Do I still need anti-depressants...and any point in therapy?

Factual Questions
1

Hi all,

It has been about a year since I have been taking anti-depressants (fluvoxamine and Lorazepam) and I realise that I couldn’t afford them anymore. My depression is usually wild mood swings, anxiety attacks, lack of motivation, irrational fear, jumping to conclusion, just feeling down and lazy.

How do I know if I still need those anti-depressants? (Note - I won’t take any replies as absolutely correct medicial advices without consulting my doctor).

On the other hand, I have found meeting out with my therapist has been…kind-of useless. We just chit-chat for about ten minutes, talk about ups and downs in my life and off I go to grab my medicine. What other ‘services’ can I ask of my therapist?

2

IMHO, you need to find another therapist! You should cerainly be getting more out of it than that. As for whether you’re ready to give up your meds, a doctor may be able to help you decide. I wouldn’t advise giving them up all at once, in any event. Usually with anti-depressants, you would need to weaned off of them. But if money is your sole concern (that is, if you still need them, but can’t afford them), tell your doctor this. He may be able to provide you with samples, or switch you to something less expensive or something.

Good luck!

3

I had the same experience with my shrink. I never got much out of therapy anyway, but I wouldn’t give up the drugs just yet. Especially if you’re bi-polar (which it sounds like you are). You just feel good now, but you won’t if you go off them. Your doctor will probably advise to stay on them.

4

What norinew and kalhoun said! I can only speak from my personal experiences, but you really need to consult a psychiatrist about the meds and see what he says. Keep in mind that these types of medications, while justifiably needed by many people, are way overprescribed. My cousin mentioned to her OB/GYN that she had been feeling stressed with school and work and the dr. gave her a scrip for Prozac! I did the anti-depressant roller coaster when I was in therapy, too, and it was not fun. I’m only speaking for myself here, but I didn’t need the medications and therapy worked much better for me once I was off them completely, but your situation needs to be evaluated by a dr.

Also, you should feel therapy working for you. It should be challenging, even difficult at times, but it definitely shouldn’t be like chatting with a friend for a few minutes. Find another therapist and see what he/she says about meds and what would work best for you. Good luck! Therapy can be difficult, but it’s the best thing I did for myself.

5

Some kinds of emotional problems can only be solved with medication. If you have clinical depression, it’s an imbalance in your brain. You can talk to the best therapist in the world all day, and it won’t do a bit of good. A chemical imbalance in your brain is only corrected with medication.
HOWEVER, clinical depression is often used as a “catch all” term for any kind of depression. Giving someone prozac because they feel “kind of sad” is foolish.

6

Depending on your dosage of lorazapam (frankly, I’m surprised somebody has been writing you a Rx for that for over a year - I couldn’t get it for longer than 2 days) - stopping suddenly could be pretty nasty.

And I REALLY wouldn’t recommend just stopping an SSRI suddenly - YOU WILL REGRET IT - beleive me.

If you have to, taper your dosage on the SSRI yourself, if you really can’t afford to get another Rx, you’ll be sorry if you don’t.

But you really need to see somebody with an M.D. to take care of it, when you start screwing around with the levels of neurotransmitters in your brains too quickly BadThings[tm] can happen.

And get a new Therapist, I’ve had really rotten experiences with 90% of all the ones I’ve been too, unfortunately, but you have to shop around. I think that really sucks as it’s not a terribly cheap or convenient thing to shop around for, but there aren’t a good deal of alternatives. Most shrinks and GP’s can probably recommend one that they have at least some sort of relationship with, but they might suck too.

Good luck.

7

I think that a lot of pharm. companies have programs to give meds to people who can’t afford them. E.g., Eli Lilly has the Lilly Cares program that gives free meds to people who can’t afford them. You might benefit from looking into that.

8

Are you saying it has been a year since you could afford your medications and that therefore you’ve been going without for a year? Or that you’ve been on them for a year and you now realize that you can’t afford them?

a) If you have gone without them for a year, you would not be asking the question if you needed them. You would know that you needed them.

b) You may or may not do OK without them. They are expensive and all other things being equal you are always better off without taking meds of this classification. “All other things being equal” does of course mean that you are able to pursue a life of quality in their absence.

c) It is a good idea anyway to go off psych meds periodically (a “drug vacation”), as long as you have someone to help monitor and intervene as per your prior instructions as need be. You’re generally best off detoxing gradually, and you should expect some rebound (highs as well as lows) as you do so. Give it a whirl and assess yourself. Are you better off without them than on them?

9

I wrote:

Uuhhh… let me rephrase that.

a) If you have gone without them for a year, you would not be asking the question if you needed them. If you needed them you’d know it by then.

10

Taking anti-depressants for all of one’s life is essential for people with truly severe, organically induced affective disorders. No amount of therapy can make up for the physical problem, and the lack of medication will make a person incapable of coping with life. If this is the case, do not stop taking the meds for whatever reason.

The good news is that not that many people fall into the above category. The bad news is that too many people who do not fall into the above category are treated like they do.

For those who are not in the severe, physically-induced disorders, they have the opportunity to ‘get off the meds’ at some point. Two reasons why the meds can be discontinued are:

  1. The disorder was situationally induced (e.g., bereavement). The meds helped the person restore manageable emotional responses. Then the person was able to psychologically deal with the situation. And so, they no longer need the meds. In this case the meds were just a temporary crutch.

  2. The disorder was mild. The meds helped the person establish manageable emotional responses. Then the person was trained to psychologically deal with their mild disorder. And so, they no longer need the meds. In this case the meds were just a temporary crutch during the learning period to deal with the mild disorder. Once the meds are out of the picture, talk therapy may stiil be needed, though.
    An article I read in the NY Times mentioned a study that showed talk therapy can permanently change brain structure and function in the same way drug therapy can. So, again, if the disorder is not severe, meds can be phased out (if not needed at all) if there is good talk therapy happening.
    The tragic situation is that too many doctors and psychiatrists reach for meds immediately and never have a clear goal of eventually getting their patients off the meds. This means it’s time for you to take control of the situation but only in conjunction with your psychiatrist – don’t do it alone!

Tell you psych that you want off the meds and real talk therapy – not a five minute how-de-do. Now it’s time for your psych to put up or drop out. If you have an organically severe affective disorder requiring indefinite medication, your psych needs to tell you and explain how he or she came to that diagnosis.

If you do not have the severe, organic disorder, then your psych needs to lay out a plan of action for how to get you off the meds. If they won’t do this with you, find one who will.

When you’re going off the meds, it should be done under very close supervision. You’ll need to check in often for evaluation and trust your psych if they tell you need to go back on the meds.

I’m in a field where I’m in contact with people in crisis and I can tell right away when someone’s off their meds (the manic delusions or descriptions of hallucinations are the big tip off). They want to talk about the cool or frightening thing they’re experiencing. I interrupt them and ask them if they’re taking their meds. And not once have I ever had someone say “I don’t take any medication.” The response is usually, “I was feeling better so I stopped.” And that’s the reason why you should never stop taking meds without professional supervision.

Peace.

No cute sig., too serious a topic.

11
  1. Get a new therapist
  2. Be careful about stopping antidepressants. They are addictive (particularly SSRIs) and you will need to slowly derease the doasage or it could thrown you very quickly back into a deeper depression than you started out with.
12

Oh, one more thing. As far as “therapist” if he is dispensing medication he is a psychiatrist and most psychiatrists these days primarily do medication management only. You might need to seek a “therapist” to get proper therapy. A lot of people have both. You might want to discuss this with your doc.

13

I’m surprised no one has addressed the fact that you really should not be seeking medical advice from an internet message board.
I hear you, and I can understand what you’re going through (I’m on Paxil withdrawal right now because I’m having a hard time getting in touch with my doctor so he can fill my scrips).

But please, see a professional.

14

Ask yourself this… Do you think you can manage with out the medication. If you think you can then you must talk to your “therapist” I don’t think your therapist will help you though since he/she sends you off to the drug store after each visit.
If you can’t manage well with out them then you must talk again to your therapist about perscribing a generic brand of medications for you. I know that might be hard to do since most for you since the meds your condition/s are all around the same price unless its been around for like eons. I have some of your and I do not regularly take medication for them. I do how ever keep in touch with my thereapist but only when I feel that I need to speak to her. Thats about every month or so.
Also if your one to believe in God try church not prayer thats a solitary thing I mean church. The folks there like to think they’re helping you. Their aid is pretty much free until you ask them for money.

All in all good luck

15

10 minutes of chit chat is not therapy.
Ask for an hour at least once a week. Have your therapist spell out to you exactly what therapeutic methods he or she is using, and what training he/she has had. You have a right to know exactly how a therapist proposes to treat you, and why.

As far as I’m concerned, if you’ve only had 10 minute sessions then you’ve had no talk therapy at all.

16

What mipiace said.

You need both a psychiatrist and a psychologist; IMHO the psychologist is more important. The psychiatrist deals with physiological issues and longer-term monitoring of your medications and moods. Generally, you talk the the psychiatrist for shorter periods of time, generally when renewing meds, discussing side-effects and discussing ramping up and ramping down as you (inevitably) try to find another med that actually works.

The psychologist talks with you a lot over an extended period of time, generally trying to help with those components of your problem(s) that you might be able to change. If you’ve got some organic predisposition for depression, anxiety, whatever, you might always need some pharmacological help, but the psychologist can help with whatever behaviors you’ve developed as a result of that organic predisposition.

Example: You’ve been depressed for a long time. As a result, you withdraw from your friends because they’re idiots and keep on saying, “Snap out of it.” An antidepressant may help prevent more depressive episodes or reduce their severity, but meanwhile, you’ve rationalized in your mind why friends are pretty useless. So the psychologist works with you on helping see where and why you’ve given up on social activities and helps you reintegrate yourself with some sort of group of friends. (Not the best example; I’m in a hurry).

People without this ‘organic predisposition’ may get to the point where they can eventually taper off medications. IMO they probably shouldn’t have been on meds in the first place, but earlier reliance on medications is the pattern the medical community has glommed onto for cost containment reasons. I was in ‘talk therapy’ for about five years, mostly on my own dime, switching to better and better therapists, before my (really good) therapist finally said that we’d hit a wall and I should consider medications. Once I started medication, things accelerated dramatically.

My method for finding a good psychologist: find the people you know who are so well-adjusted that you couldn’t possibly imagine that they need a shrink, and ask them if they know anyone who could recommend a good shrink. Eventually one of them will say, “Sure, it’s me and I was a total mess before (s)he helped me out.” Chances are, their shrink is pretty good. (Naturally you pay more attention to those people whose problems were similar to yours). In my case, the first person I asked, who was the most well-adjusted person I knew, had gone through lots of issues similar to mine and put me in contact with the best psychologist I ever had (now retired, unfortunately).

Some medications won’t work at all; some will have prohibitive side-effects, and some will work to some degree. I’m always envious of people who say they’re taking thus and such and it completely works without side effects; what I’ve accepted is medications that mostly work and that don’t add too many problems to my life.

Side issue: I’m in So Cal, where seeing a psychologist is ‘decriminalized,’ but I still encounter lots of people with outdated opinions about psychoactive medications. As a result, I’m generally fairly public about seeing a psychologist, but not too vocal about seeing a psychiatrist. YMMV.

Good luck, don’t expect miracles from medication, and be patient. Very, very patient.

17

Just a stickler: Lorazepam (Ativan) is a benzodiazepine (anti-anxiety agent), not an anti-depressant.

If you are able to cope with daily living pretty well and are motivated to continue therapy, then you don’t need any drugs.
And shop for a therapist (if possible) who is known, respected, and effective.