Good News on the Psychopharmacology Front

As some of you may know, I have suffered from depression for…well, ever, I suppose.  I’m doing well with pharmacological treatment, taking 30mg of fluoxetine a day, which makes me much more even-keeled and much less despondent.

But I didn’t start out with fluoxetine.  I started with Lexapro which, like fluoxetine, is a Selective Seratonin Reuptake Inhibitor (SSRI).  Lexapro didn’t really work for me, though, and after a few months I stopped taking it, assuming that it was proof that I didn’t really have clinical depression. 

One divorce later, I moved on to Effexor (venlafaxine), a Seratonin-Norepinephrine Reuptake Inhibitor (SNRI), but due to insurance issues, I only took that for a month, which isn’t long enough to tell you anything about whether a drug works or not.  Once I got back onto insurance, I ended up on Strattera (atomoxetine), a NRI, which helped me with long-ignored ADHD, and helped my mood somewhat.

About a year after my divorce, I looked into gastric bypass surgery.  I’m sure my friend and colleague Kate Harding can tell you many fun and exciting facts about that particular surgery; suffice to say that it turns out if they surgically remove your stomach, you may, in fact, lose weight because of it.  Or, you know, die. 

Fortunately, the clinic I went to did psychological screening before surgery.  And the screening showed that I was…surprise!…deeply depressed.

And so I went back into the doctor and got on fluoxetine, and went into therapy and got a good therapist, and in the end, I was, if not cured, then in a much better place overall.  (I never did get my stomach removed.)

A good many of you out there who are on antidepressants are nodding along with parts of my story.  And that’s because of a little-known fact about antidepressants: many, if not most people, don’t get on the right antidepressant the first time.  Or the second time.  Or even the third time.

There’s hopeful news today that this may be changing:

Scientists have identified genetic variations that affect specific neurotransmitter functions, which could explain why some patients respond to some drugs but not to others. For example, some depressed patients who have abnormally low levels of serotonin respond to S.S.R.I.’s, which relieve depression, in part, by flooding the brain with serotonin. Other depressed patients may have an abnormality in other neurotransmitters that regulate mood, like norepinephrine or dopamine, and may not respond to S.S.R.I.’s.

In a report last October in the journal Science, Dr. Francis Lee, a colleague of mine at Weill Cornell Medical College, identified a genetic mutation that could potentially predict patients’ responses to an entire class of antidepressants.

He inserted into a mouse a defective variant of the human gene for brain-derived neurotrophic factor, a protein that is increased in the brain with S.S.R.I.treatment and is critical to the health of neurons. Then he subjected these “humanized” mice to stress and found that they did not respond to Prozac with decreased anxiety. The clear implication is that people with this variant will not be able to respond to any S.S.R.I., which requires normal neurotrophic-factor function to work. A psychiatrist could identify this genetic variant and then steer his patient to a different class of antidepressants.

Furthermore, other genes may play a role in the adverse effects of antidepressants that have made recent headlines: suicidal behavior. Recent evidence shows that a small number of depressed adolescents and young adults experience an increase in suicidal feelings and thoughts when they are treated with S.S.R.I.’s, compared with a placebo. It is entirely possible that a genetic variation in one or more genes that regulate serotonin function makes these people feel briefly more suicidal, rather than less, when exposed to the drugs.

This is potentially very good news for those suffering with depression.  Getting on the right medication from the start is very important — and getting on the wrong one can be very dispiriting.  It takes a month to get a read on whether the drugs are working — and wasting three months when life doesn’t feel worth living anyhow is difficult, to say the least.  It’s very, very easy to find oneself giving up on treatment.  I did it twice.  And I know I’m not unique.

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43 Comments

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43 responses to “Good News on the Psychopharmacology Front

  1. Angelos

    Interesting.

    I’m on try #3 right now.

  2. The interaction between individual genetics and drugs is one of the best kept secrets in the pharmaceutical industry. The drug companies don’t want to mention it because any drug that’s good only for some people is going to make less money than one absolutely everybody absolutely needs.

    Testing for interaction between individual genetics and medicines is one of the earliest applications for some of the new genome scanning technology. It should be standard within a few more years, and then long odysseys like yours shouldn’t have to happen anymore.

    Cancer is an even worse example of the problem. Tumors can have very different genetic profiles, on top of the individual differences. And taking a few months / years to get that right is a huge deal that the drug companies have been trying to ignore.

  3. Kate217

    Interesting. #5 finally worked for me.

    For a while I was seeing a phychiatrist who diagnosed me as “a severe suicide risk.” He then added several “potentiators” to my Zoloft. How he expected a “severe” depressive to be able to juggle half a dozen drugs, some of which had to be taken in the morning, others at night, some on and empty stomach, others with food, is beyond me. He also could never remember me from visit to visit and would spend the first 5 minutes of my 10-miute sessions reading my file to remember the heck who I was. When I missed an appointment because my car broke down and he started dunning me for a full visit (rather than my usual co-pay, meaning that he was asking for twice what he would normally get from my co-pay and insurance company combined if I actually showed up), I fired him. I told his office manager that it was obvious that he was more interested in getting paid than in whether is “severe risk for suicide” patient were even still alive. That did more for me than Zoloft + potentiators.

    After that, my GP started me on drug #2.

    Lexapro/Celexa seems to be working pretty well.

    On a related topic, do you think that having chemical markers will have any impact on the “mental illness” parity issue? I’d like to think so (why is a chemical imbalance in the brain somehow more a person’s fault than an imbalance in the pancreas?), but I don’t hold out much hope. Insurance companies will soak people for as much as they can get.

    Sorry for the rant. All these years later it still rankles…

    *blush*

  4. Kate217

    ACK! Bazillions of typos. Sorry.

  5. Kym

    I’ve been through three medications myself, before just giving up. It just wasn’t worth it to keep looking for something that would work again, only to end up feeling worse. It’s a shame because I’ve never felt better than during those few months where the fluoxetine was working.

  6. I went through a severe clinical depression about 21 years ago. This was before there was such a thing as SSRIs, and I did an extensive jaunt through the wonderful world of tricyclates, quatricyclates, and MAOIs. If you’d like to know what a Grand Mal Seizure as an allergic reaction might be like, well, just ask me.

    Anyway, I relapsed around 1993 and low and behold! There was PROZAC! Wow did I get better fast.

    Love me some Prozac (fluoxetene).

  7. I had no idea how lucky I was! The only anti-depressant I’ve ever been on is fluoxetine, and it’s workin’ just fine, thank you. This is not to say that I’m “cured,” but I cope much better when I’m on it than I do when I’m not. Unfortunately, I’ve had trouble getting health insurance because of fluoxetine and imitrex being on my medical history, which is a little depressing. At least that’s a very different thing from being clinically depressed.

  8. anona

    I can’t go into details because I’d like to keep some measure of anonymity, but I work (in a non-scientific capacity) for a nonprofit research institute that is putting enormous resources into depression research. They’re planning projects aimed at genetics, neurobiology, biological chemistry, and a combination, and they’re working with clinical psychiatrists as well. Pretty much every scientific approach to understand depression and find better treatments for it they can think of. Since they’re part of a university, any drugs they develop won’t make Big Pharma rich, and though pharma companies will have to manufacture them, I imagine it’ll be much cheaper than a brand-name drug. My boss has helped develop a lot of the drugs currently on the market and he has a very good idea of their shortcomings.

    Also, I happen to suffer from depression myself, and I was lucky enough to find some relief with the first drug I tried, which I know from reading the scientific papers has only a 30% success rate. I’ll have to be on it for a good two years to reprogram my brain, and it’s much more effective in sync with counseling, but it does help.

    Jeff, if you’re interested in talking to me about this more, you should have my email address in the form. Best of luck! It’s hard but worth it.

  9. celexa for me! just started a few months ago. it is amazing. i was on a different one a few years ago, worked well for my depression but messed with my NF1 (blocked bowel, no fun believe me!)

    when these drugs work they are miracles. i was on librium for about a year back in high school but i hated feeling like i was wrapped up in cotton so i stopped and was never treated again til about 11 years ago.

    it was a blessing to find help finally.

  10. madame xxx

    i’ve had 2 courses of zoloft and 2 of lexapro over the past 11 years. oh – also tried cymbalta which made me feel like i was behind the cone of silence from get smart. i feel pretty good for awhile (nice to not wanna kill yourself, gotta admit) i just can’t stay on them because they flatten me out so much after about 6 months, i can’t feel anything. that’s when the shrinks start with the additions of ritalin, adderall, whatever.

    this last time seems my stomach got so messed up from lexapro that i just stopped cold turkey. i don’t give a shit…i end up suicidal if i chip away withdrawing over 6 months anyway. now i’m taking small dose of ritalin daily, with some zanax to knock me out if i go too low.

    some friends of mine that don’t do alopathic medicine have used a lab that does testing of the brain chemicals and i’m gonna try that out after another month clear of the ssri’s and try to find out exactly what’s missing.

    i have physical problems that severely limit my ability to live the active life i crave, which is the main source of my depression, and i have an awful lot of trouble coming to terms with that.

    oh and marijuana is the best medicine for that, because at least it makes sitting around doing nothing lots more fun.

  11. I’ve been prescribed a wide variety of psychopharmaceuticals in my day, but nothing fucked me up as bad as Risperdal. I was already bad crazy and it just made things worse. The shakes, the instant thirty pounds I acquired, all the oatmeal in my skull. Bad shit.

    Xanax, though, Xanax is your friend. Xanax loves you.

  12. C. Diane

    I lucked out, too, and got better on Lexapro. I only went as high as 15 mg, too. Tapered off after 6 months, and I’ve been fine since (which indicates that it was in part SAD and in part my shitty job environs, since I’m in a much happier and sunnier place now.)

    Kym, it seems to me that a lot of general practitioners, who most patients see first line for depression treatment, don’t do a good job of following up on how the treatment is doing and increasing the dose. You didn’t mention whether you’d gone to maximal doses on your meds — and if a drug works at a certain dose initially, that doesn’t mean it’ll always continue to work at that dose indefinitely (though once a stable dose is reached, it’s often good for a long time.)

    Another thing docs don’t often check is the thyroid, which is instrumental in hormone balance, including serotonin et al. So if that hasn’t been checked, ask about it.

    Genomics is pretty cool stuff. We learned about it some in pharmacy school (class of ’05), and it seems to have taken off since then. I think it’s cool.

  13. Kate217

    Kym, please don’t give up!

  14. Kym, it seems to me that a lot of general practitioners, who most patients see first line for depression treatment, don’t do a good job of following up on how the treatment is doing and increasing the dose.

    I think this is key. 30mg of fluoxetine has worked well, but I started at 10mg and moved up over about six months; I’ve had to bump my Strattera twice, and am maxed out right now. Like anything you take regularly, you can develop a tolerance for drugs. A different dosage of fluoxetine might work, or you might want to look into still another SSRI.

    Another thing that I thik is important — though not always available to everyone given health coverage — is getting some sort of therapy. Even if you’re getting your prescriptions from a GP and seeing an M.Psy., you’re getting two different views on how you’re doing, one of them specifically focused on your mood and thought patterns.

  15. I hear you loud and clear. I hate Lexapro with the burning passion of a thousand white-hot suns. Paxil was a little better, but Effexor is my nightly date while Wellbutrin is my first morning appointment. I’ve never been better in my life.

    I did about a year of talk therapy, and I also recommend it. I still remember key elements of that therapy almost every day. Medicine helps me to be me and to have the strength I need to deal with the emotions, ingrained habits and previously unconscious ways of thinking, but the therapy is what gives me the strategies I need.

    Antidepressants are a huge pain in the ass – literally, for me – but once you find the right one it can really be worth it.

  16. Moira, Risperdal is a dopamine drug. As I understand it, and in very broad terms, if your problem is serotonin, dopamine drugs make you worse, and vice versa.

    My relative has Obsessive Compulsive Disorder. Prozac is the specific for that, but it made him much, much worse. Scary freaky I don’t want to talk about it worse. Then they switched him to Risperdal. That was nine years ago and he lives a very normal (mildly twitchy) life. Yay Risperdal in my world.

  17. About ten years ago, Paxil wiped my memory clean. I couldn’t finish sentences, didn’t know my own work anymore, forgot years of my life. My shrink and my psych denied that anything I was taking could be responsible for the graying out, which is now a well-known side effect. Paxil did nothing for my depression; I spent years piecing my memory and personality back together. And because this was so bad, I have no faith whatever that next time medication might not simply kill me.

  18. cellar door

    I’m in the unhappy boat of SSRIs doing bupkiss for me at best, or being detrimental at worst. I’ve tried Celexa, Lexapro, Effexor, Zoloft, Paxil, and Cymbalta. Wellbutrin worked for a good four or five years, and then stopped (as they will over time for a lot of people). We thought it might be the norepinephrine adjustments that helped me, so we tried the Cymbalta. I couldn’t eat on that one – I was living off of Ensure shakes to keep from passing out. {The positive reactions from people about how the fat girl found something to keep her from eating are another rant}. We upped my Wellbutrin to 450 mg a day (150 over max recommended dose) and I had a mild seizure, so that got stopped completely. Argh!
    Looks like it’s a dopamine boost that helps me. But drugs that affect the dopamine system are highly regulated (the link to cocaine and meth and the potential for addiction) and not approved often here in the states. And SSRIs are still the preferred cash-cow for Pharma, and it’s easier (cheaper) to chop half a molecule off of Celexa and market it as Lexapro rather than do new research. And Lexapro is lower on the side effects for many, but still utterly unhelpful for people whose serotonin systems don’t like to be mucked with.

    I’m pretty sure from research and personal experience that a lower dose of Wellbutrin and a low dose of Provigil would be a good mix to try – enough dopamine boost to relieve depression, and the norepinephrine regulation to keep things stable. But if I walk into a psych’s office and ask for an antidepressant/stimulant combo, I’ll most likely be treated as an addict or “troublemaker”. (That assumption is from long experience in the psychiatric system – people with opinions and research, especially fat depressed women with opinions and research, aren’t regarded as cooperative patients).

    I’m off all of the meds at this point, and darn cynical about getting back on the merry-go-round. I’m sure there will be another depression crater at some point in my future, and I haven’t figured out how to handle it pharmaceutically when it happens yet. I’m hoping for research into areas other than SSRIs, but I don’t have high hopes.

  19. Deborah, thanks! I didn’t know that about Risperdal — they just told me that it would make the bad scary intrusive thoughts stop so I took it. It did, but it stopped most of my other thoughts along with it.

    These days I’m taking Cymbalta, an SNRI, for pain management* and it works pretty well.

    *And for depression, because the pain and fatigue of fibromyalgia is fucking depressing.

  20. C. Diane

    A chemistry note:

    To go from Celexa (racemic citalopram) to Lexapro (S-citalopram), one does not “chop half a molecule” off. The R-isomer is precipitated out, leaving the (theoretically more active and less side-effect-producing) S-isomer. The R and S isomers are not attached to each other.

    (My undergrad training is in chemistry.)

  21. livia

    I’m glad to see this topic being discussed. I was diagnosed with depression and had two serious bouts of it a few years apart, but luckily for me, my first med (celexa) worked.

    Less bad then dealing with my own symptoms was dealing with people who didn’t understand the disease, and would call me crazy, over-medicated, etc, and this was my boss (a whole other story).

    I’m glad to see that this illness no longer carries such a stigma, and I think its fantastic to see it discussed in public forums.

  22. Last year I took Wellbutrin for while, and it worked immediately but made me want to nap all day. Which is nice work if you can find it, but not terribly conducive to life as a mother, much less a mother with ambitions and a mountain of laundry every day. At first, I was thrilled that I could sleep an entire night without waking, and then sleep some more in the afternoon. Bliss! The doc. told me it was an adjustment period. But no–I got sleepier and sleepier. So after a couple of weeks he added Cymbalta. That stuff ripped up my stomach and made me queasy on top of sleepy–all bloody day long. I began to wonder which was worse: crying all day or sleeping and gagging all day?

    Also, after about a month, the meds made my thoughts race. I would begin thinking about something, and another thought would leap in front of it, then another and another. This is a normal state for me when unmedicated, but the antidepressants seemed to make it even more intense–as though my brain was on a tear, sometimes for many hours. I also had this odd feeling of coldness toward things that used to excite me, anger me, or touch my soul. Example: I took the husband to see Jeff Beck live, at a small, intimate theatre, and we had these amazing seats right up front. Exquisitely played music always brings me to tears and beyond, and this was Jeff bloody Beck! But I sat there, enjoying the artistry but not feeling the waves of emotion as normal, not thrilling to it, not transported by it, not gutted by it, not affected at all, really. And I looked at R and said, That’s it. Into the toilet went my remaining pills (not smart, I know).

    So here I am, a year later, once again really bottoming out with the most dreadful nightmares, the most awful thoughts, the most difficult time getting myself to complete tasks (and of those there are many around here), interspersed with bouts of I can do anything, and I can do it better than anyone. Summers were always the worst for my moods, and looking back, I can see clear patterns of up-down-up-down that intensified during the summer, for some reason, even when I was younger and single. But now I have three extremely challenging boys and oftentimes the stress is like nothing I’ve ever known, nothing I would wish on my worst enemy. Simple pleasures like tidying up and being able to step back and look at my house with a sense of accomplishment are just not available to me, because all the tidying in the world can’t keep up with three agents of entropy. And I am leery of trying another med, because I can’t afford the downtime. I’m already pretty useless as anything more than a caretaker/chauffeur/grocery shopper/warden right now.

    Sadly, my brain is very much an all-or-nothing force, and if I can’t throw myself into something full-on, which is how I’ve always been, I have a hard time getting myself to pay attention to it, if that makes sense. Black-and-white, that’s me. And right now, the world is pretty black, and the main reason I am still here–well, there are three main reasons, four counting R–is that somewhere in the mess between my ears there lies a spark of hope that one day, I will feel strong enough and confident enough to regard things more normally.

    So yeah, a way to identify brain chemistries more accurately and tailor the meds accordingly would be most welcome.

    Until then, I am going to try to get back into a daily hard-core workout, because that definitely helped in the past. That, and (believe it or not) regular sunlight and a decent amount of sleep every night. It’s amazing what happens to the brain when one is a) under chronic stress and b) not sleeping at least 7-8 hours a night (as if!). It’s a significant, measurable, chemical change that begins with cortisol and goes from there. And of course, there are the lovely reproductive hormones chiming in every month, making life that much more interesting.

    Interesting, isn’t it, that so many thoughtful, intelligent sorts (as evidenced by the many comments here) seem plagued by brain issues, too. There isn’t a whole lot of research on the connection between high creativity and depression/ADHD/bipolar disorder, but what data there is seems to confirm a strong correlation. Certainly my anecdotal data (gleaned from years of observing friends, family members, and self) supports it. Don’t get me started on the emotional states of ex-boyfriends who were musicians, writers, or artists!

  23. cellar door

    C. Diane:

    I’ve read up on it, the sloppy shorthand was only meant to underline that research isn’t really being done on new antidepressant medications, it’s largely being done to refine and renew older ones before the patent runs out. ‘Tis all.

  24. C. Diane

    Cellar door: Don’t get me started on patent extension crap. It makes me jump around and flail my arms a lot. (Oh hai, Zithromax is going off patent. U can haz ZMax now plz.) Or me-too drugs. Ugh.

    How about the risperidone patent extension (Invega) that doesn’t even work as well? Or might work as well, but hasn’t been compared, so it’s all based on conjecture! Double ugh.

    I think that’s why I really love the House episode where he has to give the speech for Vogler’s new drug. Love.

  25. amy

    I am on my 4th type of medication-currently back on Lexapro combined with Lamictal, this is after trying Wellbutrin & Effexor. Effexor would work for a while & then just stop-making me more depressed than I had ever been before-Wellbutrin just didnt work at all. Lamictal is more for mood swings, but well, I am still moody. Trying to get off Effexor right now-very difficult. Sherry-did your doctor warn that Celexa is the most difficult drug to get off of?? The side effects are horrible. Good luck to all those suffering from depression-there is hope, there is a drug that will work & there are doctors that will listen & care (that’s at least what I keep telling myself).

  26. Trying to get off Effexor right now-very difficult.

    That really scares me about being on it. I’ve had a couple of times where I didn’t take it for a few days in a row, and I would fly into unprovoked rages. If ever my doctor, wife and I decide to move away from Effexor I may actually consider a stint in rehab or at least a week away from my family.

  27. My BFF was on Effexor and it really messed her up, physically. It worked really well for a little while but then the side effects got too bad and she switched. She’s on Zoloft and other fun things now, hopefully that will continue to help. I think this is try…#4.

    I was on Wellbutrin XL for a little while and I hated it. It made me feel like crap. And didn’t really seem to work that well.

    Good luck!

  28. mamajane

    I suffer from poly-cystic ovarian syndrome. In a nutshell, I get massive and multiple ovarian cysts every month, along with premenstrual dysphoric disorder, which is basically PMS gone to the moon and back, bordering on a temporary psychosis. My gyn put me on a regimen of HRT for the cysts and Paxil for the mood swings. Thing was, I wasn’t clinically depressed, and the Paxil had exactly the opposite effect it should have. I felt absolutely numb, nothing mattered, I could not gather the strength to function. When I reported this back to the gyn, she said “but isn’t that better than the mood swings?” I said “no, at least then I was functional. I’d rather be psychotic and isolate myself 4-5 days a month than to never feel anything at all”. So I quit the Paxil, and I go into hiding a few days a month, and all else is well.

    Kudos to all of you that have stuck it out through all of this. thanks for sharing your stories, and be well.

  29. Kym

    I was on the fluoxetine for about 6 months, gradually increasing the dosage each time it felt like the effectiveness was wearing off. I think I got to about half of the maximum dosage for that before I decided to try a different drug. I tried Wellbutrin after that, which made things immeasurably worse. Lexapro was the third, and while it wasn’t as bad as the Wellbutrin, it didn’t seem to help much, either. At that point, I just decided to go without the drugs, since I felt better without them. I was also seeing one of the counselors at the student health center, but I found that he was more interested in talking about himself than listening to me.

  30. In looking for an anti-depressant that would help with both depression and chronic pain management, I went through about a dozen different meds. Hated the tricyclics and SSRI’s. Prozac made me feel like I was no longer myself. Elavil made me a zombie. Others had no effect whatsoever. I finally got some relief with Wellbutrin XL (bupropion) at 450 mg a day (450 mg is the highest recommended dose). I can certainly believe that some people are genetically predisposed one way or the other to certain meds.

  31. Oh, the evergreening. Oh, the hate. Those damn AmbienCR ads on TV make me almost as mad as the “Hi I’m a Mac” ads. Every time some Pharma rep gets up on TV and prattles about how much money it takes to take a drug from the initial research stages through FDA approval I want to bite them. Nobody ever calls them on their shit and asks what the NIH is for, or how many of their drugs are licenses purchased from university research funded by tax money. Fuck that. If government, representing us taxpayers, pays for the initial research, we damn well ought to be able to negotiate for a discount on buying the drug.

    I loved that House episode too. Yes, folks, the old, reliable, very safe diuretic meds for hypertension work great for nearly all patients. The new-fangled drugs still under patent should under no circumstances be front-line drugs. (At least I think he was talking about hypertension meds. What I said is still true even if I’ve confused House’s saying it with something else. :p)

  32. C. Diane

    Vogler’s drug was an ACE inhibitor (which are quite good drugs, and they work well) with an antacid or something in it. Yay? So House (spoiler, but it’s season 1, so…) tells it like it is: it’s not any better than the old drug. Just maybe less heartburn.

    I wish I could be as cynical and arrogant in my practice. 😦

  33. hi amy, at this point, i’d take anything that worked and if i need to get off of it then i’ll have to deal with the effects.

    my body doesn’t quite work like most peoples anyway. i have
    neurofibromatosis 1. i wasn’t diagnosed until i was 46 even tho now, looking back thru the huge med file i have ever since a brain tumor around 21/2 years of age, it’s clear what i have. it’s really a common genetic disease. 1 in every 3 thousand births and can be mild or life altering or life threatening. it also has little gifts for some, like depression, LDs and attention difficulties.

    the last depression med i was on worked wonderfully well but because the NF is screwing with my digestive system the meds helped cause a blocked bowel that nearly did me in. celexa isn’t supposed to have that effect, so we shall see.

    i have my fingers and toes crossed. : )

    yes, i think mental illnesses need to come out into the light of day. it’s about time!

    i remember when i was a small child, the word “cancer” was either never used or whispered or called “the big C”

    god!

  34. amy

    Stephen-the side effects for me are limited to extreme vertigo, dizziness, nausea-no extreme outbursts. I have heard that Celexa is even worse. This will be my second attempt getting off of it so wish me luck.
    I am so glad that depression has become a topic that people feel they can speak freely about-it is a disease that seems to be so misunderstood & underrepresented-it is encouraging to hear so many brave people seeming to win this awful battle.

  35. Kate Harding

    This is fabulous news, Jeff. I’m another who lucked out and got the right drug on the first try* (Lexapro has, so far, been perfect for me) — but that was after years and years of telling myself I didn’t need drugs at all. If the first drug hadn’t made such a profound change, I probably would have given up on the whole concept, too.

    If they can start to figure out who needs what without quite so much trial and error, a lot more people are going to be getting the help they need.

    *That’s not counting the Wellbutrin I took to quit smoking, which was marvelous after about 10 days — but during those first 10 days, I came closer to sincere suicidal thoughts than ever before. (Shrink later confirmed that’s a fairly common side effect. I thought I was just insane ’cause I was quitting smoking.) It is amazing to hear all the different stories of good and bad experiences with various drugs.

  36. ginmar

    I started having panic attacks seven or eight months after I came back from Iraq and tried to take the bus home from work. At night. Night is when you get killed in Iraq, and buses rattle and smell just like armored humvees. My doctor said I was mildly depressed—-she didn’t believe me about the nightmares—–and she gave me Celexa, a drug which I later found out can cause anxiety. I then began having grand mal panic attacks, several of hwich were so severe I fainted, certain I was having a heart attack. In order to fight those panic attacks, my doctor told me I should ‘get Depends.’ I fired her and I swear I feel better. This is the VA, but still…..I could go on and on but I’m still looking for a therapist who doesn’t dismiss sexism from male soldiers as ‘there are jerks everywhere’ and who I can afford on $712.00 a month. One ritzy therapist just asked me bluntly how I could afford his rates. Oh, yeah, and then there’s the time my shrink told me to not take the anti-anxiety meds when we were supposed to try ‘exposure’ training. This sent me into a depression that left me having bloody nightmares when I could sleep, which wasn’t often, and cutting myself as a way to let the guilt out. It took the VA two months to put me in a program, where I found myself the sole female, the only combat veteran, and the only liberal. Yelling at assholes has proven to be the best therapy I’ve ever had. I was dealing with shoplifters and wifebeaters, and they called me a man hater. I figure I’m getting better if the wingnuts in the damned group hate my guts.

    Whew, somebody put a quarter in me, I guess. Not that I’m bitter.

  37. Wave

    It took me two years and a number of meds to finally arrive at Effexor, at which point it took me another two years to dose up from 37.5 mg to 375 mg (which is a little scary, but at least it works). I don’t know where I found the guts or the patience to go through all of this during the worst of my depression, but I kept reminding myself that something would work eventually, and that I couldn’t live without help. Talk therapy has also been important.

    Now I just need to kick the ambien dependence. Should be a fun summer project.

  38. El Mocho

    I have a somewhat tangled tale about my psychopharmacological experiences.

    Late in college, a professor who’s son had made a suicide attempt said I was probably clinically depressed. He also surmised I was probably self-medicating due to the vodka, Guinness, and whatever other kinds of alcohol I consumed.

    After I graduated I spent an extra year finishing up a certificate most of my credits fulfilled anyway. Then I decided to “get away from it all” and moved from Arizona to a small town in Texas outside San Antonio. I had found work there at the local newspaper and it seemed like a good place to write. However, everyone seemed to move away after graduating high school and not return until their mid-30’s. I was not-quite 23 when I took the job.

    No one had kept the job longer than a year. Our administrative assistants seldom stayed longer than a few months, if that. Despite being a small office, I can comfortably say it was a hostile work environment. Not knowing to flee, and not wanting to seem like a job-hopper from my first real job, I decided to stick it out. This could mean putting in something close to 25 hours by the close of business on Tuesdays, with little time off on the weekends, for little pay and meager praise. I realize that everyone goes through something like this, but at the time, it leached the joy from my life. After about a year, I felt more depressed and suicidal than I ever have. The consensus from friends was to get myself to a doctor and a psychologist.

    At first we tried Paxil, gradually upping the dose. It might have seemed to have done something—and the awkwardness of that sentence reveals how accurately I was observing anything— but soon felt like it might have helped, slightly. When that failed, we moved on to Effexor. All the while I felt more depressed than ever, while basically maintaining a functioning life. I seriously considered suicide. I even dreamt of going through with it, to find myself angry to have survived after the gun went off. I don’t remember the dosage, but it seemed rather high.

    When the Effexor no longer seemed to work, we tried “spiking” it with an additional dose of Wellbutrin, which didn’t seem to do anything. So the doctors suggested I try Celexa: “It’s a good drug. It’ll work.” I filled the prescription and very slowly tapered off the Effexor. But then I looked at the bottle of pills and thought “Fool me once, shame on you, fool me twice, shame on me. Fool me three times…”

    I had done a lot of reading and research by that time, so I knew that antidepressants could take several tries to find the right dosage. I had heard of the “medication-merry-go-round.” At that point, I really felt sick of trying. I felt sick of pretty much everything. So I quite the job and moved back to Arizona, where I had something like a support network.

    My life has improved immeasurably since then. I have had dips of depression, but the symptoms have not lasted anything near a clinical duration. I have at least learned to learn the warning signs so I can try and combat it. I usually find a lack of sleep can set things off, so I try to maintain my sleep level on an even keel. I did have depressive episodes before the move and the job, but nothing has quite felt that bad since.

    I try to keep track of mental health issues and depression, but I have a deep distrust of pharmaceuticals now. I know they have worked for others and I know life events also triggered my suicidal depression, but for now, the cost I would pay in side affects doesn’t seem worth the benefit I would get.

  39. DerelictDaughter11

    i really want to thank all of you for sharing your stories and experiences. i had experiences with psychologists and psychiatrists in my early adolesence and ever since i am totally turned off to the idea of even thinking about trying any of that again. i’ve been depressed, had a hard time coping, lost support networks, and dealt with major changes with varying degrees of success. i just can’t see myself going into therapy again, or ever trying antidepressants again, ever. (maybe i wouldn’t mind an Rx for some Xanax from my GP, though.) i just feel like the effort and time it would take to find the right doctor, find the right therapist, find the right meds and dosage…would just drive me crazier. so far, my mess hasn’t been anything a moderate amount of self-medicating with a couple beers or cosmopolitans couldn’t fix. i know it’s not the best plan. i just don’t know what else to do without feeling completely out of control (at the mercy of doctors/therapists who are strangers, insurance companies who are profit-hungry, medication that does god knows what to me, and so on). argh.

    feels a bit better to vent this, though, especially to nonjudgmental strangers such as yourselves. i heart shakesville. 🙂

  40. Brian

    I think at least some of depression is just dissatisfaction with your life. It’s hard to treat that chemically with the problems still being there. Seems to me the easiest treatment for that is to change the situation.

  41. ginmar

    Gee, Brian, that was incredibly helpful. You mind telling me your trick for getting rid of nightmares, agoraphobia, panic attacks and flashbacks? If I could just get rid of those, my life would be peachy.

    You know what helps wtih depression? Not giving people patronizing advice. Try it some time.

  42. cellar door

    Wow, Brian. For thirty years I’ve thought I’ve been battling genetic clinical depression. I mean, I’ve lived in several cities, been a student, a professional, happy, unhappy, married, divorced, dating, celibate, and lived a whole lot of life in many different situations. The depression has always been there. Nice to know I should just “change the situation” and it will all be better.

    People with chronic depression have learned a lot about it. They know more about it than you obviously do. Save the patronizing attitude for people who might want it.

    Geesh. Where do people like this come from?

  43. madame xxx

    ginmar –

    when i read stories like yours my heart just breaks! the lack of proper care for trauma in your case is nothing short of criminal.

    there are some successful treatments for trauma but as far as i know the military doesn’t use them. one is called somatic experiencing, which i have had with great success, and another that i know of is emdr.

    the thing that drives me crazy whenever i read any news about vets and ptsd is that trauma is a physical condition, not a psychological one, and needs to be treated as such.

    i don’t know if you get access to these methods, but i hope and pray you can find some relief from hell you are going through.

    link for somatic experiencing is here:

    http://www.traumahealing.com/

    i don’t know if it will help you, and in no way am i saying my traumas are near what yours are, but it has helped me so much.

    and to everyone else here, thanks so much. as i lie around crying, wondering whether to just go back to an antidepressand or try yet another route, i don’t feel so alone.

    i’d love this thread to go on forever to hear others’ stories.

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