Antidepressants: you're doing it wrong

[azurelunatic]

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.

Comments

[gominokouhai]

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.

[azurelunatic]

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.

[0jack]

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.

[kaberett]

... 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.]

[gominokouhai]

Careless phrasing only. Apologies.

[kaberett]

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.)

[gominokouhai]

> 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.

[shadowspar]

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.

[geekosaur]

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.)