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Depression: Meds, Yay or Nay?
The Crowing One
Registered User regular
Registered User regular
I want to start by just saying that I've been on various anti-depressants (a short stint on Wellbutrin and then a terrible month and a half on Celexa) for the last two months or so. In this process, due to the wide variety of personal responses to medication, I have found that a wide range of anecdotal experiences tends to be more effective in evaluating one's own reaction than anything else.
So, my real question is along the lines of "should I start taking meds again?"
As I said above, I had a terrible month and a half on Celexa recently. I tend to be somewhat "unaware" of my own body, and often I fully do not understand the effects of medication until a good compare and contrast comes along. In short, Celexa "leveled me out" at a rather low place. The deep lows got cut out, but so did pretty much all of my good moods. Last week I weaned myself off the Celexa in preparation for trying Effexor per my doctors instruction. The result was, essentially, that I had the best week I have had in a long, long time. To use a phrase that's common in mental health, I "felt like myself again". I was immensely social (I barely left the house in January); I completed a long tick-list of important errands and tasks that had been sitting ignored; I was generally happy and smiling and chatty. I have yet to begin taking the Effexor.
In part, I think that the effects of the Celexa gave me a lot of perspective on my moods and have led me to seek out and appreciate my good moods far more.
Now, I'm debating if I even want to start taking Effexor. Of course, if there's a noticeable change in my moods it would be a good move to give it a shot. Yet I'm finding myself happier, more productive and a generally much better person this week while on nothing at all. I'm wondering if anyone has any experience with this sort of situation (even second- or third-hand) that they'd be willing to share?
Thanks!
So, my real question is along the lines of "should I start taking meds again?"
As I said above, I had a terrible month and a half on Celexa recently. I tend to be somewhat "unaware" of my own body, and often I fully do not understand the effects of medication until a good compare and contrast comes along. In short, Celexa "leveled me out" at a rather low place. The deep lows got cut out, but so did pretty much all of my good moods. Last week I weaned myself off the Celexa in preparation for trying Effexor per my doctors instruction. The result was, essentially, that I had the best week I have had in a long, long time. To use a phrase that's common in mental health, I "felt like myself again". I was immensely social (I barely left the house in January); I completed a long tick-list of important errands and tasks that had been sitting ignored; I was generally happy and smiling and chatty. I have yet to begin taking the Effexor.
In part, I think that the effects of the Celexa gave me a lot of perspective on my moods and have led me to seek out and appreciate my good moods far more.
Now, I'm debating if I even want to start taking Effexor. Of course, if there's a noticeable change in my moods it would be a good move to give it a shot. Yet I'm finding myself happier, more productive and a generally much better person this week while on nothing at all. I'm wondering if anyone has any experience with this sort of situation (even second- or third-hand) that they'd be willing to share?
Thanks!
The Crowing One on
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I live with my cat. I don't like living with other people.
I've gotten to the point where I'm somewhat scared. Wellbutrin caused me to have immense irritability. I was angry and snapping at everyone, everywhere. I was a real jerk. Thankfully, it hit me on a weekend and I was able to get off of it by Monday. The Celexa actually caused me to come close to losing my job (at the point where I had to come clean to my boss about my mental health issues, which is something that I'm immensely opposed to), and I'm still slightly worried that I may be out of work come next week (which, I think, is a slim chance but not confirmed). The Celexa also caused sexual dysfunction, which killed one of the few sources of actual joy that was still experiencing.
I can't afford to have negative side-effects like this (personally and, most importantly, economically). Even my doctor has been surprised by my pretty bad reactions.
Edit: Wait, you were only on the Wellbutrin for a weekend? I think you may have some severely misguided notions of how medication works. If you are only going to try it for a day and then stop, you're better off not trying it at all. None of this stuff is a magic bullet, medication takes weeks or months to reach peak efficiency and for your body to adjust or compensate for any side effects. If you are only giving it a few hours you are doing it wrong.
These seem like non-traditional anti-depression meds. He may have better luck sticking with Prozac or Zoloft or some other SSRI. I'd try and get a second opinion.
I do have weekly talk-therapy with the same doctor who proscribes my meds. The side of this that I don't think is being addressed is that I have felt no need for medications this past week. While this could be chalked up to a number of causes, if I'm not depressed I'm not going to take meds. The side effects have been so severe that if I worked for any other company I would have probably been fired.
Sorry, but I'm not certain what you mean by that first sentence...
The Wellbutrin was first-line as I'm a heavy smoker and I was able to give it a shot with my PCP while I awaited my first psych appointment. Celexa is actually generally "first line" these days, to my understanding. My doctor has explained that there's a rather systematic way of going through anti-depressants, and we have had long conversations concerning the medications. Zoloft, etc. are actually rather old at this point, and are next on the list after Effexor if I don't react well.
Sexual dysfunction was what I was referring to. Thankfully, to my understanding, having negative sexual side effects usually doesn't repeat over different drugs.
The side effects have been crazy. Really crazy. My doctor is rather confused, but we're moving along.
If I were to cease meds longer term I'd certainly continue talk therapy, as I've found it to be very useful and beneficial.
I know what I want to do, right now: stop taking meds. I also know that this is not a position that is eternal, and there's a good chance I may wake up tomorrow or in a week and go back to the lows that made me decide to seek out help in the first place. I have been on medication because I sought out medication, not because I was deemed to "need it". Anti-depressants aren't antibiotics, that is to say that there does not really exist a clear causal link between being depressed and requiring medication. This is exactly why I'm seeking others' experiences, because unlike a round of penicillin the effects are both, essentially, non-physical and wildly varied.
I was never asked to take them. I specifically sought meds as a part of the treatment as talk therapy had previously failed to create much of an impact on their own (the last time was over a year ago and resulted with me quitting a job that I, in hindsight, really shouldn't have quit).
This has also been chronic. At this point it has been up and down for almost half a decade, with the last two years or so being the worst.
Since you're continuing to see your therapist, here's what I'd do. Let him know that your time with Celexa was really stressful and that you'd like a break from trying new meds for a bit, especially because dealing with the side effects was hurting your employment status. Keep a close eye on yourself and your moods, and keep talking to your therapist honestly about how you're doing. A reasonable therapist will totally understand that kind of request, so it's not like you have to choose right away whether to be on or off meds for the rest of your life.
(And to the person who said Celexa is non-traditional, the OP was correct that it's now a first string SSRI for dealing with depression and anxiety, especially because it has a low percentage of side-effect sufferers. I'm on it for anxiety and it's amazing, but obviously it's not working for the OP.)
This isn't a zero-sum game. I'm just trying to arm myself with as much feedback from as many sources as I can. Of course, my doctor is at the top of that heap when it comes to any actual decision.
Edit: I suspect it is relevant to note that I have the Effexor I have just chosen to wait on beginning the dosing. If things change it would be a matter of just beginning to take the pills.
Eh? I'm pretty open about it (just not with employers, etc.) so I don't mind giving details. If there's anything you want to know, just ask.
Having said that, if you want to try going at it without meds for a while and see if you feel like you're making measurable gains from counseling alone, go for it. I would caution you to make sure your therapist and you create a plan by which if in the middle of the week between sessions your depression becomes unmanageable, you can get a prescription filled and in-hand quickly.
Like you noted with your time on the celexa, it leveled me out. I didn't get as super depressed as I had been and I could cope with things that would have sent me into a spiral, otherwise. Like your experience with the celexa, though, I was happy enough, but never got really happy, not even feeling excited over things that should be exciting. The worst part about the effexor was that I physically could not cry. Sad movie, nothing. My boyfriend at the time lost his childhood dog to cancer, not a single drop. I felt bad but physically could not express it. Also it completely killed my sex drive and that started a whole new set of problems not related to the meds. I also came off of it hard... which is partially my own fault, but that's an entirely different story.
Of course everyone reacts differently, but there's my brief story for you.
Keep the communication open with your doctor about what you'd like to achieve from your talk and pharmaceutical therapies, which it sounds like you're doing, and best of luck to you finding something that works for you and gives you the results you're looking for.
Ironic.
I haven't been able to speak to my doctor about it yet, but it will probably be a focus of our conversation in a week and a half.
I had to go off it for outside reasons, and just a few months ago it was decided that it would be best if I went back on. Well, circumstances... aren't the same right now. After a little more than two months, I just felt wrong. Or like I wasn't ready for it. Or something.
The moral of the story is that even something that works or doesn't work for you once might not work for you a few years down the line, especially if you tend to medication-hop.
Sorry if that isn't the clear-cut advice you were looking for, but would you ask advice for what type of antibiotic you should take from a public internet message board? No you wouldn't. Don't treat the drugs you're taking for a mental health disorder any differently from a drug you'd take for a physical health issue.
Also, DO NOT GET ANTIDEPRESSANT DRUGS FROM A GENERAL PRACTITIONER. I love GPs and think they're a bastion of awesomeness, but they should be giving out antidepressants like they should be giving out chemotherapy. It takes a lot of time and nuanced skill AND the current literature to really successfully treat mental health. GPs have none of these. Go to the specialist to make sure you actually have depression and get a drug that will actually help you out.
Then again, my case was different from yours I believe, because I was a borderline suicidal vegetable by the time I finally dragged myself to the shrink (I had a burnout that had just cost me my job). I'm told antidepressants work best in such cases, whereas finding the right meds/dosage for chronic depression is more difficult.
One thing that caught my attention: you mention you've been "up and down" for years. Do you have any family history of mood disorders? Have you talked about the possibility of bipolar disorder with your therapist/doctor? It's extremely common for certain forms of bipolar disorder to be misdiagnosed as depression. My mom was (unsuccesfully) medicated for depression and anxiety for a decade before her shrink had the sudden revelation that she might be bipolar, and after receiving proper medication her problems are pretty much gone. Antidepressants are of no use to people with bipolar disorder, and can be actively harmful.
edit: To reiterate what others have said, a month is too short to judge the effectiveness of SSRIs like Celexa. During that time the side effects are at their worst while the actual antidepressant effects haven't really even started. Like I said, it took about a month for me to see any improvement.
In fact, it has been pretty invaluable to me to be able to confirm side effects and such from others' experiences. For example, I wasn't really very aware of what the Celexa was doing to me as far as "leveling everything out" until I read an older account, here, from Ceres and then discussed it with my doctor.
A friend of mine who has a lot of experience being on anti-depressants has voiced concern that my doctor may be overdosing me. I was on 40mg of Celexa, which she believed was higher-than-normal?
Bipolar has actually always been a concern for doctors initially (more than once), though after exploring it further they have both concluded that I'm not bipolar. The same friend as above (who is bipolar) has voiced suspicion that if I am bipolar, it's probably "rapid cycling". The whole thing seems moot as I haven't been pushed into mania by my month and a half on Celexa. I'm also adopted and have no actual family medical history, which makes a lot of this kind of stuff just a bit more difficult.
This thread has actually been really helpful, so far, in getting me to look deeper at what I'm really asking about. I think this is motivated two-fold by the fact that I'm doing great this week (I haven't used that word to describe my state of mind in awhile), and that I'm basically scared shitless of ending up in a similar position to what happened with the Celexa. It's legitimate, as while I was on Celexa I was, overall and for non-depression reasons, at the worst state I think I have ever been at.
I can't afford to spend another month like that waiting for it to work. I'm not suicidal (thank heavens), but those sorts of thoughts crept in toward the end of my time on Celexa because I just couldn't see the point anymore. It was actually part of the impetus for my ceasing the medication.
Would I, perhaps, be under the effects of the Celexa now after ceasing totally this past Monday (I did a 20mg x3, 10mg x3 to wean off)?
Zoloft (middle school): Didn't do much for me. Killed libido, but I was like 13 at the time so it's hard to judge what's normal.
Effexor(first two years of high school): Works great for my dad (anxiety/depression). Worked a bit for me. Had anorexia as a side-effect at large doses.
Geodon(a few weeks in high school): Made me sleepy all the time, didn't help.
Lamictal(last two years of high school): Wonder drug for many of my friends. Was a wonder drug back for me back in high school. Though I suspect my ADHD is still worse because of it.
Then I stopped taking any meds except for my ADHD meds in college, but once I graduated I realized that the life I was leading wasn't sustainable for the long run, so I went back to the meds.
Lexapro(last eight months until two weeks ago): Worked great, helped with anxiety too. But still no sex.
Wellbutrin (past week): Only have been taking this for a week, so hard to say. No bad side effects so far, but I'm still waiting for the lexapro to get out of my system.
I understand your aversion to the meds considering the work concerns and significant side effects, including one that is a rarer in Celexa. Other than the side effects, do you have any other concerns about taking meds for your depression?
Again my information is based on anecdotes and what my mom's psychiatrist has told her, so please do take this with a grain of salt, but antidepressants in combination with bipolar disorder are prone to cause a mixed state which sounds pretty much like the worst state a person can be at.
I'm not suggesting that you self-diagnose (which can turn into a huge problem since self-diagnosing patients can sometimes convince their doctors to make the wrong diagnosis), but this might be worth keeping in mind especially when observing the effects of medication.
My therapist has actually been gone a few days now, but he's part of a clinic at one of the larger and more prestigious hospitals in the country and if I have an emergency there will be a doctor to take care of me who I can see/speak with.
I have an aversion to anti-depressants in the first place. My first experience was actually over 10 years ago in middle school when I was on Paxil and, according to my parents, went completely manic. It wasn't good. Since then I have yet to have even a tolerable experience. I'm just not the type of person who wants to be on medication, but if it would help, I've been willing to try. My long term goal is to be able to be without meds, and I didn't need them for the first 24 years of my life, so while it has been chronic in the last two years or so, I know that if I can get myself to a better place I can probably go without.
I've also always been a melancholy person. Not depressed in a clinical way, but always more "sad" than otherwise. At the same time, it never really, before this, got in the way of me leading a fulfilling and generally awesome life.
I hear you. My experience on Celexa was, as I understand, a rare side effect. To my understanding, the most common response to Celexa in a bipolar individual is extreme mania. My friend (who is bipolar) was on Celexa once. She didn't sleep for three days and was in the most manic state she had ever, ever been in. I may bring this up again to my doctor in a "things haven't been working"-type way.
Doses higher than 40mg are usually not needed, but 20mg is often used as an initial dose. Your doctor probably had a reason for starting you at 40mg. 60mg is the max prescribed dose. Side effects are dose dependent, so lowest effective dose for a patient is best (for any drug). Talk to your doc if concerned. Also, this is a PCP? Psych referral wouldn't hurt if you're having med difficulties.
To clarify, I started at 20mg a week and then increased to 40mg. The first week I had some physical side effects (GI distress, headache, etc.) which is fine as I can deal with it and they went away after a week. It is difficult for me to pinpoint when I totally fell into the "rut" with Celexa, but it was probably somewhere in the 3rd-4th week.
That's definitely understandable, and I don't think many people like to take medications. If you were very depressed in the past two years and it was significantly impacting your life, I'm glad you did something about it. It's completely possible that you'll be fine to go off the meds in the future, but maybe that time isn't now. You really should try to talk to another doc at the hospital first. You stopped taking them this monday? 4 days is really not enough time to know whether you're in the clear.
When it comes to medications for depression, just remember that it really *is* a disorder of chemical (neurotransmitter) imbalance. If you had deficiencies in some other agent your body makes, Insulin for example, would you not take medications for your Diabetes? Side effects aside, don't feel like the nature of depression makes it any less deserving of medical management.
Good luck with everything, it sounds like you've got a lot on your plate right now.
1- I started on Celexa. It knocked me on my ass and I didn't get out of bed for two weeks. Seeing as how I was away at college and had gotten these from my PCP, it was a total disaster. Some drugs just don't work for some people!
2- Wellbutrin. This stuff worked for me. Got me up instead of down like Celexa did. Serious libido killing sexual side effects for the first 6O days as it entered my system. But after that the symptoms went away. I was on Wellbutrin, or Wellbutrin+Effexor, or Wellbutrin+Zoloft for six years or so. Worked well for me, but over time my body grew a tolerance to it (but I didn't realize this!) and slowly but surely the depression came back and I stopped taking meds altogether. It is important for you to realize that not only do you not get the full effect of the drug until that first 60 days are up, but it will also fade over time and your doc will have to either up dosage or switch meds. Brain chemistry is just a pain in the ass to regulate.
3- Effexor. This was added to my Wellbutrin to ease my anxiety (I was having panic attacks). Good news is, this stuff works really well. Bad news is you have another 60 days of new side effects to wait out before your body stabilizes the drug. SUPER BAD NEWS: Effexor drops out of your system in 72 hours. If you are the type of person who is prone to missing and/or skipping a dose, either change that habit or do not take Effexor. Why? Well what happened to me is that I'd miss a couple days in a row and by Day Three I would be going nuts. Later I was informed I was experiencing symptoms of Withdrawal (because of how fast it leaves your system). So while going through withdrawal with no idea what was happening to me I'd feel like shit, and wouldn't take my meds until I was sane again. Finally I'd feel better, start taking my meds again and BAM here come the original side effects again.
Anyway, here are the things you need to know about medicating brain chemistry:
1- It works. Seriously. Yes there is a lot more trial and error type guesswork involved in psychiatry than in any other avenue of medicine you're going to come in contact with, but just because getting it right takes time doesn't mean it's never going to happen. Medication + Therapy is the best way to help yourself. Don't let whatever biases you may have dissuade you from this.
2- You have to take your meds as prescribed. Don't skip. Don't forget. Don't think you can go off and on them whenever you want. You're not only setting yourself up for failure, but you're also throwing a big mokeywrench into that thing you call a brain.
3- If things change in your mental state, or you are experiencing side effects you cannot or do not want to cope with, CALL YOUR PRESCRIBER (this person should be a licensed psychiatrist, please. Not a GP). Sure, your psychiatrist is going to ask some questions, give you a scrip and then say "See you in a month (or six)" and you're going to feel like an idiot because there's no way that a doctor you only see for less than an hour every thirty days could possibly help you. But the truth is, THEY CAN! It just happens that the effects of these drugs are strung out on a long enough timeline (usually sixty days like I said) that seeing you any more often is pointless. This doesn't mean that if you have a problem you should ignore it, or worse decide you know best. Call your doctor and tell them what's going on.
4- Brain Chemistry Changes. You've found a drug that works, only your depressive symptoms have started to reappear. OH NO, THE WORLD IS ENDING AND GOD HATES YOU! Wellll, not quite. Your body will eventually grow a tolerance to your current meds.
Like I was saying - You grow a tolerance, symptoms come back, hooray you're kinda back to square one! First thing your doctor will try is upping your dose. WELCOME BACK SIDE EFFECTS. Ride out that sixty days again, see how it goes. Next is throwing another drug on top of the first (Wellbutrin with a Zoloft chaser worked for me). And then after that a complete switch to a new drug (taking Paxil now, really low dose, should probably get it upped). Again, every time there is a change there will be side effects to contend with. Yes it sucks. Being depressed sucks worse.
5- It looks like an onerous slog, right? Well hey, it is! But it's worth it. You will feel better. And believe it or not, going through all this hassle just to feel good is so much better than giving up on yourself and staying miserable.
There is no contentment in being miserable, no matter how easy it is.
And I think that's it.. May come add some more if something strikes me