I have been living with depression since a teenager and after so many years, I recently finally started receiving psychotherapy (CBT). While I’m already seeing some modest changes in my thinking patterns, my therapist noted that in the last few weeks the severity of the condition is worsening and it might be a good time to talk with my primary care provider about antidepressants as a combination therapy.
This got a reaction out of me, specifically that I don’t like the idea of chemically altering my mental state and losing access to what “I really feel” (as I perceive it).
I know that the logic behind this sentiment is not very solid, but we can’t reason ourselves out of our feelings that easily. For me this is also challenging because I don’t take any recreational substances that affect my mental state, so I can’t tell to myself that it’s like e.g. smoking weed only more targeted and supervised.
I’m curious if this sentiment is familiar to anyone else, and how you dealt with it (whether you decided for or against medication).
What makes you feel that your current state is what you “really feel”? Who decides that? I tend to feel the opposite way; that my currently depressed, anxious self isn’t the “real” me, and that any treatment I seek- whether through therapy or medication- is just a course-correction so that I can move closer to reality. Maybe it would help to reframe it that way? When you challenge your thought patterns and work on developing healthier ones, you are making changes but you aren’t changing who you are, nor are you denying reality. Medication is just another tool/aid in the same way that therapy is.
It might be helpful to talk to your therapist about why you’re worried about losing access to your current feelings. How are they serving you right now?
Maybe you’ll find it comforting to consider that antidepressants generally aren’t that powerful and aren’t likely to change your mental state to the point I think you’re worried about. Anecdotally, I’ve been on a variety of antidepressants; some made me feel worse physically, some made me feel worse mentally, some had absolutely no effect, and some have made me feel better or more functional but in subtle ways. I’m currently on medication that isn’t the cure I’d hoped it’d be, but has enough of a positive effect that it’s worthwhile for me. Not saying that medication is for everyone, but I hope hearing others’ experiences helps you make the right decision for yourself!
What makes you feel that your current state is what you “really feel”? Who decides that?
That may be the most crucial question my therapist should ask me. The answer that’s top of mind is “this is all I ever was since I can remember, so it has to be real even if it’s bad”. I can tell how shaky the logic is but it’s convincing to me.
Thanks, you provided me with some great questions and I’ll discuss those with my therapist.
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Assuming you’re talking about depression or anxiety: while we don’t know exactly how SSRIs work, one predominant theory is that they increase neural plasticity, allowing you to make new connections and get out of ruts in thinking and feeling that constitute your depression.
If that’s true, taking SSRIs doesn’t prevent you from feeling reality, it helps you break out of the mental prison you’ve built for yourself. Psychedelics do the same thing, just far more dramatically.
This is definitely something to find out more about. My current level of understanding of their mechanism is “they dull all emotions, you don’t feel anything too strongly but that’s good because you also don’t feel too depressed”. That seems to be quite wrong.
As some who has been on at least an anti depressant for 30ish years, I found that some absolutely can numb you at all emotional levels.
I lived like this for a long time, and it was better than being unmedicated.
Then I saw a different doc, and adjusted my meds around the time I met my wife.
In thr beginning I had a lot of difficulties, not because I lacked emotion, I just hadn’t dealt with any strong emotions for 20 years so it all felt very new. Love, anger, frustration, all of it came back. Imagine being a kid again, real little, and you can’t even name how you feel because its so foreign to you.
That being said, every medication effects everyone differently.
For example, Abilify (adjunct medication for depression) made me restless, edgy, and just miserable. I would go for walks to try to burn through that uneasy feeling. I’m talking multiple walks a day. My ass has (and will continue) to say that the fridge is too far away and too much trouble to get off the couch, in comparison.
A good friend of mine is on it and has no issues, helped with her depression as advertised.
Sadly, it involves some trial and error to find what works for you.
Be honest with your docs. Don’t tell them you’re “fine” because you’re functional to society, so that must be good enough. Its not.
They do tend to have that effect as well, though if your emotions are too muted that’s a reason to switch to a different SSRI
I’ve encountered your sentiments many times while treating patients. I don’t push too hard on the medication suggestion but it really is the case that medication and therapy can be of more help than therapy or medication alone. What I’d suggest is that you keep the suggestion in reserve until such time as the depression is kicking your ass again and then consider trying it. Its worthwhile to discuss the issue in advance with your MD and review the various options as some are more activating than others and some are more likely to produce side effects than the others. You could get the prescription filled to have it ready in the event you changed your mind.
What I’d suggest is that you keep the suggestion in reserve until such time as the depression is kicking your ass again and then consider trying it. Its worthwhile to discuss the issue in advance with your MD and review the various options as some are more activating than others and some are more likely to produce side effects than the others.
Thanks, I think this is the path I will take for now. I’ll talk with my GP about it today and start the process to find out my options first. It might not even be something she’s allowed to prescribe anyway, so I’ll need to visit a neurologist or a psychiatrist for more consultation.
That did happen to me, and I didn’t end up taking the medication thinking I’d try my luck treating it just with therapy and improving my health in other ways. While I found the therapy extremely helpful and well worth it, I really really regret not trying the medicine in hindsight. Because of life complications and my employment situation, I haven’t had the opportunity to try it since and can’t shake the feeling this would be much much easier to tackle with it if one of my main problems is a chemical imbalance. For context: mental health issues run on both sides of the family.
If I get good healthcare again, I’m immediately going to go back to get some proper care.
I hope you are able to access proper care soon.
Personally, I sought help because I didn’t want to feel those things/that way, and I couldn’t achieve that goal entirely through force of will. For what it’s worth: I still feel all of those things, but those feelings are nowhere near as intense. They no longer control me and prevent me from feeling anything else.
Plus as another commenter said, having been on and off meds that worked and didn’t work, I am absolutely still me. I’m just a more emotionally composed and in better control of myself and my feelings me.
I also didn’t get there immediately on the first medications my doctor prescribed. They’re there to work with you to find what works, so don’t be afraid to tell them if something doesn’t.
It may be worth talking to your therapist about the fact that you may have internalized these feelings as being a core part of your identity, something that you’re afraid to lose. I promise there’s more to the things that make you who you are.
It may be worth talking to your therapist about the fact that you may have internalized these feelings as being a core part of your identity, something that you’re afraid to lose. I promise there’s more to the things that make you who you are.
Yeah, I think you are hitting an important point and he also tried to poke at it when I told him how I feel about the suggestion.
One aspect of it is definitely that I’ve been depressed since I had a personality. At some level, I think I believed that this could never change (and that’s why I was so amazed when some of the CBT exercises started having the exact effects the theory said they would). Thinking of a potential me without all of the maladaptive patterns I developed since I was a kid is about as stressful to me as meeting a stranger.
Part of it is also that I don’t understand the chemical mechanism behind the various antidepressants though, so I’ll definitely need to talk with medical doctors about it.
First, I just don’t have very good experience with drugs in general. As a kid I waa being stuffed with useless pills against allergy and whatnot that just kept making things worse, and my problems basically stopped when I rejected them as a teen.
Second as a result of the above and other similar things, I had to learn to be very aware of how my body and mind function, what I can do and when and how. Considering drugs have known mechanics how they achieve the effects, it’s often not too hard to predict how they’ll affect you.
It’s not 100% reliable tho… Lots of people report better results than they expected. It’s probably worth a shot, if you ask me.
Btw would you consider crossposting to [email protected] too? You might get more varied opinions and get people to think. (Disclosure: it’s “my” community.)
Btw would you consider crossposting to [email protected] too? You might get more varied opinions and get people to think. (Disclosure: it’s “my” community.)
At this point I would not, but only because I want to engage with all replies actively and the amount of replies I got here was already a positive surprise but also a number that is only just about manageable for me.
I know this is an odd answer, and may not be for everyone. I got the prescription filled, and held the dose in my hand and asked it: “will you hurt me?” And worked with that in meditation. It said it was okay to take. These days, I’m more inclined to research the heck out of it online before starting any drug, any reason. (And: I would never do this with a rando drug which came from who-knows-where.)
If you don’t like how you feel, after giving it a fair shake (several weeks, whether you want to see the change as blood plasma concentrations or rearrangement of neural pathways), you can stop. You’re not committing to it forever and ever; the effects will wear off once you stop taking it.
If you do want to stop, be sure to contact the prescribing doctor—or if the doc is unavailable, at the very least a pharmacist. Some drugs for depression need a gradual tapering-off schedule to avoid nasty effects of going cold turkey.
Good tip, thanks! I did read somewhere that scheduling dose increases and decreases is extremely important with this class of medication, so I’ll definitely only do it with a doctor who can observe me closely.
I didn’t give a shit about real any more. I wanted more comfortable and did not cate at all whether my new state would be “real”.
I was an eager user of recreational drugs, and I never saw any of my drug experiences as “not real”. Doing psychedelics and uppers and muscle relaxants and all sorts of “research chemicals” gave me a view of my own consciousness as a little tiny sliver of reality modulated by neurotransmitters.
So for example the crazy world of interconnection and possibility that I saw during a trip was just part of reality that I normally wasn’t able to see. And the dark hell that I’d find myself in when coming down from MDMA was just another aspect of reality that I only saw in a certain brain state.
So a better way to put it is that I didn’t really think of there being a reality that I could see while “sober”. I just saw “sober” as a particular state point on the map of states of consciousness.
If I was going to take a drug that got me “high” by making me on average happier and more effective, I was fine with that. I didn’t want to run to win medals I wanted to run to explore the world. Give me steroids, robot legs, rocket skates, I don’t care if it’s my own “accomplishment” or not I just want the mobility.
Now I see it slightly differently. I still believe “sobriety” is but point in a vast landscape of equally legitimate/valid states of consciousness. But I also understand that what antidepressants do isn’t just get you “high” like any other paychoactive drug. They don’t change your mental state directly like that. Instead they alter neurogenesis patterns, and these grow certain parts of your brain, and the expansion of processing power in certain parts of your brain alleviates the depression. The extra capacity tends to lower the threat level perceived by your brain and it enables exploratory, spontaneous engagement with life and that’s the end of your depression.
They like to say “it takes a couple weeks to build up in your blood”.
Naw. MDMA and all other psychoactive oral drugs take a quite uniform 30 - 90 minutes to “build up in your blood”.
What takes two weeks is the effects of neurogenesis — the growth and differentiation of neurons — to have a discernible effect in mood. It’s physical brain changes that take two weeks, not blood concentrations of various orally ingested drugs.
I was an eager user of recreational drugs, and I never saw any of my drug experiences as “not real”.
I definitely think that some of my hesitations have to do with not having any experience of using chemicals that affect the mood before, so I don’t have a mental model that I can re-use for antidepressants. I definitely drink caffeine though, so it’s probably valid to say that I have constructed a fiction of me never having done anything like this, but it’s a convincing fiction.
I think of it like a sci for scenario where Earth is destroyed. There’s a new planet and some people might be thinking “but it’s not the same”, but I say it’s better than death.
Without the antidepressants, my emotional world was a charred landscape of pain and misery. No place for a life, even if it is more “natural”.
There’s nothing natural about a helicopter airlifting you out of the water, but the loss of natural is made up for by no longer drowning in a roiling sea.
Just try it for a month. If you decide there’s something too valuable missing with the loss of your “natural” state of mind, you can go back.
Rhetorical: How much enjoyment do you get out of what you feel now? If you try a medication and find that you aren’t getting a benefit from the change, there are a bunch of reasons why that could happen. Your doctor won’t be insulted if it takes a few different trials to see which ones help or if you try it out and realize that it’s not the way forward for you. It’s a chemical tool to give you a little more leverage on what’s bothering you but you’re still the one in charge.
I was worried about this as well for a long time. Something that helped me through those thoughts was finding a medication that worked for me and then (with proper medical advice) discontinuing it for a little while. That “little while” ended up being a few years due to the whole COVID thing and wanting to stay out of hospitals as much as was practical but it allowed me to see what was different with and without the added chemistry at work. I was still the same person with the same thoughts and feelings but better able to manage the distressing parts that come along with all of this “being a human” stuff.
It’s not my business to say that you should do one thing or another but if you decide to have that discussion with your doctor, I’d recommend bringing along a small notepad or some paper and a pen/pencil so you can take notes. There’s a jumble of alphabet soup with stuff like SSRIs, SNRIs and NDRIs (among others) that’s easy to forget once you walk out of the office. You may have limited or no response to one type and a great response to another but I found the process less frustrating when I had a basic understanding of what was going on.
Best of luck to you whichever way you choose to go.
Good tips, thanks! I’ll really have to be careful with understanding everything said for sure, since it will even be happening in my third language.
I personally dislike antidepressants intensely. But the alternative is far worse. Antidepressants dull all sensation. It takes a lot to make me laugh. It takes me even longer to want or be ready for sex. All I feel is a great and vast emptiness. But that’s better than being actively suicidal as I’ve been there as well.
If you continue to make strides through CBT, then I’d consider psych medications unnecessary. They should be a last resort because of the unpleasant side effects.
Thanks for sharing this @[email protected].
