Depression : seeking opinions on medication and other things

In My Humble Opinion
1

I have a few questions about Dopers’ reactions to anti-depressants. I’m considering maybe seeing a doctor and trying something new, but it’s a little hard to take the first step and I could use some advice.

A little background info:

I first started to feel depressed when I was a teenager. I’d always had low self-esteem, but gradually I started wanting to be alone more often and became quieter and more self-conscious in social situations. At 18, I got dumped by a girl, and that was when the real fog set in.

In the six years since, it’s never really left. I’ve never been seriously suicidal, so I’m lucky for that, but it doesn’t mean that I’m not totally miserable. I’ve been married for four years, and am lucky enough to have my wife for constant support, but still, I can think of less than a dozen days in the last six years that I really, truly felt happy.

Knowing I was depressed, but not having insurance, I tried St. John’s Wort. Didn’t do a thing. So I went to a Walk-In Medical Center, taking ephedrine beforehand so I would feel speedy and actually have the courage to talk to the doctor. I did inform him of this fact so that he didn’t freak out when he saw my heartrate. He gave me some Wellbutrin samples. No effect whatsoever.

Other doctors at similar establishments have prescribed me two different SSRIs, Prozac and Effexor. People around me (especially my wife) noted that I was more talkative and seemed happier. I wasn’t, though. The SSRIs felt fake. As I was smiling and talking, I felt a revolting sense of deception, as if by acting happy, I was lying to the world. Bad feelings were just underneath the surface and it felt like the SSRIs were just masking inexplicable pain. I say it’s inexplicable because I really don’t have anything to be sad about, nor do I have any deep-seated trauma that could be affecting me. I was never abused in any way. My parents were good and fair people and I never wanted for anything.

Has anyone else experienced the “phony” feeling with SSRIs? If so, did you get it with one SSRI, but not another, or at one dose, but not another?

I need to find a good doctor. I finally just got health insurance and a prescription plan, so I’m in business. The only problem is that I don’t know anyone (shy and self-conscious, remember?) that I can ask for advice on a good doctor to see.

I’ve also heard things about people’s anti-depressant doses being tailored to them. How does this work? Does a regular doctor do this, or would I need to see some kind of specialist? If I want to get some type of therapy, how does that work? Will a doctor refer me to a therapist?

Also, should I go straight to a mental health specialist for my depression or see a general practitioner first? In either case, how do I find one?

2

I’ve been on just about every anti-depressant made so I can probably be of help. There are some things that you said that makes me think you really need to see a therapist as well as a psychopharmacologist. SSRI’s should not be giving you the feeling that the happiness is “fake.” When they are working properly your outlook changes, not just your ability to raise a facade. This is what is making me think you are looking for reasons to hate yourself. You indicated that you took some samples of Wellbutrin and felt nothing. I don’t know how many samples he gave you but my guess is that it wasn’t nearly enough time to make a decision about the drug’s efficacy.

Paxil is marketed for shyness and self-conciousness, the operative being marketed. Don’t go to a gp - go to a shrink who is balanced in his approach of talk therapy and meds. See an M.D. - a psychiatrist. Not a Phd or a social worker (At least not at first). If you have a GP that you know and trust you can ask him to refer to a good shrink. Any more questions, just post. Good luck to you friend - I know how you feel.

3

You need to take an SSRI at a therepeutic dose for a full 6-8 weeks before knowing whether or not it is working for you.

And to answer your question, each drug may work differently in each person.

4

I just (as in, last week) started Celerex and am experiencing a lot of side effects. Headaches, trouble sleeping, heartburn (could be unrelated, though), hunger. I’m hoping these will settle down soon and we can get on to the business of fixing my brain. I tried Prozac a few years ago but it didn’t do anything for me.

When I can’t sleep I sometimes take a Diphenhydromine (OTC allergy pills that also have a drowsy effect). The brand I use doesn’t have any contraindications on the label, but I’m not certain if it’s a good idea to take them with the Celerex. I suppose that’s something I should go to a doctor for instead of a message board.

5

Not to imply that you are not entitled to your own “I’m depressed” thread (god, talk about how not to be supportive—“You can’t cry here, get in the designated crying area and wait in line” – !) but because there may be useful advice and experiences made available there, let me point you to the thread Tell Me Life Will Get Better which is a currently active thread.
Regarding meds, meanwhile: [disclaimer warning: I’m the board’s token anti-psychiatric activist, and the psychiatric inmates’ lib movement of which I am a part does tend to be harshly critical of psych meds] – some people find that one medication helps them; other people with what appear to be the exact same symptoms find that it doesn’t but that another one does; and still others find that all of the medications make them feel worse sooner or later, and choose to go unmedicated. Ideally, work with a psychiatrist who will be extremely receptive and flexible in working with you, and who will not pressure you to take anything that isn’t working for you, or dismiss your what you have to say about how you feel on this or that medication.

Note your own observations:

Although this does not rule out biomedical brain dysfunction, it leaves plenty of room for social, personal, identity-related issues, and general coming-of-age issues being the cause of what you are feeling. Those emotions are normal and healthy (even if unpleasant). If in fact you are feeling miserable because of necessary “self work” that is not completed (and DAMN it’s a difficult task in the modern world, I have most certainly not forgotten what it’s like to be 18, 19, 20…), you could be doing yourself a horrible disservice by dampening the intensity of what you feel, and the vividness with which your mind focuses on (often unpleasant or uncomfortable) thoughts and concerns, with psychiatric medications.

For some people, there is a pharmaceutical out there that does make all the difference for them. For others, the differences between different available medications is akin to the difference between an onion, a leek, a scallion, and a shallot, none of which are going to perk up the taste of your spice cake.

6

Umm…that should be Celexa.

7

Thanks for the answers so far.

Sorry about not making it clear in my OP, but every anti-depressant I tried, I used for at least two months, some for even longer. I was popping samples of Wellbutrin for over three months before I finally gave up. There were also several unmedicated weeks (months in some cases) between trying different drugs.

8

The problem with the drugs you took before might have simply been a matter of dosage, or maybe you needed to be put on a different one. It also sounds like you should talk to a therapist - I’m of the opinion that most anyone could benefit from at least a few sessions, and you might well have some issues that you’re dealing with but don’t even really know it. That might have been part of the reason behind the “fake” feeling; some people also feel worse when on some antidepressants, as the medications are removing a feeling of being numb, and the pressures of their life are pushing on them - the person has to get through this with therapy and dealing with those pressure situations in direct ways, before they begin to feel better.

How you find a decent physician depends on your health insurance plan. If it’s a HMO, you’re more limited in your choices, so start with the provider directory that they give you. Some other insurance plans may limit what doctors you can see as well. Aside from that, your insurance plan may have a doctor information site where you check on doctors in a certain area, and can check on where they went to med school, if they’re board-certified, and so on.

I would go to a general practicioner first - find someone in family practice or internal medicine, I’d say. It sounds like you could use a checkup, and most physicians would want to get any non-psychological/neurochemical causes excluded first. You might possibly have something else that’s affecting your mood. After that, the physician will probably want to make a psychiatrist referral. If they work like most psychiatrists do, this doctor will probably talk to you for a while, get your history, and probably refer you to a therapist/psychologist/counselor, but will be the one who will prescribe any medications if he or she thinks it’s necessary.

9

Like KidCharlemagne, I also have tried a lot of different medications. I think the “fake” feeling you’re referring to is the general elevation of mood without the resolution of deeper issues that brought on the symptoms in the first place. To me, this suggests that you need therapy to change your outlook. A combination of therapy and medication seems to be working for me these days. I’ve tried both without the other, and found that they work well for a while, but something always seems missing in the long run.

I get the feeling you don’t think you have any “deep-seated issues that need resolution” or any of that psycho-babble, but let me ask you this: When you’re sad, what are you sad about? Could this offer any clues to the source of your dissatisfation with your life right now?

10

Good question, cuauhtemoc. What am I sad about? Hmm. Well, basically nothing. I mean sometimes I’ll have some petty issue that I can focus my ire on, but usually I’m just sad for no discernable reason.

I’m not dissatisfied with my life right now. I do well in school and good at my part time job. I have a happy marriage. Like any couple we fight once in a while, but we usually don’t raise our voices and never hit each other or anything like that.

I guess the only thing that really sucks is that it’s so hard for me to talk to people IRL. Sometimes I get down on myself for that. In the majority of cases, I have to spend literally hundreds of hours with a person before I feel even relatively comfortable talking to him. People who seem to be more like me (in terms of attitude, opinions, and other factors) I’m comfortable with faster; people less like me I often never become comfortable around. After over four years, I’m still not comfortable with most of my co-workers.

11

I can do little more than echo all the other comments here.
Do see a psychiatrist if you can, they will understand the medications better, and can offer you other methods towards recovery.
Medications work differently for different people. What one person finds helpful may be a complete failure for you. Case in point I had very good reaction to Celexa.
If you don’t go to a psychiatrist, make sure your Doctor is aware of changing dose strength if results at a lower dose are insufficient. And also make sure he/she knows how to reduce a dose slowly if coming off a medication.

There are a few medical conditions that can seem like Depression (thyroid problems is one) that your GP or Psych should consider.

Good luck, Cheers, Keithy

12

Okay, to me it sounds like you’re lonely. Try to think of a time when you were not lonely. Did you ever have a group of friends that you felt really comfortable with? Or maybe it was your family that gave you that secure feeling? Are you trying to get back that feeling of belonging?* What can you do to feel like you belong again? Is there anything you can do to bring about the changes you would like to happen? These are things that a therapist can help you with. Talk to someone if at all possible. It doesn’t have to stay like this, you don’t have to be lonely forever.
*For you psychology students, this is a phenomenon known as “projection”. :smiley:

13

Your description makes me think social anxiety more than depression, although the two are often linked.

I echo the advice about therapy. You sound like you would be a good therapy candidate–insightful, willing to change, etc. Just give yourself some time to get comfortable with the therapist.

14

A little backround is in order so as to quailify my statements on your questions. In July of 1998 I fell about 8 ft. to asphalt on my right side. The soft tissue damage has yet to heal. I am in constant pain and my doctors all agree this has got to be the worse case of destroyed soft tissue they have ever encountered. I was not able to work but had the means to help support my family without it. I had numerous hours of in home theraphy and countless hours of sleepless nights because of the pain and my resistance to using pain killers. The only rest I was able to get was sleeping in my recliner, and then only a couple of hours at a time. In March of 2001 I was diagnosed with chronic emphysema. I continue to have to sleep in my recliner, but now it is because of both the tissue damage and the emphysema. I have about lost about 80% of the capacity of my lungs and am on oxygen 24/7. I have the portable tank for when I do leave my home, an oxygen concentrator for home use, an electric scooter for mobility, a C-net mask for sleeping, a nebulizer for breathing trearments, and the inhalers I need to reinforce the breathing treatments, and in the event of an emergency. On January 1, 1999 I met my dad for the first time in my life. He and the family had been searching for my brother and I for over 50 years, and I found them by using the internet. I have been out of my house less than 22 times since November of 2000. I am taking 6 “have to” medications, besides the inhalers and using the nebulizer. My doctors would like me to have a few more scripts but I will not put any more chemicals than necessary into by body. I threw the thing in about dad because I wanted you to know, there was a lot more to that story than I need to share in this fourm but, there were a lot of emotional issues that came to bare on me other than my physical condition, and the associated emotional issues with it.
Two of the prescriptions I take are Wellbutrin SR Tabs @ 150 mg, one in the morning and one in the evening and Celebrex Caps @ 200 mg., once in the morning. It took several months of trial and error before we came up with a doseage that would work for me. Even though there is not suppose to be an interaction between these two drugs, it was found there was in my system. This is why doctors are in a ‘practice’, because they have a lot to learn. Medical science is not an exact science and therefore, as in my case, may need to be resloved in a trial and error manner.

In addition to these medications I have used Oxazepam 15 mg Caps as needed, up to two every four hours, while under the care of a psychiatrist. This theraphy was necessary to help me deal with deep seeded personal issues that were the major cause of my depression. But, your MD may want you to change from what the psychiatrist had you on to something a little easier on your system, as was the case with me.

I still have some sessions from time to time. Mostly we talk about family interacting, since my psychiatrist is a niece. This was convient for me, since she came to my house for our sessions. Although her profession tends to frown on treating family, we had no problems at all.

15

In high school, yes. We drifted apart as I got more withdrawn, and wanted to spend more time alone in my room. And that is exactly the problem - how could I be anything but lonely when all I want to do is be alone?

EasyCo thanks for the interesting story (50 years! Wow, you could be on a talk show!) and for relating your medication experiences. Welcome to the boards.

Now, about therapists… Well, I’ve always been kind of skeptical. What exactly will a therapist do to help me feel better? I know it feels good to talk about these things (talking to my wife about this and posting it both help me feel like I’m getting a load off my chest), but that feeling is always short-lived. Are there “tricks” a therapist does to help me change my way of looking at things?

16

Therapists don’t have any “tricks” (or at least, I don’t think they do), but they are trained to help you work through things that non-professionals are not trained to help with. If I may be permitted to make an analogy: Let’s say you’re trying to clean out your attic. You’re opening up boxes of old stuff, and trying to decide not only what to do with it, but exactly how to do that. The difference between your wife and your therapist is this; your wife will say, ‘gee, maybe you should do this or that, but I don’t know how you would go about it’. She’s supportive, but not particularly knowledgeable about this, and she’s emotionally invested in you and your “attic stuff”. Your therapist on the other hand, can say, ‘what do you want to do with this? Do you want to keep it? Why? Do you want to throw it away? How can I help you do that?’ Not only is your therapist experienced and professional, she (or he) is emotioanlly neutral.
I hope this makes sense to you. I’ve been in therapy to deal with childhood abuse for just over a year now. As supportive and wonderful as my husband is, he could never have done for me what my therapist has.

Best of luck to you.

17

Neutron star, here is a link to a very comprehensive forum site where you can ask very detailed and specific questions about different meds (and everything else related to depression). So it would be more tailored to exactly what you’re asking. And the inhabitants seem like good people who take it all seriously.
Depression Forums

And below is a good general head-case site :wink: with a lot of links, and I think there may even be something in there about finding a local therapist. I know there are many therapist finder sites out there, some of which aren’t advertisements paid for by the listed doctors. As I recall they can typically be found at national nonprofit organization sites devoted to specific afflictions, or maybe even NIMH (National Institutes of Mental Health).
Psych Central

As far as therapy, I would suggest picking someone who practices cognitive therapy and behavior modification. Those are the ones who do not just listen, but actively set goals with you on how you can start making small changes towards fixing what’s not working. I do believe that is much more useful. It adds an active dimension to what I see traditional therapy as seeking to accomplish: get things off your chest; reduce feelings of isolation (that you’re the only one who’s like this, etc.); make sure someone is aware of what’s going on with you, just in case you take a turn for the worst; and overall give yourself the feeling you’re doing something, anything, about your situation, just by being there. That’s all good, but before you know it it can be 20 years later with no concrete suggestions made; that’s why cognitive/behavioral is better.

Have you looked into or heard about what’s called bright light therapy? It’s a very accepted, non-drug method of treatment these days. Not a new-age, out-there trend as it may sound. It has very real chemical actions on the brain. Was mostly used in treatment of S.A.D. (seasonal affective disorder) until recently, when it’s been proven effective for general depression. A plus is that it can also help if you have any trouble sleeping. (Not that it makes you tired, it just can regulate an out-of-whack cycle.) And, many insurance companies reimburse for the light box you purchase. Sometimes this turns out to be all a person needs.

Hope this helps!