When to Start

[cyanidebreathmint]

I'm curious about stories of when people decided to start on the meds.

I am in the same camp as Paul, I think that it many cases it is a good idea to try therapy and other natural/behavioral remedies to alleviate some of the symptoms of mental illness (especially depression and anxiety) and to consider medication when it seems you still need the push. The question is, when is that turning point?

I gave myself a goal of a year, to see if I notice arching trends of betterment which would indicate long term help from therapy rather than short term changes which could indicate therapeutic help, but also short term hormonal shifts, etc.

What do you guys think?

[in_media_res]

I gave myself a goal of a year

Where are you at in the year?

[cyanidebreathmint]

just short of 5 months

[Rosie]

Hi Breathmint

I started my meds about two years ago, the trigger was a destructive relationship with a guy who was totally unavailable emotionally. I'm away from it now and kind of battling loneliness and beating myself up daily because I'm alone, I have no children (fertility problems) and I wanted more for myself. I ran out of my Citalopram (celexa) a couple of times and wow did the tears flow, so I'm still on them and will continue to be on them for as long as I need to. My friend feels guilt about having to take meds, but sod it I don't want to feel out of control like I did when I ran out of my meds no way!

[in_media_res]

I went back and read some of your posts -- what a tumultuous life. You're very strong to have survived and have the strength to keep working at these issues.

There are a couple of things that come to mind. I'll share in the hope that something in my experience helps you or someone else.

First, to try and answer your question, I first came to medication over 20 years ago when a failed marriage and difficulties in establishing new relationships kicked off a severe, suicidal depression. I was given a course of tricyclic antidepressants. Never really did much for mood, and the depression lifted as I managed to get my life back on track. Nothing for a few years, then a career setback combined with stress set off another severe depression. This time, my physician prescribed an SSRI, and I've been on and off the path ever since.

In many respects, that depression has never really completely lifted -- it comes and goes. I've worked with my own physician, as well as a couple of psychiatrists. The first was a friend, and was aggressive and inventive in trying different medications and supplements. At various points there was some relief, but I was continuously plagued with side effects (weight gain (>300 pounds at 5' 8"), sexual dysfunction, high blood pressure, etc.). That all ended after he killed himself. My second, current, and soon to be former psychiatrist is probably well-meaning but not especially helpful. Most of my visits with him have ended up with him regurgitating pharmaceutical manufacturers' talking points.

Based on my personal experience, and a lot of reading and study, I gave up on meds about a year and one-half ago. I kept going on Ambien, but gave that up two months ago when my new therapist (the last one abandoned me after two and one-half years) suggested it introduced an increased risk of suicide. I also have a substantial stash of Ativan, prescribed by the second psychiatrist for stress. I use that very rarely, since as someone who has abused alcohol heavily since I was 14 (I'm now 54, and sober for 2 years), getting started on another highly addictive drug didn't seem like the best path to take. I keep both the Ambien and Ativan around and with me all the time in case I reach a point where I just can't take all of this any more.

So, to answer the question of when to start, my experience would suggest the answer is "never." If I look at the course of my life over two decades, relying just on medications, it's gone from bad to much worse. The meds haven't helped, and the belief that all I needed to feel better was a pill has kept me from other activities that might have helped.

Your mileage will, no doubt, vary. For everyone like me with an unhappy story to tell about meds, there are many others for whom meds have been transformative, quite literally saving their lives.

It seems like there are a couple of things for you to consider.

The first would be what's happening with your other efforts to overcome your depression? Early on, you talked about studying Buddhism and finding some relief there. I've found it to be very helpful. Is that working for you? How about nutrition? Exercise? Therapy? When I read what you've written about your life, I'm struck by the amount of trauma and pain you've had to endure. A good therapist -- perhaps combined with some meditation practices on forgiveness and letting go -- would seem to be essential, regardless of where you eventually come down with respect to meds.

The second is to determine just how you feel about meds. If you think they might help, are not concerned about possible side-effects or long-term consequences, then why wait? If you end up trying them, and get relief, will you be happier for having waited the seven additional months to give it a try? Please note that I'm not encouraging you to try them -- at least not without some careful thought and research. But if you're ok with the risk/reward profile, why wait?

I'm not sure if any of this helps, or just confuses the issue for you. Hopefully there is something in there that is helpful. Be kind to yourself.

[cyanidebreathmint]

Wow, I think it's really nice that you went back and read my old posts and shared so much, in media res. Thanks.

Everything you bring up about the meds has me worried. I don't appreciate that we have to be guinea pigs with this stuff, should we decide to try it out of desperation or in deference to a doctor's wisdom. It really does feel like we're too early to the party. Maybe some years down the road, the way the meds work won't just be a happy coincidence and we'll have a better grasp of how and why different ones work, and what depression (or types thereof) really is and looks like in the brain. But for now, I really don't trust the anti-depressants. I think, mostly, people speak about them with too much confidence. And I think, mostly, from what I've read, nobody quite knows what the hell they're talking about with this thing. I am often frustrated that this thing doesn't just come down to science.

I worry that I am getting in my own way by being stubborn, unwilling to trust in the wisdom of others, being irrational and spiteful toward myself. I worry these are the real reasons I am not taking meds, and not the informed reasons I've come up with.

But there's a much bigger part of me that is very resistant to prescriptions and thinks much more caution should be taken with them than is taken with them. I worry about the damage to vital organs, withdrawal, addiction/dependence, side-effects like suicidality, the fact that it seems like it's a sort of sentence with no end etc. I also worry about brain health. If I can achieve chemical changes in my brain through actions rather than medications, I want to do it that way because it seems better healthwise, and also more likely to stick. Kinda like steroids versus the gym work.

Also, some ways in which I am miserable are things I'd not like to medicate away. For instance, my misery at my job is a result of my character, I think. I think I should be miserable there, I kind of think it's good. Obviously I do not enjoy misery, but I think sometimes it is meaningful.

My other efforts are ok. I was thinking recently if I was being lazy in helping myself, if maybe I was thinking therapy was sufficient for helping myself and I could stop trying in a certain sense. I had been practicing mindfulness, but I got a bit lazy with it and could be doing a lot better. My therapist asks me to share my feelings with people, to experiment with that. I do it a small amount, but don't think it's a good time because my friends seem disinterested/unavailable. Am I making up excuses? I don't know. I feel that I am trying, but it's possible I might try harder. Mindfulness is a Buddhist idea, from what I can tell. I stopped reading much Buddhism, but couldn't deny the help that came from mindfulness. I dunno, my nutrition sucks, my exercise is non-existent. I really hate myself and don't want to help myself, so I think I am giving it a good try for the amount of opposition I find in myself.

I really think you did help me, in res. I feel more strong in my decision to try and work therapy as hard as I can, and less guilty/childish/stubborn/foolish for not going the meds route more quickly and with enthusiasm.

I am really frustrated by people who take for granted that someone should be on meds, when they have no experience with this thing and frankly don't know what they're talking about. How condescending.

Rosie,

I go through that routine, too, beating myself up for having failed to meet some milestones I feel I should have. I'm sorry you had to go through running out of the celexa like that. Do you notice the difference immediately? I understand that viewpoint that we don't deserve to feel the way we do, so why should we? It's an important question to ask.

[cyanidebreathmint]

Oh, and I meant to say you should think about throwing out the Ambien and Ativan, if I read you right.

[in_media_res]

Oh, and I meant to say you should think about throwing out the Ambien and Ativan, if I read you right.

Yeah, you're probably right. Yesterday turned out to be a difficult day, although good in the end. But I actually managed to get to a place emotionally where I can contemplate leaving them in the medicine cabinet rather than carting them around. First time in ten weeks. Tossing them may have to wait for another day. But that's another thread.

In any event, on some of the other ways to treat and overcome the challenges...

Therapy is important. Hard to write about right now, as I have had some setbacks in that regard that I'm trying to mend. But if your depression stems from how you approach people and the world, I think that's the only way to pick those sorts of issues apart and get past them. This is my biggest criticism of meds (and in particular, with my former psychiatrist) - that somehow taking a pill is going to help undo the situations that have led to pain and fear. That's probably all I can say right now.

Mindfulness does come from Buddhism. I find the religion itself interesting, although I know next to nothing about it. I'm probably more of a student of buddhist psychology than buddhism, if that makes any sense. I'd like to learn more -- spirituality is an area that's not seen a lot of focus from me, and I think it would be helpful.

I've been able to use mindfulness to help improve how I relate to other people. My upbringing saw a lot of uncertainty. People I care for very deeply, and looked to for support, behaved in unpredictable and often frightening ways. All of that laid down a foundation of fear - you can never be sure how people are going to react to you. Over time, that fear grew to be a defining characteristic of all my relationships. (Paradoxically, the more important the relationship, the worse the fear.) I'd spend huge amounts of time trying to analyze how somebody would react and what they might say or do, was always on the watch to try and gauge how someone was reacting and guessing what they were thinking, trying to figure out how I should respond, what their reaction meant for me, and so on, and so on, and so on. As is probably obvious, it didn't leave a lot of actual time for communication...not to mention coming off as distant, and controlling, and a bit manipulative at times. With mindfulness, I've been able to break some of that behavior. To just sit and listen, and take in what somebody is saying, and then react has been a huge help.

I've also done a lot of work with meditations on forgiveness, acceptance, and letting go. There's a lot of stuff I've drug around for a very long time. And having a structured way to set some of that down has been necessary for me.

Exercise and nutrition have been doubly important for me...as I mentioned earlier on, while on meds I gained a huge amount of weight. The extra weight fueled an already poor vision of myself. Over a couple of years, I've managed to lose 90 pounds. I feel much better, physically and emotionally, and feel better about myself. A lot of what I read talks about the importance of accepting yourself as you are, but I'll confess that's one thing I've been happy to be able to change. I think it has more practical uses as well - on days when I'm struggling, going and working out can (but doesn't always) help me get out of my head, and it does help my mood.

Journaling helps - I've been keeping a journal for about a year and one-half. I keep it up using an application on my phone - it's nice, since I can capture photographs (photography is important to me as well, it's a creative outlet) with my observations.

There's probably other stuff as well...supplements. Trying to be more engaged in the community. At some point, it starts to become a question of how you want to try and live your life and less a question of "treatment" but I think it's all relevant.

That's an awful lot about me. Hopefully something in there helps. I think what's perhaps most important to try and keep in mind is that there are many, many ways you can respond to all of this. In the end, I think it's important to be flexible and pragmatic. Assuming there isn't a lot of risk otherwise, feel free to try different approaches. If you find things that work, keep them up. If they don't, don't beat yourself up for trying something that didn't work or didn't pan out.

Hope everyone finds some peace today.

[cyanidebreathmint]

i wanted to check in and let you know that i read your post and it has me thinking. i have been moving for the past week and it has been hectic and i have ni internet at the moment at home but i hate to leave people hanging!

[in_media_res]

No worries, good to know you're ok. Hopefully there is something in my ramblings that will help. Keep us posted, and take care of yourself while moving. It can be quite stressful, as I'm sure you realize.