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Antidepressants: The Need-to-Know Series (Part 4: A Must-Read!)

You’re considering taking an antidepressant for the downs. You go online to learn a bit and you’re more mixed-up that ever. “OMG! This site says they’re great, the other says they’re poison.” How ’bout a voice of reason?

In Part 1 of the series we reviewed some history, the tricyclics, and the tetracyclics. Part 2 covered the monoamine oxidase inhibitors. Part 3 handled the selective serotonin reputake inhibitors, serotonin-norepinephrine reuptake inhibitors, and a norepinephrine-dopamine reuptake inhibitor.

Just click on the colored links to go to the articles. Part 1 Part 2 Part 3

In this final piece in the series, I’m going to present a strong dose of Reality, some Gotta’ Think Abouts; as well as my opinion regarding the use of antidepressants. Hopefully you’ll find mine to be the voice of reason.

Reality

Whether we’re taking an antidepressant for anxiety issues, depression, smoking cessation, or irritable bowel syndrome; they are not magic pills!

Oh, I suspect Big Pharma had much to do with the hype over the years; however, we have to continue to brew and smell the coffee.

Gotta’ Think Abouts

Here are some idle, and powerful, notions to consider as we think about using an antidepressant – or continuing.

  1. Within the realm of the emotional and mental health disorders, antidepressants alone aren’t the best option. If our situation is severe enough to require medicine, there’s no excuse for not participating in counseling.
  2. It’s common knowledge that antidepressants manipulate neurotransmitters involved in the mood and anxiety disorders. But science has no idea as to why that makes us feel better. Using antidepressants is rather a blind, shotgun approach.
  3. Antidepressants don’t have much impact on mild disorder presentations.
  4. A black box warning regarding the risk of suicidal symptoms in users under age 24 appears on all prescription antidepressants. As much as it’s a nice heads-up, the “facts” are debatable.
  5. In addition to causing some inconvenient side effects, some may continue after stopping the med.
  6. Yes, taking an antidepressant involves risk. But what’s the upside? How do the scales tip?
  7. As we’re considering an antidepressant we have to ponder and record our goals. What are we trying to accomplish? What are our expectations?
  8. Once we have that bit of business handled, are there other ways to achieve our goals, short of taking medicine? For example, have we tried counseling? Have we had a physical? Perhaps we have a thyroid problem or mitral valve prolapse.
  9. When taking an antidepressant, there are serious alcohol, drug, supplements, food, and beverage interaction concerns. Do we know what they are? Have we chatted with our physician? Are we willing to adjust and live with them?
  10. Once we begin an antidepressant regimen, we can’t suddenly stop. Antidepressant Discontinuation Syndrome is no fun (been there). Click here to read the first in a series I wrote on exactly that.

My Experience / My Opinion

Within the grips of devastating panic attacks, generalized anxiety, and accompanying depression; I elected to take the tricyclic antidepressant, imipramine (Tofranil), in 1989.

Within several weeks the quality of my life dramatically improved. I still had some research and counseling work to do; however, I was much better equipped to get it handled.

Four years later I was feeling so good that I decided I didn’t need to take meds – so I stopped. A few weeks later, all of my symptoms returned.

I ran to my psychiatrist asking for help. By then, the SSRIs were on the scene, so I chose to take paroxetine (Paxil). In short order, my symptoms went bye-bye.

Some years later, I decided to switch to sertraline (Zoloft). And to this very day I take 100 mg of sertraline daily. That’s 22 years of antidepressant therapy – with counseling along the way.

Now, then – do I tolerate a few mildly inconvenient side effects? Yes. Do I have any major health issues? No. Do I face severe health concerns in the years to come (I’m 56)? Don’t think so.

And how ’bout these questions and answers? Do anxiety and mood issues interrupt my life? No. Had I not taken medicine, where would I be today? Not to be overly dramatic – perhaps dead.

In his book, On Not Leaving It to the Snake, theologian Harvey Cox wrote “Not to decide is to decide.” There are always going to be polar opinions on most any subject. And so it is with antidepressants. Some will say they’re miracle meds, while others will say they’re poison.

If you’re thinking about using an antidepressant, or jumping the train – get active. Do your research, talk to people you trust, chat with your physician and counselor – and take notes.

When you’ve completed your work, make a decision and get after it!

We’re Done!

Well, that will do it for our antidepressant series. I sure hope it’s been helpful. If you have thoughts and feelings you’d like to share, why not do so in a comment? Or feel free to drop me a line.

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  • karen

    A fabulous series. Waaaaaaaaaay too many docs just hand them out and people are so desperate for any relief, they just take them. and continue to drink or self medicate instead of dealing with the issues. thanks, Bill.

    • Well, thanks for your kind words, Karen. You know, we all need to take responsibility for our wellness. For sure, docs do just hand them out – and I’m thinking all too often without the objective facts. In my opinion, so much in life is about observing the tipping of the scales – and, of course, expectation. I sure appreciate your loyal reading and commenting.

  • Camille

    I have had symptoms of ocd since my early teens and I’m in my 40’s. I am fine with meds like low dose Klonopin and Xanax. However, I am tired and feel depressed. I also have MVP. The doctor says if I can’t stand SSRIs then I could try a tricyclic antidepressant. One concern is that they can affect your heart rate. I am a real worry wort when it comes to medications like these. I also don’t have much friendship or family support in my life, so encouragement is appreciated.
    Thanks,
    Cammy

    • Hi, Cammy. Really glad you stopped-by and contributed…

      When you say “can’t stand SSRIs,” I’m assuming you’ve tried them and things didn’t work-out. If that’s the case a tricyclic is a reasonable alternative. In fact, the tricyclic clomipramine (Anafranil) is reported to work real well for OCD. Sure, tachycardia and palpitations present in 1-10% of cases, and arrhythmias in .1-1%. But those are extremely low odds, given the potential benefit. Heck, I’m sure we could find all sorts of potential side effects of benzo use, but you’re fine with taking them. Actually, I’d rather see you get comfy with an antidepressant and dump the benzos (but you didn’t ask my opinion, did you).

      Why not talk with your doc about clomipramine, or another tricyclic. Share your concerns about cardiac side effects and let her/him address them. Also include the benzos in your conversation.

      Cool?

      Thank you for your Chipur visit and participation, Cammy. Why not update us?

      Bill

  • Luci

    Don’t forget that exercise and diet as consistent interventions can be as efficacious as any antidepressant. If you’re not sure about taking medication, try getting a gym membership and really committing to a healthy diet for at least 60 days. See what happens! :) -from a very happy welbutrin rescuee

    • Well, Hey, Luci…

      Thank you for stopping-by and participating. Very wise counsel. Yes, exercise and diet are huge factors in the war on depression/anxiety. Then there’s the commitment thing, right? Dang, I wish it was as easy as grabbin’ a script, but it just isn’t. And what better credential could you present than “from a very happy Wellbutrin rescuee?” You’ve obviously been there, done that.

      Please visit again…
      Bill