Over at Health Central, I’ve put up a post called My 20 Meds. It’s about the trial and error process I went through to find a medication for depression that gave me more help than harm. The interesting thing is that none of the newer antidepressants worked for very long. The most effective have belonged to older classes of drugs.
The first one I used was Elavil (amitritypline) back in the 1960s. It worked perfectly to get me through a two-month crisis. After that brief use, I took no medications until the 1990s – primarily because the psychiatrists I worked with, especially in the 60s and 70s, prescribed medication only when depression reached crisis proportions.
I wrote about that practice in this 2007 post. Depression, according to Peter Kramer, was considered a useful tool for motivating a patient to dig deep into the past to identify the “real” problems buried in the unconscious. The question of medication never came up, and I didn’t even think to ask about it.
When the 90s brought in the widespread use of the newer generation of drugs, psychiatrists started making up for all the time lost in my medication history. I wrote about my experience with the side effects of the SSRI antidepressants and their close cousins in Feeling Fine on Prozac.
Prozac was the first SSRI I tried, and I felt an immediate turnaround. Energy, focus, upbeat attitude – all returned – for just about three months. Then I went through a long period with the drug declining in effectiveness as the symptoms of depression grew worse. I moved on from Prozac to Effexor, Paxil, Zoloft, Lexapro – each for at least two years – and many others, 20 in all, for briefer periods.
Each one gave me the same experience. At first there would be a slight improvement in mood. Then, as that wore off, the dosage would be increased and often another medication added. Eventually, it became clear that the drug wasn’t doing anything, so it was on to another. I’ve never had a psychiatrist who suggested stopping medication altogether, and I never wanted to stop for fear that I’d fall into an abyss without antidepressants.
The medication that finally worked for a sustained period was selegiline, the antidepressant in Emsam. It’s a member of one of the oldest groups, the MAOIs (monoamine oxidase inhibitors). The innovation of Emsam is its transdermal delivery system that uses a patch to put the chemical directly into the bloodstream. Bypassing the gastrointestinal tract greatly reduces the danger of interaction with a substance found in most foods, an interaction that can cause a stroke-inducing spike in blood pressure.
The effect of Emsam, however, also started to wear off, and so Lamictal (lamotrigine) was combined with it. That combination has held up for several years and has given me the energy I needed to make dramatic progress in recovery. Lamictal, though, is not an antidepressant but rather an anticonvulsant originally used for epilepsy. It turned out to be effective in treating bipolar, and quite recently has been prescribed as an adjunct treatment for major depressive disorder.
So all the promises of the “designer” drugs of the last 20 years have fallen through, at least in my experience. What they did most of the time was drain all feeling out of my system. I felt disconnected from everyone, and that wasn’t due to depression itself, even though loss of the ability to feel emotion is a common symptom. The success I’ve had with Emsam and Lamictal hasn’t dulled me down but rather energized me, showing that an effective medication doesn’t necessarily force you to pay a high price by intensifying some aspects of depression while mitigating others – if they offer any help at all.
Everyone has a different experience with medication, and I know that side-effects are likely to develop the longer I stay on the combination I’m now using. But they’ve served their purpose as a tool to help me do the hard part of recovery – finding out who I am, rebuilding a life, restoring relationships, and all the other human things that drugs can never reach.