My relationship with antidepressants
I’ve taken Zoloft on and off (but mostly on) for over eight years. If you’ve read the posts Philip Dawdy made last month or last week about an article in The New England Journal of Medicine, “Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression,” or read this news article about it, you know that this study shows that antidepressants aren’t effective in treating bipolar depression.
Okay, so you probably could have figured that out anyway.
At this point, I am taking Zoloft for two reasons:
- I’ve mostly been feeling good since I started taking meds again, so I don’t want to screw with my medications in case Zoloft is helping me avoid depression.
- Some medications have made me extremely tired. Since Zoloft does the opposite, I assume it is helping me wake up in the morning. I have trouble falling asleep, but I wake up and I can function. I think it’s balancing out any drowsiness that my Epival might cause.
I don’t know if either of these are valid long-term reasons to be taking Zoloft, but they’re good enough reasons for me in the short term.
Zoloft is the only SSRI I’ve ever taken, but I took Effexor in January and February of 2006. Three weeks starting on it, and then three weeks coming off it. See, I was taking it all by itself without a mood stabilizer or an antipsychotic. I had gone off all of my medications in the fall, felt fine, then got really suicidal really quickly and wound up in the hospital. The psychiatrist on the unit discharged me with a prescription for Effexor although I told him I didn’t think it was a good idea for me to take an antidepressant without a mood stabilizer.
He told me it would be fine, and I figured I might as well listen to the doctor, because stopping all my meds all by myself hadn’t worked out too well for me. I was also not thinking very clearly and it didn’t occur to me that this could have more dire consequences than a mild hypomania followed eventually by another depression.
So what happened? Well, I once read the phrase “rapid cycling/mixed state hell” on an online forum, and that describes it perfectly. I don’t feel like going into any detail today, but suffice it to say that I wound up back in the hospital exactly three weeks later. It wasn’t pretty. It was, in fact, really ugly. I mean the situation, but come to think of it, the hospital was ugly, too.
I’m sure my being bipolar rather than unipolar had a lot to do with that in my particular case, but we all know that you don’t have to be manic-depressive for antidepressants to make you flip out. So it’s nice that the FDA has finally ordered updated black box warnings on antidepressants “to include warnings about increased risks of suicidal thinking and behavior, known as suicidality, in young adults ages 18 to 24 during initial treatment (generally the first one to two months),” whereas the warning only applied to those under 18 before that.
Health Canada had already issued a warning about this:
Health Canada is advising Canadians that Selective Serotonin Re-uptake Inhibitors (SSRIs) and other newer anti-depressants, now carry stronger warnings. These new warnings indicate that patients of all ages taking these drugs may experience behavioural and/or emotional changes that may put them at increased risk of self-harm or harm to others.
The new warning for each of these drugs, which are listed below, appears in the information package received by patients and in the prescribing information available to health professionals.
Patients, their families and caregivers should note that a small number of patients taking drugs of this type may feel worse instead of better, particularly within the first few weeks of treatment or when doses are adjusted. For example, they may experience unusual feelings of agitation, hostility or anxiety, or have impulsive or disturbing thoughts that could involve self-harm or harm to others…
That’s from a press release issued June 3, 2004.
It’s a bit different, though — it applies to all ages, not just people under 25; it includes harm to others as well as self-harm; and it doesn’t include all antidepressants, just newer ones.
May 6th, 2007 at 2:57 am
I’m surprised about that study finding antidepressants ineffective, but can believe it. My pdoc periodically puts me on prozac when I’m depressed and I really don’t feel it making a difference. I always suspect my depression would have passed, even without it. I’m on prozac now and will be interested to hear what my pdoc will have to say on this.
May 6th, 2007 at 7:10 pm
Bipolars should on a mood stabilizer if they’re taking an anti-depressant. I mean, duh. For unipolars, it may improve the depression, but for bipolars it could trigger a hypomanic episode!
The longest combo that worked best for me was Effexor, Tegretol, and trazodone to sleep. Unfortunately, I’ve been on nearly everything in the PDR aside from tri-cyclics and MAOI’s except for that new MAOI patch, EMSAM. Even that didn’t work. So, it’s maintenance ECT for me.
I’m lucky to have what a lot of local folks in the therapy/psych field a pdoc that’s pretty much the Godfather of Psychiatry in Chicago. When other pdocs have done me wrong — he takes care of it.
Still, I’m very lucky to have him — he’s an excellent pdoc and I’ve been seeing him since 1994.
Can you choose your own pdoc?
May 6th, 2007 at 10:51 pm
Oh, the mental hospital pdoc didn’t believe I was bipolar, although it said in my file that I was and it’s not as if he did a diagnostic interview himself. Maybe he had some sort of hunch? If he did, it was an incorrect one.
He told me that if I still got depressed sometimes when I was on Zoloft, that meant no SSRIs would ever work for me, so he prescribed me Effexor. When Effexor made me considerably worse, he said that no medication would ever help me. I guess he couldn’t admit to himself that the Effexor made me go batshit insane while I was taking it, because that would be admitting he was wrong, so instead he told me I was borderline and histrionic and that all my problems were purely psychological.
He asked me what kind of help I wanted. I said I wanted to be referred to a psychiatrist and a therapist on an outpatient basis. He FLAT-OUT REFUSED to do either of these things and said the only thing he would do was refer me to a partial hospitalization programme. It was either that or nothing. So a few months later (after my school term finished), I spent seven weeks in the partial hospitalization programme.
But that was last year, in a different city. I still don’t think I have the option of choosing my own pdoc right now, though. I’m just lucky that I was able to find a GP who is a) a good doctor and b) close to town.
May 7th, 2007 at 10:34 pm
Sounds like a quack to me. I know other people whose pdocs have told them they aren’t borderline because they can’t make money off of these patients because they don’t really need prescriptions.
I guess the medical system is very different in Canada, but at least you have a good GP.
May 17th, 2007 at 2:56 pm
You shouldn’t do this.