I don't know if I want antidepressants

I've been generally functional, but severely depressed for close to ten years...maybe much longer. I've always tried to just ignore it and go on with life even though it feels like I'm carrying a 200 lb boulder over my head most of the time. But, during the last couple years, I feel like I've just hit a brick wall and it just seems like everything is so utterly hopeless that I can't even push through the depression and pretend I'm a normal person. I just feel trapped and want to disappear.

I've been in therapy for a few months now, but only go every other week because, even with her extremely generous sliding scale, it's too expensive to go every week. I did go to therapy every week for a few months back in 2010 and it helped slightly, but not enough.

I tried a few types of antidepressants in 2010/2011 and didn't like them, but may not have given them enough of a chance. They made me even more tired than I usually am...I was sleeping 14+ hours a day on them. And the sexual side effects were horrible. The inability to climax drove me nuts because that, along with food, have always been the two things I could rely on to make me feel good. So, I would stop taking the meds for two or three days sometimes simply so I'd be able to orgasm.

I tried St. John's Wort which didn't really do anything for me at all. I walk or run every day and have lost 64 lbs and am a healthy weight and bmi, but that didn't really help me. I still feel like a fat, lazy, slob even though I'm actually the healthiest I've been in 12+ years and am not even overweight. I tried SAM-e which has helped the most, but I need 1600-2000mg a day at this point and it gets extremely expensive at that dosage. And, I'm still in severe depression. The SAM-e has just helped me get the energy to lose the weight and start trying to improve my life, but I don't feel it's strong enough. I need something that is really intended for a person with moderate to severe depression and anxiety.

But, I'm scared of getting on antidepressants again. I'm worried they will make me gain weight. I still have 10 lbs to lose before I'm at my goal, but losing 64 lbs is the *only* thing I've done in my life in years that has given me confidence. I need to lose the last ten and I cannot gain any. I can't lose the one positive change I've made.

I'm scared of dealing with the sexual side effects again, but I'm also kind of thinking it might not be such a big deal because I feel like masturbation runs my life sometimes in an unhealthy way. Maybe the antidepressant will help me feel better so I don't have to "self-medicate" with orgasms, and maybe knowing how difficult it is for me to climax will train me to stop masturbating at times when I don't even want to. Currently, there is a very obvious difference to me between the times when I do it because I really want to and when I do it because I feel like I have to as part of a daily ritual or realize I'm doing it because I'm depressed and need some dopamine released.

When I was on antidepressants before, I got angry a lot more easily...I'm usually a very calm and easy going person (well, except for the anxiety, but only I can see that). I made a lot of decisions when I was on antidepressants very quickly which probably shouldn't have been made so quickly. For instance, I kicked a roommate out. But, this roommate had been causing me problems for a long time, and it was probably the right decision to kick them out. I don't know if the antidepressant simply allowed me to have the energy and confidence to make a decision and do what I knew needed to be done, or if it caused me to do something drastic.

I realize antidepressants don't make you into an entirely different person, but it still scares me to think that I might begin making decisions and doing things again while on them that I probably wouldn't do without them.

With SAM-E, I still feel like myself...just with a little more energy and positivity. I just wish it was stronger and cheaper. I feel like it has helped me a lot during the last year that I've been taking it daily, but the progress is just too slow.

The next time I visit my doctor, I'll probably ask him about prescribing me some anyway and just hope I don't gain back 50 lbs and make decisions I regret.

Can I ask what you were on before? Some are more known for weight gain and sexual side effects than others. I've heard that if you're on an SSRI and also take Wellbutrin, it can often help with sexual side effects. Or have you tried an SNRI like Cymbalta (that's what I'm currently on)?

I was first put on an MAOI that I don't remember the name of...it made me want to sleep 16 hours a day. Then I tried citalopram (generic for Celexa) which made me extremely tired and caused the inability to orgasm. Next I tried sertraline (generic for Zoloft) which caused the same problems. Seems like there was another I tried, but can't recall the name now.

I, myself, did not notice weight gain, but wasn't on them for an extended time because I gave up on them too quickly. But, I know weight gain is an extremely common side effect, and one that I do not want to risk. The *only* thing about my life that I'm happy with is that I can almost feel comfortable again in the same clothes I wore when I was 18. Some women actually find me attractive now instead of being repulsed like they were 64 lbs ago. I feel, physically, like a human being again and without that, I'll truly have nothing and the last two years will have been wasted as I feel that losing weight is the *only* accomplishment I've made outside of simply waking up every day during the last two years.

May I ask what diagnosis you were given when you were taking meds? If it's plain vanilla depression, you might try Wellbutrin alone to see if that helps. It won't disturb your sex life, but it may make you jittery and give you insomnia.

I think it's great that Sam-E works for you. I have taken it before and liked the way it made me feel, but at the time, there seemed to be quality control issues or something, because one bottle would work great then then next one (same brand) didn't seem to do anything.

May I ask what brand you like? Does it still have to be taken in the morning before you've eaten anything? (It's been years since I took it, and at that time, the formulation was still kind of "delicate".)

Your exercise and weight loss are a significant accomplishment, and I completely understand why you don't want to jeopardize that.

The diagnosis was dysthymia and social anxiety disorder. I've never really understood the dysthymia diagnosis because all the definitions I've seen use the phrase, "mild depression" when describing dysthymia, but I wouldn't say there's anything terribly mild about it. When I'm feeling "good" and I take the depression quiz here, I'm on the low side of the "severe depression" category, if I'm feeling bad like I have been recently, I'm about 20 points further into the severe depression category. I wound up in the "moderate depression" category one time in the last three years that I've been taking the quiz.

I've had plenty of trouble with insomnia in the past, so Wellbutrin alone may be a bad idea.

The only Sam-e brands I've tried have been Nature Made and the CVS store brand, both seem fine to me. I take it in the morning because it gives me a mild energy boost...enough to cause insomnia if I take it at night. You are supposed to take it on an empty stomach. I take it as soon as I wake up, then wait 30 minutes before I eat anything. A lot of people have reported stomach upset, but the only time I've had trouble was at 2,000 mg/day (which is higher than the maximum range Nature Made lists...I believe their max is 1,600mg). Anything less than 1,200mg has no noticeable effect on me at all (I'm male, 5'8", 160lbs). I really need 1,600-2,000mg daily which is quite expensive.

If you keep eating healthy and exercising, it seems unlikely that an SSRI antidepressant would cause you to gain weight. You could keep taking the SAM-e with it as well.

It's very likely that an SSRI would cause sexual dysfunction and insomnia, though. If neither is very bad, it's tolerable. I like to use a supplement with 5-HTP, L-theanine, & melatonin for sleep rather than trazodone or Ambien.

If you want to stick with supplements, L-theanine might be helpful.

I hate that it's cheaper to treat depression with prescription medication than to use supplements and alternative methods.

Some other non-drug things that might help you are yoga classes and massage. I know that neither of those are cheap.

Really, any activity that you really enjoy and that gives you "feel good" vibes is helpful. (I guess that's common sense, but I know that when I'm depressed, I often will stop doing things.)

I take antidepressants myself. I have fibromyalgia and need one for pain relief. I need it for depression, too, but I feel like I'm kind of stuck taking it because of the fibro pain.

Have you looked into books that suggest diet and supplements especially for supporting a healthy mood?

I'm rambling because I know that if I didn't take an antidepressant and I was healthy enough to exercise a lot, I'd want to investigate every avenue I could find before taking a prescription antidepressant. I'm not saying that they don't help. It's just that every one I've ever taken has given me some other problem like insomnia or anxiety and I then needed a med to treat that. Not everyone does.

I would just say that if you do decide to try a prescription antidepressant again, keep an eye out for food cravings. I have never gained weight from one without being aware that I was having food cravings - for sugar, for carbs, sometimes just for lots more food than I would normally want.