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Antidepressants were weird for me because they just made me temporarily satisfied with my life going nowhere and working a terrible job that I hated. Also when

by wincy 4y ago

Antidepressants were weird for me because they just made me temporarily satisfied with my life going nowhere and working a terrible job that I hated. Also when I got off of Paxil I felt like I was being dropped down an elevator shaft for months. Turns out I just needed to succeed in life and suddenly I’m not depressed anymore. I was keenly aware of what a loser I was and through marriage and a small amount of amphetamines am doing pretty well now.

cnity 4y ago
Chiming in with an anecdote that aligns with yours. I've never used antidepressants but my sense of self-confidence and "happiness" is so highly correlated with my level of mastery and control on my life progression that I now ask myself the same question when I'm feeling vaguely bad: "what is going on in my life that I have the ability to improve that I do not like?", and I fix the first thing that comes to mind as soon as possible.
- missingrib 4y ago
  What if it is something that is impossible for you to improve?
  - cnity 4y ago
    Yes, that is where acceptance is required for sure. I found that for me, I was using mindfulness and acceptance as an excuse to avoid dealing with the things I _did_ have the power to control. It's better for me, my wife, and the world around me for me to manage my sphere of influence and use it to make a space that is comfortable and fun for my family. Learning that I have the power to change some things I don't like is gratifying.
vorpalhex 4y ago
"I found Jesus and meth-amp-hetamines!" (I realize you almost certainly mean adhd medication) I do worry that practicioners jump too quickly to antidepressents versus attempting other interventions, but I've also seen practitioners fail to have even basic alternatives. To quote one MD, "Oh that sounds bad... uhm, maybe therapy?" No referral, nothing. We are starting to see Cognitive Behavioral Therapy take flight not just as a guided therapy but also something where the patient can just work through a workbook solo and try exercises on their own.
bluefirebrand 4y ago
I see this observation a lot on conversations around positive thinking and CBT too. When your life actually sucks, no amount of positive thinking is really productive. At some point trying to turn everything into some kind of positive is basically self-abuse. Using medication to force your brain to stop being unhappy in truly crappy circumstances is more or less the same.
psychphysic 4y ago
You nicely comment on an important point. To non-psychiatrists depression is a synonym for sadness. To a psychiatrist depression is more about the functional impairment (social occupational effects). How sad you are is only a tiny part of how clinically "depressed" you are! Check out how depression is graded in research and clinical practice. * https://www.mdcalc.com/calc/10043/hamilton-depression-rating-scale-ham-d https://www.mdcalc.com/calc/10043/hamilton-depression-rating... * https://www.mdcalc.com/calc/4058/montgomery-asberg-depression-rating-scale-madrs https://www.mdcalc.com/calc/4058/montgomery-asberg-depressio... * https://www.mdcalc.com/calc/1725/phq9-patient-health-questionnaire9 https://www.mdcalc.com/calc/1725/phq9-patient-health-questio... (sadness isn't even the first question for the PHQ9!) You could have a wildly effective antidepressants that doesn't make you happy, or you could be crushingly sad and not depressed (subclinical depression).[0] [0] https://pubmed.ncbi.nlm.nih.gov/18688776/ https://pubmed.ncbi.nlm.nih.gov/18688776/
- echlebek 4y ago
  What if they weren't sad? What if they were depressed, but the cause of their depression was situational rather than a chemical imbalance? Isn't that possible?
  - spoiler 4y ago
    Didn't recent research show that's it's usually not a simple case of "chemical imbalance". So, antidepressants on their own won't do much. Maybe getting kicked out of this "unhealthy homeostasis" by medications helps some people find new ways of coping/perceiving their life, but AFAIK that's not the default case. So, they should be administered with therapy (and no, I don't consider therapy seeing them once every two months to renew your subscription lol)
    - psychphysic 4y ago
      No one in recent history thought it was a chemical imbalance. But there was a recent paper on it yes. Here's a real mind bender. In social anxiety (at least), people on the same antidepressants will have detectable differences in neurochemicals based on if they were told the pills would work, or won't work. Mind bender. https://www.nature.com/articles/s41398-021-01682-3 https://www.nature.com/articles/s41398-021-01682-3
partiallypro 4y ago
Coming off of Paxil is the worst. I've come off of it, I've read it can even be similar to come off of than heroine. I was sick for weeks with lingering aftereffects that I'm still not completely recovered from (I've read it can take over a year)

by wincy 4y ago

cnity 4y ago

Chiming in with an anecdote that aligns with yours. I've never used antidepressants but my sense of self-confidence and "happiness" is so highly correlated with my level of mastery and control on my life progression that I now ask myself the same question when I'm feeling vaguely bad: "what is going on in my life that I have the ability to improve that I do not like?", and I fix the first thing that comes to mind as soon as possible.

missingrib 4y ago
What if it is something that is impossible for you to improve?
- cnity 4y ago
  Yes, that is where acceptance is required for sure. I found that for me, I was using mindfulness and acceptance as an excuse to avoid dealing with the things I _did_ have the power to control. It's better for me, my wife, and the world around me for me to manage my sphere of influence and use it to make a space that is comfortable and fun for my family. Learning that I have the power to change some things I don't like is gratifying.

vorpalhex 4y ago

"I found Jesus and meth-amp-hetamines!" (I realize you almost certainly mean adhd medication) I do worry that practicioners jump too quickly to antidepressents versus attempting other interventions, but I've also seen practitioners fail to have even basic alternatives. To quote one MD, "Oh that sounds bad... uhm, maybe therapy?" No referral, nothing. We are starting to see Cognitive Behavioral Therapy take flight not just as a guided therapy but also something where the patient can just work through a workbook solo and try exercises on their own.

bluefirebrand 4y ago

I see this observation a lot on conversations around positive thinking and CBT too. When your life actually sucks, no amount of positive thinking is really productive. At some point trying to turn everything into some kind of positive is basically self-abuse. Using medication to force your brain to stop being unhappy in truly crappy circumstances is more or less the same.

psychphysic 4y ago

You nicely comment on an important point. To non-psychiatrists depression is a synonym for sadness. To a psychiatrist depression is more about the functional impairment (social occupational effects). How sad you are is only a tiny part of how clinically "depressed" you are! Check out how depression is graded in research and clinical practice. * https://www.mdcalc.com/calc/10043/hamilton-depression-rating-scale-ham-d https://www.mdcalc.com/calc/10043/hamilton-depression-rating... * https://www.mdcalc.com/calc/4058/montgomery-asberg-depression-rating-scale-madrs https://www.mdcalc.com/calc/4058/montgomery-asberg-depressio... * https://www.mdcalc.com/calc/1725/phq9-patient-health-questionnaire9 https://www.mdcalc.com/calc/1725/phq9-patient-health-questio... (sadness isn't even the first question for the PHQ9!) You could have a wildly effective antidepressants that doesn't make you happy, or you could be crushingly sad and not depressed (subclinical depression).[0] [0] https://pubmed.ncbi.nlm.nih.gov/18688776/ https://pubmed.ncbi.nlm.nih.gov/18688776/

echlebek 4y ago
What if they weren't sad? What if they were depressed, but the cause of their depression was situational rather than a chemical imbalance? Isn't that possible?
- spoiler 4y ago
  Didn't recent research show that's it's usually not a simple case of "chemical imbalance". So, antidepressants on their own won't do much. Maybe getting kicked out of this "unhealthy homeostasis" by medications helps some people find new ways of coping/perceiving their life, but AFAIK that's not the default case. So, they should be administered with therapy (and no, I don't consider therapy seeing them once every two months to renew your subscription lol)
  - psychphysic 4y ago
    No one in recent history thought it was a chemical imbalance. But there was a recent paper on it yes. Here's a real mind bender. In social anxiety (at least), people on the same antidepressants will have detectable differences in neurochemicals based on if they were told the pills would work, or won't work. Mind bender. https://www.nature.com/articles/s41398-021-01682-3 https://www.nature.com/articles/s41398-021-01682-3

partiallypro 4y ago

Coming off of Paxil is the worst. I've come off of it, I've read it can even be similar to come off of than heroine. I was sick for weeks with lingering aftereffects that I'm still not completely recovered from (I've read it can take over a year)