Situational Depression and Meds

Factual Questions
1

I have an appointment with my physician on Friday. I’m looking for some information to take with me to that appt. Does anyone have any experience with medicating a depression caused more by crappy circumstances than a chemical imbalance?

My doc has tried to talk me into taking depression meds before, but I’m not sure that’s really a solution in my case. I think my depression is caused by the bad situation I’m trapped in, rather than due to the nature of my brain chemistry. I’m worried that I could muck up my system for good by screwing with chem levels when the problem is external. And I’m not sure that meds will do me any good, since they won’t solve any of the actual problems causing the depression.

For instance, he put me on anti-anxiety meds (Buspar) a few years back with the stated intention that I’d be on them for the rest of my life. Long story short, the problem wasn’t brain chemistry, it was other meds I was taking for my reflux. I stopped taking those and haven’t had any anxiety problems, even after quitting the Buspar.

I’ve noticed a lot of the depression meds seem to show bad side effects, addiction problems, etc., that they don’t notice until they’re on the market for some time. I don’t think they really know what they’re doing with all the new drugs, just that they can do something.

On the other hand, I need some kind of help. (I mean, come on, I’m desperate enough to post this to a messageboard!) I’m getting nowhere solving any of my problems because I’m just completely overwhelmed by them. I start on something, and realize that I first need to do ninety-eleven other things to be ready to work on that one. Every time I try to work on one piece, a different one falls apart. I’ve reached the point of just avoiding all the stuff I need to do, or sitting staring at it without actually doing anything.

I can’t focus on anything anymore, I can’t keep track of anything, and I’m generally just pretty miserable most of the time. My stress level is astronomical and is wrecking my health. I was fairly suicidal for a while (just couldn’t figure out a means that was both foolproof and undetectable), but I seem to be over that for now. And, unfortunately, I’ve got no support at home and no one to talk to about any of this.

I’ve considered therapy, but my past experiences with therapists have been pretty bad. And, again, (IME) they won’t actually help solve any of my problems, they’ll just tell me how to feel about them. I KNOW how to feel, what I need is some fixes!

So - any personal experience with medicating for this type of problem? What did you take? Did it help? Any problems? How long did you have to take it? Did you notice any after-effects after you stopped?

2

I’m not a physician or therapist, so please consider that when evaluating my response. Unfortunately, however, I have had experience with depression.

One school of thought that has been shown to assist with the kind of depression you describe is called Cognitive Behavioral Therapy (CBT). It doesn’t use any drugs, but instead, works at the internal messsages you give yourself that (this school says) are the root cause of situational depression. There are plenty of therapists (not psychiatrists, who mostly prescribe med, but therapists and therapeutic social workers) versed in this school. The most prominent popular writer in this field is David Burns: http://www.feelinggood.com/.

He has a book called “10 Days to Self-Esteem” which provides a series of structured exercises in this technique to do yourself. He has a number of other publications; you can find them used on Amazon often for very little.

I have found that this CBT technique does indeed bring relief. You may try it a little and see what you think.

Hope this helps. In any event, I hope you get some good advice and that things look up for you.

3

My marriage is swirling the toilet right now and I’ve got a lot of situational depression. I considered suicide at one point it was so bad.

The Psych I saw has given me some anti-depressents and they’ve really helped. It’s not artificial happiness, it’s more like artificial resolve. I’m more able to deal with the problems in my life since they’re not overwhelming me into inaction. Last night I was able to have a conversation with my wife about our impending divorce. I don’t know if I would’ve been able to do that before.

$.02 but they’ve worked for me.

4

I had a similar situation. I tend to get a bit depressed when things aren’t going my way. When my father died, I decided to actually try taking something for it. I went to my Dr. and was prescribed Paxil. I took it for about a year and a half. I suffered no side effects that I can recall, but then again, I don’t see that it really did anything at all. It certainly doesn’t make things not suck. So it was a meh experience for me.

I think that it’s really meant for people who have the “OMG, I’m not going to get out of bed except to reach for the revolver” type of depression. I’ve found that doing the little things that make you happy are a much better treatment for the situational blues.

5

You might consider asking for a referral to a social worker with experience resolving the type of problems you have. You don’t describe your problems in your post, so it’s hard to get too specific, but I can understand why you might not choose to go into it all. But maybe just working with someone to go through the checklist of the various steps that it will take to resolve a situation (as an example, moving a parent to a nursing home) could be helpful.

6

SteveHasAQuestioin: I’ve heard of CBT and known some people it worked for (although more with generalized depression than situational). I’ll take a look at the book, though. Thanks!

Belrix - yeah, I’ve been following your threads. I just haven’t had anything constructive to say, much of it is too close to home for me. I’ll toss in here that I think splitting is your best choice. I wish I could make that work right now. (I think that’s the solution for me, too, but it’s taken me several years to reach that realization. And it can’t happen for a long while, for purely practical reasons.)

Artificial resolve is exactly what I need at this point. Somewhere along the way I’ve lost all confidence in my ability to do anything without screwing it up, and I’ve always tended a bit to the perfectionist/procrastinator side, so I’ve ended up not able to do anything. Would you mind telling me what type you’re taking?

An Arky Yep, that’s straight where my doc went. He wanted me to do Paxil plus some other stuff. I’m really running out of “little things” is one of the problems. There’s really nothing anymore that makes me feel happy, which is depressing in itself. The best I can manage most days is “meh, not too bad”.

Harriet - yeah, don’t really want to go into details here. Part of the problem is that my home situation is unusual, and it can be difficult to find someone who can look past that part to actually see the real problems. I think that’s a significant part of why previous counseling failed. I also hired some accountants to work on the taxes, but their interest in helping me seems to be minimal. Their interest in billing, however, is terrific.

Love your username, by the way. Always makes me grin - I read those a zillion times when I was a kid.
Thanks for the suggestions, guys. I guess I’m actually improving at the moment, since I’m actually doing something to try and fix this. Just don’t know how long it will last, unless I can get some help.

7

IANAD, therapist, psychiatrist, etc. But I do take medication for clinical depression and am currently in a crappy situation that makes it very challenging to tease apart all the issues. Regardless of whether your symptoms are related to the situation or to brain chemistry, depression can make it very difficult to think clearly about how to resolve the situation and, as Belrix noted, to take action.

There is no question that some people experience emotional blunting with antidepressants. According to one study on patients taking SSRIs, “Compared to controls, patients reported significantly less ability to cry, irritation, care about others’ feelings, sadness, erotic dreaming, creativity, surprise, anger, expression of their feelings, worry over things or situations, sexual pleasure, and interest in sex.”

Cite

Losing your ability to worry over situations can be a good thing, or it may lull you into a place where you simply don’t care all that much about anything.

From another article:

**The most frequent description of the effects of SSRIs that I have heard from my patients are “It doesn’t matter.” or “Don’t sweat the small stuff.” or “What’s the big deal?” It is this “Don’t sweat the small stuff” perspective that I believe is SSRIs unique blessing and curse. It means relief from worry, relief from the feeling that something is missing, something needs to be done, something needs to be fixed, “my makeup isn’t right, the sky is falling, I won’t be able to pay my bills, I’m not smart enough, I won’t be able to tolerate the loneliness if I leave my lover” (even if he/she is abusive).

SSRIs supply, if not always happiness, a nice contented feeling that all is well and will be well. They can allow parents to be able to play with their children more, fret less over the details, appreciate what is, actually want to do the proverbial modern mantra, stop and smell the roses. They are the answer to existential angst. Perhaps Sisyphus, if he had only been born in the 90’s, could have left that rock alone and had a nice snooze.

On the other side of the equation, I have a psychiatrist colleague who took Prozac to relax and enjoy his vacation. It worked very well. He told me that he tried it at home when he returned. He quickly stopped it when he found himself thinking, “Who cares?” when his patients described their problems.**

(Complete article here.)

I’m trying to tread that line between removing some of the irrational worries that can paralyze me but not removing my ability to feel that my situation is intolerable.

Good luck!

8

I’ve had situational depression before myself. I was prescribed Celexa.

It worked, with a big caveat: I was like the good CAPT Kirk from the ST:TOS episode whre he’s split into good and bad. The spark of the dark side that makes me decisive wasn’t there, and I didn’t give a rat’s ass about anything in a bubble-headed manner.

I was a hell of a lot more pleasant to be around on the drug than I was off of it, however. My situational depression manifested itself as a really bad case of grouchiness, BTW.

As an aside, I experimented with St. John’s Wort before I went on the prescription, and, it took the edge off my mood.

9

I have also had situational depression. I was reluctant to try the meds my doctor prescribed because I didn’t want to trick myself into thinking everything was okay when it really wasn’t. What my doctor told me was that if you’ve been really stressed and depressed for a long time, your brain basically gets in the habit of being stressed and depressed and makes that your new normal state. He recommended meds as simply as a booster to get my brain behaving normally again, thus giving me the emotional resources to handle my problems myself.

I think Belrix said it perfectly when he called it “artificial resolve.” With the meds, I found I could deal with life in a productive manner again but had no false rosy glow about how bad things really were. I made real progress that I don’t think would have been possible without meds. They did have some unfortunate side effects for me. I don’t think this was ultimately so bad, though, since it encouraged me to get back off the meds quickly (6 months) and not come to rely on them emotionally.

10

Sometimes situational depression can disable you to the point that, in the spirit of “whatever gets you through the day”, I have to be supportive of whatever you find that helps, and of any experimentation you may do in your search for such help.

But situational depression isn’t a disease. (Even if ‘clinical depression’, allegedly caused by ‘chemical imbalances’ and not by situations, actually exists, situational depression, by definition, ain’t it). And aside from the positive outcome goal of “getting you through”, taking a mind-altering medication is probably not the most ideal thing you could do. Used in this fashion, it’s not functionally different from getting intoxicated on illegal drugs, in other words. (And in some cases may be less therapeutic and beneficial).

We attach a negative connotation to “crutch” but when your leg is busted a crutch can be a very good thing; but only if you’re going to do the physical therapy and otherwise do whatever needs doing in order to heal and move past the use of the crutch.

Be aware that many cavalier claims are made for antidepressants, claims which exaggerate the benefits and pretend the absence of negative outcomes and side-effects. Don’t take anything without researching it a bit, and your research should include the clinical pharmacology (PDR, etc) and also stories both good and bad from folks who have taken the exact med you’re contemplating. And by all means find out if there are, or are not, any detox difficulties when it comes time to going OFF the stuff.

11

Depression (and the social stigma still associated with mental illness) is very, very good at fooling you into thinking it must be something other than depression making you feel bad. I know- I spent a good ten years telling myself, “I’m not really depressed, it’s…”. Then I went on Prozac, and a couple of weeks later noticed that I hadn’t had one of those fits of depression I’d had for the past ten years in a while. I’m not saying you’re in the same situation I was (I’m not in your head, IANAPsychiatrist), but if you’re situationally depressed most of the time, you might want to think about it.

12

Sure, I’m on Bupropion, the generic for Welbutrin SR, and Citalopram, the generic precursor to Lexapro.

FWIW, I’ve also been told I have chronic depression, too, but it’s being compounded by the life situation. I was taking Welbutrin before but the Psych added the Citalopram after my suicidal thoughts were revealed. Once worry I had was crushing money issues so I requested drugs that had generic equivalents. Downside, I have to take the Welbutrin twice a day rather than once for the “XR” (extended release) version. That’s OK, though, because I was already taking another non-depression drug twice a day.

The dulling of the highs & lows is something I think I can say I’ve experienced. The “Don’t sweat the small stuff” definitely occurs for me but that’s preferable to the tight circle my mind was stuck in where I obscesed over the small stuff. Perhaps, when my life stabilizes, I’ll be able to drop to more “maintenance levels” of the drugs.

HTH - B

13

People often worry that anti-depressant medications will turn them into somebody else. This is not an entirely irrational worry, since brain chemistry obviously plays a big role in “who we are.”

One of the more adequate articles on the subtler effects of SSRIs that I’ve read describes quite aptly the way that they tend to act as a “hand on the shoulder.” As people have endorsed here, rather than evincing a change in personality, the SSRI expanded their ability to use coping skills that they already possess. This is probably what the OP’s prescriber is hoping to achieve, since this could be a very useful enhancement in a miserable situation.

Common problems that people often say led to their stopping use of SSRIs include sleep disturbances (almost always transitory), sexual side effects (like anorgasmia), and a sense of emotional flattening (like not feeling like crying at a funeral). If these things are deal-breakers for you, there are always other anti-depressant meds to try (up to a point, of course!), or you could try something like St. John’s Wort. The effectiveness of SJW is debatable, to be sure, but side effects are thought to be pretty rare.

14

Neither of those happens to everybody who uses SSRIs- neither one has happened to me.

I am amused when people say Prozac will turn you into a “shiny happy person”. I think anyone who thinks that should say it to Mr Neville, or any of my other friends. Have a phone handy, though- you’ll probably have to call 911 when they laugh so hard they can’t breathe.

15

If even 10% of the worst outcomes of psych meds happened to everyone who took them, I’d be very ridigly against them being legal to prescribe or dispense to anyone.

Certainly some folks credit various psych meds with saving their lives and/or making it possible for them to function.

But don’t even consider dismissing the horror stories. They’re real enough for enough real people plenty often enough.

16

Except for one BIG one: it drastically reduces the efficacy of hormonal birth control for women. It says so on the package (of BC, don’t know about SJW).

17

Sounds like you need a good friend more than anything to talk to.

18

Of course I wouldn’t- I know they’re all too real for some people, too.

But some people seem to think that SSRIs or other psych meds work by turning you into an emotionless and mindlessly happy person. They don’t- they work for some people without doing that.

I’ve heard that, too. I’ve also heard that you shouldn’t take SJW if you’re taking other antidepressants. Moral of story: just because it’s an herb doesn’t mean it can’t interact with drugs.

On the subject of birth control pills, I was once on a BCP that made me more depressed than usual. Some medications that would seem to have nothing to do with depression can make you depressed- just something to think about if you’re on other medications or taking herbs.

19

I’m taking Remerol (sp?) for anxiety/depression, which I think is both situational and chemical-imbalance related. I’m really happy with it, because I WOULD SWEAT ALL THE SMALL STUFF. It’s been really helpful by providing enough releif that I can function rationally to solve my issues and eventually stop taking the meds.

I have no side effects with Remerol, but I had every side effect in the book with Lexipro.

20

Hence at no point have I indicated that these things happen to everybody who uses SSRIs. They happen often enough to be noteworthy, however, in that these are reasons people cite for stopping use or seeking alternatives.

As for St. John’s Wort and birth control (and other interactions), I take for granted that people taking ANY other type of medication regularly would consult a doctor to discuss possible interactions before introducing something new. This is always wise, whether you want to start taking SJW or baby aspirin.