9 ms·

I was also put on antidepressants as a teenager and am trying to get off them after well over a decade. It's a tricky task to distinguish the withdrawal effects

by pc2g4d 9y ago

I was also put on antidepressants as a teenager and am trying to get off them after well over a decade. It's a tricky task to distinguish the withdrawal effects (which can be extreme) from the difficult emotions that come with rediscovering how to face the world without the drugs. It really feels like a part of my personality was frozen in time when I went on the drugs, and that as I come off them slowly that part of me has thawed. And that can be painful, but also extremely rewarding. It forced me to acknowledge truths about myself that I resisted for many years. It forced me to be more real with people in my life. It's the realization that I was depressed for actual emotional reasons and not just because of some putative neurochemical imbalance, the idea of which in such huge numbers makes absolutely no evolutionary sense. A trait this common is not a disorder---it's a survival mechanism.

jakebasile 9y ago
I'm glad you are feeling better but while some people's problems do come from emotional sources, please don't act like the chemical imbalances in the brains of other people aren't a disorder. I promise you, I and others like me have tried our damndest to "feel better".
- frgtpsswrdlame 9y ago
  Can we really distinguish those two sources? It seems to me that the chemicals and the emotions are the same thing.
  - Crespyl 9y ago
    The problem, I think, is that sometimes the chemicals come first and other times the emotions come first. Both can lead to a self-reinforcing downward spiral, but trying to fix the wrong half is likely to be ineffective.
    - frgtpsswrdlame 9y ago
      I'm out of my depth here so apologies if I'm stepping into some Very Bad Anatomy but my point is that neither one can come first because they are the same thing, that those chemicals are your emotions and vice versa.
      - kolinko 9y ago
        They don't map one to one. There's a thousand variants of emotions, and just a few neurotransmitters. Also, even with all the chemistry being fine, there can be certain receptors messed up, or parts of brain not functioning properly. A story I read in "Listening to Prozac" was about a patient that for years couldn't get over his low self esteem issues. He worked through all of them, but the feeling persistent, and there were no other issues with his mood aside from that. He was finally put on antidepressants, and that issue was fixed. Unfortunately, whenever he tried to get off them, the issue - and only that issue - kept coming back. The theory is that something made that part of his brain resistant to serotonin. There are many kinds of serotonin receptors, and perhaps a genetic problem messed up one of them. Or there was an issue with serotonin not being delivered where it should've been. Or who knows what. In the end, increased serotonin levels fixed that. A blunt tool, but no other one worked. Similarly with attention deficit (which comes with anxiety and sleep issues quite often) - the original theory was that it was due to dopamine issues, because increasing dopamine levels helped most people. The current theory is that in many cases it may a whole class of issues - from a mechanical damage to prefrontal cortex to allergies, magnesium processing issues, tyrosine processing problems, or even a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) Also, in most cases it's probably more than issue at root. The problem is that it's difficult to figure it all out, and many cases medicine is simply not there yet.
        pdkl95 9y ago
        > a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) My doctor actually recommended nicotine for that exact reason. My family's history with heavy tobacco use combined (my father in particular) and my experiences with nicotine in the past were positive, so the doctor suggested trying a strong nicotine patch for a while. It worked reasonably well, and more importantly it didn't have the (many) problems the usual SNRI or NDRI. Nicotine definitely does have its own problems, but it's an interesting option that deserves more research. (We had also discussed briefly the idea of trying a very small dose of one of the acetylcholinesterase inhibitors used for Alzheimer's, but eventually decided against it, because they can be somewhat dangerous drugs.) For decades, research on the nicotinic acetylcholine receptors was limited (probably tanks to the tobacco industry). Research in this area is improving a lot, but it will take time to make up for the lost time.
- psyc 9y ago
  This isn't like a reprimand or anything, just to point out that this problem cuts both ways. Having been entangled with the mental health system for 20 years, I say the lion's share of attention and advice, from everywhere and everybody, comes from the chemical imbalance / illness / disorder perspective. And this really, really does leave those of us who don't respond to drugs and are fundamentally unhappy with our lives very frustrated and without anywhere to turn. Yeah, therapy's a thing, but it's commonly perfunctory and treated as secondary. Treating depression like it's just one thing can harm sufferers on both "sides".
  - JamesBarney 9y ago
    A big reason drugs are preferred to therapy is that the drugs are far cheaper. 6 months of antidepressants can be like $80, 6 months of bi-weekly therapy $5,600.
    - bspn 9y ago
      My understanding is that mental health therapy should be covered by most insurance plans these days so the out-of-pocket shouldn't be that high. While it's a sample size of only one, my wife sees her therapist bi-weekly and I think the co-pay is $20 per session. A month's supply of Duloxetine (generic Cymbalta) actually costs us more per month at $45.
      - nugget 9y ago
        It's incredibly difficult to find a great therapist. There is a fundamental supply and demand imbalance, and plenty of quacks on the supply side.
    - humbleMouse 9y ago
      Not to mention the potential cost of missing work to go to therapy. Some people don't have PTO or a flexible schedule and getting to therapy appointments is a real pain in the ass.
    - fivestar 9y ago
      Not only is therapy expensive, it is non-existent. We live in a decent-sized city and have tried numerous psychologists for our daughter and they all suck. I've decided that outside of psychiatry, as in, someone who is actually an MD, the rest of the field is utterly worthless. And the psychiatrists only want to medicate. Honestly, we've gotten better outcomes from just our family pediatrician.
- pharrington 9y ago
  OP is not telling you to "feel better" - he is saying he was only able to tackle his depression after taking a more holistic approach to monitoring and changing his brain operation. Emotions are, quite literally, certain chemical states in animals with nervous systems of at least a certain complexity. That's where the "chemical imbalance" mantra falls apart - at best, it adds no information, and even worse, its used to peddle drugs which are developed without coherent and predictable models of the neurology involved in the symptoms/diseases they're supposed to treat. Medical doctors get at least one objective measure of your blood pressure before prescribing blood pressure medicine. When was the least time you heard of a psychiatrist only prescribing meds after performing an MRI?
  - kolinko 9y ago
    What new information would current state fMRI give them? If I'm not mistaken, a person that is depressed due to environment will have similar fMRI as a person who has messed up biology (not just neurotransmitters btw). Also, even with acute depression, antidepressants may help to get the patient on track.
    - pharrington 9y ago
      https://www.nih.gov/news-events/nih-research-matters/brain-scan-may-predict-best-depression-treatment https://www.nih.gov/news-events/nih-research-matters/brain-s... The objective outcomes differ with different treatments even in cases of subjective success. The specific neurology (protein levels, chemical ratios, etc) should determine how exactly you intend to alter it.
  - pw 9y ago
    Psychiatrists (well, ER doctors, usually) do, in fact, perform MRI's before prescribing meds. This happened to me when I was first diagnosed with bipolar disorder, and I assumed it's not an uncommon practice. It's easy to think of psychiatry being wishy-washy when all you're considering is mild to moderate depression and the like, but it becomes much harder when you consider the entire spectrum of mental illness. Full-blown mania, psychotic depression, or untreated schizophrenia scream illness in a way that is hardly subjective.
- zardo 9y ago
  >I promise you, I and others like me have tried our damndest to "feel better". There is a whole arm of behavioral therapy based on the idea that trying to feel better, is a major cause of people feeling bad. https://en.m.wikipedia.org/wiki/Acceptance_and_commitment_therapy https://en.m.wikipedia.org/wiki/Acceptance_and_commitment_th... Of course, it doesn't work for everyone.
- InclinedPlane 9y ago
  I'm not quite sure how to respond to this, so I apologies in advance if it comes off wrong. I would say it's not about trying to "feel better", you can't just force yourself to not feel depressed, the brain is too complex for that. There are, however, many rigorously proven methods for tackling depression that can work in replacement of or in addition to medications. The one I think has the most merit is mindfulness based cognitive behavioral therapy. The idea is to build up a new set of habits, coping skills, and behavior patterns that let you life your life without getting sucked into depression. Depression is vastly more complex than simply "a flaw in brain chemistry", that's very reductive reasoning but it's been a relatively successful one for the psychiatrist business and pharmaceutical industry. That brain chemistry is as much a symptom as it is a cause though. And with enough work it's possible to make yourself more resilient to potentially depressing circumstances and thoughts. It's possible to train yourself to recognize and change the constantly running background narrative of negative self-talk that gets you down, the rumination, the trains of thought that seem so unavoidable, and so on. And then on top of that to build better habits, to tackle your problems, that you're in control of, and prevent them from growing out of control, to regularly exercise, etc. Of course, it can be difficult if not near impossible to do all that, or, really, anything whatsoever, if you're deeply depressed. Which is why for many people it's necessary to begin anti-depressants before starting therapy, making behavioral/cognitive changes, etc. The problem the parent poster is talking about is the tendency today to just shove people into the top of the process and call that done. It's now expected that most people who have experienced major depression should just take anti-depressants for their entire life and that's the "cure" for their problems. With only a token concern for building up the skills, habits, and coping mechanisms that people actually need. You see the same thing with a lot of other things like ADHD or anxiety, with a tendency to look for the chemical answer first and foremost and call that good enough.
meesterdude 9y ago
Thank you! This really hits home for me. It's exactly how i've feel but always get ridiculed for because of the sheer number of people who are prescribed it and that it works for them so I must be wrong. I don't doubt that some people really do need it, but I was not one of them (I didn't respond well to them) and I have a hard time believing so much of the population actually needs them too. But if anything, better solutions / alternatives need to be presented and made available before people are just thrown off something that has helped them handle some really tough stuff. But the problem with that is, then the drug companies wouldn't make so much money. (which, I think plays a large part of it)
- kolinko 9y ago
  It's not just that - it's that from a perspective of a psychiatrist there is no safer drug to get someone out of a deep hole. The thing is that people should be trying to figure out what was the underlying issue and whether it's possible to fix it. Not many doctors have the motivation to do this infortunately, and many patients don't either. I've met people with adhd and daytime sleepiness, who spent years on antidepressants. The effect was that they still couldn't focus, but didn't feel depressed because of that, and didn't even know they had problem.
rm_-rf_slash 9y ago
I had a similar experience after ending my 15 years on Concerta/Ritalin. I was so used to feeling "always on," that it warped my worldview. That, to me, was more disconcerting than having to reevaluate my understanding of myself. I can identify with my medicated self, because I am always in some sort of flux and I accept that ambiguity. I cannot relate to my medicated worldview; I am out of Plato's Cave.
kolinko 9y ago
Remember that this is just your experience - just like some people have messed up insulin, some others have serotonin. It's just that in this case we distinguish genetic issues from environmental.
mjevans 9y ago
My own personal opinion is that modern society is more crazy than most patients. This is likely the root cause of over-prescribing drugs. Yes people are in need of changes in their life to feel better, but the solution should be for society to suck less, not some pill to mask the symptoms in individuals.
- derefr 9y ago
  Note that anti-depressants—at least in the case of episodic depression—are supposed to be used as a crutch, not as a "management therapy." You prescribe anti-depressants to someone who can't get out of bed to see a therapist, so that they will then get out of bed to see a therapist, where the therapist can then get them over their depression. Anti-depressants are not supposed to be used "mask pain" any more than crutches are supposed to be used to "mask pain" in your leg. They're supposed to take the pressure off a thing that generates pain, so that you can work productively on making your life better (healing the leg) so that you don't need the crutch. Though, that being said, there's also a second, less obvious thing anti-depressants do: first-line anti-depressants specifically are hard to distinguish from placebos, but that's okay because first-line antidepressants are often prescribed by doctors who believe† that a placebo is, in fact, all a person might need in order to feel better. That's why they're given out so freely: placebos are pure benefit (no risks, possible reward) so it doesn't hurt to try them before doing literally anything else. If the person doesn't improve under first-line placebos, then the doctor will move on to figuring out what "actual" medical interventions might help. † This approach is doctrine among psychologists, but not necessarily what your average psychiatrist/therapist/prescribing GP will be thinking about. Prescribers "out in the field" are mostly following the DSM guidelines for first-line/second-line/Nth-line treatments of depression, which just say that the first-line pharmaceutical interventions are very well-tolerated and low-risk.
  - mjevans 9y ago
    I can see how you were probably trying to say that these medications are supposed to be used to empower the kind of changes you thought I was talking about. However, I'm actually talking about society in general being depressive. About it being difficult to socialize because of distance, economic/social divides (real or imagined), the time spent at work (duration and even sometimes just the conflict) or because transportion is so bad/costly. There are also those who are stuck in some rural/suburban desert of contact and opportunity. My ultimate point is that the /depression/ might actually exist for valid reasons. That in a pre-modern society this feeling could be a survival trait in driving an individual to leave a bad or over-populated area for new/different grounds. However modern society has closed off these historic reactions and has not replaced them with modern equivalents. Thus the subjects experience learned helplessness, as there isn't any way out and they thus give up on looking for or taking opportunities to have a way out. This same lack of a visible, viable, and valued escape trajectory can also explain other contexts where subjects act against the rational interests of themselves and the communities that they seek to remain part of. For example, when I was describing the above class of scenario victims of abuse from those close to them (parents/spouses/etc) come to mind.
pc2g4d 9y ago
Thanks to everyone for their heartfelt responses and interesting viewpoints! Some have pushed back regarding the notion of serotonin imbalance. I would point you to literature that strongly challenges the idea of straightforward neurochemical imbalance as the cause of depression. This is a good place to start: http://kellybroganmd.com/depression-serotonin/ http://kellybroganmd.com/depression-serotonin/ From that article: > "The most applicable analogy is that of the woman with social phobia who finds that drinking two cocktails eases her symptoms. One could imagine, how, in a 6 week randomized trial, this “treatment” could be found efficacious and recommended for daily use and even prevention of symptoms. How her withdrawal symptoms after 10 years of daily compliance could lead those around her to believe that she “needed” the alcohol to correct an imbalance. This analogy is all too close to the truth." I believed in the chemical imbalance theory for many years, but now I am persuaded that it's more marketing slogan than scientific reality. This is not to say that antidepressants cannot have beneficial effects. Just that it's not clear that they are correcting any naturally occurring imbalance. As far as the interesting point that emotions and neurochemical brain states may be equivalent, I grant that this may be true. I guess it was more my way of referring to two approaches to emotional problems: the first, which sees the problems originating in the brain chemistry, internalizing the dysfunction within the sufferer. The second, which sees the brain chemistry mostly as a reaction to the life and environment of the sufferer, wherein the true dysfunction lies. This points people in the direction of their relationships, the congruence of their values and choices, their life philosophy, etc. which I find a more productive pursuit.
- hosh 9y ago
  This is exactly why I've been trying to get my step-daughter off of the meds. She is on the autism spectrum, and her previous guardian solved behavior problems by pushing more and more meds. We've weaned her off of the anti-psychotic and in the process of weaning her off of the anti-anxiety. We'll see if we can do the same for the vyvanse or adderall. I have worked with a lot of intense emotions and pain within myself. I have faced them in life and in meditative, psychedelic, and dream states. There are not a lot of darkness and intense emotions that faze me much anymore -- though it isn't as if I've become invulnerable to emotions. If anything, I've become to be more sensitive to emotions, and being OK with that vulnerability. Whatever the emotional state or the narrative, the way it dissolves generally remains the same. In all the things I have tried, the key ingredient has always been mindfulness. I have found that surfacing up deeply-buried emotions don't do much if one becomes mindless and intoxicated by those emotions. At the same time, I have also tried suppression and repression. Numbing oneself or cutting oneself off from the emotions at best, defers the emotional work you end up doing. Instead, it usually causes more damage. Mood-altering drugs can help _if_ they are taken along with therapy that necessarily includes mindfulness. The therapy helps change and shift deeply-held beliefs, and it is the mindfulness that lets one unwind the damage from root cause. The drugs in question can help if they support such a process, to be able to help face the scary things within you. If they are taken as a way to _avoid_ this kind of work, yeah, I too also hear they can freeze you at that emotional maturity level.
CodeWriter23 9y ago
I empathize with your struggles to be chemically independent and to dig deep to confront your truth. Any naysayers just don't and can't understand your path. Without digging to deep, I just want to express my support and a {{{{{{{giant internet hug from a stranger}}}}}}}
Steeeve 9y ago
> It really feels like a part of my personality was frozen in time when I went on the drugs, and that as I come off them slowly that part of me has thawed. I'm sure you are talking about antidepressants, but I wonder if the same isn't true for people who have consumed recreational drugs for extended periods. It seems natural that if you regularly alter your internal chemistry, the natural processes that would happen in an unaltered states (such as psychological maturation) would also be altered. I also wonder if there isn't a standardized therapy kind of like PT for physical injuries for bringing people back up to speed emotionally.
- md224 9y ago
  It's also possible that antidepressants (and drugs of abuse) numb some part of your mind that's broken due to emotional trauma, and as a result you lose that part of your personality while it heals. Then, when you come off the drug, you're all better. It's like a kind of mental anesthetic. This could explain why many drug abuse problems spontaneously resolve. I'll admit this sounds kind of insane, but I'll also point out that we still really know so little about the actual workings of our own minds. Maybe we're misunderstanding the relationship between people and psychoactive drugs.
ohstopitu 9y ago
Just out of curiosity - what would be the adverse effects of being on anti-depressants all your life? Are there any side effects that negatively effect you if you use it in medical doses?

by pc2g4d 9y ago

jakebasile 9y ago

I'm glad you are feeling better but while some people's problems do come from emotional sources, please don't act like the chemical imbalances in the brains of other people aren't a disorder. I promise you, I and others like me have tried our damndest to "feel better".

frgtpsswrdlame 9y ago
Can we really distinguish those two sources? It seems to me that the chemicals and the emotions are the same thing.
- Crespyl 9y ago
  The problem, I think, is that sometimes the chemicals come first and other times the emotions come first. Both can lead to a self-reinforcing downward spiral, but trying to fix the wrong half is likely to be ineffective.
  - frgtpsswrdlame 9y ago
    I'm out of my depth here so apologies if I'm stepping into some Very Bad Anatomy but my point is that neither one can come first because they are the same thing, that those chemicals are your emotions and vice versa.
    - kolinko 9y ago
      They don't map one to one. There's a thousand variants of emotions, and just a few neurotransmitters. Also, even with all the chemistry being fine, there can be certain receptors messed up, or parts of brain not functioning properly. A story I read in "Listening to Prozac" was about a patient that for years couldn't get over his low self esteem issues. He worked through all of them, but the feeling persistent, and there were no other issues with his mood aside from that. He was finally put on antidepressants, and that issue was fixed. Unfortunately, whenever he tried to get off them, the issue - and only that issue - kept coming back. The theory is that something made that part of his brain resistant to serotonin. There are many kinds of serotonin receptors, and perhaps a genetic problem messed up one of them. Or there was an issue with serotonin not being delivered where it should've been. Or who knows what. In the end, increased serotonin levels fixed that. A blunt tool, but no other one worked. Similarly with attention deficit (which comes with anxiety and sleep issues quite often) - the original theory was that it was due to dopamine issues, because increasing dopamine levels helped most people. The current theory is that in many cases it may a whole class of issues - from a mechanical damage to prefrontal cortex to allergies, magnesium processing issues, tyrosine processing problems, or even a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) Also, in most cases it's probably more than issue at root. The problem is that it's difficult to figure it all out, and many cases medicine is simply not there yet.
      - pdkl95 9y ago
        > a deficiency in nicotinic receptors (where supplementing nicotine is really a solution!) My doctor actually recommended nicotine for that exact reason. My family's history with heavy tobacco use combined (my father in particular) and my experiences with nicotine in the past were positive, so the doctor suggested trying a strong nicotine patch for a while. It worked reasonably well, and more importantly it didn't have the (many) problems the usual SNRI or NDRI. Nicotine definitely does have its own problems, but it's an interesting option that deserves more research. (We had also discussed briefly the idea of trying a very small dose of one of the acetylcholinesterase inhibitors used for Alzheimer's, but eventually decided against it, because they can be somewhat dangerous drugs.) For decades, research on the nicotinic acetylcholine receptors was limited (probably tanks to the tobacco industry). Research in this area is improving a lot, but it will take time to make up for the lost time.
psyc 9y ago
This isn't like a reprimand or anything, just to point out that this problem cuts both ways. Having been entangled with the mental health system for 20 years, I say the lion's share of attention and advice, from everywhere and everybody, comes from the chemical imbalance / illness / disorder perspective. And this really, really does leave those of us who don't respond to drugs and are fundamentally unhappy with our lives very frustrated and without anywhere to turn. Yeah, therapy's a thing, but it's commonly perfunctory and treated as secondary. Treating depression like it's just one thing can harm sufferers on both "sides".
- JamesBarney 9y ago
  A big reason drugs are preferred to therapy is that the drugs are far cheaper. 6 months of antidepressants can be like $80, 6 months of bi-weekly therapy $5,600.
  - bspn 9y ago
    My understanding is that mental health therapy should be covered by most insurance plans these days so the out-of-pocket shouldn't be that high. While it's a sample size of only one, my wife sees her therapist bi-weekly and I think the co-pay is $20 per session. A month's supply of Duloxetine (generic Cymbalta) actually costs us more per month at $45.
    - nugget 9y ago
      It's incredibly difficult to find a great therapist. There is a fundamental supply and demand imbalance, and plenty of quacks on the supply side.
  - humbleMouse 9y ago
    Not to mention the potential cost of missing work to go to therapy. Some people don't have PTO or a flexible schedule and getting to therapy appointments is a real pain in the ass.
  - fivestar 9y ago
    Not only is therapy expensive, it is non-existent. We live in a decent-sized city and have tried numerous psychologists for our daughter and they all suck. I've decided that outside of psychiatry, as in, someone who is actually an MD, the rest of the field is utterly worthless. And the psychiatrists only want to medicate. Honestly, we've gotten better outcomes from just our family pediatrician.
pharrington 9y ago
OP is not telling you to "feel better" - he is saying he was only able to tackle his depression after taking a more holistic approach to monitoring and changing his brain operation. Emotions are, quite literally, certain chemical states in animals with nervous systems of at least a certain complexity. That's where the "chemical imbalance" mantra falls apart - at best, it adds no information, and even worse, its used to peddle drugs which are developed without coherent and predictable models of the neurology involved in the symptoms/diseases they're supposed to treat. Medical doctors get at least one objective measure of your blood pressure before prescribing blood pressure medicine. When was the least time you heard of a psychiatrist only prescribing meds after performing an MRI?
- kolinko 9y ago
  What new information would current state fMRI give them? If I'm not mistaken, a person that is depressed due to environment will have similar fMRI as a person who has messed up biology (not just neurotransmitters btw). Also, even with acute depression, antidepressants may help to get the patient on track.
  - pharrington 9y ago
    https://www.nih.gov/news-events/nih-research-matters/brain-scan-may-predict-best-depression-treatment https://www.nih.gov/news-events/nih-research-matters/brain-s... The objective outcomes differ with different treatments even in cases of subjective success. The specific neurology (protein levels, chemical ratios, etc) should determine how exactly you intend to alter it.
- pw 9y ago
  Psychiatrists (well, ER doctors, usually) do, in fact, perform MRI's before prescribing meds. This happened to me when I was first diagnosed with bipolar disorder, and I assumed it's not an uncommon practice. It's easy to think of psychiatry being wishy-washy when all you're considering is mild to moderate depression and the like, but it becomes much harder when you consider the entire spectrum of mental illness. Full-blown mania, psychotic depression, or untreated schizophrenia scream illness in a way that is hardly subjective.
zardo 9y ago
>I promise you, I and others like me have tried our damndest to "feel better". There is a whole arm of behavioral therapy based on the idea that trying to feel better, is a major cause of people feeling bad. https://en.m.wikipedia.org/wiki/Acceptance_and_commitment_therapy https://en.m.wikipedia.org/wiki/Acceptance_and_commitment_th... Of course, it doesn't work for everyone.
InclinedPlane 9y ago
I'm not quite sure how to respond to this, so I apologies in advance if it comes off wrong. I would say it's not about trying to "feel better", you can't just force yourself to not feel depressed, the brain is too complex for that. There are, however, many rigorously proven methods for tackling depression that can work in replacement of or in addition to medications. The one I think has the most merit is mindfulness based cognitive behavioral therapy. The idea is to build up a new set of habits, coping skills, and behavior patterns that let you life your life without getting sucked into depression. Depression is vastly more complex than simply "a flaw in brain chemistry", that's very reductive reasoning but it's been a relatively successful one for the psychiatrist business and pharmaceutical industry. That brain chemistry is as much a symptom as it is a cause though. And with enough work it's possible to make yourself more resilient to potentially depressing circumstances and thoughts. It's possible to train yourself to recognize and change the constantly running background narrative of negative self-talk that gets you down, the rumination, the trains of thought that seem so unavoidable, and so on. And then on top of that to build better habits, to tackle your problems, that you're in control of, and prevent them from growing out of control, to regularly exercise, etc. Of course, it can be difficult if not near impossible to do all that, or, really, anything whatsoever, if you're deeply depressed. Which is why for many people it's necessary to begin anti-depressants before starting therapy, making behavioral/cognitive changes, etc. The problem the parent poster is talking about is the tendency today to just shove people into the top of the process and call that done. It's now expected that most people who have experienced major depression should just take anti-depressants for their entire life and that's the "cure" for their problems. With only a token concern for building up the skills, habits, and coping mechanisms that people actually need. You see the same thing with a lot of other things like ADHD or anxiety, with a tendency to look for the chemical answer first and foremost and call that good enough.

meesterdude 9y ago

Thank you! This really hits home for me. It's exactly how i've feel but always get ridiculed for because of the sheer number of people who are prescribed it and that it works for them so I must be wrong. I don't doubt that some people really do need it, but I was not one of them (I didn't respond well to them) and I have a hard time believing so much of the population actually needs them too. But if anything, better solutions / alternatives need to be presented and made available before people are just thrown off something that has helped them handle some really tough stuff. But the problem with that is, then the drug companies wouldn't make so much money. (which, I think plays a large part of it)

kolinko 9y ago
It's not just that - it's that from a perspective of a psychiatrist there is no safer drug to get someone out of a deep hole. The thing is that people should be trying to figure out what was the underlying issue and whether it's possible to fix it. Not many doctors have the motivation to do this infortunately, and many patients don't either. I've met people with adhd and daytime sleepiness, who spent years on antidepressants. The effect was that they still couldn't focus, but didn't feel depressed because of that, and didn't even know they had problem.

rm_-rf_slash 9y ago

I had a similar experience after ending my 15 years on Concerta/Ritalin. I was so used to feeling "always on," that it warped my worldview. That, to me, was more disconcerting than having to reevaluate my understanding of myself. I can identify with my medicated self, because I am always in some sort of flux and I accept that ambiguity. I cannot relate to my medicated worldview; I am out of Plato's Cave.

kolinko 9y ago

Remember that this is just your experience - just like some people have messed up insulin, some others have serotonin. It's just that in this case we distinguish genetic issues from environmental.

mjevans 9y ago

My own personal opinion is that modern society is more crazy than most patients. This is likely the root cause of over-prescribing drugs. Yes people are in need of changes in their life to feel better, but the solution should be for society to suck less, not some pill to mask the symptoms in individuals.

derefr 9y ago
Note that anti-depressants—at least in the case of episodic depression—are supposed to be used as a crutch, not as a "management therapy." You prescribe anti-depressants to someone who can't get out of bed to see a therapist, so that they will then get out of bed to see a therapist, where the therapist can then get them over their depression. Anti-depressants are not supposed to be used "mask pain" any more than crutches are supposed to be used to "mask pain" in your leg. They're supposed to take the pressure off a thing that generates pain, so that you can work productively on making your life better (healing the leg) so that you don't need the crutch. Though, that being said, there's also a second, less obvious thing anti-depressants do: first-line anti-depressants specifically are hard to distinguish from placebos, but that's okay because first-line antidepressants are often prescribed by doctors who believe† that a placebo is, in fact, all a person might need in order to feel better. That's why they're given out so freely: placebos are pure benefit (no risks, possible reward) so it doesn't hurt to try them before doing literally anything else. If the person doesn't improve under first-line placebos, then the doctor will move on to figuring out what "actual" medical interventions might help. † This approach is doctrine among psychologists, but not necessarily what your average psychiatrist/therapist/prescribing GP will be thinking about. Prescribers "out in the field" are mostly following the DSM guidelines for first-line/second-line/Nth-line treatments of depression, which just say that the first-line pharmaceutical interventions are very well-tolerated and low-risk.
- mjevans 9y ago
  I can see how you were probably trying to say that these medications are supposed to be used to empower the kind of changes you thought I was talking about. However, I'm actually talking about society in general being depressive. About it being difficult to socialize because of distance, economic/social divides (real or imagined), the time spent at work (duration and even sometimes just the conflict) or because transportion is so bad/costly. There are also those who are stuck in some rural/suburban desert of contact and opportunity. My ultimate point is that the /depression/ might actually exist for valid reasons. That in a pre-modern society this feeling could be a survival trait in driving an individual to leave a bad or over-populated area for new/different grounds. However modern society has closed off these historic reactions and has not replaced them with modern equivalents. Thus the subjects experience learned helplessness, as there isn't any way out and they thus give up on looking for or taking opportunities to have a way out. This same lack of a visible, viable, and valued escape trajectory can also explain other contexts where subjects act against the rational interests of themselves and the communities that they seek to remain part of. For example, when I was describing the above class of scenario victims of abuse from those close to them (parents/spouses/etc) come to mind.

pc2g4d 9y ago

Thanks to everyone for their heartfelt responses and interesting viewpoints! Some have pushed back regarding the notion of serotonin imbalance. I would point you to literature that strongly challenges the idea of straightforward neurochemical imbalance as the cause of depression. This is a good place to start: http://kellybroganmd.com/depression-serotonin/ http://kellybroganmd.com/depression-serotonin/ From that article: > "The most applicable analogy is that of the woman with social phobia who finds that drinking two cocktails eases her symptoms. One could imagine, how, in a 6 week randomized trial, this “treatment” could be found efficacious and recommended for daily use and even prevention of symptoms. How her withdrawal symptoms after 10 years of daily compliance could lead those around her to believe that she “needed” the alcohol to correct an imbalance. This analogy is all too close to the truth." I believed in the chemical imbalance theory for many years, but now I am persuaded that it's more marketing slogan than scientific reality. This is not to say that antidepressants cannot have beneficial effects. Just that it's not clear that they are correcting any naturally occurring imbalance. As far as the interesting point that emotions and neurochemical brain states may be equivalent, I grant that this may be true. I guess it was more my way of referring to two approaches to emotional problems: the first, which sees the problems originating in the brain chemistry, internalizing the dysfunction within the sufferer. The second, which sees the brain chemistry mostly as a reaction to the life and environment of the sufferer, wherein the true dysfunction lies. This points people in the direction of their relationships, the congruence of their values and choices, their life philosophy, etc. which I find a more productive pursuit.

hosh 9y ago
This is exactly why I've been trying to get my step-daughter off of the meds. She is on the autism spectrum, and her previous guardian solved behavior problems by pushing more and more meds. We've weaned her off of the anti-psychotic and in the process of weaning her off of the anti-anxiety. We'll see if we can do the same for the vyvanse or adderall. I have worked with a lot of intense emotions and pain within myself. I have faced them in life and in meditative, psychedelic, and dream states. There are not a lot of darkness and intense emotions that faze me much anymore -- though it isn't as if I've become invulnerable to emotions. If anything, I've become to be more sensitive to emotions, and being OK with that vulnerability. Whatever the emotional state or the narrative, the way it dissolves generally remains the same. In all the things I have tried, the key ingredient has always been mindfulness. I have found that surfacing up deeply-buried emotions don't do much if one becomes mindless and intoxicated by those emotions. At the same time, I have also tried suppression and repression. Numbing oneself or cutting oneself off from the emotions at best, defers the emotional work you end up doing. Instead, it usually causes more damage. Mood-altering drugs can help _if_ they are taken along with therapy that necessarily includes mindfulness. The therapy helps change and shift deeply-held beliefs, and it is the mindfulness that lets one unwind the damage from root cause. The drugs in question can help if they support such a process, to be able to help face the scary things within you. If they are taken as a way to _avoid_ this kind of work, yeah, I too also hear they can freeze you at that emotional maturity level.

CodeWriter23 9y ago

I empathize with your struggles to be chemically independent and to dig deep to confront your truth. Any naysayers just don't and can't understand your path. Without digging to deep, I just want to express my support and a {{{{{{{giant internet hug from a stranger}}}}}}}

Steeeve 9y ago

> It really feels like a part of my personality was frozen in time when I went on the drugs, and that as I come off them slowly that part of me has thawed. I'm sure you are talking about antidepressants, but I wonder if the same isn't true for people who have consumed recreational drugs for extended periods. It seems natural that if you regularly alter your internal chemistry, the natural processes that would happen in an unaltered states (such as psychological maturation) would also be altered. I also wonder if there isn't a standardized therapy kind of like PT for physical injuries for bringing people back up to speed emotionally.

md224 9y ago
It's also possible that antidepressants (and drugs of abuse) numb some part of your mind that's broken due to emotional trauma, and as a result you lose that part of your personality while it heals. Then, when you come off the drug, you're all better. It's like a kind of mental anesthetic. This could explain why many drug abuse problems spontaneously resolve. I'll admit this sounds kind of insane, but I'll also point out that we still really know so little about the actual workings of our own minds. Maybe we're misunderstanding the relationship between people and psychoactive drugs.

ohstopitu 9y ago

Just out of curiosity - what would be the adverse effects of being on anti-depressants all your life? Are there any side effects that negatively effect you if you use it in medical doses?