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“It’s really hard to withdraw from antidepressants,” said New York psychiatrist and pharmacology expert Julie Holland. In some cases, “people feel like cold wat

“It’s really hard to withdraw from antidepressants,” said New York psychiatrist and pharmacology expert Julie Holland. In some cases, “people feel like cold water is running down their spine. They can feel their brain sloshing around, or electric zaps in their head.” Dang. If it's true as claimed that medications only help half the time, this seems like a strong encouragement to try things like exercise, yoga, and lifestyle changes before going the medication route. Unless you're so depressed you honestly can't make those changes... as commenters have mentioned, sometimes medications are absolutely helpful, needed, and life-saving. I've heard of cases where being on a medication just for a short time helped people break out of a rut. If you're getting a prescription, it seems worthwhile to ask docs for options that are less problematic to get off of.

ianai 10y ago
It can be chicken and egg. I imagine that for many personal lifestyle changes are more difficult than popping a pill. Once they start to feel the benefits of medication then doing things out of the norm may come easier. In my own anecdote, it was over the counter stuff like St John's Wort and valerian that helped me do the life change stuff. Also, no one lives in a vacuum. If your husband/wife and kids are all used to you not doing things like yoga, exercise, and whatever else they may subtly make comments or behaviors that make lifestyle change difficult to near impossible.
- fapjacks 10y ago
  For me, as someone that's been through it, and as someone that other people in my group of friends come to for help, the thing about exercise, cleanliness, and diet is that you're right, it is a hard lifestyle change. For most people. But I notice that almost everyone gets to a point when they hit their own personal rock-bottom, and they're willing to try anything. One of my best friends said something similar when we were talking about his wife, who suffers from PTSD and bouts of depression. He said she wouldn't want to try it because she is stuck in bed all day. And I told him to tell her that the change will be almost immediate, and it will keep up as long as she keeps it up. She got out of bed. Maybe some people don't want to change. But in the pits of despair that I have been in, and my friends have been in, people are willing to do almost anything to make the pain go away. Exercise, cleanliness and diet are not cures for everyone, but they do help, and they help immediately, for long enough to make it to your doctor's appointment. For some reason, I get pushback from people on the internet about this, but it works. The only cure for this is time, and that's just an unfortunate fact. But when people are told those things make positive changes immediately, almost everyone gets out of bed or off the couch to try it. It all comes down to whether or not the person wants the pain to go away. If they do, they'll make the change, even temporarily.
  - Bluestrike2 10y ago
    Much of that pushback is because that same advice can be twisted into a sort of "just will the depression away" suggestion that's kind of tone deaf and insulting to people suffering from depression. It's not uncommon for people to say exactly that, as if it's little more than a light switch that needs to be flicked off. And most of the time, those sorts of comments are pretty patronizing, along the lines of "just man up and get over it." Not yours, but I can see how people might interpret it that way based on the way others have acted towards them in the past; basically, your suggestions were judged by the words of others. You're looking at exercise, social activity, and other lifestyle changes as a means of combating depressive symptoms. That's absolutely true, and there's a wealth of peer-reviewed evidence to support that. Almost anyone with a depressive disorder would benefit. For that matter, almost anyone would benefit. And the social aspect, with friends and family pushing and supporting you as you set out on those efforts, can absolutely play a profound role in mitigating those symptoms (assuming those around you notice; it's quite common for people even with severe depressive disorders to be able to mask their feelings from even those closest to them). But for the worst cases, and even many that aren't as severe, those first steps are the difficult on a level that those who don't suffer from depression can't really conceptualize. Imagine a mental pain so severe that it cuts through to your very soul; an existential despair so pervasive that simply envisioning a life without it is nearly impossible. I remember a professor of mine discussing a former patient of his: the patient described her depression as an overwhelming hopelessness so great that even suicide was too much of an effort despite wanting to do just that. Obviously, she managed to get help at some point but I remember feeling goosebumps along my spine as those words were repeated to us. It was a chilling description of an inner hell that nobody realized this woman was living in. At some point in their lives, almost every single human being will feel a sense of hopelessness, despair, sadness, etc. Even the shitty emotions are part of the human condition. It's when they start to interfere with your ability to function in everyday life, and/or they persist for a longer period of time, that you start to look at a problem beyond the norm. Depression isn't about simply hitting rock bottom; it's more about not being able to see anything but. But even that's a bit of a generalization.
    - DanBC 10y ago
the_bad 10y ago
All I can say is, I was fit, ate well, while living healthy, and I still needed the medication to help me get through a tough spot. Living a healthy life, and needing medication are not mutually exclusive.
Bluestrike2 10y ago
Especially for depression, prescribing medications is about stabilizing a patient's mental health and building a safe platform from which the patient can work to minimize the negative consequences of their depression (or many other mental illnesses, for that matter) on their daily life. No psychiatrist is going to suggest that there's a magic pill, dosage, or regimen that will make the depression go away. What medication can do, though, is help keep a patient's depression from overwhelming them. Ideally, medication gives the patient both time and enough separation from those negative emotions and consequences to make changes that become well-reinforced habits. That can be through traditional talk therapy, cognitive behavioral therapy, simple exercise, changes in diet and sleep patterns, etc. Medication can serve as a sort of barrier between emotions that can overwhelm you and keep you from getting out of bed at all. It doesn't make those feelings go away entirely, but it gives you the breathing room you need. Of course, the public doesn't necessarily see things that way. There's a common belief that the right medication will 'cure' the problem for you or, barring that, make it go away. After all, that's how other medications work! Blood pressure problems? Take a pill. Bacterial infection? Antibiotics, and poof, it's gone! That's a huge problem for psychiatry, and it's one that's probably not going to go away anytime soon. Your GP might be willing to prescribe an antidepressant, an ethical psychiatrist is almost always going to be the better choice precisely because treatment isn't about just receiving a script and heading to the pharmacy.
- duaneb 10y ago
  I agree with what you said. Of course, I've also heard psychiatrists call me irresponsible for going off medication that was actively holding me back from the energy and motivation I need to work well (and feel good about my life). There is certainly a diversity of opinion amongst practicing psychiatrists even what the role of the medication is.
  - bcook 10y ago
    Did you go off the medication without any input or supervision from a doctor? I've had doctors accuse me of being irresponsible for doing that, and I have to agree.
nugget 10y ago
Medication works best in combination with therapy. A med check takes 15 minutes once a month while therapy might be 2 hours a week. You can guess which insurance covers.
forgotpwtomain 10y ago
> If it's true as claimed that medications only help half the time, this seems like a strong encouragement to try things like exercise, yoga, and lifestyle changes before going the medication route. Medications help pharmaceutical companies make money all the time. There is a huge incentive for this path and it's hard to come-by adequate science, since a large percentage of funding for long-term and expensive studies comes from the very same pharmaceutical companies.
Mz 10y ago
There is a lot you can do with diet and other lifestyle approaches. Though this site is mostly about managing my physical health that way, I blog some about managing mental stuff that way here: http://miceats.blogspot.com/ http://miceats.blogspot.com/ I am posting this here in hopes of making it available to people reading comments here who wish they had alternatives to medication, but just do not know how to make that work. It isn't guaranteed to work, but it's a place to start getting more informed.
noobermin 10y ago
May I note there is one drug that is relatively safe from addiction and unhealthy side-effects, and it is good that since last Tuesday, it is becoming legal in more places.
- throwanem 10y ago
  It can also enormously exacerbate symptoms of depression, and despite claims often made by its cheerleaders is no more a panacea than exercise, SSRIs, or indeed anything else.
  - noobermin 10y ago
    Yeah, did a quick google, only reputable thing I could find is this[0]. Yes, a tired meme, but what is asserted without evidence can be dismissed without evidence...and at a rung above no evidence, can be eviscerated with a link from a first pass at a google search. [0] http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/marijuana-and-depression/faq-20058060 http://www.mayoclinic.org/diseases-conditions/depression/exp...
    - throwanem 10y ago
      Everyone seems hung up on causation. I'm just talking about how something that glues your ass to a couch isn't necessarily the best thing to combine with a disease that also saps volition. Sure, you don't feel it so strongly while you're high. That's one of the nicer things about that particular drug, paranoia aside. But that only works while you're high, subject to the same habituation process as anything else - and it's not the same as actually doing something to help yourself. I don't doubt there are people with depression for whom marijuana has been a substantial help. That's great! I'm glad for them, and that legalization is making it easier for people whom marijuana helps to maintain access to it. I also think it's reasonable to approach marijuana with the same caution as any other potentially beneficial drug. Arguing that, because there's no uncontested evidence that marijuana causes depression, there's no harm it can possibly do a person with depression - does not seem all that cautious to me.
gww 10y ago
I tried a low-dose of anti-depressants for a year while I was going through a rough patch. They helped quite a bit but the withdrawal symptoms -- especially the brain zaps -- were quite unpleasant.

ianai 10y ago

It can be chicken and egg. I imagine that for many personal lifestyle changes are more difficult than popping a pill. Once they start to feel the benefits of medication then doing things out of the norm may come easier. In my own anecdote, it was over the counter stuff like St John's Wort and valerian that helped me do the life change stuff. Also, no one lives in a vacuum. If your husband/wife and kids are all used to you not doing things like yoga, exercise, and whatever else they may subtly make comments or behaviors that make lifestyle change difficult to near impossible.

fapjacks 10y ago
For me, as someone that's been through it, and as someone that other people in my group of friends come to for help, the thing about exercise, cleanliness, and diet is that you're right, it is a hard lifestyle change. For most people. But I notice that almost everyone gets to a point when they hit their own personal rock-bottom, and they're willing to try anything. One of my best friends said something similar when we were talking about his wife, who suffers from PTSD and bouts of depression. He said she wouldn't want to try it because she is stuck in bed all day. And I told him to tell her that the change will be almost immediate, and it will keep up as long as she keeps it up. She got out of bed. Maybe some people don't want to change. But in the pits of despair that I have been in, and my friends have been in, people are willing to do almost anything to make the pain go away. Exercise, cleanliness and diet are not cures for everyone, but they do help, and they help immediately, for long enough to make it to your doctor's appointment. For some reason, I get pushback from people on the internet about this, but it works. The only cure for this is time, and that's just an unfortunate fact. But when people are told those things make positive changes immediately, almost everyone gets out of bed or off the couch to try it. It all comes down to whether or not the person wants the pain to go away. If they do, they'll make the change, even temporarily.
- Bluestrike2 10y ago
  Much of that pushback is because that same advice can be twisted into a sort of "just will the depression away" suggestion that's kind of tone deaf and insulting to people suffering from depression. It's not uncommon for people to say exactly that, as if it's little more than a light switch that needs to be flicked off. And most of the time, those sorts of comments are pretty patronizing, along the lines of "just man up and get over it." Not yours, but I can see how people might interpret it that way based on the way others have acted towards them in the past; basically, your suggestions were judged by the words of others. You're looking at exercise, social activity, and other lifestyle changes as a means of combating depressive symptoms. That's absolutely true, and there's a wealth of peer-reviewed evidence to support that. Almost anyone with a depressive disorder would benefit. For that matter, almost anyone would benefit. And the social aspect, with friends and family pushing and supporting you as you set out on those efforts, can absolutely play a profound role in mitigating those symptoms (assuming those around you notice; it's quite common for people even with severe depressive disorders to be able to mask their feelings from even those closest to them). But for the worst cases, and even many that aren't as severe, those first steps are the difficult on a level that those who don't suffer from depression can't really conceptualize. Imagine a mental pain so severe that it cuts through to your very soul; an existential despair so pervasive that simply envisioning a life without it is nearly impossible. I remember a professor of mine discussing a former patient of his: the patient described her depression as an overwhelming hopelessness so great that even suicide was too much of an effort despite wanting to do just that. Obviously, she managed to get help at some point but I remember feeling goosebumps along my spine as those words were repeated to us. It was a chilling description of an inner hell that nobody realized this woman was living in. At some point in their lives, almost every single human being will feel a sense of hopelessness, despair, sadness, etc. Even the shitty emotions are part of the human condition. It's when they start to interfere with your ability to function in everyday life, and/or they persist for a longer period of time, that you start to look at a problem beyond the norm. Depression isn't about simply hitting rock bottom; it's more about not being able to see anything but. But even that's a bit of a generalization.
  - DanBC 10y ago

the_bad 10y ago

All I can say is, I was fit, ate well, while living healthy, and I still needed the medication to help me get through a tough spot. Living a healthy life, and needing medication are not mutually exclusive.

Bluestrike2 10y ago

Especially for depression, prescribing medications is about stabilizing a patient's mental health and building a safe platform from which the patient can work to minimize the negative consequences of their depression (or many other mental illnesses, for that matter) on their daily life. No psychiatrist is going to suggest that there's a magic pill, dosage, or regimen that will make the depression go away. What medication can do, though, is help keep a patient's depression from overwhelming them. Ideally, medication gives the patient both time and enough separation from those negative emotions and consequences to make changes that become well-reinforced habits. That can be through traditional talk therapy, cognitive behavioral therapy, simple exercise, changes in diet and sleep patterns, etc. Medication can serve as a sort of barrier between emotions that can overwhelm you and keep you from getting out of bed at all. It doesn't make those feelings go away entirely, but it gives you the breathing room you need. Of course, the public doesn't necessarily see things that way. There's a common belief that the right medication will 'cure' the problem for you or, barring that, make it go away. After all, that's how other medications work! Blood pressure problems? Take a pill. Bacterial infection? Antibiotics, and poof, it's gone! That's a huge problem for psychiatry, and it's one that's probably not going to go away anytime soon. Your GP might be willing to prescribe an antidepressant, an ethical psychiatrist is almost always going to be the better choice precisely because treatment isn't about just receiving a script and heading to the pharmacy.

duaneb 10y ago
I agree with what you said. Of course, I've also heard psychiatrists call me irresponsible for going off medication that was actively holding me back from the energy and motivation I need to work well (and feel good about my life). There is certainly a diversity of opinion amongst practicing psychiatrists even what the role of the medication is.
- bcook 10y ago
  Did you go off the medication without any input or supervision from a doctor? I've had doctors accuse me of being irresponsible for doing that, and I have to agree.

nugget 10y ago

Medication works best in combination with therapy. A med check takes 15 minutes once a month while therapy might be 2 hours a week. You can guess which insurance covers.

forgotpwtomain 10y ago

> If it's true as claimed that medications only help half the time, this seems like a strong encouragement to try things like exercise, yoga, and lifestyle changes before going the medication route. Medications help pharmaceutical companies make money all the time. There is a huge incentive for this path and it's hard to come-by adequate science, since a large percentage of funding for long-term and expensive studies comes from the very same pharmaceutical companies.

Mz 10y ago

There is a lot you can do with diet and other lifestyle approaches. Though this site is mostly about managing my physical health that way, I blog some about managing mental stuff that way here: http://miceats.blogspot.com/ http://miceats.blogspot.com/ I am posting this here in hopes of making it available to people reading comments here who wish they had alternatives to medication, but just do not know how to make that work. It isn't guaranteed to work, but it's a place to start getting more informed.

noobermin 10y ago

May I note there is one drug that is relatively safe from addiction and unhealthy side-effects, and it is good that since last Tuesday, it is becoming legal in more places.

throwanem 10y ago
It can also enormously exacerbate symptoms of depression, and despite claims often made by its cheerleaders is no more a panacea than exercise, SSRIs, or indeed anything else.
- noobermin 10y ago
  Yeah, did a quick google, only reputable thing I could find is this[0]. Yes, a tired meme, but what is asserted without evidence can be dismissed without evidence...and at a rung above no evidence, can be eviscerated with a link from a first pass at a google search. [0] http://www.mayoclinic.org/diseases-conditions/depression/expert-answers/marijuana-and-depression/faq-20058060 http://www.mayoclinic.org/diseases-conditions/depression/exp...
  - throwanem 10y ago
    Everyone seems hung up on causation. I'm just talking about how something that glues your ass to a couch isn't necessarily the best thing to combine with a disease that also saps volition. Sure, you don't feel it so strongly while you're high. That's one of the nicer things about that particular drug, paranoia aside. But that only works while you're high, subject to the same habituation process as anything else - and it's not the same as actually doing something to help yourself. I don't doubt there are people with depression for whom marijuana has been a substantial help. That's great! I'm glad for them, and that legalization is making it easier for people whom marijuana helps to maintain access to it. I also think it's reasonable to approach marijuana with the same caution as any other potentially beneficial drug. Arguing that, because there's no uncontested evidence that marijuana causes depression, there's no harm it can possibly do a person with depression - does not seem all that cautious to me.

gww 10y ago

I tried a low-dose of anti-depressants for a year while I was going through a rough patch. They helped quite a bit but the withdrawal symptoms -- especially the brain zaps -- were quite unpleasant.