So I was browsing the interwebs for information on anti-depressant medications from a student services point of view (I work as an advisor and many of my students take medications in the SSRI and SNRI categories.)
I came across a Duke University Psychological Services Page that goes through Anti-Depressant Medication Questions & Answers. I thought it would be interesting today to juxtapose my experience with SSRIs, with the Q & A on the official website.
I haven’t actually read the Q&A yet. I am literally going to read it as I go along here with you and type my answers in blue below the Duke text. Let’s see how this goes! My goal is to reflect upon my own experiences once I made the decision to go on some medication & also to inspire others to be open 🙂
The writing in black is the Duke University Q &A Text.
The sentences in purple are my own personal reflections on how the above Q&A applied to my situation.
1. Why would taking a pill help the way I feel?
Anxiety, sadness, and even depression are normal feelings that all of us have experienced for brief periods at one time or another. Usually we have an idea of what led to these feelings and what we can do to feel better. However, prolonged, more intensely down or anxious feelings are different from everyday sadness or anxiety, and medication can help with these symptoms. Often caused by changes in chemicals in the brain, these more tenacious problems sometimes make no “sense” to you. Even when you can identify a starting cause, the depression may get in the way of clear thinking and interfere with your ability to figure out coping strategies.
It may feel like nothing you try to do helps, or you may notice changes in yourself that you can’t understand, such as problems with sleep or appetite, low energy, or frightening thoughts. It’s also not normal for bad days to outnumber good ones for weeks or months on end.
Because depression and anxiety disorders are sometimes caused by biological changes in our body, a biological treatment, such as a pill, can be helpful. In some cases a biological treatment is absolutely necessary. Antidepressant medicines correct the chemical changes that lead some people to feel depressed or anxious.
In a lot of reflection of late (I’ve been re-reading my childhood & teen journals) I’ve realized I was actually quite depressed throughout my teen years, much more prolonged and intense than the typical teen ups and downs. For months at a time. I’ve also experienced what I’d describe as 3 minor depressive episodes. However, I did not know it at that point in my life.
It didn’t make sense to me at the time, because I was using my tool kit for happiness and had a great life. In terms of family dynamics, I had one parent who was super intense on the tough love / suck it up spectrum and I bought into that mindset and sucked it up, held my chin up and carried on.
At the time I was not simply aware of what was normal and what was not. I also did not understand that how I felt could be caused by chemical imbalances. As a teen and in my 20s, I just felt like I was going through similar ups and downs to everybody else. Life is a struggle, right?
I was very positive and engaged / active in my life, but couldn’t escape the internal biological feeling of crushing sadness. Only now, at the age of 33 with development and the power of hindsight, do I realize I’ve had ups and downs in mental health over the years.
2. Why can’t I do it on my own?
If you could just “snap out of it,” you probably would have by now. Often students try hard to “get over” their unpleasant feelings before coming to CAPS. Medication is not the only treatment option: some kinds of depression and anxiety get better with counseling. Sometimes, however, the level of pain is high enough, or interferes enough with your ability to function in your daily life, that medications are especially needed. Just as people with high blood pressure can’t simply “will” their blood pressure to go down to normal and have to take a pill to help it, people with certain kinds of emotional suffering need a pill to get back to normal.
That’s not to say there aren’t things you can do to make a big difference. Just as people with high blood pressure can make lifestyle and diet changes that help bring their blood pressure into normal range, so can people with depression or anxiety. A pill won’t solve all of your problems, but it will help diminish the symptoms which interfere with your ability to work on them.
My thought processes do improve with counselling, because in my down times, my positive nature and great self talk spiral down slowly and gradually. I am able to observe and catch it now in its earliest stages, which has taken work over several years. I noticed it just recently and that made me pick up the phone and resume counselling. Externally I still show up as positive, but the % of positive self talk slowly decreased on the inside. They say depression is an invisible disease; it is. You are battling it on the inside, without it showing on the outside (or if it does, it is subtle.)
This is just personal preference: I would not have gone on meds if I only needed to work on the mental component. I think therapy, journalling and personal research /CBT work helps with that patterning.
What made me sit up and take notice and consider professional help & medication was the body component. For me, that’s when shit gets real. I’ll give you an example of the last two months at work: Though I was on my game performance wise, I was working my.ass.off. to show up and perform at a relatively average level for me.
My brain felt like it was wrapped in cling wrap, I was struggling with simple cognitive tasks (missing normal turns on my commute home from work), focusing on reading an email, this internal “heavy” feeling, brain fog, and feeling panicky when I laid down in bed at night. I was crushingly exhausted ALL day every day. In the past I have had a major insomnia episode and I felt myself going there- trouble falling asleep and jolting out of bed at 4am with nightmares.
I was feeling so energetically down and drained that I HAD to take a nap at lunch to get through 3 hours in the afternoon. Lunchtimes I was desperate to find some space on campus to rest. For me, that is unusual. That is when it started interfering with my life. That is the benchmark – When things become “unusual” for me and they start making basic tasks difficult.
3. How do these medicines work?
The answer to this question is not entirely clear. The brain is a very complex organ and we are just beginning to understand how it malfunctions in anxiety states and depression. Having said that, it is clear that these medicines do work, and work very well.
Antidepressants adjust the brain’s balance of neurotransmitters such as serotonin and norepinephrine. When these and other neurotransmitters get out of balance your brain doesn’t function normally; the neurons become less responsive and less adaptive. This translates into symptoms such as changes in sleep, changes in your ability to concentrate on schoolwork, excessive worrying, panic attacks, changes in eating patterns, loss of interest and motivation, loss of pleasure in one’s usual activities, feelings of hopelessness, thoughts about death, and even loss of interest in sex.
Once the medicines have corrected the imbalance of neurotransmitters, gradually over days to weeks the brain resumes its normal functioning. The neurons start responding normally and the depressive symptoms resolve. After a period of time on the medicines, usually six to twelve months, the brain regains its ability to maintain its healthy balance without the help of medication.
I take a 10mg dosage of an SSRI, Cipralex. I went on it 3 months post partum in 2013 when I was in the deepest stages of grief from losing my mum and struggling to adjust to new parenthood. I was just so raw and emotional after 18 months of emotional lockdown as a cancer caregiver and preggo with hyperemesis. I was quite acute at that stage, crying every day. It’s hard to separate grief and depression, but I knew whatever it was, it was a lot to overcome and my physical symptoms (listed above) were beginning to interfere with being able to function on a basic level. It’s hard to remember that stage but looking back, I went on it in the new year of 2014 and I do remember many moments of joy and grattitude in the spring/summer – I had a fantastic time the rest of my maternity leave and was in a really, really great place. That means it took about 3 months for me to see some results. Everyone is different.
I am currently adjusting again, from 10mg to 15mg which hasn’t really had any side effects. I am now 2 weeks into a different dosage but I have not noticed tangible improvements yet. The key point to underline here is how holistic this whole process is. With a decision to take meds comes the decision to employ EVERY tool in the toolkit. It means commitment and making promises to yourself, as well.
4. What are the side effects?
All medicines have the potential to cause side effects, but, fortunately, modern antidepressants don’t cause major side effects in most people. Some people feel a little queasy the first couple days as they get used to the medicine. Some people feel the medicine wakes them up like a cup of coffee and can interfere with sleep if they take it late in the day while others feel it makes them a little sleepy so they take it at bedtime. Other possible but not too common side effects include vivid dreams, headaches, and increased sweating. Most of the newer antidepressants don’t cause any significant change in weight.
Occasionally, an anti-depressant can make a person feel restless, agitated or anxious. Very rarely, these feelings might trigger thoughts about harming oneself. It is very important that you call your doctor immediately if you experience these side-effects.
The most common side effect of some anti-depressants is a sexual side effect. It usually manifests as delayed orgasm in both men and women. Some women develop anorgasmia, the inability to have an orgasm, which can be very frustrating. In contrast, some male students find that mildly delayed orgasm improves their sexual function. Your doctor can suggest solutions for this particular problem, or discuss changing or stopping the medicine if you are troubled by sexual side effects.
All of the side-effects that can occur with anti-depressants go away once you stop the medicine. There are no known long-term problems caused by these medicines.
Surprisingly, the SSRI had a profound effect on my chronic back pain and took me from a 6/10 daily pain level to a 1-2/10 daily pain level. I didn’t know this would happen when I first decided to go on it. It was a great, unexpected outcome. I decided to stay on the SSRI from 2013 to now, because of this one game-changing effect it has had on me. With a back injury, I manage daily pain and have attended pain clinics and pursue regular manual therapy – the SSRI bought it to manageable levels for me in combination with continued treatment and corrective exercise.
It’s tricky talking about SSRI side effects because it really depends on you and what you already had challenges in to begin with. I have a pretty low sex drive (I am comfortable owning this part of myself at this point in my life) and I have noticed it has been REALLY low since 2013 (I also have had 2 children in 3 years – this may be a factor LOL.)
I’ve always thought that for my activity levels and clean eating and healthy lifestyle, my body is surprisingly resistant to losing weight. I was able to lose the baby weight first maternity leave – about 40 lb over 10 months. I am still on the same dosage of meds, on a second maternity leave but haven’t been able to shift more than 20 / 40 pounds up to this point. So I don’t think the meds are the issue. I think the issue is me 🙂
5. Are these medicines addictive?
No. Because these medicines don’t make you feel high and because their onset of action is over many days, they don’t produce any psychological craving to take the drug. They also don’t produce any physiological dependency. You can stop taking the drugs at any time. It’s important to understand, though, that your risk of lapsing back into depression or anxiety is much greater if you don’t stay on the medicines for several months.
Some students have physical discomfort if they stop some of these medicines too suddenly. You might feel dizzy, have minor visual changes, nausea, or fIu-like symptoms. These symptoms can usually be avoided by tapering the medicine slowly. If they do develop they are usually mild and fairly short-lived. If you have trouble with these symptoms talk with your doctor about a remedy.
Not addictive at all, BUT I was so surprised when I tried quitting SSRI meds. I tried coming off of them 2 different times and I had really, really bad headaches and after a week felt pretty down, and threw in the towel.
That frightened me a bit, I’m not going to lie, because a part of me is, and always be a bit resistant to medicating. I am not 100% comfortable yet, talking about the fact I am on medication. I do have a lingering fear that coming off of them will mean more struggles. But I want to come off of them.
Part of me still believes (even though I know this is not the case) that if I really wanted to, I could fix this myself without medication. So taking meds still feels a bit like cheating and giving in to big pharma. I have to remind myself that this is a chemical imbalance in my brain that needs some pharmaceutical care, because I am already using all of the mental, physical and spiritual tool sin my tool kit and pursuing the best life I can.
6. If I start one of these medicines do I have to take if for the rest of my life?
No, but taking the medicine for several months will reduce your risk of relapsing back into a depressed or anxious state. Anti-depressants take several weeks to start working, and once they’ve returned your brain chemistry to normal, it takes several months before your brain is able to maintain the restored balance on its own. The research shows that the longer a person stays on the medicine the less likely he or she is to redevelop depression. Current recommendations are to continue the medicine for six to twelve months after your symptoms are gone. Most people feel that if the medicine has been helpful and there are no troubling side-effects, then it’s not a problem to continue taking it for this length of time. Obviously, if the medicine is not particularly helpful or you have side effects you don’t like, the medicine can be stopped at any time.
The bottom line is that if an antidepressant works for you, you’ll increase your chance of staying well if you stick with the medicine for six months or more.
Another disclaimer, this is my experience: I was excited to to get off the meds as soon as possible (during my 2nd pregnancy I wanted off of them) but my doctor was in favour of me continuing to manage my back pain (which goes through the roof in pregnancy) and staying on it because it was such a small dosage (and safe for the baby.)
I’ve been on the meds now for 2 years, and was feeling like I’d totally restored my brain chemistry, but 2 months ago, I started to cycle down into a tough episode that I am working to climb out of now. This was a really important reality check for me, that I am still vulnerable & dealing with a few major life events did knock me off kilter (we had a death in the family, natural disaster and family stress.) I recently decided to increase my dose by a very small amount.
7. How do I know if it’s working? What will I notice?
Most antidepressant medications take two to four weeks to begin having their effects, although some people notice improved energy sooner. You can expect to feel less moody, and less tearful. Your concentration and memory should return to normal. You may also notice you’re “back to your old self,” enjoying the things you used to enjoy, and less preoccupied with negative thoughts. That does not m’ean you will feel happy all the time. These are not “happy pills” – they simply seek to return you to normal functioning, where you can feel the full range of human emotions rather than mainly sadness or anxiety.
Once you’ve started a medication, it’s very important to meet regularly with your doctor to monitor your progress. As you start to feel better it may be hard to remember just how badly you felt, and an outside opinion may be especially helpful.
What I noticed:
The overwhelming heavy, dark, sad, lethargic energetic feeling slowly lifted.
My aches and pains improved (especially my back pain)
I was able to muster the motivation to take part in little challenges for myself (ie a walk, going to bed early one night, eating healthy, etc.) and those built on each other like building blocks. I do believe the meds got me back to that initial motivation stage (they got me to the start line) then it was up to me to keep building on that (and get myself to the finish line.)
Less meltdowns. I have spectacular “let teh steam out of the kettle” crying / grief bursts. A totally normal part of the grief process when you lose one of the most important people in your life. However, the frequency of them decreased.
Thinking patterns: The overall % each day of positive self talk to negative self talk totally improved to a 90% positive self talk ratio. Again, it got me into the right place to practice it and it was up to me to practice.
Hobbies became fun again. Running left me feeling euphoric. **Right now, going through a relapse, I’ve gone from running 10ks and loving runs, to feeling absolutely nothing on runs – no joy, no grattitude, just”meh” – for me that is such an obvious indicator something is not right. Sometimes you don’t have the classic symptoms of depression, but I do believe pattern that is consistent across the board is you do lose the level of joy you once got from your favourite activities. You feel more detached / not present during the activity, when it used to be a source of presence and flow.
8. Can I drink alcohol with it?
Alcohol can interact with medicines in unpredictable ways, and different people react differently. If you drink alcohol while on antidepressants, you might get drunk much faster than without the medicine or the alcohol might interfere with the medicine’s ability to help your symptoms. Driving after drinking is especially dangerous. Because these medicines need to be taken consistently-every day-to work, you can’t stop the medicine for a day in anticipation of going out and having a drink.
Certain medicines may have more dangerous interactions with alcohol, so be sure to ask your doctor about the specific medicine you may be taking.
Keep in mind that alcohol is also a depressant, meaning it can make you feel worse whether or not you’re taking a medication.
I am a social drinker and have gotten pretty drunk a few times being on these meds. Over the last few years it hasn’t had any side effects, but in this latest episode I am noticing that I am in a really, really down mood the day after getting drunk. My mental state and self talk are pretty bad and my energy is non existent. (Oh right, that might be a hangover.) Yes it could be a hangover, but it feels more intense than that. I just feel SO blah. Lately I’ve really noticed that. Also, I notice if I lie down after a night out and a few beers, I feel “spinny” sooner than I ever did before medication. It would take me a lot to feel like that before medication.
9. Will it change my personality?
If you are having trouble with depression or anxiety and you take an anti¬depressant, after a period of time you will feel “normal” again. Students often report feeling like their old selves again. If you have been depressed for a very long time, then perhaps this change could make you feel like your personality changed. Most students find they think more clearly and are better able to get their work done once their anxiety and depressive symptoms are successfully treated.
This is a difficult question to answer fully, because the depression experience has a mostly internal component, with possible external components, too. People who know me would have to answer the external piece. I would say personality wise, yes, the medication helped – because I think overall my friends know / see me as a really happy, engaged person – but they’ve seen me at two major lows (my mum dying in 2013 and my father in law dying recently which were both times I decided on medicine.) They can see the difference between outgoing bubbly enthusiastic Carina, and quiet, reserved, hermit styles. The medication helped a ton with clear thinking and regaining the precision focus and intellectual ability that is important in my job at a University (and similarly important for a student!)
10. How much does it cost? Is it covered by insurance?
Most of these medicines are fairly expensive, costing from $70 to $100 per month. They are virtually always covered by insurance. The Duke Blue Cross plan pays 80% of medication costs, reducing the out of pocket expense to $14 to $20 per month. Other insurance plans may have insurance cards that allow you to get your medicine with just a small co-payment.
In Canada I have two Alberta Blue Cross supplemental plans through our employers, one is a University and the other is the City of Calgary – so we are very lucky. My medication is fully covered under both plans, but one plan does not cover “brand name cipralex” – only non-brand name (huge price difference so the insurance companies obviously support the ones whose prices haven’t been jacked.) There is a serious financial consideration to medication if it is not covered, because you will be committing to it for some time to re-balance your brain chemistry which is a gradual process. We’re talking months, not weeks.
Depression and anxiety cause miserable symptoms, as uncomfortable as any physical pain. Although medicine is not always the answer to this kind of psychic pain, often it can be extraordinarily helpful. If you are struggling with anxiety or depression, you owe it to your self to talk to a professional about the option of medication. If it’s appropriate for you and works for you, you will be amazed at the relief treatment can bring to your life.
I like that they call depression psychic pain but for me, my thinking patterns and thought patterns are quite evolved through lots of work with a brilliant psychologist, reading, worksheets, podcasts, practice and journalling. In my experience of it, minor depressive episodes are in the form of energetic and somatic pain – a dampened aura (for the metaphysical types,) exhaustion, aches, crippling sadness, lack of engagement, a foggy head and feeling detached, and supremely unmotivated (my normal is a very motivated, engaged form of life.)
I decided to medicate and work on things before getting to what I knew would be the rock bottom stage which involves crying, misery and deep sadness. I have never been to the next level, and never want to, which I’d assume is hopelessness.
My pilot light, the little voice that says “it will be all ok!” NEVER goes away. I know I will be fine because I have all of the tools that are needed to climb up and out and re-balance my mood. Maybe this is the gift of sub optimal mental health? Knowing you can fall down and get back up?
I’ve done this a few times now and have accessed the appropriate help.
That’s why I wanted to write this article because I’ve been in and out of these processes. I stand here in another “valley” but am confidently working my way out and back to normal. This time I have no expectations around timing, because it is not a step-by-step sequential process. You can’t look at it that way: “If I do A+B then I will feel C.”
If you are going through your first major “down” in your life, and you are thinking about counselling, medication, doctor consultation, etc. I encourage you to explore your options.
Leave your expectations and judgements at the door. Go in, be you, be authentic. Be honest. Be open. Embrace the unique version of your own mental struggle and be able to elaborate on it.
It’s not a sign of weakness to ask for help. But did you know that up until the 1980s in research literature, it was considered a bad thing to seek help ? There is still a powerful stigma against seeking help, and it is because only 30 years ago (when some of us were kids) it was not okay to ask for help. It was a sign of failure, and researchers AND the media told us that. Crazy, no?
There’s also powerful conditioning amongst us millennials when it comes to big pharma. We have learnt to see it as the scourge of the earth. I think there are horrible, horrible practices in the big pharma world and their corporate ethics are questionable – yes – but I also have a chemical imbalance in my brain that I need to manage. I hate the system, that pharma is for profit, yes, but I also realize the profound impact of medicine.
If you’ve worked your butt off and things aren’t improving with your own self-help, or you can’t even bring yourself to help yourself, TALK TO SOMEONE.
Speaking from 3 years down the road and about 3 episodes in my 20s and 30s, each time you go through it and climb back out, you acquire new tools, and most importantly, that powerful inner messaging that stops it from swallowing you. That inner message keeps telling you that you will get better and be back to normal.
Every time you go through depression or a prolonged decline in your mental state, you become that much closer to unbeatable. The most powerful people I know / have studied, are those who have struggled the most.