I have been living with depression since a teenager and after so many years, I recently finally started receiving psychotherapy (CBT). While I’m already seeing some modest changes in my thinking patterns, my therapist noted that in the last few weeks the severity of the condition is worsening and it might be a good time to talk with my primary care provider about antidepressants as a combination therapy.
This got a reaction out of me, specifically that I don’t like the idea of chemically altering my mental state and losing access to what “I really feel” (as I perceive it).
I know that the logic behind this sentiment is not very solid, but we can’t reason ourselves out of our feelings that easily. For me this is also challenging because I don’t take any recreational substances that affect my mental state, so I can’t tell to myself that it’s like e.g. smoking weed only more targeted and supervised.
I’m curious if this sentiment is familiar to anyone else, and how you dealt with it (whether you decided for or against medication).
I know this is an odd answer, and may not be for everyone. I got the prescription filled, and held the dose in my hand and asked it: “will you hurt me?” And worked with that in meditation. It said it was okay to take. These days, I’m more inclined to research the heck out of it online before starting any drug, any reason. (And: I would never do this with a rando drug which came from who-knows-where.)
If you don’t like how you feel, after giving it a fair shake (several weeks, whether you want to see the change as blood plasma concentrations or rearrangement of neural pathways), you can stop. You’re not committing to it forever and ever; the effects will wear off once you stop taking it.
If you do want to stop, be sure to contact the prescribing doctor—or if the doc is unavailable, at the very least a pharmacist. Some drugs for depression need a gradual tapering-off schedule to avoid nasty effects of going cold turkey.
I’ve encountered your sentiments many times while treating patients. I don’t push too hard on the medication suggestion but it really is the case that medication and therapy can be of more help than therapy or medication alone. What I’d suggest is that you keep the suggestion in reserve until such time as the depression is kicking your ass again and then consider trying it. Its worthwhile to discuss the issue in advance with your MD and review the various options as some are more activating than others and some are more likely to produce side effects than the others. You could get the prescription filled to have it ready in the event you changed your mind.
What I’d suggest is that you keep the suggestion in reserve until such time as the depression is kicking your ass again and then consider trying it. Its worthwhile to discuss the issue in advance with your MD and review the various options as some are more activating than others and some are more likely to produce side effects than the others.
Thanks, I think this is the path I will take for now. I’ll talk with my GP about it today and start the process to find out my options first. It might not even be something she’s allowed to prescribe anyway, so I’ll need to visit a neurologist or a psychiatrist for more consultation.
Rhetorical: How much enjoyment do you get out of what you feel now? If you try a medication and find that you aren’t getting a benefit from the change, there are a bunch of reasons why that could happen. Your doctor won’t be insulted if it takes a few different trials to see which ones help or if you try it out and realize that it’s not the way forward for you. It’s a chemical tool to give you a little more leverage on what’s bothering you but you’re still the one in charge.
I was worried about this as well for a long time. Something that helped me through those thoughts was finding a medication that worked for me and then (with proper medical advice) discontinuing it for a little while. That “little while” ended up being a few years due to the whole COVID thing and wanting to stay out of hospitals as much as was practical but it allowed me to see what was different with and without the added chemistry at work. I was still the same person with the same thoughts and feelings but better able to manage the distressing parts that come along with all of this “being a human” stuff.
It’s not my business to say that you should do one thing or another but if you decide to have that discussion with your doctor, I’d recommend bringing along a small notepad or some paper and a pen/pencil so you can take notes. There’s a jumble of alphabet soup with stuff like SSRIs, SNRIs and NDRIs (among others) that’s easy to forget once you walk out of the office. You may have limited or no response to one type and a great response to another but I found the process less frustrating when I had a basic understanding of what was going on.
Best of luck to you whichever way you choose to go.
Personally, I sought help because I didn’t want to feel those things/that way, and I couldn’t achieve that goal entirely through force of will. For what it’s worth: I still feel all of those things, but those feelings are nowhere near as intense. They no longer control me and prevent me from feeling anything else.
Plus as another commenter said, having been on and off meds that worked and didn’t work, I am absolutely still me. I’m just a more emotionally composed and in better control of myself and my feelings me.
I also didn’t get there immediately on the first medications my doctor prescribed. They’re there to work with you to find what works, so don’t be afraid to tell them if something doesn’t.
It may be worth talking to your therapist about the fact that you may have internalized these feelings as being a core part of your identity, something that you’re afraid to lose. I promise there’s more to the things that make you who you are.
It may be worth talking to your therapist about the fact that you may have internalized these feelings as being a core part of your identity, something that you’re afraid to lose. I promise there’s more to the things that make you who you are.
Yeah, I think you are hitting an important point and he also tried to poke at it when I told him how I feel about the suggestion.
One aspect of it is definitely that I’ve been depressed since I had a personality. At some level, I think I believed that this could never change (and that’s why I was so amazed when some of the CBT exercises started having the exact effects the theory said they would). Thinking of a potential me without all of the maladaptive patterns I developed since I was a kid is about as stressful to me as meeting a stranger.
Part of it is also that I don’t understand the chemical mechanism behind the various antidepressants though, so I’ll definitely need to talk with medical doctors about it.
I didn’t give a shit about real any more. I wanted more comfortable and did not cate at all whether my new state would be “real”.
I was an eager user of recreational drugs, and I never saw any of my drug experiences as “not real”. Doing psychedelics and uppers and muscle relaxants and all sorts of “research chemicals” gave me a view of my own consciousness as a little tiny sliver of reality modulated by neurotransmitters.
So for example the crazy world of interconnection and possibility that I saw during a trip was just part of reality that I normally wasn’t able to see. And the dark hell that I’d find myself in when coming down from MDMA was just another aspect of reality that I only saw in a certain brain state.
So a better way to put it is that I didn’t really think of there being a reality that I could see while “sober”. I just saw “sober” as a particular state point on the map of states of consciousness.
If I was going to take a drug that got me “high” by making me on average happier and more effective, I was fine with that. I didn’t want to run to win medals I wanted to run to explore the world. Give me steroids, robot legs, rocket skates, I don’t care if it’s my own “accomplishment” or not I just want the mobility.
Now I see it slightly differently. I still believe “sobriety” is but point in a vast landscape of equally legitimate/valid states of consciousness. But I also understand that what antidepressants do isn’t just get you “high” like any other paychoactive drug. They don’t change your mental state directly like that. Instead they alter neurogenesis patterns, and these grow certain parts of your brain, and the expansion of processing power in certain parts of your brain alleviates the depression. The extra capacity tends to lower the threat level perceived by your brain and it enables exploratory, spontaneous engagement with life and that’s the end of your depression.
They like to say “it takes a couple weeks to build up in your blood”.
Naw. MDMA and all other psychoactive oral drugs take a quite uniform 30 - 90 minutes to “build up in your blood”.
What takes two weeks is the effects of neurogenesis — the growth and differentiation of neurons — to have a discernible effect in mood. It’s physical brain changes that take two weeks, not blood concentrations of various orally ingested drugs.
I was an eager user of recreational drugs, and I never saw any of my drug experiences as “not real”.
I definitely think that some of my hesitations have to do with not having any experience of using chemicals that affect the mood before, so I don’t have a mental model that I can re-use for antidepressants. I definitely drink caffeine though, so it’s probably valid to say that I have constructed a fiction of me never having done anything like this, but it’s a convincing fiction.
