This month, The American Recall Center is encouraging conversations online and offline about medication safety (check out their post on the newly-discovered side effects of Xarelto). Judy, their Outreach Coordinator, got in touch recently asking if I’d be willing to write about my own experience with medication. I realized I’ve hardly (publicly) talked about the role of antidepressants in my road to recovery, and so I thought this could be a good place to start.
For 3 months or so, I’ve been getting by with a little help from Lexapro (or escitalopram). Owing to my own stubbornness, compounded by my ignorance about the nature and effects of antidepressants, I waited almost 6 months into this current cycle of depression before agreeing to be medicated. There are a few things I wish I’d known earlier, which I hope could be helpful to you or someone you know:
Antidepressants are not magic pills that will “make us forget all our pains” a la Helen’s drug in The Odyssey, as many people might assume. People looking for a “quick fix” would be disappointed, and it is unfortunate and irresponsible that antidepressants are overprescribed to people who don’t necessarily need them. On the flip side, they are underprescribed to those who actually need them, but are wary and skeptical of antidepressants. I belonged to the second camp.
I was under the impression that antidepressants were mood-altering drugs that would do no more that make me numb to my problems. So to me, to take antidepressants would be to live in denial. And since living with integrity is of paramount importance, this was a huge no-no. For half a year I resisted my parents’ and then-boyfriend’s persistent efforts to get me to see a psychiatrist, until eventually caving in only because I felt guilty for making them so anxious. “Oh, you’re definitely depressed,” the doctor told me as I tried to argue incoherently that I was simply seeing the true terribleness of my existence. She prescribed Lexapro. I brazenly told her, “This is not what I need. What use would it be to feel better and still be this despicable person that I am?” She asked matter-of-factly if I had anything to lose. I guess I didn’t. Perhaps at the very least I would stop embarrassing myself by sitting on road curbs or hugging lamp posts while sobbing about being alive.
Most antidepressants take about 4-6 weeks before they start taking effect. (There’s also a very real possibility that a particular antidepressant may have no effect, or none that is substantial, even after that period. In that case, your doctor would put you on a different antidepressant.) I first noticed it when I began moving around a lot more than usual while in the shower. Considering that I’d recently found myself curled up in a fetal position under running water, that was a big deal. On the same day, I also found myself having enough energy and motivation to finally clean up my bedroom from corner to corner. Overall, I began feeling generally “lighter”, while remaining acutely aware that I was still struggling with negative thoughts and a low self-esteem.
That leads me to the next point: the first symptoms to improve will be energy level, concentration, and motivation. And the last to improve will be your low mood and feelings of hopelessness. I was experiencing improvements in my ability to think, read, articulate myself, and perform basic, everyday tasks. And yet I continued to hate myself and have a bleak outlook on life. I mistakenly thought this was a confirmation of my initial understanding of antidepressants.
That period before your mood begins to improve can be dangerous. While my suicidal thoughts used to be purely fantastical, during this period, I began to think they were actually quite reasonable and doable (it scares me to admit this now). This is a very real danger for anyone starting out on antidepressants: you might begin to have energy and cognitive ability to actually execute suicide plans. If a loved one is relatively new on antidepressants, please be more attentive and vigilant than usual. It is also important that they are taking these antidepressants under regular consultation with their doctor. He/she will be able to assess how well the patient is reacting to it, if there’s a need to adjust the dosage or switch to a different kind, etc.
I have come to a point where my mood has improved remarkably, and where I’m starting to have much healthier and more realistic thoughts. There is still one more thing I or anyone in my position should remember: do not stop taking your antidepressants at this point. During this cycle of depression, I was informed by my doctor that at whichever point I start feeling “fine”, I will actually need to stay on my medication, and at that optimal dosage, for an additional 9 months to maintain the balance within my body.
I’m also seeing a counselor regularly, even though I didn’t think I needed it anymore. When I found out what a long wait list there was, I told her, “You know, you should just give my slot to someone who needs it more than I do. I’m honestly quite okay nowadays.” However, she told me that given my history of recurrent major depression, it’s important that I continued to see someone to process what’s happened, and also so that the symptoms can be caught much earlier when depression returns. Experience with previous episodes confirm this: inadequate treatment can lead to relapse and recurrence. We should also note that it’s been well documented that the risk of recurrence increases with each subsequent episode. It’s not something we want to gamble with.
Lexapro is an SSRI, or selective serotonin reuptake inhibitor, one of the main classes of newer antidepressants. SSRIs act on a chemical in the brain called serotonin (a neurotransmitter), which helps relay signals from one area of the brain to another. Its many functions in the brain include the regulation of our moods, and many researchers believe that a serotonin deficit leads to depression. SSRIs elevate the level of serotonin in the brain by inhibiting its reuptake. They do not alter our personalities. I also strongly recommend talking to a counselor to complement the medication, and your doctor will most likely say the same. The medication will help us be better receptive to adjustments to our thought processes achieved through counseling, so these go hand in hand!
While depression distorts our perceptions, there are very real hurts in our lives that need to be healed, and real problems to be solved. We need to be in the right frame of mind and have adequate energy to be able to deal with them, and that’s where antidepressants come in. We are “dependent” on them only in the sense that someone with a broken foot has to depend on crutches until he recovers.
My final concern, and this will be pertinent to fellow Christians, is where psychiatric medication falls in our theological framework. We recognize the limitations (and dangers) of psychiatry when taken to reductionist, materialistic directions. It is preposterous to oversimplify mental illness as “chemical imbalance in the brain”, though I have definitely been guilty of that. The Church teaches that the human being is a union of body and soul — what affects physically will also affect us spiritually. We need a physician for our body, and we most certainly and desperately need a physician for our soul, and that is Christ. Seeking medical treatment is not to turn our backs on God — all truth is one; the wisdom amassed in the field of psychiatry, when rightly applied, is part of God’s gift to us. (Highly recommended reading: The Catholic Guide to Depression by Aaron Kheriaty, MD with Fr. John Cihak.) At the same time, we also don’t want to come to view antidepressants as a guarantor against suffering, for we know that in this lifetime there will always be suffering. But we take comfort in that with God we can offer our suffering for something greater than ourselves (I will save this another time — I know it’s not an easy thought to swallow — I will admit it is also rather difficult for me at this moment and I have much to learn from the saints who so lovingly carried their crosses).
I’ll end here for now. Unsure about anything? Talk to a medical professional. All I can share is based on my own experiences, plus some information from trusted sources — I am in no way qualified to dole out expert advice!
Under Reconstruction 
I am back on Prozac and going through the process again of another SSRI. Love your post, so true to the experience. Thanks
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Reblogged this on Deviations on a theme.
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Very brave of you to write about something so personal. Paxil is what i have been on for the last couple of years. Before that, Effexor, which did not do much for me. I have tried to live without the Paxil, but it does not work. I suffer to much and the days are an uphill struggle without Paxil. I think i have given in and no longer see my meds as a “crutch” so to speak. Anyhow, i am going to take more time to read your blog. Thanks
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I was the same with medication, I didn’t want to rely on them because I thought I can (and I should) overcome my illness only with the help of a phsycologist. It is not surprising at all, because no one around me noticed that there is something wrong with me, besides myself. They kept telling me that it’s just my imagination I’m overreacting everything and I should stop whining. So I went to a doctor on my own. It turned out that throughout about 3 years I was sufferring from panic disorder. And, since I waited too long, eventually I didn’t have any other choice, than medication (SSRI), since the long-lasting illness started to affect my body seriously.
I also felt guilty and a bit disappointed. But it was a great lesson to me; only I know what’s on my mind, and though I was devastated by the behaviour of my closest people I became more aware of myself.
Again, I’m happy for you! And thanks!
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Reblogged this on humanponderings and commented:
Mental health is a subject so rarely covered in an honest manner. As is medical help for mental health issues- this post engages conversation and experience that is brave and vitally important.
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I actually just started on Lexapro a few days ago- this post is incredibly helpful and answered many uncertainties as well as calmed some anxieties. I too would belong in the “second camp” you described and the decision to start taking Lexapro was a scary one, it still is. But I do believe it is an important step. Thank you.
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Thanks for sharing. I have been taking anti depressants for 15 years and 4 years ago was prescribed mood stabilizers as well. I agree with everything you wrote. The medications literally saved my life. 15 years ago suicide seemed the only alternative to the life I wasn’t living. Thankfully no thoughts of suicide now enter my mind. I am mindful though of the negative effects of chemical buildup in my body as a result of permanent medications. I have learned to go off medication until I recognize signs of regression and then go back. This works for me. I also now take daily solar strips to build up my immune system and they seem to also have a positive effect on my mental wellness also.
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Reblogged this on SixtyOne Counselling and commented:
Love this blog…
A great insight into a very difficult world…
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Tristan, sorry it took me this long to respond! Thank you so much for your affirmation, it encourages me to keep writing about my experiences! It means so much to get this from a trained counsellor, and I thank you for the difficult but amazing journeys you must be walking with your clients.
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Wow. I am blown away all at once by your mature writing style, great perspective, and strong faith. I too am a Christian who values her faith but also struggles with depression. I used to be very much against psychiatric medication, but now I am taking it in addition to therapy and surrounding myself with fellow seekers of Christ. Thank you! Your story gives hope.
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For what it’s worth, I give you extra credit for a well-balanced article based on your experience.
As you pointed out, psychiatric medication is over-prescribed. Ironically, that’s partly the reason it gets some of the negative publicity. In essence, pharmaceutical companies and doctors are one cause of the confusion surrounding the use of psychiatric medication. Most people would just simply blame the “nuts” who say they don’t work, and many bloggers are simply labelled as scientologists if they speak ill of SSRI, SNRI, benzodiazepine, etc. use.
I fall into the category of those who are more likely to experience severe adverse reaction with few, if any, benefits. I first started mental health treatment in 1991. My father was prescribed Restoril, a benzodiazepine, in 1981.
Several years ago, I began blogging very negatively about psychiatric medication, but as I’ve read more stories such as yours, it’s helped me to understand that though they have been ineffective for me and many other people I’ve spoken with or of whose stories I have read, I’ve come to realize there’s a significant number of people who have been helped by them. And as you say, they are not a magic pill; it’s fortunate you are working with a doctor who you seem to think highly of.
I would like to more patients being better informed of the risks, and more studies being done. In fact I read on Psych Central recently Dr. John M. Grohol (I believe he was the founder of Psych Central) state unequivocally that low seritonin levels don’t cause depression. Notably, he wrote in a separate article that antidepressant can and do work, and they work best when combined with psychotherapy.
I don’t see the two ideas as mutually exclusive, in fact I read once that researchers don’t actually know how they work. I fail to recall the source on that. If you’re interested in the articles I mentioned from Psych Central, I can provide you with links. As far as I know, they are a trusted source, but anyone can come along and say a source is trusted. 😉 But perhaps you’re already familiar with the site. 🙂
I admit I’m rather biased though I try to look at all sides. A week or two after my father started Restoril, he committed suicide. He’d worked the same job for 16 years and provided for a wife and his children, and it seems rather unusual to me that his suicide would happen so closely to his seeking help. Some side effects of Restoril are loss of inhibition and suicidal thoughts, so it will always be a mystery as to whether or not the medication played a role.
As for myself… that’s a much longer story. 😉
I’m glad to see people are getting the help they need. Hopefully one day people will have the information they need to make informed decisions about their own health care, without all the marketing hype. I hope your treatment continues to go smoothly. Have a nice day, Karen, and thanks for sharing your story. 🙂
Oh there’s a good article on Canvas of the Minds about medication sensitivity. A person had a test done that helped her doctors figure out which meds may work better for her. At the time of her post, she was very pleased with the results up to that point. Apparently, as I’m sure you’ve learned, medication simply works better for some people than others. The test for it hasn’t been researched well enough yet though to determine the accuracy. I can’t get you more info on that if you’re interested. I’ll provide you with the best links possible. 😉
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I enjoyed reading this.
My experiences weren’t identical to yours, but I can definitely relate.
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Reblogged this on Casual Bedlam and commented:
I think this encapsulates what a lot of us go through when beginning medication therapy. It can be daunting and confusing and I think that sharing experiences can make the whole deal a lot less scary. It’s important to maintain an open dialogue about medication, especially as we discover and invent new therapies. Please note re: the 2nd to last paragraph: I am not religious and therefore can’t personally advocate for any theological doctrine to augment treatment; however, I recognize that spiritual guidance and fulfillment is are indispensable to the mental wellbeing of some, and I think that’s legitimate. Thanks, Karen! -LB
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Thank you for opening up like this. It is very important to share these things with the world because we don’t talk about them near enough. People would rather sweep the depressed under a rug and forget about them because it’s too hard to deal with. On my blog, I posted about my own issues with Anxiety, depression, and secondary PTSD just last week. It has taken me years to admit. And I am hoping I can help others not be afraid of their own feelings. I also opened up about my husband’s medication problems here: http://caringforaveteran.wordpress.com/2014/03/19/the-importance-of-knowing-your-medication/
It’s so important to know what your doctors put you on and their interactions, know your body and know your loved one’s actions. I nearly lost my husband, twice, to this. Thank you for liking my most recent post. I hope you will continue to visit.
Jamie Dement (LadyJai)
Caring for My Veteran
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Such a great blog! Thank you. A really refreshing approach to understanding our relationship with the different types of support available and the importance of ongoing dialogue around treatment and not making snap decisions.
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Brilliant post! Thank you for sharing this with us ❤
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I’ve suffered from bipolar depression for over 10 years now and have been continually medicated for the last five years. But the depression keeps coming back. I up the meds, and that helps for a while, until it comes back again.
I’m in an episode now, and the feeling I have about it this time is that I’m under spiritual attack. I was baptized several weeks ago, and since then I’ve felt the joy slowly seeping away from my body. I cry in church, always at the altar sobbing and asking Jesus to help me. I can’t imagine my world without Him, but He seems so far away.
I say all this to say — you are so right about what antidepressants can and cannot do. I’m getting out of bed and showering and eating, even though I feel like something is gravely wrong on the inside. That’s the gap.
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I’ll pray for you. Many, many saints have written about the dark night of the soul, if that brings you any comfort.
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Reblogged this on jessicat16- My Life and commented:
I thought this was great!!
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This was a great read! Medication is a weird subject and it can take along time to find the right one. My advise to anyone new to medication is if one doesn’t work, keep trying different ones. Everyone is different and one medication might do great work one person and not work on the next. I currently take Zoloft, Invega, and Lamictal. It took me a good 4 years to find the right combination that works the best for me with the least amount of sideffects. Its a process that will pay off in the long run so don’t give up!!!
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This is so well-written! Thank you so much. I once spoke with a very wise friend about a loved one’s mental illness. I asked her – is it physical? is it spiritual? Yes, she replied, it’s the whole person. Where a person might begin feeling unwell because of a physiological reason, certainly the “one who comes only to steal, kill, and destroy” will take full advantage of the vulnerability. I really appreciate your holistic and honest post.
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This is an absolutely brilliant and essential post. With anti-depressants, I also experienced the effects in a few days and felt that it gave the suicidal thoughts more momentum. I was 18. My mother was dying. She had Alzheimer’s for years before that. I think that would do it to anyone! I have to admit that this what led me to have the negative view of anti-depressants for a long time to come. I really like your suggestion about family and friends needing to pay more attention to their loved one who has just started taking anti-depressants. It may seem counter-intuitive, but it actually isn’t.
Your honesty is very encouraging for me. I have thought about writing about my experience for so long, but just the fear of being judged by people, the fear that I won’t get employment because of what I went through is paralyzing for me. However, when I read your posts and how I respond to it, I realize it just needs to reach a few people who really need it…the rest doesn’t matter.
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Henri,
It means a lot to receive this message from you. I’m so sorry for all the pain you’ve gone through, and I hope (and I believe) it’s made you stronger and more compassionate as a person. I look forward to hearing more about how your honesty will help so many other people! 🙂
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I have never suffered from depression, rarely even normal depression, so I am in no position to comment on your post, other than to say how wise you are to realise that clinicians cannot address the whole person, therefore the whole problem. It is refreshing to see you point to God who heals as part of the way forward. I pray God will continue to lead you in paths which lead to complete recovery, with no relapses!! x
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Thank you for your honesty- a real help to many people.
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I second all of this, matches up pretty much perfectly with my experience. I did find community to be super-important, if only because talking with other people was substantially better than the conversations I would have with myself, even on antidepressants.
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Joe, so good to hear from you! I know we never got a chance to talk about our common struggles in person, though I hope some day we will. Thanks for adding a note about the importance of community — I definitely agree! Being around others, especially in contexts where we are helping others (e.g. volunteering), also help us take our minds of ourselves.
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Reblogged this on Chronically Me.
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Went through the same thing! Such a good post. Thank you
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Which part(s) can you especially identify with? Is there anything you would add from your own experience?
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This was a very interesting read for me. I’m one of those people who are wary and suspicious of antidepressants, mainly because I have this (probably wrong) idea that they will somehow change my personality or erase some part of my soul, if that makes any sense. Especially after reading a post like this written by a person of faith, I will need to reconsider my point of view.
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Thank you for sharing this. I’m sure it isn’t easy.
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