azurelunatic | Antidepressants: you're doing it wrong

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Antidepressants: you're doing it wrong

Every last one of you peeps who have never been on an antidepressant: the next time you are tempted (whether out of ignorance, fear, or some other non- evidence-based reason) to dismiss the entire category as "happy pills", pipe the fuck down.

Of course some people have shitty reactions to antidepressants, either a specific one or entire categories. This includes shitty emotional reactions. Also, a health provider who pushes pills without other treatments is an utter shithole of a system.

However, for the people for whom it works right (with or without other treatments), this is what it does:

Stops the self-reinforcing cycle of shitty life events bringing down brain chemistry and shitty brain chemistry hindering recovery.
Makes it possible for other brain tinkering to work.
Allows a normal range of emotion while preventing the deepest lows from sticking. (Me off St. John's Wort looks a lot like me on, until I get in a shitty mood and don't recover.)
Saves people's goddamn lives, jobs, relationships.

"Happy pills," my ass.

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Here, here! Thank you for saying this.

It needed saying.

FUCK YES.

This.

Being as I'm bipolar, antidepressants can increase the possibility of manic episodes, but that's only because I get them just fine on my own. But Zoloft was a goddamn miracle. Cognitive behavioral therapy has helped my ability to handle stress, but without the meds giving me some distance, therapy would have been useless. Worse than useless, probably; seeing a therapist and not improving would just be further evidence that I'm damaged and worthless. Ah, depressive reasoning. Gotta love it.

I'm one of those people for whom all neurochemical medications are potentially dangerous, even fatal. Non-psychiatric meds that affect brain function even marginally are bad for me. I genuinely envy those for whom the drugs work.

It's like calling insulin 'happy shots'. Anti-depressants aren't even... anti-depressant in the way most people think of it. They're chemical regulators that help restore the brain to functionality. They don't remove depressive thought patterns or bad situations, they just normalize function so that one can do the heavy lifting. I think people are vastly misinformed about what depression is, because it's not being 'sad'.

Further, that attitude always seems to me to be so puritanical, as though one is devalued by not 'suffering through'. Even if they were 'happy pills', what would be so terrible about being happy with just a pill? Ridiculous.

I have heard the "They're just a crutch!" thing too damn many times, and fuckin' hell, IF YOUR GODDAMN LEG IS BROKEN, THERE ARE MANY VALID REASONS TO USE A CRUTCH. Or, you know, if your legs are generally not working right in a way that's not expected to improve...

"They're chemical regulators that help restore the brain to functionality. They don't remove depressive thought patterns or bad situations, they just normalize function so that one can do the heavy lifting."

I've been on antidepressants (well, on and off) for 3+ years, and I've not heard anyone describe what they do as well as you have here. Thank you for giving me a way to articulate this kind of thing!

I'm of the opinion that therapy should often be tried first. Some doctors have a propensity to give the damn things out like sweeties, and this is often counterproductive. (I still have a packet of Prozac that was, for want of a better phrase, forced upon me. I never opened it.) You and

amberfox both note above that the meds can often have a stabilizing effect, and it's often this that allows therapy to work, which can be a better longer-term solution. I am very glad that they seem to be working for you.

All that said I'm currently on braindrugs just to treat my headaches, so I'm probably not one to talk.

There's a whole toolbox, and the braindrugs are but one set of wrenches within it. Sometimes you just need a goddamn hammer. (When the pharmaceutical companies are greasing the doctors, everyone looks like a nut?)

I've done the "welp, all this therapy has been great; I guess I'm better now and can ditch the meds" thing, and it turns out that until I can actually will my brain chemistry into normality when it fucks up on me, while still fucked-up, I'm staying medicated.

Very often people can't GET to therapy without the meds. Literally not able to get out of bed and make it there. Therapy is excellent for working on past issues and reprogramming thought patterns but if someone's brain chemistry is out of alignment enough, you might as well spit in the wind. Someone with 'depression' (read: poor brain chemistry) to the point that they're sleeping 20hrs a day, unable to actually process and store events in memory, or hallucinating and hearing voices (that's not just schizophrenics who have that happen) are not going to be able to focus on therapy, which requires complex cognition, self-awareness, memory and recollection, self-expression, mobility, and much more.

This is what I mean above about people not understanding what depression is and why medication is often a vital step in having therapy at all. Further, therapy is in the realm of those privileged enough to be able to spend the money and time on it--or to access it at all, some areas do not even have a therapist for those who could afford to attend.

The fact that general practitioners (who might have 6 weeks on a psych ward at best) sometimes don't properly prescribe medication is not in question. But even using language like "handing them out like sweeties" puts a judgment on everyone who does take them, and they can be left feeling vaguely fraudulent and guilty for accepting something that other people so easily denigrate. It adds to the culture of shame and negativity around those who can't just 'bootstrap' themselves well.

... thank you: I was having a very unsettling gut reaction to

gominokouhai's comment and was second-guessing myself about differences between UK & US medical systems; I think you are super-articulate, and I am very grateful to you for the reassurance (even though it wasn't aimed at me!).

[Happy to expand on this into the realms of ~personal experience~ if anyone is interested, but don't wanna hijack the thread.]

Careless phrasing only. Apologies.

Sorry, did not mean to pile on - and thank you. Luck to you!

(-- esp. as I am also in the UK and have been lucky enough to have very different experiences -- but part of that is having had a lot of practice at being really, REALLY assertive about my medical care before I hit crisis point with my mental health.)

Edited 2013-01-04 00:42 (UTC)

> But even using language like "handing them out like sweeties" puts a judgment on everyone who does take them

That was not my intention; I apologize if that's how it came across. My experience is limited to the UK health service which, for all its marvels, often has a tendency to prioritize cost-saving. Take this prescription and get out of my office. In such a system medication is sometimes used to fob off patients who deserve a more complete regimen of treatment.

I shall stop now before I dig myself any deeper.

I totally agree that antidepressants alone, without any other intervention, don't represent an adequate standard of care. It's unfortunate that some GPs seem to act as though they are, and that many people -- myself included -- have health insurance that will pay a well-nigh unlimited amount for drugs, but effectively nil for therapy.

Now, I don't work in the mental health field, so I'm not up to date on the leading research, but it's my understanding that, at least so far as numbers go, antidepressants + therapy together tend to be the most effective treatment for depression; better than either one alone.

Different people are going to come to different decisions as to which treatment choices are most appropriate for them. However, given that depression is a seriously debilitating disorder, and one that if left untreated can certainly be fatal, I for one am going to opt for hitting it with both barrels by trying the most efficacious treatment combination first.

Therapy's great when appropriate. For those of us born with f**ked up brain chemistry (my mom's side of the family has pretty much every dopamine-related issue on the map, and I fully expect to start manifesting either FET or Parkinson's within the next 5-10 years), medication's pretty much the only way to normalize things to the point that therapy will work. (I've been going through this particular fight since my early teens.)

YES THIS. My AD does just as you say -- it puts a damper on my emotional reactivity to negative events. So, somebody saying something negative or critical to me doesn't send me into an uncontrollable crying jag or completely crush my whole day under feelings of worthlessness or despair. It gives the CBT space to work, so that I can have the chance to realize "Hey, that reaction is pretty disproportionate; this isn't something worth feeling horrible about" or some similar such.

Plans changed for something I was looking forward to very much! It's time to:

a) cry, scream, curse, and yell
b) sleep through the whole day with the help of a passive-aggressive dose of benadryl
c) be upset and need comforting, then feel like a horrible person for ruining everyone else's day too
d) be disappointed and generally low-grade miserable (quietly) for a few days
e) be disappointed and generally low-grade miserable for about five minutes, disappointed for another twenty or so, then get back on with the day

Answers:
a) me, ~1980-1997
b) me, 1999
c) me, ~2004
d) me, post-therapy, unmedicated.
e) me, post-therapy, medicated.

Edited (lol, no, the tantrums didn't stop at age 7. I fucking wish. ) 2013-01-03 19:15 (UTC)

e) be disappointed and generally low-grade miserable for about five minutes, disappointed for another twenty or so, then get back on with the day

YES THIS.

Things that happened to me when I was un/undermedicated:
Feeling weepy and miserable for a whole day because I saw a sad movie.
Crying for a week over an upsetting scene in a novel.

And the chorus of Greatest Fuckups From 20 Years Ago (not the big, life-ruining sorts of things, but the really obviously stupid social interaction stuff that you wonder why you just did that five seconds later).

Unfortunately, I have yet to find a medicine that stops that chorus. But at least it doesn't affect my mood as drastically.

THIS.

YES. I LOVE not lying awake in a haze of intrusive thoughts about how useless I am and what I should do about it because of things I did when I was seven, for crying out loud.

Man, when they killed my favourite character in a TV show, I was just... broken for about a week.

(I am taking this as more evidence that my current anti-depressants aren't actually working. Icon not related!)

They're only "happy pills" inasmuch as they make it possible for me to be happy. They don't make a person happy on their own!

Exactly!

This exactly, and very well put.

Amen!

Complete and total agreement here. I call the amphetamines I (legally) take 'happy pills', because they allow me to interact with the world at large MUCH better then I would otherwise*. There's a marked difference with how I handle stress and frustration when I'm on and off the meds, and frankly, I don't like the latter. So I take me pills, and I (along with the people around me) are happier that way. Hence the reason why I call my drugs that.

* I have been dealing with ADD/HD for a good 20+ years, and I finally got it in my head to resume treating it with medication ~6 years ago after having neglected it for the prior 12, leaving a series of pink slips and speeding tickets in my wake.

Hooray for pills that do what they're supposed to do!

Allows a normal range of emotion while preventing the deepest lows from sticking. (Me off St. John's Wort looks a lot like me on, until I get in a shitty mood and don't recover.)

Thank you, this is probably the best description I've seen of what St. John's wort does. (At least for me.)

We call my antidepressant and ADD meds "brain drugs". Yes, they make me happier. I've got seasonal affective disorder, and while light therapy helps some, I haven't managed to form a good set of habits for doing it. But I do have a good set of habits for taking pills once a day, so... there's one brain pill for whacking the SAD upside the head so I don't spend October through March wandering from couch to bed in a fog of grey blahness where all I do is read and work on foreign languages all day, because those are the only things that feel good. Then there's another that helps me to have hyperfocus that turns OFF (thus further cutting the odds that I spend the whole day reading), and a short term memory that sometimes manages to retain a whole 3 chunks so I have a fighting chance of writing a to do list.

It's not good for me to be able to concentrate on reading so well that I read for 8 hours straight and don't eat. It's not good for me to work out a plan for the day, and then forget it faster than I can write it down. Those are reasonable things to feel sad about. I'd be really unhealthy if I didn't feel bad when I was starving or I couldn't plan my day!

A lot of my low grade or early depression symptoms don't really look like depression the way it's described in clinical literature. By the time I'm at the overwhelming sadness or the really weird depressive logic, I've already been depressed for a long time. I take my brain drugs so I can maintain good habits and not wander off into feeling awful by accident, and then wind up staying there. I think of them as being like asthma drugs... the point is to prevent problems, not run around in a panic after problems happen.

I was utterly terrified off anti-depressants when Paxil started producing migraine auras on an almost-hourly basis (it was given to me once upon a time by one of those horrible pill pushers sans other treatment -- as it turned out, it was purely situational depression and went away when the situation did), but I just don't get why anyone would say anything disparaging about someone's medication. I'm a lot more ticked off at medication commercials where the drug companies try to make people go tell their doctors they need a particular pill under the guise of "let your doctor do what s/he does best, and you do what you do best" -- as one particular drug company is doing right now.

But then I think I live a pretty sheltered life -- to the best of my knowledge, I've never met anyone who abused prescription medication, either, so I tend to give people the benefit of the doubt, as I hope they do me.

Word up, yo.

I've always thought of "happy pills" in "I take these to become happy, which is a good thing." Perhaps I need to add in some so that it's "I take these so that I have the possibility of being happy", but I want to peer inside and understand why someone would user that term derisively, since we're all supposed to want to be happy, right...?

Pride/machismo: a person "should" be able to regulate their own emotions without help from a pill (as espoused by my goddamn father, delaying the time until I got what I needed).

Fear of becoming a Stepford Wife: one of the bad stops on the meds-go-round is the one with the flatline emotions; the traditional fear puts the flatline at Fucking Perky instead of dull grey cotton wool.

the traditional fear puts the flatline at Fucking Perky instead of dull grey cotton wool.

I remember one of the Sith Academy fics had that plotline: Obi-Wan turned out to be taking a drug called Perkium, and that was why he was so fucking cheerful. Maul replaced his meds with yellow Skittles and Obi-Wan stopped wearing beige and started wearing a kilt and ripped t-shirts, and fucking shit up.

I still have a little bag of yellow Skittles in my desk drawer at work. (Next to the rum.)

You can have my share of any bag we consume together. I dislike yellow Skittles more than any flavour except orange Skittles.

I wonder what the psychiatric effects of purple Skittles would be. They're my preferred Skittle.

I remember Perkium. And My Apprentice, and who could forget the Goth Tournament? Ah, the simple joys of TPM fandom. ^_^

Oh. Right, those kinds of reasons. I forget humanity's ability to be shitheads to reach other is always greater than you think.

Thanks for writing this, someone really really had to.

I wouldn't necessarily agree that ADs allow a normal range of emotion, at least all the time - they certainly didn't for me. The anti-depressant part worked a charm, but as I put it to my doctor: "I'd rather have the lows and the highs, than not have any highs at all." - that was after two years of trying different meds and eventually finding one that worked on the lows, but meant I never felt like smiling... and life without smiles is no life at all, for me.

I have been known to call them happy pills, in an odd mix of affection and cynicism - they didn't work for me, but I know they work for others, and for that I'm glad, because I have so many friends and acquaintances who literally depend on antidepressants to make it possible for them to get up in the morning. As another commenter said, they're "happy pills" in that they make it possible to be happy, so I see them as a bloody good thing, because what's a world without happiness?

So, yeah, it fucks me off something chronic when I see ADs dismissed so readily, especially "because so many people take them" and "depression is the nation's illness". Here's an idea, maybe people are depressed 'cos this world is full of fucked up people who dismiss anti-depressants and criticise the mentally ill, as if they have some kind of choice about their brains playing silly buggers. Maybe what we need to do is stop dismissing people's illnesses, and make the world a happier place to be in. Depression and anxiety can be genetic, but they're environmental too; for a lot of sufferers, mental illness a product of the stress we place on ourselves every day, and that sucks.

(Can you tell this is a bugbear of mine?)

*nods*

I have no issue with someone who's on them or who's tried them using whatever term (affectionate or otherwise) that works for them. It's the folks who have no interest in trying them using the phrase to brush them off that gets substantially up my nose.

If they don't allow a normal range of emotion, then I'd say that they're not working right for you, and you're likely better off without them.

There's some famous quotation about checking first if you're surrounded by assholes before seeking treatment for depression, which is all well and good if you can then actually escape the assholes. (This is much more difficult if you're, say, 16 and maybe financially dependent and legally tied to the assholes in question.)

Quite. (Turns out that, lately, I've been surrounded by assholes - or one in particular. Now that I've broken up with him, I'm feeling a lot happier. But yeah, not so good a hint for a 16 year old stuck at home with a crap family who make them depressed, and ADs could quite possibly help them not feel so desperate about their situation until such a time they *can* escape.)

I just watched Tangled, the Disney Rapunzel, this week, and I'm impressed that there's now a commonly-not-censored kids' movie that not just illustrates, but explicitly acknowledges the poisonous and villainous nature of the parent who claims to love you but really is controlling and demoralizing.

So, yeah, it fucks me off something chronic when I see ADs dismissed so readily, especially "because so many people take them" and "depression is the nation's illness".

Hear, hear. I get my back up when I see alarmist "news" articles decrying the increase in prescriptions of antidepressants, particularly since they usually give no context and somehow make this out to be a problem in and of itself. Mental illness is drastically undertreated -- the figures vary depending on who you ask, but roughly half the people with mental illness aren't receiving treatment. Since 1 in 5 people have a mental illness, and anxiety & depression make up a goodly chunk of those, it's possible that the increase in antidepressants is a good thing -- that more people are getting the help they need.

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Antidepressants: you're doing it wrong

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