ARE YOUR ANTIDEPRESSANTS WORKING
FOR YOU, OR AGAINST YOU?
By Shari Schreiber,
First of all, it's very
important you understand that antidepressants are not
"happy pills." They're not intended to block-out
your pain or totally eliminate your feelings. They're designed
to raise the floor of your depression, so that you're
able to get out of bed each morning, and (at least) function
in your personal and professional domains. If you're feeling depressed,
you should be engaging solid, responsible help (talk therapy)
to assist you with issues that are contributing to your difficulties,
so they can be resolved/healed. If you're taking antidepressants
alone (without doing inner work), it's just like slapping
a Bandaid on a deep, bleeding gash--and expecting it
and side-effects from your antidepressants show up pretty
quickly. Within a couple of days, you should be noticing how your
body feels on that medication. This business of waiting
six weeks or more before you notice
any change, is utter nonsense! In my clinical experience,
it simply isn't true. Full benefit is cumulative--meaning
it takes awhile for your body to absorb sufficient levels of the
drug you're on, to where you feel considerably better, but to
presume that someone with acute clinical depression has to wait
over a month to feel incremental improvements, is ludicrous.
generally like to recommend that my clients start out with a micro-dose
of their antidepressant. A gradual initial introduction, say 5
mg's of an SSRI as opposed to a standard beginning dose of 20
mg's is a better way to ease a client into drug support with fewer
side effects. I'm certain that no medical practitioner would sanction
this approach, but many of my clients have had splendid results
from following this protocol. Some continue indefinitely on a
'mini-dose' without ever increasing. When the client is monitored
closely, maximum benefit can be achieved~ and in the arena of
drugs, less is often more (unless we're attending to
acute or suicidal depression, of course).
you're taking an SSRI and it makes you feel tired/drowsy,
scroll down to the last several paragraphs of this article, where
you'll find ways to resolve this extremely
common reaction! Do it now, then come back--'cause there's some
really important facts you should learn about your meds here.
Use this article only as a guideline (an information resource).
am not a medical professional. Please
do not write me about your drug issues! Make a list
of your questions or troubling side effects, and initiate a conversation
with your prescribing physician about these concerns,
should begin to impact your depression within a few days
to a week; if they don't, speak with your doctor. If they make
you feel more depressed or suicidal,
you could be having a paradoxical
response to this particular drug, and you should phone your
physician immediately, and stop taking it! The
generic versions of certain antidepressants can be more
problematic in this regard, because they're less stable in composition--so
when beginning drug therapy, it's really best to start
with samples from your physician (if he/she doesn't offer these,
be sure and ask!) or buy the name brand.
This will at least give you a frame of reference as to how effective
a particular antidepressant can be for you, and whether a generic
refill of your Rx might be sufficient for managing your
symptoms. (A number of different companies manufacture generic
drugs; your *drugstore chain* pharmacist cannot control
the source of his/her supply month to month,
which could have unfavorable consequences for you!)
to a different drug is generally no problem, particularly if they're
in the same family (like with SSRI's and SSNRI's). Each Selective
Serotonin Re-uptake Inhibitor has slightly different properties,
in order to target adjacent symptoms like Obsessive Compulsive
features (OCD) and/or anxiety. This is discussed further down
within this text.
individual's physical chemistry is somewhat unique; a medication
that works well for your closest friend or sibling, may not be
the optimal choice for you! If you're not
experiencing a favorable response to your initial drug trial or
there are unpleasant side-effects, it could be that another
within the same family, or a different type of antidepressant
may yield better results.
your antidepressants around the same time each day (or night)
keeps this drug at consistent levels in your system, which is
always a good idea; just make it part of your morning or evening
ritual. Some folks find it easier to remember their pill(s) if
they're in the bathroom, next to their toothbrush. Find a place
that's convenient for you, and stick with it. If you oversleep
one day or get thrown off schedule, don't sweat it. Just try to
take your dosage as close to the time you normally do, and you'll
be okay. If you accidentally miss a day, the sky won't fall--but
be consistent when you're starting.
on how long you've been taking them, most of these drugs
have a half-life of a week or two. This means that the
time it takes your body to rid itself of this drug (completely),
could take up to about 14 days. Having a bad reaction to your
first or second pill? You should be feeling much better in a day
or so, after discontinuing it.
very brief, manic/hyper or non-response
to your drugs over a reasonable period (1 - 3 weeks)
can indicate an atypical or non-specific Bipolar
that your physician may have overlooked during your psychiatric
evaluation. Exploring this further (ruling out a bipolar issue)
is critical to the success of your drug therapy! Bipolar
Disorder generally requires that a mood stabilizer be combined
with your antidepressant therapy. Mood stabilizers are different
than antidepressants, as they are anti-convulsive drugs
that control extreme mood shifts or swings.
essential, it's helpful if your talk therapist is somewhat
familiar with various types of antidepressants, and can function
as your advocate (or go-between) with your prescribing physician.
Your psychiatrist typically sees you for follow-up visits once
every couple of months (or less often, once you're stabilized),
but your weekly clinician has a more direct sense
of how you're feeling, and should be alert to any side-effects;
lethargy/fatigue, skin rashes, sleeplessness, sexual difficulties,
stomach/intestinal problems, etc., that may be caused by the drug
you're taking. Based on much closer, more frequent monitoring,
he/she should also be noting whether your current drug therapy
is sufficient in helping you move through
your crisis or difficulty. In my view, two heads are better than
one, and a collaborative effort involving your doctor
and therapist can significantly enhance your ability to mend.
depression is almost never "just a chemical imbalance,"
balancing brain chemistry can be a critically
useful adjunct to your psychotherapeutic treatment. Depending
on the nature and severity of your challenge or crisis,
meaningful therapeutic intervention without the help
of antidepressants can be like undergoing surgery
without anesthetic! Acute levels of pain make it tough for you
to 'hold' the work, or make good use of it. Antidepressants can
relieve some of the stress associated with psychic trauma, and
make it possible for you to move to the other side of an issue
more effectively, and come out much stronger.
While you may decide (instead) to rely on coping strategies you've
used in the past, like alcohol/illicit
drug use, overeating,
over-work, shopping, getting a new pet or starting
a romance to divert your pain, these can
further complicate and compound your struggle! Frankly, no matter
how tempting it seems, it's best to resist these impulses
if you're hoping to make tangible and timely progress.
frequently asked if antidepressants inhibit psychic abilities.
While these medications can reduce/control psychosis,
it has never been my experience that one's psychic or clairvoyant
capacity is diminished by these drugs.
should be advised, that alcohol is
a depressant. Drinking counteracts the benefits of any
medications you're taking to combat your discomfort, and undermines
even the most solid therapeutic intervention! Aside from
this, if you feel your current antidepressant therapy is insufficient
for managing your symptoms, speak with your therapist and/or
physician about switching to a different prescription, or increasing
the one you're taking. If your doctor seems unresponsive
to your concerns or needs, find another doctor! OK,
now with that out of the way . . .
days, a lot of people on antidepressants are taking SSRI's
(Selective Serotonin Re-uptake Inhibitors), such as Zoloft, Celexa,
Lexapro, Prozac or Paxil. Cymbalta (an SSNRI) is a newer member
of this family that contains norepinephrine, and alleviates physical
pain that can accompany depression. Cymbalta seems well tolerated
by some people who've had difficulty with other SSRI's, or found
them to be less than effective. A few of these meds (Celexa, Lexapro,
Paxil) are formulated to target additional symptoms,
and obsessive-compulsive tendencies.
Each SSRI has slightly different properties, so it might take
a little experimenting to find out which is most effective
for you. While a psychopharmacologist or psychiatrist
can send you home with drug samples, your general practitioner/GP
isn't likely to have these on hand--nor is he/she trained to prescribe
psychotropic drugs or diagnose you properly! This means, you could
end up with a cabinet full of costly prescriptions you can't
use, which isn't just a nuisance--it deters your ability
to recover. Drug manufacturers have cut
back on free samples to Dr.'s since the inception of this article.
What a bummer... sorry 'bout that!
these lines, I've seen many instances where folks are over-medicated
(taking several drugs simultaneously that can counteract each
other, and/or be superfluous)! This issue is frighteningly
common among doctors who lack experience, or who are under-educated
in the realm of psychopharmacology; too often, they'll prescribe
additional meds to relieve a patient's unpleasant side-effects
on a drug, rather than switching him or her to a different
one. I personally believe that in the world of drug therapy, less
is usually more. A medication that's designed to target
several of your symptoms, is healthier (and more economical) than
taking several that haphazardly address each one. Add
to this, various antidepressants like Effexor may
be tolerated at lower doses, but lethargy/fatigue, intense sweating
and other uncomfortable side-effects can manifest as dosage escalates.
Increased intake problems can also occur with certain mood stabilizers
(like Lamictal), used for Bipolar symptoms.
or tiredness can easily be experienced if your doctor has started
you on an elevated dose of your antidepressant. The initial dosage
on your SSRI should never be higher than 10 mg., to see how your
chemistry handles that drug. Combating fatigue on these drugs
is addressed very shortly, but if your beginning dose is too
high, you will feel like a zombie--no matter
what time of day you're taking it!
Keep scrolling down, for more on SSRI
psychiatrist may send you home with pharmaceutical sample packs
that increase your daily dosage exponentially--which means that
your body must immediately adapt to twice
the amount of this medication in your system. Using a tablet cutter
can help increase your dose more gradually, and save you from
having to deal with any unpleasant side effects, as you adjust
to a higher intake (make sure your doctor sanctions this). You
should not try this with capsules, but your prescription
might be available in more moderated doses, which will help you
adapt to these changes more comfortably.
light of these various considerations, it's imperative you understand
that your best outcome depends on solid pharmaceutical
wisdom and responsible assessment. As with any professional
domain, medical practitioners can vary widely in terms of experience,
dedication and skill--but a thorough diagnosis of your
symptoms is essential in determining
your success with treatment.
levels are raised over a period of time with use of these drugs,
so while you could begin to feel a degree of relief within a few
days, optimal effectiveness may take several weeks.
SSRI's and other antidepressants can cause dehydration,
which leads to headaches, dry mouth, constipation and other related
physical issues, so it's important to drink plenty of water
while taking them. The most common sexual
side effects of SSRI's, is they may inhibit libido and your
ability to achieve orgasm, but individual results can vary significantly;
I once had a client who'd taken Paxil years before
we'd met, and reported a marked increase in his
sex drive during the time he was on that drug. Naturally, this
somewhat atypical response might be attributed in part, to relief
from depressive symptoms.
you're not currently in a sexual relationship, it might be wise
to attend to the more immediate need for relief from your depression,
instead of worrying about the "what if's" that
may loom ahead. It's just common sense.
are rarely tolerated by individuals who have irritable
bowl syndrome (IBS) or a medical history that's included
other colon disturbances. In these instances, a cholinergic
reaction (intense diarrhea) is very common, but your doctor
should cover this during your intake session. Taking
these meds with a little food rather than on an empty
stomach, can decrease the incidence of nasty side-effects, like
time of day you take your antidepressants
can influence outcome; most prescriptions indicate morning dosage,
but this can interfere with your ability to concentrate/focus
or function well during your waking hours!
All SSRI's are formulated to raise and maintain serotonin
levels in your brain tissue, which provides a soothing, relaxing,
mood-elevating effect. The problem is, your productivity
at work can be seriously compromised, if you're taking them at
the start of your day--particularly while you're adjusting
to them. While your depression should lift
with the use of these drugs, if you take them in the morning,
you could feel sleepy or lethargic afterward.
This is pretty critical, because nobody feels
good when they're fatigued, unfocused and anxious about
performing well at their job! In light of this, you might find
yourself asking; "Is the prize
worth this price I'm paying to
feel better? And if not, do I throw the baby out with the bathwater--or
make a simple adjustment?"
I'm utterly mystified as to why doctors are still recommending
their patients take SSRI's in the morning, given these known,
anticipated side-effects! While it's true that certain antidepressants
(such as Wellbutrin) are activating and must be taken
during daytime hours, it's certainly not true
for most of them. Maybe pharmaceutical companies should become
more aware of how you actually feel
on their drugs, and give more specified guidelines to physicians
prescribing them. Now that's a novel idea, isn't it?
drowsiness issue is exacerbated if you're struggling
with symptoms of Attention
(ADD/ADHD) in conjunction with your depression. Your SSRI can
slow you down, but if you're taking a stimulant for your ADD,
it's supposed to wake up your brain and activate
you! It seems reasonable to presume that the properties of these
two drugs (when taken at the same time) could counteract
each other, to where you may not receive full benefit from either.
In recent years, some physicians have found that adding small
amounts of a stimulant drug to their patients' antidepressant
therapy had a synergistic effect; meaning, one enhanced the other's
effectiveness. Perhaps this practice was originally intended
to mitigate the tranquilizing side-effects
of these drugs--and (voila!) an inherent synergy between
the two, was the unintended by-product. This
appears to mean, that taking your SSRI around dinnertime
(later, can leave you groggy the next morning) might enable you
to sleep more soundly, and awaken more refreshed.
amphetamine-type stimulants can be very helpful if you have ADD,
but WellbutrinXL is an activating antidepressant
that's often prescribed for attention deficit issues, and may
better address your needs. This drug is fast acting, and has a
short half-life (the time it takes to leave your body). Wellbutrin
isn't well-tolerated by everyone; some may experience irritability
or even intense rage, and it might be better to start with a non
time-release version, so unfavorable reactions can pass quickly.
This drug might be worth trying--especially if your doctor can
send you home with some samples. If you're hyperactive with ADHD,
you may have difficulty with Wellbutrin, as it can trigger anxiety,
nervousness or irritability. Under these circumstances, Strattera
or small amounts of an amphetamine like Ritalin or Adderall, may
be a better option for you. Withdrawing from almost any prescription
should be done gradually to avoid uncomfortable and/or
dangerous side-effects. The exception, is when you have a paradoxical
response (mentioned earlier) to a new Rx.
am not a physician, but I've worked closely enough with individuals
taking psychopharmaceutical drugs, to have noticed a pattern of
improvement after they've implemented a simple time shift
in their antidepressant therapy. I strongly urge you to
always check with your doctor about any
concerns you have regarding your existing drug regimen or amending
it, before initiating any changes. It's perfectly acceptable to
ask him/her about taking your SSRI in the evening, if
you suspect this could provide a better night's sleep, while enhancing
your alertness, focus and motivation during daytime hours. Maybe
it's true--at least in this instance, that "timing
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