BM1: When are antidepressants needed?

[BM1]

With all of the focus on getting off of antidepressants (AD) and withdrawal effects, I wonder how to determine if and when I will need an AD. I am currently down from 150 mg of Effexor to 25 mg. I am weaning slowly and intend to follow the 10 percent reduction recommendation. At this pace it will take 30 to 40 weeks to get off it depending on how it goes and how small the increments get. I am not experiencing an significant physical side effects but am experiencing a general lack of enthusiasm, low motivation, am a bit edgy and easily agitated. Sadly, these symptoms are not uncommon for me and I cannot really ascribe them to withdrawal. I hope that they improve as time goes on but frankly do not expect them to. Since I have been on and off ADs for 13 years and have tried many of them, I am not sure if I need one or if I can get by without them. I want so much to get off them and see how I feel after so long but worry that I will be able to live the life I want to. I have never been a really joyous person but I never considered myself depressed until a divorce, a few losses of loved one, and and an overabundance of stress in my life left me feeling I needed some help. I have been on them ever since. I think I fell victim to their addictive qualities.

 

I am very susceptible to stress and experience a fair amount of in my life and recognize the impact that has on ones psyche and seratonin levels. It is apparent to me that ADs are overprescribed, overdosed, and used for too long, but my basic question is, how do I determine if I really need one and avoid getting back onto them un-necessarily if I find after all this that I am still sad, edgy, unmotivated and feel I need a better quality of life? I never wanted to get on them in the first place but did find that they helped much of the time. I have had long periods where they seemed to work pretty well. I continue to try to exercise, get counseling, read, meditate, eat a good diet etc and do what I can as alternative treatments for depression. I am just trying to keep an open mind for my options after I "survive antidepressants" and try to live my life without them. I feel a lot of the focus is getting off ADs but what's next and what if I really need them to be happy. My depression is mild but I do so much want more joy, peace of mind, and acceptance in my life and have not had great success finding it. I think I need some encouragement and proof that people are able to kick ADs and win that battle but do not have to battle too hard living with depression without them. I welcome any thoughts or success stories.

[Nikki]

Hi....that sure is an interesting question which I have asked myself many times.

The answer I come up with is ~ how much can I take in terms of anxiety/depression.

 

So many people who get off of meds experience protracted withdrawal which can last a long time. This is where my question comes in for me. How much of this can I take? Is it wd or is it how I am wired?

 

The members of support groups that I have posted with over the years, who took the longest to get off of their med by slowly tapering were the more successful in terms of feeling better and not returning to ad's.

 

Is everyone who gets off of an ad supposed to? I don't think so. There are lots of people who do well on meds, once they find the right one. I have friends who fall into this category.

 

I guess it ultimately comes down to 'quality of life'.

 

Honestly BM1, I wish I were med-free. I don't relish the thought of feeling lousy for the next couple of years either from tapering, protracted wd, or finding out that after all of the misery, I need to stay on an antidepressant......

 

Right now it's all speculation. I don't know what the next drop in dose may be....could be lousy and then again I could feel better and better as I get further away from ssri's.

 

Hugs

[Barbarannamated]

BM1,

I dont have the answer to that million $$ question.

 

"Antidepressants" (SS/NRIs, TCAs, neuroleptics) never helped me throughout 15+ years of continual use. Doctors only recently discovered underlying medical conditions that likely caused my original presentation of "depression". It got much worse and was exacerbated by "antidepressants".

 

So, my answer is very personal: antidepressants may be appropriate as a last resort when all medical and psychosocial causes have been addressed. They are not benign drugs - they CAUSE illness.

 

If I had experienced any benefit, my answer may be different.

[peggy]

i think the main problem is that these drugs were formulated and tested for short term use - they don't just effect one or two neurotransmitters - there is a whole cascade of after effects further up (or down) stream. They cannot be good for long term use...I have always deep down believed that our brains are wired to achieve homeostasis - when depressed it may take a little while for us to achieve it - the drugs help speed up that process, but then they overshoot the mark and have further reaching effects than what they were designed to do. That is what makes me so reluctant to stay on in the long term - i always felt great on my poison, but i KNEW that it wasn't good to stay on forever, that is why i have been trying to get off for so many years. This time i am down to about 16mg effexor and feeling great - no withrawal at all and am going down in micro steps now - about 5% every week or 10 days - it is hard not to be impatient from here, but i have never been this low and felt good so onward and downward!

[strawberry17]

That is a really good million dollar question. I was given to believe, when I was prescribed them, that they were only to be taken for a year or 18 months from the point they make you feel well again. That's all well and good if you can get off them with ease. Many people can't, and for many I think they can cause more problems than they solve. I am currently tapering super slow the end is in sight for me, can't see myself ever going back on them, ever!

[Skyler]

 

So, my answer is very personal: antidepressants may be appropriate as a last resort when all medical and psychosocial causes have been addressed. They are not benign drugs - they CAUSE illness.

 

If I had experienced any benefit, my answer may be different.

I agree with you Barb. I strongly encourage anyone on who is considering long term AD medication to read Robert Whitakers' The Anatomy of an Epidemic, and Irving Kirsch' The Emperor's New Drugs. Both books are easy to read, and made a big impression on me. ~S

[BM1]

Thank you all for your feedback. Lots of good nuggets there and lots to ponder. I do hope that I can feel better as I continue to reduce. I know even at the low dose of 25, 16 percent of my original dosage, it still has its hold on me. I feel the withdrawal symptoms in the morning before I get up as it reminds me I am ready for another dose. I know it is not good for me overall otherwise I would not be so committed to getting off. But the quality of life issue is ever present. I do not want to feel down or flat all the time and really would like to feel more joy and alive. Someday...

[renee]

that is the question.I have switched my meds from cipralex to prozac as i could never get off the cipralex the withdrawl was so awful.But i must admitt i feel much better on an antidepressant as to not anything.The only time i didnt feel good was before i went on them; for years I had anxiety and depression,and when i tried to come off.Im feeling really good on the prozac 30mg now and plan to stay on,maybe for life.With the prozac if want to come off i know it will be much easyier than the cipralex.I do not plan to live the rest of my life suffering from anxity or depression and for me antidepresants do the trick.I also have done and do many other things.Im in a 12 step group eat well exercize ect,;but if somethng helps me why not???Thats the road imgonna chose,and I feel at peace with this choice now

[Altostrata]

Originally, antidepressants were intended only for people with a very serious, extreme form of depression that was incapacitating.

 

If you had this form of depression, you couldn't work, you might not eat, and you wouldn't be able to log in and post here. Even so, this depression usually would run its course after some number of months or years and the person would recover. Even this very serious type of depression was considered to be episodic, not chronic.

 

(If you think of how many people you've known who were truly incapacitated by depression, you would understand this is not very common.)

 

Lesser forms of depression, which are mostly situational, would resolve by themselves, without medication, 70% of the time within 6 months.

 

In the last 20 years, research has emerged showing that antidepressants are only significantly effective in the most extreme form of depression, and are about as effective as placebo in the lesser forms of depression. This doesn't mean they have no effect, it means the chance they are responsible for improvement in your mood is only 50%.

 

Antidepressants were never tested for long-term safety, and were always intended for limited use. The current APA practice guidelines for major depressive disorder state, "To reduce the risk of relapse, patients who have been treated successfully with antidepressant medications in the acute phase should continue treatment with these agents for 4–9 months." This recommedation is graded as having the top level of empirical evidence backing it up.

 

Anyone taking antidepressants for a year or more has probably exceeded those guidelines.

 

However, due to drug company efforts in the last 20 years, antidepressants have been promoted for every kind of distress, from mild to severe, from situational to chronic, from physical ailments to mental problems, and for indefinite periods.

 

Many people have decided having a negative outlook on life, or a dour personality, or a history of failures and disappointments means they have a mental illness requiring psychiatric medication.

 

Many people are taking antidepressants who should never have been prescribed them, and most people taking them are taking them for far longer than they should be.

 

According to the US CDC http://www.cdc.gov/nchs/data/databriefs/db76.htm ,

More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.

BUT

About one-third of persons with severe depressive symptoms take antidepressant medication.

If by "severe depressive symptoms" the CDC means that extreme depression (the definition of "depression" has become so blurred you can never be sure what it means), this means of the estimated 6% of the adult population with major depressive disorder (whatever that is), only a third (2%, about 6 million), are being medicated.

 

Yet 11% of the adult population is taking antidepressants, about 30 million people. If only 2% have major depression, the other 9% -- 24.6 million, or 82% of those taking medication -- don't have major depression, should never have been prescribed antidepressants, and have been exposed to their risks for far too long for no good reason.

 

So when are antidepressants needed? Can you live without them? In the words of Henry Ford, "Whether you think you can, or you think you can't -- you're right."

Edited July 7, 2012 by Altostrata
updated information

[Shanti]

I've thought about this a lot, what would I advise someone to do if they have depression. I think ADs are for dire emergencies, suicidal. I would recommend Homeopathy and change in diet. Herbal remedies, and alternative therapies such as CBT. I see so many options now. I would strongly urge my friends to try these things before taking medicine. Unfortunately, my word isn't always enough to convince people. I find that a lot of people are so taken in by the ads and the assurance of their doctors, that they don't listen to me. Even though I tell them that what I went through isn't uncommon, they think that my experience was only because I had a reaction or something. Or, they simply can't grasp how serious the risk is and how hellish this experience was. But I try.

[BM1]

After over a year of withdrawing from Effexor, I finally stopped completely over a week ago. I am still adjusting, but overall feel pretty good and I seem to be improving. I have very minor physical symptoms that I could potentially tie to the drug. I have emotionally felt a bit raw and sensitive. My job is a daily emotional roller coaster and I do not have a lot of joy in my life. I have always been susceptible to stress and tend to be a pretty serious person, partly because I have a responsible position and feel I need to be responsible. I wish I could let loose more and not take things so seriously but that is a constant struggle. I have had some relatively minor health issues reently that have put my body into tilt and some other emotional things going on in my life. These things would be hard for anyone to deal with. Finding peace and happiness has long eluded me and my chemical, physical, and emotional reactions to stressors and things in my life do not help. I try to make changes to my life but it is difficult and will take time. In the meantime, I vaccilate from being ok and reasonable comfortable to being a bit over the top and stressed out. I don't consider myself to have an anxiety problem per se but I do think a lot and am serious and always sweat the details. I am sure people consider me mildly to moderately depressed. I consider it a reasonable response to a difficult life without a lot of positives to focus on.

 

In any event as I go forward, I know I have to deal with this and find things to improve my situation. But I do at times feel like I need help. I do not want to go back on ADs but family members have noticed that I am not happy and at times have withdrawn from things and they are encouraging me to go back on the medication saying life is too short and it is not worth being miserable when you can be happy. ADs have not been the absolute solution but they have helped at times. I got off because I was on them way too long and knew that I was addicted to them and needed to clean them out of my system. But what now? When life knocks me down, and it does, I do get depressed and lose my hope and optimism. I continue to try all the right things, counseling, yoga, diet, supplements etc. I do want to enjoy life more, fine some joy and take myself less seriously. I have tried St Johns Wort in the past before going on ADs and they seemed to help a little. Should I consider that again as a little halper? I have been on pretty much every AD with mixed results. Is it more of an anxiety problem than depression? Is there something that will give me a little boost for times when I am losing the battle? I am open to suggestions. I will continue to try to do what is right, but sometimes it is just hard and the reality is that as I age, it is only going to get worse. Any toughts or encouragement out there?

[Jemima]

I agree with Shanti and Alto that antidepressants should be restricted to people who are suicidal and/or completely non-functional, and even in those cases, every possible medical cause should be ruled out first. I was at that point about three years ago and was hospitalized and given antidepressants. Unfortunately no one thought to check for medical problems, such as having a cholesterol level that was dangerously low due to Lipitor. It took eight weeks for the first antidepressant to have any effect at all, and only after I had overdosed on another one that was prescribed for sleep did I perk up in the least. I was overstimulated at that point but not quite "manic". However, I eventually figured out what was wrong, quit taking the Lipitor, and within three months was having difficulty with flight of ideas and hyperactivity from the antidepressant and began tapering off too fast on my doctor's instructions.

 

IMO, one problem so many of us have is an utter lack of patience. Before there were mood-altering drugs, people pretty much toughed it out and accepted that life is full of problems and woes. Now, at the slightest twinge of discomfort, we start looking for a pill or some other quick fix instead of facing whatever problems we have and working on them over however much time it takes. I include myself in that description, although I'm struggling to get over it.

 

Antidepressants are not harmless medications that we can take at will to cheer ourselves up. They can cause all sorts of medical problems as side effects, such as enormous weight gain, diabetes, and kidney failure, and there is ample evidence that long-term use shortens the life span, especially for those who go on the drugs in early adulthood and stay on them. I believe GiaK, one of our mods and the author of the blog "Beyond Meds", once posted an article about the lifespan young men being shortened to 45 years with continuous use of an AD. These are scary drugs, poisons, IMO. It's not a matter of "What the heck, I may as well be happy on drugs as not without them". Uh-uh.

[Narcissus]

or is it how I am wired?

There is no evidence that certain people are 'wired' to be depressed. If we can draw any conclusions at all from all of today's neurobiological fervor it's that the brain is not a fixed mechanism but a bundle of extremely complex and changing relations/processes, all of which are intimately tied to the world around us. We need to stop referring to ourselves as if we were machines, it's this reductive and mechanistic view that got us here in the first place.

[BM1]

I'm sorry but this response is not the least bit helpful. Who is referring to us as machines? What do you mean this reductive and mechanistic thinking? I am wrestling with quality of life issues as we all are. I do not want to deny who I am and am not reacting to the "slightest twinge of discomfort". A few weeks ago, I was pondering my very existence and future and take this very seriously. I am not trying to take the easy way out. I am 62 years old and do not want to be miserable to my dying days. It is not black or white, do we take the easy way out and take a happy pill. I am trying to deal with my daily dilemmas and find some measure of comfort in my life. I know that ADs are not the panacea, but I also know that we have a tendency in our genes toward depression and other mental disorders. What the hell do you mean there is no evidence that certain people are wired for depression? There are most certainly familial factors and tendencies toward these afflictions and "disabilities". I have a brother who would not be functioning were it not for the lithium that keeps his bipolar disorder at bay. I am sorry I asked for opinions, these two have been totally counterproductive.

[Meimeiquest]

This is grossly off-topic to this board, but you might want to check out psycheducation.org. My end-game question about meds will be How can I best love well. I do not want my epitaph to be "She maximized her mental health." I have no idea where I'll end up. I pray you will find peace. You certainly don't lack for effort. Meimeiquest

[alexjuice]

Hey BM,

 

Everyone gets to (has to, actually) decide how they want to look at questions of this sort. I think there is a diversity of opinions on this forum on the causes of depression or anxiety, however there is less diversity, naturally, on the question of whether or not the current pharmaceutical remedies are useful treatments.

 

If you've perused the forum, you've read scores of stories of lives worsened by the medications and numerous studies about the negative side effects.

 

I think most of the best treatments are based in more basic human therapies: meaningful work and relationships, spirituality, exercise, nutrition and excerise, being a part of ... though I never felt very "happy" on the antidepressants I took.

 

I understand your distress and also understand the search for answers. I hope you find something that works for you.

 

best,

Alex

[Narcissus]

I'm sorry but this response is not the least bit helpful. Who is referring to us as machines? What do you mean this reductive and mechanistic thinking? I am wrestling with quality of life issues as we all are. I do not want to deny who I am and am not reacting to the "slightest twinge of discomfort". A few weeks ago, I was pondering my very existence and future and take this very seriously. I am not trying to take the easy way out. I am 62 years old and do not want to be miserable to my dying days. It is not black or white, do we take the easy way out and take a happy pill. I am trying to deal with my daily dilemmas and find some measure of comfort in my life. I know that ADs are not the panacea, but I also know that we have a tendency in our genes toward depression and other mental disorders. What the hell do you mean there is no evidence that certain people are wired for depression? There are most certainly familial factors and tendencies toward these afflictions and "disabilities". I have a brother who would not be functioning were it not for the lithium that keeps his bipolar disorder at bay. I am sorry I asked for opinions, these two have been totally counterproductive.

 

Sorry BM1, my comment was not directed to you and was not meant to address your situation. I was just railing against an imaginary enemy I guess, I dunno. Again, my apologies.

 

I would be careful about the genetic origins of mental disorders though, all of that stuff is purely speculative.

[Jemima]

pgd, I think your comment was probably in response to post #2 by Nikki who said, "How much of this can I take? Is it wd or is it how I am wired?" I reacted to that statement too, as I believe all so-called mental illness, with the exception of physical brain damage, properly diagnosed hormonal imbalances and other odd medical problems that affect the mind come down to "problems in living" per Thomas Szasz.

 

But getting back to BM1, you've only been off Effexor a matter of days, so please don't come to a decision about antidepressants just yet. From my own experience coming off 10 mg. Lexapro too fast, I can tell you that feelings of sadness and anxiety linger for some time after getting off the drug and that is part of withdrawal syndrome, not a matter of being "wired" wrong. It's been fifteen months off Lexapro for me, and only the past month or so that I haven't been experiencing neuro-emotions. As for things getting worse with age, I'm not sure where you got that information, but I'm 67 and feel that I can handle emotional situations better than before AD withdrawal. If nothing else, tapering or withdrawal syndrome will teach a person patience!

 

I tried to find your background information and could not, so I've moved this topic to Introductions and updates. When you have time, would you please put your drug history in your signature? It would help us respond to your posts more effectively. Thanks.

[alexjuice]

Well said, Jemima. Taking some time for settling is always a good idea before abandoning plans or making big decisions.

 

Also, BM, I don't think I did a job of saying what I wanted to say and hope my response didn't come across as unsympathetic.

[CopingMechanism]

pgd, I think your comment was probably in response to post #2 by Nikki who said, "How much of this can I take? Is it wd or is it how I am wired?" I reacted to that statement too, as I believe all so-called mental illness, with the exception of physical brain damage, properly diagnosed hormonal imbalances and other odd medical problems that affect the mind come down to "problems in living" per Thomas Szasz.

 

 

 

Are you actually aware of anything that man wrote, or just name dropping?

 

You do realise the prick wrote off mental disorder carte blanche, don't you? Whether it has/had a biological basis or is a purely psychological disorder, he thoroughly believed all patients who presented symptoms of mental distress were deliberately doing so for some sort of social gain.

 

The man was as damaging to a humanistic approach to psychiatry and of the same intellectually dead-endedness as the absolute biological reductionists.

[Narcissus]

he thoroughly believed all patients who presented symptoms of mental distress were deliberately doing so for some sort of social gain.

That's quite a claim, and shocking if it's true. Does he say this somewhere?

 

I've read the essay (not the book) The Myth of Mental Illness a few times now. It's a complex critique of psychiatry, but it seems that all of his arguments boil down to a single objection, which is the use of a scientific/medical framework to mask what he sees as a social process. This seems to be the crux of his critique here:

 

In actual contemporary social usage, the finding of a mental illness is made by establishing a deviance in behavior from certain psychosocial, ethical, or legal norms. The judgment may be made, as in medicine, by the patient, the physician (psychiatrist), or others. Remedial action, finally, tends to be sought in a therapeutic -- or covertly medical -- framework, thus creating a situation in which psychosocial, ethical, and/or legal deviations are claimed to be correctible by (so-called) medical action. Since medical action is designed to correct only medical deviations, it seems logically absurd to expect that it will help solve problems whose very existence had been defined and established on nonmedical grounds.

 

So, based on this argument, the term 'disorder' is objectionable because it hides the social/ethical considerations that inform it, whereas a phrase like 'problems in living' would include these considerations. Szasz's real hang-up seems to be the medicalization of psychiatry, and he sees the notion of mental disorders as a part of this medicalization. You suggest that Szasz would write off a disorder even if it were purely psychological, but this is to confuse his ideas I think. He would say that the notion of mental disorder itself, deriving as it does from medicine, always implies a physical component, and so if psychiatry insists that something is a disorder it really means that some sort of physical anomaly is at some level present. And Szasz would object because he sees the entire affair as psycho-social.

 

None of this means, however, that the individual suffering experienced under the guise of a mental disorder is feigned or somehow unreal. Where Szasz objects is the use of standardized, mecicalized terminology to describe such suffering, which he sees as belonging to the realm of "private, sociopsychological happenings". I'll let the man speak for himself.

 

 

While I have argued that mental illnesses do not exist, I obviously did not imply that the social and psychological occurrences to which this label is currently being attached also do not exist.  Like the personal and social troubles which people had in the Middle Ages, they are real enough.  It is the labels we give them that concerns us and, having labelled them, what we do about them. 

 

One of Szasz's most interesting points is that by universalizing and objectifying the patient's suffering mental disorders override the complex person-to-person dynamic between patient and psychiatrist. To Szasz, this dynamic is crucial if psychiatry is to be ethical. So, it seems to me somewhat ironic to accuse Szasz of damaging 'humanistic' psychiatry when one of his chief criticisms is that the standardizing practice of assigning people mental disorders makes psychiatry less ethical, and therefore less humanistic. A large chunk of his essay is on psychiatry and ethics, and I think it's safe to say that ethics is one of his main concerns.

 

Modern psychiatry has tried desperately to align itself with humanism. It wants us to think that to deny the existence of mental disorders is to be inhumane, that the greatest humanity is to present someone who is suffering with a diagnosis. This is nonsense. Violence and intolerance begin with objectification, with denying people the complexity of their own subjective experience and attempting to restrict it to some sort of preconceived mold. This is precisely what diagnostic psychiatry does, and it is profoundly unethical. As long as it remains chiefly diagnostic, psychiatry cannot be humanistic. This is my view, anyway.

[Rhiannon]

or is it how I am wired?

We need to stop referring to ourselves as if we were machines, it's this reductive and mechanistic view that got us here in the first place.

 

Absolutely! Thank you! This drives me nuts, and you see it everywhere. As if humans and our little machines were somehow smarter and more complex than the creations of five BILLION years of evolution. Once you see it, you see it everywhere, this hubris of humanity. There is not one single machine or device invented by humans that is anywhere near as complex as the simplest of natural systems.

[Narcissus]

There is not one single machine or device invented by humans that is anywhere near as complex as the simplest of natural systems.

Amen sister.