[Abe Froman]

First I was on Cymbalta, experienced side effects. But none the less it was effective for a few days and then not. Then Welbutrin, but that was literally for a day, they didn't step me down off Cymbalta so I started taking that again. Then a week ago moved me to Lexapro.

Sorry, I didn't have a chance to speak to T or pdoc about this because everything is a rush.

But what are the expectations of antidepressants? What should be the goal? A cure? No depression? No sui thoughts? I guess I'm wondering when you know a med is working and you've found the right one.

Thanks for any responses.

[lozza89]

It's hard to say cuz everyone will have a different expectation from a medication..

For me though I know that no med will ever 'cure' my depression or completely get rid of the suicidal thoughts and self harm urges as I know these things will always be there and that my depression is treatment resistant. But with that being said my goals for being on an AD is that it will make the days a bit more barable and easier to get through, that I may have a few more happy days in my week.

It is hard to know if a med is working or not but I think if your mood has improved a bit and if you can think a bit more clearly, feel more motivated to do things.. then you are definately on the right track!

Good luck

[ChipperMonkey]

Maybe I'm misreading you, but the actions of antidepressants aren't immediate in that you need to be on them for at least a few weeks to experience full benefits, but some improvement can sometimes be seen after a few days.

No medication will cure you or give you full relief. I have always been told that the goal of medication is to get you to a functional level so that therapy has a chance of working, and then you work on your coping skills. Then again, I don't have "chemical imbalance" depression, so that may be a whole 'nother ball game.

[ChangingMyMind]

I believe it depends on the person but I can say Celexa took away my depression completely. I believe I have a chemical imbalance becuse I can't seem to connect my depression to any event or negative thinking patterns. Once I get serotonin I start feeling better. Now even though Celexa took away my depression completely and without therapy it was not a cure becuse once I stopped the medicine the depression came right back. Now if I was able to stay on the medicine forever and the medicine didn't poop out on me (which it did not after 11 years) then I doubt I would ever have depression again. Would I be sad sometimes, of course but not clinically depressed.

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I know it's working if I can get some relief, get some air into my brain, and life feels doable. It does not have to feel great, or be a cure. It just has to make my thinking okay enough for me to do things that make life worth living. Sort of like going from a flat tire to one that's road worthy. The car might still need a lot of work, but it can move and take me places.

[vonmoxie]

When I was taking Cymbalta, I called the manufacturer because nowhere in the yards of tiny insert print could I find any reference to what total lengths of time seemed be most effective for people taking it, and my psychiatrist was reluctant to answer for whatever secret underlying reason that he was also holding close to the vest (which was probs that he didn't know..).

I would think this would be an excellent measure to establish through clinical trials, even if there was an array of resulting information, that some percentage of people found the most benefit over a 6 month period, some other percentage for one year to two... or whatever the results might be, but what I was shocked to find is that not only was the manufacturer surprised by my question (?), they had no such data available. They did send me some extra coupons, and some shiny large print optimisto-collateral.

I should think that would be a measure worth establishing with responsible trials of any anti-depressant; even an industry standard to do so. I was surprised to find otherwise, at least with the one I bothered to check about, which ended up being the very last one I ever took. Likely not entirely a coincidence. For me it was quite disheartening to find no one is holding manufacturers to that standard, including themselves.

[ChangingMyMind]

Originally Posted by vonmoxie

When I was taking Cymbalta, I called the manufacturer because nowhere in the yards of tiny insert print could I find any reference to what total lengths of time seemed be most effective for people taking it, and my psychiatrist was reluctant to answer for whatever secret underlying reason that he was also holding close to the vest (which was probs that he didn't know..).

I would think this would be an excellent measure to establish through clinical trials, even if there was an array of resulting information, that some percentage of people found the most benefit over a 6 month period, some other percentage for one year to two... or whatever the results might be, but what I was shocked to find is that not only was the manufacturer surprised by my question (?), they had no such data available. They did send me some extra coupons, and some shiny large print optimisto-collateral.

I should think that would be a measure worth establishing with responsible trials of any anti-depressant; even an industry standard to do so. I was surprised to find otherwise, at least with the one I bothered to check about, which ended up being the very last one I ever took. Likely not entirely a coincidence. For me it was quite disheartening to find no one is holding manufacturers to that standard, including themselves.

I am not surprised at all. Drug companies are minimalists. They do what they must to get FDA approval then quit testing. What do they care if it works longer than a year or less? They just keep the mental health professionals pushing their drugs trough drug reps and free samples.

I do think it would be nice to have more information but unless they have to provide it to sell their drug the drug company won't bother.

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[LastQuestion]

I've been living with treatment resistant depression for the majority of my lifetime. I would explain it away as just my bi-polar, a little bit of life circumstances, or due to the season. These things contribute, yet I now think it's far more complex than I believed it was, or perhaps it is better to say as I'd been led to believe due to the treatment I received throughout life.

This year has been the worst of my life.

I was tired of being so emotionally numb; I no longer had a sense of self, of being alive, so I quit my Mirtazapine cold turkey. Things went from bad to worse, to terrible, to...there's no way to accurately express what this past year was like. It was bad.

However, I'm no longer depressed, without an anti-depressant. Diet, exercise, sleep, reducing stress, taking supplements which attenuate my stress response, doing everything but relying on medication was enough to get me here.

After all of my research I now understand why this year was so bad. It was withdrawal symptoms from a psychotropic medication my brain had become dependant upon and chronic stress.

I'm not saying anti-depressants cannot help, but their efficacy is unreliable and my experience is that they have never been enough on their own. I place far more importance now on all the other things which can be done to address depression than the potentially destructive and destabilizing administration of anti-depressants.

I cannot emphasize that enough. By doing what I did I was able to reduce the depth of my depression while in withdrawal from Mirtazapine and Temazepam, after having suffered a concussion, and while continually haunted by how depressing my life is in itself. Even now I have to be careful about thinking too deeply about how little there is in my life. There's this big crushing pit of loss and despair I'm afraid of revisiting. I still have yet to work through the issues which it arises from. I am certainly not happy, but I know I'm not depressed in a way which requires psychotropics to address.

Effectively treating my depression required a systemic change in lifestyle and perspective; going farther will require even more, but it need not involve an anti-depressant.

To be clear, if anti-depressants are not working for you then pursue alternative solutions. Everyone is different, so it is upon yourself to find out what works.

I don't want to misled anyone into thinking there is any easy answer or that finding answers must necessarily be hard. It us just the one thing I am truly certain of at this point is that Psychiatrists don't have answers, they have pills, sketchy research data, and lots of maybe's (at least the ethical ones do).

[ChangingMyMind]

Originally Posted by LastQuestion

It us just the one thing I am truly certain of at this point is that Psychiatrists don't have answers, they have pills, sketchy research data, and lots of maybe's (at least the ethical ones do).

I couldn't agree more. I have yet to meet a psychiatrist that can help me with my situation. Often I know more about the drugs than they do. They reach for their book when I talk about medicine. It saddens me to know they are in this field but really only push drugs that do not work well. Either they don't work at all, they only work somewhat, or they produce more dangerous or unacceptable side effects.

I really hope neuro science improves in the coming years.

I read somewhere on this site where somebody said that said their therapist told them depression and anxiety are side effects of life. This statement really stuck with me and I am starting to believe it's true. If these are side effects of life then we should be able to fix it. I don't think it's easy by any means but I do think we know ourselves best, much better than the doctors. I think solutions can be found internally if we soul search long enough and dig deep. At least that is what I hope and pray for. I have been stuck in my depression for 8 months. The longest and worst year of my life but I am feeling a little better and I have come to accept my current state and a little is better is much better than nothing!

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[vonmoxie]

I've come to similar conclusions, that statistically they don't know enough for me to entrust them. Which isn't a personal judgment, but just simple math, +experience. If I'd ever had a surgeon tell me there was only a 50/50 chance of a surgery working, but that I also might sustain permanent long-term effects of the surgery whether it worked or not, I would be very carefully weighing my options! And yet I've never had a psychiatrist appropriately brief me about the risks of anti-depressant use, and the sad 50% efficacy rate. To find out now, after years of trusting that their insistence was indicative of a greater relative usefulness, leaves me feeling pretty abused by the industry.

While I respect how individual successes contribute to many concluding that it's merely a matter of finding the right combination, with the numbers being what they are how can that premise possibly be quantified as being anywhere near a universal truth? .. and what seems to keep doctors "believing" it? (Wanting to believe it, I guess. Since having perky drug reps drop by bearing gifts is likely often among very few uplifting moments in their day.)

I certainly would not have kept trying with anti-depressants as much as I did had I known sooner. And I would have known sooner had I been blessed to realize sooner the extent and degree to which conducting my own research turned out to be necessary. I don't mind throwing a dart once in a while. But not for a decade.

[purplepearl]

In my experience, my depression manifests itself not as sadness but as an intense mood shift; I am highly irritable, argumentative, quick to snap back at someone, and hold grudges. I take Fetzima (levomilnacipran, SNRI) and though I don't notice a difference in my daily mood, per say, I do notice that I am extremely less combative, less argumentative, less stubborn, and don't get as mad/hold grudges with people like I do without the medication.

The goal for me is that I need to be able to feel stable, to not uncontrollably lash out at my family and friends for no reason. The medicine helps me control this. I generally feel better about life.

[The_little_didgee]

I have no expectations at all, because no antidepressant has ever alleviated my so-called depressions. I've had two manias and chronic suicidal ideation while on these drugs. I can tolerate Cipralex because the dose is low. I'm only on 5 mg and it is enough to get rid of my obsessions.

I really think SSRI response depends on the type of depression one has. Antipsychotics seem to help me a lot more than antidepressants. My depressions are nothing like typical depressions which probably explains why. I get very irritable, experience hallucinations, and get very restless. The restlessness causes me to pace, yell and sometimes explode. In that state I'm not pleasant to be around.

Depression treatment should also include social activities and psychotherapy.

[Disorder7]

I take Prozac for panic attacks. It seems to reduce the frequency.

It doesn't touch the bipolar mood swings. I could be wrong, but I've read that bipolar is more of a problem with dopamine, which is why antipsychotics work. Since antidepressants work on seratonin, they don't do much for bipolars except maybe make them nervous, and sometimes manic.

From what I've heard, seratonin impacts "fight or flight", which is why they sometimes help with panic attacks.

But I'm not a doctor; who knows how much of what I've read online is correct.

[purplepearl]

Originally Posted by Disorder7

I take Prozac for panic attacks. It seems to reduce the frequency.

It doesn't touch the bipolar mood swings. I could be wrong, but I've read that bipolar is more of a problem with dopamine, which is why antipsychotics work. Since antidepressants work on seratonin, they don't do much for bipolars except maybe make them nervous, and sometimes manic.

That is very interesting to learn; I had no idea that seratonin based antidepressants could actually increase nervousness in some. Do you think doctors misdiagnose bipolar people with depression?

[Disorder7]

Originally Posted by purplepearl

That is very interesting to learn; I had no idea that seratonin based antidepressants could actually increase nervousness in some. Do you think doctors misdiagnose bipolar people with depression?

I was misdiagnosed with anxiety and depression for about 15 years. All I focused on were panic attacks. If meds helped the panic attacks, I considered myself doing very well.
I never stopped to realize the meds weren't doing anything for the mood swings, the inability to concentrate, the impulsiveness....I never made a connection.

[purplepearl]

Originally Posted by Disorder7

I was misdiagnosed with anxiety and depression for about 15 years. All I focused on were panic attacks. If meds helped the panic attacks, I considered myself doing very well.
I never stopped to realize the meds weren't doing anything for the mood swings, the inability to concentrate, the impulsiveness....I never made a connection.

I'm finding that the anti-depressant I'm currently taking is helping tremendously with mood swings and irritability, but I have noticed an increase in my anxiety levels (even though I also have an RX for xanax).

[Disorder7]

Originally Posted by purplepearl

I'm finding that the anti-depressant I'm currently taking is helping tremendously with mood swings and irritability, but I have noticed an increase in my anxiety levels (even though I also have an RX for xanax).

Be sure to mention that to your doctor. It may be nothing at all. But some things we dismiss as no big deal, turns out to be a huge deciding factor to a doctor.