ARE YOUR ANTIDEPRESSANTS WORKING
FOR YOU, OR AGAINST YOU?
By Shari Schreiber,
M.A.
www.GettinBetter.com
First of all, it's very
important you understand that antidepressants are not
"happy pills." They are not intended to block
your feelings, or completely eliminate your pain. Essentially,
they're designed to raise the floor of your depression,
so that you're able to get out of bed each morning, and (at least)
function in your personal and professional domains.
If you're feeling depressed,
you should be engaging solid, responsible help (talk therapy)
to assist you with issues that are contributing to this difficulty,
so they can be resolved/healed. If you're taking antidepressants
alone (without doing inner work), it's like slapping
a Bandaid on a deep, bleeding gash--and expecting it
to heal.
Your
antidepressants
should begin to impact your depression within a few days
to a week; if they don't, speak with your doctor. If they make
you feel more depressed or suicidal,
you could be having a paradoxical response to this particular
drug, and you should call your physician immediately,
and stop taking it! The generic forms of certain
antidepressants can be more problematic in this regard, because
they're less stable in composition--so when beginning
drug therapy, it's best to start with samples from your physician
(if he/she doesn't offer these, be sure and ask!) or buy the name
brand. This will at least give you a frame of reference
as to how effective a particular antidepressant can be for you,
and whether a generic refill of your Rx might be sufficient
for managing your symptoms. (A number of different companies
manufacture generic drugs; your pharmacist cannot
control the source of his/her supply month to
month, which could have unfavorable consequences for you!)
Each
individual's physical chemistry is somewhat unique; a medication
that works well for your closest friend or sibling, may not be
the optimal choice for you! If you're not
experiencing a favorable response to your initial drug trial or
there are unpleasant side-effects, it could be that another
within the same family, or a different type of antidepressant
may yield better results. If you're taking an SSRI
and it makes you feel tired/drowsy,
this (very common) reaction is easily resolved, and discussed
in detail within the last few paragraphs of this piece.
A very brief, manic/hyper or non-response to
your drugs over a reasonable period (1 - 3 weeks) can indicate
an atypical or 'non-specific' Bipolar
Disorder,
that your physician may have overlooked during your psychiatric
evaluation. Exploring this further (ruling out a bipolar issue)
is critical to the success of your drug therapy!
Though
not
essential, it's helpful if your talk therapist is somewhat
familiar with various types of antidepressants, and can function
as your advocate (or go-between) with your prescribing physician.
Your psychiatrist typically sees you for follow-up visits once
every couple of months (or less often, once you're stabilized),
but your weekly clinician has a more direct sense
of how you're feeling, and should be alert to any side-effects;
lethargy/fatigue, skin rashes, sleeplessness, sexual difficultes,
stomach/intestinal problems, etc., that might be caused by the
drug you're taking. Based on closer, more frequent monitoring,
he/she should also be noting whether your current drug therapy
is sufficient in helping you move through
your crisis or difficulty. In my view, two heads are better than
one, and a collaborative effort involving your doctor
and therapist can significantly enhance your ability to mend.
While
depression is almost never "just a chemical imbalance,"
balancing brain chemistry can be a critically
useful adjunct to your psychotherapeutic treatment. Depending
on the nature and severity of your challenge or crisis,
meaningful therapeutic intervention without the help
of antidepressants can be like undergoing surgery
without anesthetic! Acute levels of pain make it tough for you
to 'hold' the work, or make good use of it. Antidepressants can
relieve some of the stress associated with psychic trauma, and
make it possible for you to move to the other side of an issue
more effectively, and come out much stronger.
While you may decide (instead) to rely on coping strategies you've
used in the past, like alcohol/illicit drug use, overeating,
over-work, shopping, getting a new pet or starting
a romance to divert your pain, these can
further complicate and compound your struggle! Frankly, no matter
how tempting it seems, it's better to resist these impulses
if you're hoping to make tangible and timely progress.
I'm
frequently asked if antidepressants inhibit psychic abilities.
While these medications can reduce/control psychosis,
it has never been my experience that one's psychic or clairvoyant
capacity is diminished by these drugs.
You
should be advised that alcohol is a
depressant. Drinking counteracts the benefits of any medications
you're taking to combat your discomfort, and undermines even the
most solid therapeutic intervention! Aside from this,
if you feel that your current antidepressant therapy is insufficient
for managing your symptoms, speak with your therapist and/or
physician about switching to a different prescription, or increasing
the one you're on. If your doctor seems unresponsive
to your concerns or needs, find another one! OK, now
with that out of the way . . .
These
days, a lot of people on antidepressants are taking SSRI's
(Selective Serotonin Re-uptake Inhibitors), such as Zoloft, Celexa,
Lexapro, Prozac or Paxyl. Cymbalta (an SSNRI) is a newer member
of this family that contains norepinephrine, and alleviates physical
pain that can accompany depression. Cymbalta seems well tolerated
by individuals who've had difficulty with other SSRI's, or found
them to be less than effective. A few of these medications (Celexa,
Lexapro, Paxyl) are formulated to target additional symptoms,
like anxiety/panic
and obsessive-compulsive tendencies.
Each SSRI has slightly different properties, so it may take a
bit of experimenting to find out which is most effective
for you. While a psychopharmacologist or psychiatrist
can send you home with drug samples, your general practitioner
(GP) isn't likely to have these on hand--nor is he/she trained
to prescribe psychotropic drugs or diagnose you properly! This
means, you could end up with a cabinet full of costly prescriptions
you can't use, which is not just a nuisance--it deters
your ability to recover.
Along
these lines, I've seen many instances where folks are over-medicated
(taking several drugs simultaneously that can counteract each
other, and/or be superfluous)! This issue is frighteningly
common among doctors who lack experience, or who are under-educated
in the realm of psychopharmacology; too often, they'll prescribe
additional meds to relieve a patient's unpleasant side-effects
on a drug, rather than switching him/her to a different
one. I personally believe that in the world of drug therapy, less
is usually more. A medication that's designed to target
several of your symptoms, is healthier (and more economical) than
taking several that haphazardly address each one. Add
to this, various antidepressants like Effexor may
be tolerated at lower doses, but lethargy/fatigue, intense sweating
and other uncomfortable side-effects can manifest as dosage escallates.
Increased intake problems can also occur with certain mood stabilizers
(like Lamictal), used to treat Bipolar symptoms.
Drowsiness or tiredness can easily be experienced if your physician
has started you on too high a dose of your antidepressant.
Your initial dosage on an SSRI should never be higher than 10
mg., to see how your chemistry handles that drug. Combating fatigue
on these medicines is addressed very shortly, but if your beginning
dose is too high, you'll feel like a zombie--no
matter what time of day you're taking it!
Your
psychiatrist may send you home with pharmaceutical sample packs
that increase your daily dosage exponentially, which means that
your body must suddenly adapt to twice
the amount of this medication in your system. Using a tablet cutter
can help increase your dose more gradually, and save you from
having to deal with unpleasant side effects, as you adjust to
a higher intake (make sure your doctor sanctions this). You should
not try this with capsules, but your prescription may
be available in more moderated doses that help you adapt to these
changes more comfortably. In light of these considerations, it's
imperative you understand that your best outcome depends
on solid pharmaceutical wisdom and responsible assessment. As
is the case with any professional domain, medical practitioners
can vary widely in terms of experience, dedication and skill--but
a thorough diagnosis of your symptoms is essential
in determining your success with treatment!
Serotonin
levels are raised over a period of time with use of these drugs,
so while you could begin to feel a degree of relief within a few
days, optimal effectiveness may take several weeks.
SSRI's and other antidepressants can cause dehydration,
which leads to headaches, dry mouth, constipation and other related
physical issues, so it's important to drink plenty of water
while taking them. The most typical sexual
side effects of SSRI's, is they can inhibit libido and ability
to achieve orgasm, but individual results may vary significantly;
I once had a client who'd taken Paxyl years before
we met, and reported an unusual increase in his
sex drive during that time. Naturally, this somewhat atypical
response might be attributed in part, to relief from
depressive symptoms. SSRI's are usually not well tolerated
by individuals who have irritable bowl syndrome
(IBS) or a medical history that includes other colon disturbances.
In these instances, a cholinergic reaction (intense diarrhea)
is common, but your doctor should cover this during your
intake session. Taking these medications with a little food rather
than on an empty stomach, can decrease nasty side-effects,
like nausea.
The
time of day you take your antidepressants
can influence outcome; most prescriptions indicate morning dosage,
but this can interfere with your ability to concentrate/focus
or even function well during waking hours. All SSRI's are formulated
to raise and maintain serotonin levels in brain tissue,
which provides a soothing, relaxing, mood-elevating effect. The
problem is, your productivity at work can be
seriously compromised, if you're taking them at the start
of your day--particularly while you're adjusting to them! Your
depression should lift with the use of these drugs, but if you
take them in the morning, you could feel sleepy
or lethargic afterward. This is critical, because nobody
feels good when they're fatigued, unfocused and anxious
about performing well on their job! In light of this, you might
find yourself questioning; "Is the prize
worth the price I'm paying to feel
better? And if not, do I have to throw the baby out with the bathwater,
or make a simple adjustment?"
Frankly,
I'm utterly mystified as to why doctors are still recommending
their patients take SSRI's in the morning, given these known and
anticipated side-effects! While it's true that certain antidepressants
(such as Wellbutrin) are activating, and must be taken
during daytime hours, it's certainly not true
for most of them. Maybe pharmaceutical manufacturers should become
more aware of how you actually feel
on these drugs, and provide more specified guidelines to physicians
prescribing them. Now that's a novel idea, isn't it?
This
drowsiness issue is exacerbated if you're struggling
with symptoms of Attention
Deficit Disorder
(ADD/ADHD) in conjunction with your depression. Your SSRI can
slow you down, but if you're taking a stimulant for your ADD,
it's supposed to wake up your brain and activate
you! It seems reasonable to presume that the properties of these
two drugs (when taken at the same time) could counteract each
other, to where you may not receive full benefit from either.
In recent years, some doctors have found that adding small amounts
of a stimulant drug to their patients' antidepressant therapy
had a synergistic effect--that is, one enhanced the effectiveness
of the other. Perhaps this practice was originally intended
to mitigate the tranquilizing side-effects
of these drugs, and (voila!) an inherent synergy between
the two was an unintended by-product. This appears to mean, that
taking your SSRI around dinnertime (later, can leave
you groggy the next morning) may enable you to sleep more soundly,
and awaken more refreshed!
Various
amphetamine-type stimulants can be very helpful if you have ADD,
but WellbutrinXL is an activating antidepressant
that's frequently prescribed for attention deficit issues, and
may better address your needs. This drug is fast acting, and has
a short half-life (the time it takes to leave your body). Wellbutrin
isn't well-tolerated by everyone; some may experience irritability
or even intense rage, and it might be better to start with a non
time-release version, so unfavorable reactions can pass quickly.
This drug might be worth trying, especially if your doctor can
send you home with some samples. If you're hyperactive with ADHD,
you may have difficulty with Wellbutrin, as it can trigger anxiety,
nervousness or irritability. Under these circumstances, Strattera
or small amounts of an amphetamine like Ritalin or Adderall, can
be a better option for you. Withdrawing from almost any prescription
should be done gradually to avoid uncomfortable or dangerous
side-effects. The exception, is when you have a paradoxical
response (mentioned earlier) to a new Rx.
I
am not a physician, but I've worked closely enough with individuals
taking psychopharmaceutical drugs, to have noticed a pattern of
improvement after they've implemented a simple time shift
in their antidepressant therapy. I strongly urge you to
always check with your doctor about any
concerns you have regarding your existing drug regimen or amending
it, before initiating any changes. It's perfectly acceptable to
ask him/her about taking your SSRI in the evening, if
you suspect this could provide a better night's sleep, while enhancing
your alertness, focus and motivation during daytime hours. Maybe
it's true--at least in this instance, that "timing
is everything."
If
you still have questions pertaining to this topic, feel free to
contact
me.
Meet
the Author
Articles
Ask
Me Anything!