -- sticking by you now to continue to stick by you. The biggest risk, once you go on meds, is suddenly going off them. For whatever reason (sometimes something as simple as forgetting to pick up a subscription, but often a dislike of the side effects), people sometimes go off their meds, cold turkey, and this can lead to suicide or worse.

You need a friend who will keep an eye on you.

Good luck to you!
posted by grumblebee at 7:39 AM on May 24, 2006

Whether or not you decide to the take the drugs should be up to you. I was forced to take nearly a dozen different drugs in my teen years. From this experience, I would recommend one principle to follow if you decide to take the drugs:

Look at them as a bridge to something else. Do not look at them as the solution. Go on them with the intention of using the help they give you to improve your life in real, practical ways and to eventually get off of them. I've seen too many people fall victim to the "drugs are the solution" thinking. It really hurts people in the long run. They can't get off of them, etc.

Also, remember...just because you have these "symptoms" doesn't mean there is anything wrong with you or that you have a "chemical imbalance." Do not pathologize yourself. These are parts of life, no matter what mainstream america or the drug companies say. This is not to say you shouldn't seek relief if you need it. But chances are, if you work through these problems, you will come out the other side a more mature, loving, developed individual with a higher self-esteem and self-worth.

Good luck.
posted by milarepa at 7:43 AM on May 24, 2006

I am not a doctor or a therapist, and I haven't been on antidepressants, but I have been in therapy.

From what I understand, a huge part of the benefit of any treatment for depression comes from the client's expectation that it's going to work. If you're hesitant about meds, then, and you're convinced that other methods would work better, then that might be a consideration.

On the other hand, anxiety has been described as one of the easiest things to control medically, and you mention panic attacks, so if that's the major part of what your doctor is trying to help, then that might be a consideration. (How's that for vacillating?!)

Also, it sounds like your medical doctor is wanting to prescribe the drugs -- have you talked to you therapist about it?
posted by occhiblu at 7:46 AM on May 24, 2006

"often medications are required to get a person to a place where exercise and talk therapy will help."

This is so so SO true.

(IANAD, or even very knowledgeable as a lay person.)

My meds help me feel like myself enough that I can drag myself to a therapist. Therapy is where the bulk of my healing from depression is taking place, but I couldn't even do that much without some medical intervention. Exercise is a necessary part of my treatment, but again, if I can't drag my ass out of bed because I felt like such a schlub, how am I going to exercise in the first place?

For me, therapy, exercise and medication are a combo that I have to constantly tweak to get maximum results. I'm pretty much on a stable dose of Effexor, but I'm still learning what amount (and kinds) of exercise and therapy is ideal for me. (And I've been dealing with this damn depression for over a decade.)

Someone posted in another thread today a site called CrazyMeds. I've been reading all morning, and there is a lot of frank info there that you might find helpful.
posted by SuperSquirrel at 7:49 AM on May 24, 2006

For some people, SSRIs are absolutely magical. One moment they're depressed, and a few weeks later they're better. It's quite amazing, and demonstrates how much of depression seems to be chemical and biologically based. It's a shame there's so much stigma attached to it. There are absolutely side effects, and they can significant and frustrating (weight gain, sexual side effects, insomnia, etc).

Go the non-drug route, and stay away from them if that works for you, but you might also be one of those people for whom the drugs really work.

I think the most important thing is that you've recognized that you're in a place that you don't want to be, and you're going to try and find your way back out. Good luck!
posted by fcain at 7:58 AM on May 24, 2006

My advice would be to hold off from the drugs for now, but do decide on how long is a reasonable amount of time to give the alternatives a chance, and actually set a date when you will call and make an appointment to talk about starting the meds if you don't feel markedly better by then. This date should apply even if you don't feel that you've put as much effort into the alternatives as you should have.

My second piece of advice would be to do everything that you can to improve your sleep. At the very least, make sure that your bedroom is uncluttered, as dark as possible (get blackout curtains if you need them) and that you are not doing anything very stimulating in the last hour or so before sleeping. And needless to say, take care with caffeine.
posted by teleskiving at 8:03 AM on May 24, 2006

On the other hand, anxiety has been described as one of the easiest things to control medically, and you mention panic attacks, so if that's the major part of what your doctor is trying to help, then that might be a consideration.

Anxiety is also one of the easist things to control with CBT. And you don't have to keep refilling a prescription.
posted by dame at 8:06 AM on May 24, 2006

Drugs and therapy work about equally well for treatment of both anxiety and depression. occhiblu is also correct that patient expectation for change is a big predictor of how well either is going to work. The most important aspects of treatment other than that are a positive relationship with the provider (either the MD or the therapist). Changes that occur outside of therapy, like a new job or improved relationships, are by far the most important aspects of people feeling reliably better.

If you've been in counseling for a while (more than a couple of months) and you don't feel like you're getting any better, address that with your therapist. They work for you, and the research on getting better in therapy suggests that 1) it happens relatively quickly, 2) early change in therapy predicts later change (if you don't see change by session 10 you aren't likely to magically see it at session 100), and, 3) not all therapists are right for all patients.
posted by OmieWise at 8:07 AM on May 24, 2006

So my question is this - would you try treating depression with natural treatments - such as counselling (which I am doing anyway) and exercise and other methods like that, or would you recommend going on the meds (not sure which medication in particular she would recommend for me)?

I'm not a doctor, but don't rule meds out. They can help, especially if you combine them with therapy. And sometimes they can drastically improve your state of mind. Getting other parts of your life together helps, too. But people suffering from depression often have trouble making significant changes in their lives without one or the other. Depression encourages you to do nothing, or at least nothing productive.

Meds have side effects. It can take a while to find the right drug and the right dosage. But letting depression go untreated will also likely have some negative consequences for you. So it's a trade off.

I'm not a doctor, but I used to have trouble with depression and anxiety. A combination of meds and the talking cure worked for me. I'm quite fortunate that I am no longer in need of either. So I say try it and see (and give it time).
posted by wheat at 8:07 AM on May 24, 2006

Oh, two other things I forgot to mention:

It really doesn't matter what kind of therapy you choose to use, they all work about the same. (According to meta-analysis of all the studies comparing different therapies, Bruce Wampold suggests that only about 1% of treatment variance is due to the type of therapy engaged in.)

Many people I work with (I'm a therapist) who have problems sleeping have poor sleep hygiene. It's easy to get into bad habits, particularly in an effort to ameliorate the side-effects of insomnia itself. Here's a pretty good page from the U of Md outliing some things to consider in this regard.
posted by OmieWise at 8:13 AM on May 24, 2006

Your question -- would you try treating depression with natural treatments, or would you recommend going on the meds -- seems fundamentally misguided to me.

Therapy and medication aren't opposite to each other; they're two parts of effective treatment that work together. Likewise, exercise and diet are not alternatives to medication, they are in addition to medication. There is no reason on God's green earth why you could not take an antidepressant, go to therapy, modify your diet, and get more exercise all at the same time.

If you're thinking of herbal stuff, remember that herbal remedies are not an alternative to drugs; they are drugs, plain and simple. The difference between drugs extracted from plants and drugs synthesized in a lab are that the botanical ones are likely to be less well understood and, in the US, less well regulated by the State. That certainly doesn't mean you should avoid herbal remedies, but don't fool yourself about what they are.

I was on bupropion for a while. The main effect was, simply enough, that I felt better enough to go to therapy and get something out of it, better enough that my problems were something I could look at and not just another horrible thing to be miserable about. The side effect I had was a bit of insomnia for a couple weeks.

OTOH, bupropion carries a small but nontrivial risk of seizure. All of the antidepressants are pretty serious juju -- they're getting into your brain and affecting your neurology, which is a big deal. OTOH, their effects and side effects are pretty well known by now.
posted by ROU_Xenophobe at 8:23 AM on May 24, 2006

Are you speaking with a GP, or a psychiatrist? If you can find one that treats patients with anxiety, and you can afford it, I would suggest visiting a psychiatrist or psychopharmacologist before accepting medications to ensure that you are receiving the most appropriate treatment (and not just the treatment the GP knows most about, or has the most samples of).

You should be aware that there are different classes of drugs used to treat mental health problems, and that an anti-depressant may or may not be the most appropriate treatment of your symptoms. Has your doctor considered the use of benzodiazepines (klonopin et al) or other anxiolytics to deal with the panic attacks instead of anti-depressants? Pro: you can take benzos as needed, and you don't necessarily require a maintenance dose. Con: risk of dependence.

And what everybody else said about exercise/sleep/meditation/therapy/etc. If those work for you great, if not, go the med route. But be sure you are working with a physician that is knowledgeable about current meds.
posted by crazycanuck at 8:34 AM on May 24, 2006

I should add: I have taken anti-depressants. They did not work for me, because they were an inappropriate treatment of my underlying symptoms (which are/were different than yours, so I'll spare you the details). I now take a mood stabilizer, and I am quite pleased with this treatment.

After 7 years of treatment (off and on), I am now on maintenance medication for life. Both I and my doctor have agreed that my illness is biological in nature, and we treat the problem appropriately. In my case, treatment would be ineffective without permanent drug therapy. YMMV
posted by crazycanuck at 8:46 AM on May 24, 2006

The only thing I'd add to the suggestions above: if you decide to try exercise/diet first to see if they are sufficient, then decide how long you'll give them, and set a doctor's appointment for that date now. That way, you have to actually cancel the appointment if they're working, instead of trying to whomp up the energy and motivation to make an appointment if they're not.
posted by joannemerriam at 8:47 AM on May 24, 2006

In my view (and it's only that), I wouldn't touch anti depressants with a ten foot bargepole if I were you.

Only now (years after they've been widely adopted) is information coming to light that they actually cause suicidal thoughts (and actions) in some people where there were none before. This happened to me four years ago, and I was left in a far worse state than before I began.

Advocates will say, compared to the amount of people they help, those who experience these effects are very few. But I'm automatically suspicious of anyone -doctors especially- who can bypass the fact that people can and do actually die because of these things.

Something tells me more and more unforeseen bad consequences of taking them is going to come to light as time goes on.

My bottom line advice, if this is not a life or death crisis and you can see something else that might work, anything at all, exhaust it before even thinking of medication.
posted by fiver at 8:49 AM on May 24, 2006

Piggybacking on crazycanuck's post: if the doctor you're talking to is your GP, proceed with caution. By definition they don't specialize in administering psych meds, and for this sort of thing you really want to be talking--often--with a specialist. You may have to try several different meds and/or dosages before finding something that works.

I have been suffering from occasional panic attacks, constant tiredness, anxiety, and insomnia over the last few years

This statement, in conjunction with the counseling you're already doing, makes me think that looking into meds might be a good idea for you. BY ALL MEANS make the other lifestyle changes that have been suggested in this thread (diet, exercise, etc), because they do help. But also be aware that depression is great for creating feedback loops: it affects your sleep patterns, eating habits (because who wants to cook when you can hardly drag yourself out of bed?), which in turn just makes you feel worse. Meds can help break that cycle. Go putter around on crazymeds for a while; it's full of good information.
posted by Vervain at 8:56 AM on May 24, 2006 [1 favorite]

This sort of medication affects people very differently, but my own experience has been very positive, especially in combination with therapy.

Part of the aversion people have to anti-depressants is a feeling that the drug is going to change their personality, and that they will suffer a loss of self. I think this is an unreasonable fear, and certainly far from my own experience.

All that the drug does for me is lessen the regular waves of panic and anxiety that come over me, and makes me more able to control my life, and find joy in it. If I have to take them for the rest of my life, it really wouldn't bother me.

Having said all that, there is much more to recovery from depression than drugs. You will need to make the lifestyle changes detailed in other posts, and a good therapist is, in my view, the most important thing.

Depression and Anxiety are very beatable, so good luck!
posted by Touchstone at 9:25 AM on May 24, 2006

Antidepressants definitely saved my life. They are not for everyone, and they are not all the same, but there are a lot of people who should be on them but aren't. In my experience, most shrinks will be pretty open-minded about working with you to find the one that's best for your specific needs.
posted by bingo at 9:39 AM on May 24, 2006

4 years ago I was in your same situation. I was prescribed an SSRI but was adamant about not taking it. Fast forward to last year, where the problem of my anxiety started effecting me physically: feeling very sick and run down all the time, massive sweating when meeting with other people, and the worst: chest pains that were really causing me a lot of problems. After a few heart tests that showed me to be perfectly healthy, I ended up talking to my doc about anxiety and decided to start on Lexapro. Within 1 month all of my symptoms finally started leaving. To make a long story short: SSRI's have changed my life for the better. You will hear *more* negative remarks about SSRI's than you will positive, at least that's what I found in my research before deciding to give them a chance. Ultimately, the decision is yours, but do some research. Ask about the positives instead of the negatives.

I am, however, concerned with 2 things:

1) I may be developing a tolerance to Lexapro and will be speaking with my doctor early next week about it. (See post here.)

2) I wonder if I will ever be able to *stop* taking these. I absolutely do not want to go back to feeling how I used to. I know I'll eventually need to cross this bridge someday.

Again, ultimately it is your own choice. But for me, SSRI's were a godsend that are really helped me get back on my feet again.
posted by punkrockrat at 9:43 AM on May 24, 2006

My experience with meds - they have been extremely useful in stopping the downward spiral when I couldn't pull myself out. However, as many people here have said, they never became a solution in and of themselves. They would bring me to a level just above the danger zone and leave me hovering there, where I continued with all of my daily bad habits of thought and action.

I've also been through years of counseling, off and on. Sometimes it helped, sometimes it didn't. I can't stress how important it is to find somebody you really work well with.

All of this did nothing for my long-term well-being until I became proactive in my own treatment. This involved making healthier choices on all levels: the people I surrounded myself with, the ways I talked to myself, how I took care of my body, etc. Instead of talking passively to a professional and leaving it at the door, I took the tools home and used them. I did homework. I chose to be constantly aware of my thought patterns and emotions, and then personally took steps to change them.

In order to do this, I needed to be in a place where I could pull myself up. This took being informed and armed with the hows and whys (this is what I took from the counseling and from reading). It also took an interruption of that nasty cycle (which didn't take meds this time, but I wouldn't have spurned them if it was necessary).

Now, I consider exercise and diet my "meds," and continued awareness of thought processes - and conscious changes in unhealthy ones - mandatory for a higher quality of life. When I stop being proactive about these things, I struggle. The difference has been absolutely incredible - night to day.

If it matters, I have dealt with both anxiety and depression, and went through a plethora of different meds and counselors.
posted by moira at 9:51 AM on May 24, 2006 [6 favorites]

Mild anxiety or depression often respond well to lifestyle changes: eating well, exercising, getting enough sleep, meditation, making the time for the things that relax you and make you happier.

Clinical anxiety or depression very actively interferes with getting those things done.

If you feel your life is generally in control and you have the ability to make those changes, then you could consider the lifestyle changes. (It's the choice I made under those circumstances.)

If you feel trapped in a vicious cycle of being unable to make positive changes in your life, I'd listen to your doctor and take the anti-depressants.

As JFitzpatrick noted, this is a personal decision.
posted by Zed_Lopez at 10:07 AM on May 24, 2006 [2 favorites]

I eschewed antidepressants for a long time (during which I had counselling etc. for persistent, lifelong depression). But I finally (after several years just talk therapy) decided that it would be worthwhile to try something to reinforce the other things I was doing.

I actually sought a psychiatrist, rather than just relying on the advice of my counsellor (a psychologist) and GP. I'm glad I did this, I felt it led to a more thorough selection process (I did end up starting with something that did not work out before I got to an effective therapy). This did cost more than just regular doctor visits would have. I proceeded to take a modest dose of Paxil for several years.

Overall I felt it was positive. I had no severe side effects (I did feel I was more prone to morning fatigue and weight gain during the period, and I'd get these weird zappy feelings in my head if I missed a day or two). Taking this clearly reduced obstructive cyclical thinking - dwelling on negative thoughts with no benefit/object - and reduced the frequency/duration of episodic severe depression and anxiety. I felt that this gave me some additional psychological space that allowed me to carry what I was doing in therapy to a fuller integration in my personal life/mindset.

On the other hand, I do think it made me somewhat complacent. There were several issues I wanted to deal with (for example, I'd started smoking again and was an on-again/off-again smoker throughout my use of paxil) and seemed to find it easier to "accept" that I wasn't dealing with them. In other words, it increased my general sense of well-being/comfort, but in some cases this action seemed undifferentiated. And it was no cure-all. I still struggle with many of the same things I always have. There was also a definite withdrawal when I quit, but it wasn't that big of a deal for me compared to some of what I read.

It was sort of difficult to make the decision to stop - not that I had severe concerns about my reaction, it was just sort of ambiguous. Mainly I wanted to see how I felt now after several years. It's been around a year now, I think, that I've been off Paxil. I do feel the treatment ended up making me more intinsically able to deal with depression and its effects. There's no question I have more anxiety and depression now, than when I was on the pills. And I vacillate whether I should reinstate it when things are relatively bad. But I do feel like I'm able to take the line of (for example) "you don't have to worry about that, that isn't what's happening right now" about some semirational anxiety and have that attitude stick, so to speak. My impression is that for a lot of people, unfortunately, the decisions - whether to takle the pills, whether to stay on them, whether to go back on them - are similarly not clear cut.

There's no reason not to hold off a little longer if you really believe you can make lifestyle changes stick. Diet, exercise, getting sufficient sleep (you could consider treating that as well if you don't), and meditative practice could all certainly make a difference. Give it a try, there's no reason it couldn't preceed drug therapy, and even if you decide to try meds later it can only make the process more effective. But don't rule out meds - I, at least, had no problem doing them for a while, then stopping, and do feel I ended up with a clear net gain.
posted by nanojath at 10:11 AM on May 24, 2006

I had anxiety problems for the greater part of my life. Last year it got so bad that I was almost unable to drive for fear I would have a panic attack while driving. It started to impact my physical health as well. My doctor, a GP, put me on a small dose of Zoloft and in two weeks, when it started to kick in, I started my journey to an almost anxiety-free life. The only thing it didn't really help with was my fear of flying. But, that's just my experience. I should note that it did not change my personality except for overall being more happy and calm.

I would definitely start out with exercise and good sleep habits, though. I feel that is at least the foundation of healthy living if not the first step on the road to recovery.

As for the meds, I haven't had any negative experiences with them and I've been on them for almost a year. It is my understanding from multiple doctors that no one stays on Zoloft for more than two years, and that they will wean you off of it but you will be able to continue your new anxiety-free lifestyle.
posted by bristolcat at 10:14 AM on May 24, 2006

This is going to sound silly but it worked for a few people I know (including myself).

Stop eating sugar. Avoid all corn syrup, refined sugar and fruits. You have to look at everything you eat and avoid sugar. Eat carbs. Eat anything at all you want to.. except for sugar, corn syrup and fruit.

Try the diet for two weeks. Every single person I know who has tried this feels better. It works.

Some people are sugar sensitive.
You may be one of them.
Hey, it's worth a shot. Better than pills.
(cheaper too)
posted by Bighappyfunhouse at 10:16 AM on May 24, 2006 [1 favorite]

Wellbutrin gave me a seizure (surprise!).

Zoloft ended up fucking with me a LOT, in the weight-gain and libido areas, but I'm off it now. I'm still dealing with the problems it gave me. Or exacerbated, if it didn't start them completely. I started having anxiety problems when I was on a too-high dosage, but that stopped when the dosage was lowered.

Don't let your GP prescribe you anything. Go to someone who knows about medicine. My GP didn't know what the hell he was doing, and finally admitted it and sent me to a psychiatrist (or psychologist? I always forget which...). Unfortunately that was a year into him denying that my problems were the medicine's fault. He just blamed them on me. Lovely.

There's more, but other people have said it better above.
posted by ruby.aftermath at 10:44 AM on May 24, 2006

Chronic Depression is a physical and mental condition which can be treated with medication the same as other disorders. If you want to rid yourself of depression, attack it on multiple fronts. Exercise, Diet, Therapy, Work on your relationships, and medication. Therapy is the most critical component of the equation: analytical followed by cognitive. It can take a very long time (sometimes decades). The good news is once you start Therapy, you can begin to manage your depression and feel better almost immediately.
posted by sswiller at 11:27 AM on May 24, 2006

I am the Zoloft poster child. After about fifteen years of exercise, dietary changes, cognitive-behavioural therapy, St John's Wort and trying to tough it out, I went on Zoloft in May 2003. I was dysthymic, but what the drug actually did was take away the anxiety and OCD symptoms. I realize now that I was scared out of my mind every day of my life from age 8 or so until 32.

Now I think I know what normal people feel like! My friends who knew me in the before-time say I'm the same, only happier. My friends who have met me since are surprised to learn that I was so badly depressed for so long. My psychiatrist has no problem with keeping me on a maintenance dose for the rest of my life, and neither do I. I figure, if the problem wasn't physical, the pill wouldn't fix it.

Hardly anyone has such a straightforwardly positive reaction. These are powerful and poorly-understood drugs. But for me and my family, they've been a godsend.
posted by rdc at 11:40 AM on May 24, 2006

I just wanted to address a few things that have come up in this thread since I last commented, hopefully in the spirit of making it easier for you to make a decision about what to do.

Medications help a lot of people with depression and anxiety feel better. They are the right treatment for some people some times. No treatment is right for all people all of the time, and indeed, the research on absolute and relative efficacy indicates that not only is therapy at least as effective as medications (79% of people treated by therapy do better than those wanting but not receiving treatment), in both cases it is more likely the general ingredients of the treatment rather than the specific ingredients (either the specific medication or the specific therapy) that is what helps. The research on this is quite well established, Wampold provides a great introduction in his book The Great Psychotherapy Debate. Again, this is not to suggest that you shouldn't take medication, but just that the choice is truly yours. You would not be lessening your chances of getting better to not take medication, although you would be lessening those chances if you did nothing to treat your depression.

In light of this information, rdc's reasoning should be avoided. The fact that Zoloft helped his/her depression tells us nothing about etiology, just as aspirin helping a headache or a twisted ankle (or alcohol helping a sense of shyness) tells us nothing about the cause of those problems. What Zoloft working tells us is that Zoloft works for rdc, which is excellent, and may well be reason enough to take it for life. This is an important point because the argument about physical causes is powerfully persuasive as a rhetorical device, but isn't adequately proved at this point.

I also have to point out that sswiller's contention that therapy can take years to be effective is disproved in the research literature, which suggests precisely the opposite. Again, this is important because part of what people consider when making their choices is a very legitmate cost-benefit analysis (with both terms used to describe several spectrums of costs and benefits). Taking a pill every day for life may seem much less onerous than attending therapy for ~10 years, but most people are helped by therapy much much more quickly (in months, not years).

I would like to be clear that my own position is that whatever helps people to live fulfilled lives, whatever works as treatment, is fine. I'm not against medication, and I have no belief that there is some kind of metaphysical or spiritual problem with avoiding suffering by taking them. I think that's a ridiculous position. On the other hand, medications are heavily advertised and there has been a persistent medicalization of our emotions and thoughts which I find to be poorly supported by the research literature. Especially when the results are examined vs. placebo or therapy, the supposed miraculous effects of medications are not so miraculous. When coupled with disturbing side-effects that have resulted in multiple black box warnings in the US and a recommendation in Britian that therapy is more appropriate as a first-line treatment (published in the BMJ), I think we have to be careful about how we talk about medications and the alternatives if people are to make rational and evidence based decisions about which to choose.
posted by OmieWise at 12:07 PM on May 24, 2006 [1 favorite]

Lotta good stuff here, but I'll just tell you my story.

I resisted ADs for a long time, despite a lot of negative results. I self-medicated with caffeine and alcohol. I made bad choices and self-destructive decisions. What finally changed was a conversation I had with a professor where the matter came up and I expressed a discomfort with brain-altering drugs and needing to keep taking them forever (which was part of but not the entire problem I had with them).

She stopped me and asked one simple question: If I was diabetic, would I take my insulin?

I said yes. She said "so take the damned pills."

I don't know if you need them or not, but if you do - take them. I can't possibly convey the number of ways they changed my life.
posted by phearlez at 1:48 PM on May 24, 2006

I'm on zoloft, love it. I've taken it a couple other times in the last 9 yrs, never for longer than a year. Before taking it I was always hesitant, it felt like cheating. After taking it for a couple weeks, I always end up wishing I'd just gotten over myself and taken it earlier.

There are some studies showing regular aerobic exercise can be as effective as SSRIs for mild depression. The combo of exercise and SSRIs, rules the school, IMHO.
posted by selfmedicating at 1:49 PM on May 24, 2006

OmieWise, you are right about the length of treatment required for therapy, but I believe that even if a few months of counseling relieve the symptoms of Depression, the longer you stick with it, the better your chances of remission. I say that if you feel better after a couple months, you should continue to check-in periodically for maintenance.

I am an advocate of medication for depression. I think that a lot of the people who have moral qualms about it have never experienced depression, never known a person with depression, or don't fully understand what chronic depression is all about. If you were drowning and Osama Bin Laden threw you a life vest, would you take it or drown?

I also think a distinction must be made between pscyhology and psychopharmacology. There are many psychiatrists who are skilled diagnosticians and physicians, but poor psychologists. Conversely, there are many psychologists who believe they know something about medication. Be very careful of these characters, and DO NOT get your medication from a primary care physician unless he or she also specializes in psychomarmacology.
posted by sswiller at 2:40 PM on May 24, 2006

I've been taking Wellbutrin for ADD for about a month now. I really have not notice any difference. It might work differently for a depressed person but for ADD its worthless. Before resorting to anti-depressants I'd seriously consider counseling. A lot of doctors over prescribe medicine when it's really not needed.
posted by isopropyl at 3:01 PM on May 24, 2006

I vote for the pharmacueticals.

I started bupropion as an aid to stop smoking, I'm still smoking but the profound effect on my personal life led me to conclude that I have been fighting depression all this time when I thought I was just a lazy, morose person.

I personally never saw any value in therapy and I always felt it was a waste of time when I hung out with all the pillow hugging feeling chatters as a child.

posted by Megafly at 6:03 PM on May 24, 2006

Speaking of flax, it reminds me: I once lucked out and got a fair-sized tub of shelled hempseed for an ok price. I swear I felt much better for having had a tablespoon every day.

Dagnabit, I gotta see if I can track it down at a good price again. The local health store has it insanely overpriced, at least triple what I'd paid, and I wasn't trying for a deal.
posted by five fresh fish at 6:18 PM on May 24, 2006

I went on Prozac about 12 years ago after I was diagnosed with chronic dysthymia. This is one of the best things I have ever done. The meds were augmented with cognitive therapy. I was on the meds for about 4 or 5 years.
Looking back on it, I don't think I would have had the kind improvement I had without the Prozac. My bootstraps were just not going to get pulled up that way. (I was underwhelmed by the cognitive therapy also.)
It helped that I was a classic "good responder".
I wouldn't discourage any non-medication directions you decide to go if you are inclined. But I wouldn't hesitate to recommend meds either.
Good luck.
posted by doowop at 6:55 PM on May 24, 2006 [1 favorite]

The best way I can describe it:

Before anti-depressants I was staring at a brick wall and was incredibly uptight about the fact that I was staring at a brick wall.

After anti-depressants I was staring at a brick wall but didn't care that I was staring at a brick wall.

I'm not sure which was better.
posted by TiredStarling at 2:27 AM on May 25, 2006

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