ARE YOUR ANTIDEPRESSANTS WORKING FOR YOU, OR AGAINST YOU?
BY SHARI SCHREIBER, M.A.
First of all, it's very important you understand that antidepressants are not "happy pills." They're not intended to block-out your pain or totally eliminate your difficult feelings. 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 your difficulties, so they can be resolved/healed. If you're taking antidepressants alone or without doing inner work, it's just like slapping a Bandaid on a deep, bleeding gash--and expecting it to heal. That's just wishful thinking.
I am not a medical professional. This article is intended solely for your edification. Please do NOT contact me about your drug challenges or difficulties! Instead, make a list of your questions and/or troubling side effects, and have a dialogue with your prescribing physician about these concerns as soon as possible.
Benefits and side-effects from your antidepressants show up pretty quickly. Within a couple of days, you should be noticing how your body feels on that medication. This business of waiting "six weeks or more" before you notice any positive change, is utter nonsense! In my clinical experience, it simply isn't true. Full benefit is cumulative--meaning it takes awhile for your body to absorb sufficient levels of the drug you're on, to where you feel substantially better, but to presume that someone with acute clinical depression has to wait over a month to feel incremental improvements, is ludicrous.
I generally like to recommend that people ask their physician about starting out with a micro-dose of their antidepressant. A gradual initial introduction, say 2.5 to 5 mg's of an SSRI as opposed to a standard beginning dose of 20 mg's is a better way to ease a client into drug support with fewer side effects. I'm certain that no medical practitioner would sanction this approach, but many of my clients have had splendid results from following this protocol with their doctor's permission, and some have continued indefinitely on a mini or 'micro-dose' without ever needing to increase their daily intake. When the client is monitored closely, maximum benefit can be achieved~ and in the arena of drug therapy, less is often more--unless of course, your physician is attending to acute or suicidal depression.
If you're taking an SSRI and it makes you feel tired or drowsy, scroll down to the last several paragraphs of this article, where you'll find ways to resolve this extremely common reaction! Do it now then come back~ because there are some important things you should learn about your meds here. Use this article only as a guideline (an information resource).
Your antidepressants should start 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 phone your physician immediately, and stop taking it! Generic versions of certain antidepressants can be more problematic in this regard, because some tend to be less stable in composition--so when beginning drug therapy, it's really 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 *drugstore chain* pharmacist cannot control the source of his/her supply month to month, which could have unfavorable consequences for you!)
Switching to a different drug is generally no problem, particularly if they're in the same family (like with SSRI's and SSNRI's). Each Selective Serotonin Re-uptake Inhibitor has slightly different properties, in order to target adjacent symptoms like Obsessive Compulsive features (OCD) and/or anxiety issues. This is discussed further down within this text.
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.
Taking your antidepressants around the same time each day (or night) keeps this drug at consistent levels in your system, which is always a good idea; just make it part of your morning or evening ritual. Some folks find it easier to remember their pill(s) if they're in the bathroom, next to their toothbrush. Find a place that's convenient for you, and stick with it. If you oversleep one day or get thrown off schedule, don't sweat it. Just try to take your dosage as close to the time you normally do, and you'll be okay. If you accidentally miss a day, the sky won't fall--but try to be very consistent with a daily routine when you're starting out on psychopharmaceutical medication.
Depending on how long you've been taking them, most of these drugs have a half-life of a week or two. This means that the time it takes your body to rid itself of this drug (completely), could take up to about 14 days. Having a bad reaction to your first or second pill? You should be feeling much better in a day or so, after discontinuing it.
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 initial psychiatric evaluation. Exploring this further (ruling out a bipolar issue) is critical to the success of your drug therapy! Bipolar Disorder generally requires that a mood stabilizer be combined with your antidepressant therapy. Mood stabilizers are different than antidepressants, as they are anti-convulsive drugs that are designed to control extreme mood shifts or swings.
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 what you're feeling, and should be alert to any side-effects; lethargy/fatigue, skin rashes, sleeplessness, sexual difficulties, stomach/intestinal problems, etc., that may be caused by the drug you're taking. Based on much 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' therapeutic work, or make good use of it. Antidepressants can relieve some of the stress associated with psychic trauma, make it possible for you to move to the other side of a setback 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 best 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 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 taking. If your doctor seems unresponsive to your concerns or needs, find another doctor! 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 Paxil. 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 some people who've had difficulty with other SSRI's, or found them to be less than effective.
A few of these meds (Celexa, Lexapro, Paxil) are formulated to target additional symptoms, like anxiety/panic and obsessive-compulsive tendencies. Paxyl is very hard to tolerate for many, due to its tendency to make patients very drowsy. Each SSRI has slightly different properties, so it might take a little experimenting to find out which is most effective for you. While a psychopharmacologist or psychiatrist may send you home with drug samples, your general practitioner/GP isn't likely to have these on hand~ and he/she is seldom 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 isn't just a nuisance--it deters your ability to recover. Drug manufacturers have cut back on free samples to Dr.'s since the inception of this article. What a bummer... sorry 'bout that!
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 or 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 escalates. 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 doctor has started you on an elevated dose of your antidepressant. In my view, the initial dosage on your SSRI should never be higher than 10 mg., to see how your body chemistry handles that drug. Combating fatigue on these drugs is addressed very shortly, but if your beginning dose is too high, you will feel like a zombie--no matter what time of day you're taking it! Keep scrolling down, for more on SSRI fatigue!
Your psychiatrist may send you home with pharmaceutical sample packs that increase your daily dosage exponentially--which means that your body must immediately 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 any 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 might be available in more moderated doses, which will help you adapt to these changes more comfortably.
In light of these various considerations, it's imperative you understand that your best outcome depends on solid pharmaceutical wisdom and responsible assessment. As 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 for 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 common sexual side effects of SSRI's, is they may inhibit libido and your ability to achieve orgasm, but individual results can vary significantly; I once had a client who'd taken Paxil years before we'd met, and reported a marked increase in his sex drive during the time he was on that drug. Naturally, this somewhat atypical response might be attributed in part, to relief from depressive symptoms.
If you're not currently in a romantic or sexual relationship, it might be wise to attend to the more immediate need for relief from your depression, instead of worrying about the "what if's" that may loom ahead. It's just common sense.
SSRI's are rarely tolerated by individuals who have irritable bowl syndrome (IBS) or a medical history that's included other colon disturbances. In these instances, a cholinergic reaction (intense diarrhea) is very common, but your doctor should cover this during your intake session! Taking these meds with a little food rather than on an empty stomach, can decrease the incidence of 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 function well during your waking hours! All SSRI's are formulated to raise and maintain serotonin levels in your 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. While your depression should lift with the use of these drugs, if you take them in the morning, you could feel sleepy or lethargic afterward. This is pretty critical, because nobody feels good when they're fatigued, unfocused and anxious about performing well at their job! In light of this, you might find yourself asking; "Is the prize worth this price I'm paying to feel better? And if not, do I 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, 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 companies should become more aware of how you actually feel on their drugs, and give 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 physicians have found that adding small amounts of a stimulant drug to their patients' antidepressant therapy had a synergistic effect; meaning, one enhanced the other's effectiveness. Perhaps this practice was originally intended to mitigate the tranquilizing side-effects of these drugs--and (voila!) an inherent synergy between the two, was the unintended by-product. This appears to mean, that taking your SSRI around dinnertime (later, can leave you groggy the next morning) might 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 often 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, may be a better option for you. Withdrawing from almost any prescription should be done gradually to avoid uncomfortable and/or dangerous side-effects. The exception, is when you have a paradoxical response (mentioned earlier) to a new Rx.
SSRI drugs often help one focus more easily, because we can relieve intense psychic/emotional pain, which drives obsessive-compulsive thinking, self-sabotaging behaviors and anxiety issues in many people. My experience with ADD and ADHD'ers is they do far better on a mini-dose of antidepressant than on a stimulant drug typically given to treat attention deficit problems.
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 that at least in this instance, "timing is everything."
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