How often is “often?” 50% of the time? 80% of the time? I wonder if this impression isn’t inaccurate now that there are more/better antidepressants on the market.
Sorry, no data on this observation. The source, again, is my aforementioned friend. He observed - in passing - that patients referred to him and his colleagues by a psychologist or a therapist w/o a medical degree “often” are worse off than patients who inititate the contact by themselves. We discussed that in the course of talking about statistics. He opined that looking at referrals form therapists to psychiatrists alone, once could probably come to the conclusion that a therapist is bad for you - which of course is bunkum.
He also cited Plato who in 500 BC said that talk is great, but that medical problems need medical help. (I did not write down the exact quote.) My friend’s conclusion: “Nothing has changed in 2500 years in this regard.”
The question is not how often, the question is a loss of time and effective treatment. At any given time, between 2% and 4% of Americans suffer from full blown clinical depression. During the course of a year, 17.5 million Americans suffer from clinical depression.
Talk may be cheap (for the patient and - if they pay at all - for the insurance company), but in the case of a clinical depression, talk alone is a waste of money and time. Yes, there are certainly more and sometimes better antidepressants on the market, and getting them into the hands of a patient before the situation deteriorates (the patient’s situation, his situation at home and in the workplace) is of high importance.
Even a highly competent and open-minded psychiatrist may have to experiment with different drugs and dosages. This again takes time.
The bottom line is that a therapist often (here is that vague word again) loses his or her patient once the patient is referred. A lost patient is lost money. The therapist effectively gives up. Our health care is influenced more by money than we dare to believe. You don’t want to create a larger conflict than there already is.
Those 17.5 millions (some estimates are higher) belong into the hands of a competent psychiatrist. According to http://www.ndmda.org/depover.htm, “Research indicates that only one-third of those with major depression will get proper treatment, and two-thirds of those with any kind of affective disorder who do receive treatment will be misdiagnosed. These statistics reflect the insidiousness of the illness and the importance of both public and physician education. A lag in diagnosis and treatment could prove deadly; people with severe, untreated depression have a suicide rate as high as 15 percent. In fact, the number one cause of suicide in the U.S. is untreated depression.”
Having had Anxiety Attacks I first took Nardil and MAO and it was NOT good. It IS dangerous. It did nothing for me and was so restricitive I can’t see one on it for life.
I went off of it and 10 years later I got them again. This time I got Tricyclates (Sp??) Imiprimine(Sp?).
Worked within DAYS. Amazing. Side effects you bet lots of them. Nothing big though. Dry mouth (chew gum), Constipation (eat fruit) etc. Well worth the side effects.
On it for a year. Went off. About 5 years later I got them again. Tried Prozac. One side effect killed my sex drive. Didn’t help one bit. I couldn’t even tell I was on something. Was like taking a $4 sugar pill. Back to imiprimine. 2 months later off of it.
After trying to take a plane this year I got a few attacks. Instead of waiting for them to get worse I asked my doctor last month. He told me to try Prozac. Told him it didn’t work. He gave me Paxil. BOOM worked within days. One side effect. Makes me sleepy. I simply switched to taking it night and have one extra cup of coffee.
So I guess the morale is there are lots of alternatives out there. Remember YOU know what YOU can tolerate. Ask your doctor to switch and if it is OK do it.
Also despite the side effects Imiprimine is dirt cheap. If you have no insurance look into it. 120 bucks for Paxil or Prozac isn’t worth it.
Also if you ever do go off of anti depressents please WEAN YOURSELF OFF THEM SLOWLY.
I learned this the hard way. Go to the lowest dose then once every other day. Then once every three days and once a week then etc…You get the idea.
Very true. The art is to find the alternative that’s best for you. If you have a good doctor, he or she will be highly interested in what works for you and how. If you can, keep a diary and write down the effects (or lack thereof). Share findings with your doctor on a regular basis. Be as precise as possible. If doctor is disinterested, switch doctors. There are more of those than anti-depressants.
On the weaning off part: discussed that with my friend and he says there is no pharmacological nor physiological reason for a weaning off period. You aren’t taking Heroin. What you probably see when you stop the drug is the difference between protection that kindof (but not completely) works, and no protection at all. By weaning you off the drug, you simply get slowly used to the old (bad) situation. Why wait? My friend listens to the patient and simply switches him or her to something that makes more sense. There is no reason to suffer in between. Although there are substantial differences between anti-depressants (read more at http://www.ndmda.org/peacedep.htm ), they all work on neurotransmitters. Of course, there are some substances which should not be taken with another substance. And that other substance has to be out of the body.
And while we’re on the topic, St. John’s Wort appears to work similarly to the old MAO inhibitors. Along with certain cheeses, you should avoid red wine while taking SJW or any of the MAO inhibitors (as opposed to the SSRIs).
My Aunt swears by Celexa. I, OTOH, after taking a very small dose over 3 days, was so sick I couldn’t get out of bed. Her only side effect was a tingly forehead. Did any of you get that?
I started Paxil a little while ago–no nausea! Yay! But, my ears clogged up, I couldn’t stop yawning, I couldn’t sleep (actually independent symptoms), and my libido went bye-bye! Now, yawing, not sleeping, and not hearing too well I can live with. But I’m 20! I need my libido! So I’m back to being non-medicated and nutty. Oh well. The big question is: What do I tell my dad was the reason I quit? “Oh yeah, dad, you don’t have to write me a new scrip 'cause I lost my sex-drive whilest on the Paxil.” Yeah, that’d go over well… 
Jill:
You should avoid any alcohol while depressed, because alcohol is a depressant. And that’s exactly what you do not want in an already depressed situation.
This is worth a whole new topic, whether we open one is up to you folks. Again, different people react differently, and it will be a function of your general neurotransmitter mix. In some cases, combining alcohol with depression is like combining a match with a gallon of gas. In other cases, alcohol won’t trigger a different reaction than with “normal” people. But a depressed person easily gets obsessive, and a depressed person drinking alcohol easily turns into an obsessive drinker.
The jury is out btw whether acoholism can be the reason for depression. It’s a chicken and egg situation, and most of the time, it’s futile to ponder a chicken and egg situation. You want to avoid a situation where you no longer know whether you are a chicken or an egg.
Hijack-
But, under no circumstances, self medicate yourself with marijuana. I have tried this and, while my depression completely disappears and I am allowed to go about my daily routine without the major mood swings that plague me, I am faced with the elitist persecution that our Dubment invokes on us in the hope of filling our prisons and alienating our youth.
Medicinal Marijuana?
No way! If we allow this, the next thing they will want is to use the stem cell matter from unborn babies to “cure” cancer or AIDS…oops, no wait. But, stem cells are a natural resource, we can always grow more babies, you can’t just grow marijuana…no, wait. But harvesting stem cells from unborn babies is harmless, it can’t be compared to the horrible effect on society that is inflicted by a “pothead” smoking a joint in the privacy of his own home. No comparison indeed! If they want to smoke something, let them smoke stem cells.
/hijack
As for the weaning off, I only know from my experience that I needed it. It isn’t from the action of the drug as much as the side effects.
When I went off imiprimine(sp?) cold turkey the SIDE EFFECTS that I had gotten used to came back in full force. The sensitivity to light, the constipation and especially the dry mouth were horrible. It constantly felt like cotton in the mouth. I would wake up at night and couldn’t swallow as my mouth was so dry. By weaning myself off it stopped this. Because my body was slowly adjusting to it.
As for going off, I did not make myself clear. I meant when you stop taking it all together. Not when switching over. I reckon some people need to remain on meds their whole life but with Anxiety Attacks mine has been about 3 months then my brain corrects itself.
Further reading the posts though I can say I had no sex drive with Prozac but neither Paxil or Imiprine effected me in that area.
So I would say the effects are pretty much varied from person to person.
I have read horror stories about Paxil. In fact when I look in search engines that is what comes up first. But I have found the only effect I noticed was I was tired. So I take it at night.
And make sure you question your doctor if you aren’t satisfied. I always ask "this is where I am…This is where I want to be… How do I get there from here?
And I don’t worry about what casues it. For example I had no problem with Anxiety Attacks for years, then this year I tried (and failed) to get on a plane. (I’m scared of it). Boom full force they came back. Why? I don’t know something in my brain chemistry got jarred.
One last thing go online or read the pamphlet in your meds. I noticed with Paxil it gives a lot of HERBS you should stear clear of (e.g. St John’s Wort, Kava etc) when you are on Paxi.
You may be harming yourself if you think that all herbs are harmless.
I just wanted to drop a note regarding MAOIs and the tricyclics - there is a reason that doctors tend to attempt treatment with one of the SSRIs before switching to the other drug types: SSRIs have very limited overdose potential. MAOIs and tricyclics are more damaging when taken in large quantities (MAOIs moreso than tricyclics). This is a major concern in cases of depression, as anyone who isn’t thinking with a rectally located ganglion is aware. There are also concerns for people changing from other anti-depression drugs to MAOIs - there is a 6-week (if I remember correctly) period where the drugs should NOT be overlapped. Doctors, of course, are aware of this.
Don’t think the SSRIs are more successful in treatment… that’s just the advertising. The reason they’re the most current fad (well… those and the atypicals) is because they have a more limited regimen of side effects and the low overdose potential I mentioned. (this information is from the 2nd edition of the Handbook of Depression, for those who are interested. It’s a good manual, as manuals go).
In the meantime, if you have taken the medication for a long enough time to notice the effects (2 weeks, usually, give or take depending on the drug) or have found the side effects too unpleasant to handle, either change the drug or change your doctor.
A doctor is just like the drug: if it’s not working to your liking, find a new one.
F-Diddy. Werd.
Funkdaddy:
{quote]SSRIs have very limited overdose potential. MAOIs and tricyclics are more damaging when taken in large quantities (MAOIs moreso than tricyclics).
[/quote]
Discussed that with my friend and he laughed. He said SSRIs may have lesser overdose potential than MAOIs, but only in a very relative sense. He considers the overdose potential of both as non critical: “You can kill yourself with an overdose of salt, and many over the counter drugs are far more dangerous in high dosages than MAOIs or SSRIs.”
The monograph of Parnate, a leading MAOI, says under overdose: “Some patients exhibit insomnia, restlessness and anxiety, progressing in severe cases to agitation, mental confusion and incoherence. Hypotension, dizziness, weakness and drowsiness may occur, progressing in severe cases to extreme dizziness and shock. A few patients have displayed hypertension with severe headache and other symptoms. Rare instances have been reported in which hypertension was accompanied by twitching or myoclonic fibrillation of skeletal muscles with hyperpyrexia, sometimes progressing to generalized rigidity and coma.”
The same (and probably 5 pages more) could be said for beer.
I’m on day 5 of Celexa and the only remaining side effects are lack of appetite (yay!) and everything tastes funny, coffee tastes like old cigarettes, my favorite candy doesn’t taste good, turkey tastes different. Oh, and I’m always fidgeting, but that’s ok. Odd. But the nausea, headaches and generally ooginess are gone.
And I’ll be honest, it may all be psychosomatic (or maybe the start of the football season) but yesterday I felt GREAT! I had energy, I was talkative, happy…it was a good feeling.
jarbaby