After about 18 years of non-stop, mostly ineffective antidepressant treatment, I’ve brought this long experiment to an end. I had been wearing Emsam patches for the past six years, but I’ve been fairly sure for some time that they had stopped working.
It seems I was right. Getting off the drug has made no difference at all in how I feel. It’s been a non-event. I haven’t had a relapse, despite all the warnings you hear when you consider stopping antidepressants. I was preparing myself for one because I thought it might be hard for my brain, so long conditioned to these drugs, to adapt to the change. But so far, so good.
Stopping antidepressant treatment is always a tricky thing. When you feel better, or completely recovered, as I do, a psychiatrist might tell you that the medication is the reason for improvement. That could well be the explanation, and you might be setting yourself up for a bad recurrence if you stop taking it.
In my case, I kept track for three years after I first sensed that the drug had stopped working. During that time, it failed to prevent the customary cycle of ups and downs of the “hangover” symptoms of depression I’ve had since recovery began. Only after this period of observation did I decide to stop.
I’m still taking lamotrigine (Lamictal) which was added to Emsam after the antidepressant stopped working on its own. Lamotrigine is one of the major mood stabilizers used to treat bipolar disorder. In recent years it’s also been approved as an added treatment to boost the effect of an antidepressant.
Now that I’m done with Emsam, I’ll be planning with my doctor the best way to withdraw from lamotrigine. I’m confident that I’ll have the same result – no change at all – but only time will tell.
What Do We Know about Antidepressants?
As I’ve read more about antidepressants, I’ve become concerned about how little is known about the effects of long-term use. Now that I’ve stopped using Emsam, I’m trying to bring myself up to date on recent research.
I soon found a December blog post by Thomas Insel, head of the National Institute of Mental Health. He provided an overview of antidepressants that gives me a start in getting answers. What he says about treatment with medications emphasizes how complicated depression is and how far we have to go to find better treatments.
1. How Many Take Them:
The Center for Disease Control says that 1 in 10 Americans are now taking antidepressants. The growth in their use has been enormous, but it hasn’t been due to psychiatrists. About 80% of the 250 million or so prescriptions written each year (at a cost of $10 billion) come from non-psychiatrist physicians. A great many of those prescriptions are not based on a depression assessment or diagnosis, nor are they written to treat depression.
2. What They’re Used For:
Psychiatrists routinely prescribe these medications not only for depression but also for the fear-related disorders, as they’re known in the official diagnostic manual. They include obsessive-compulsive disorder, post-traumatic stress disorder, general anxiety disorder and various phobias. Primary care doctors prescribe them for numerous problems: back pain, migraine headaches, fibromyalgia, menstrual symptoms and fatigue, among others.
3. How Well They Work:
Insel reviews several problems with antidepressant research that limit what the studies tell us about long-term effectiveness of these drugs. To begin with, most studies in the past only looked at short-term effects over a few months. Researchers have used different criteria for effectiveness. Some consider any level of response as the measure, while others require elimination of all symptoms. All the studies use standard lists of symptoms to measure effectiveness, but these leave out the ability to function well socially and mentally as well as the patient’s main concern about feeling better overall.
The studies that have tried to measure long-term effectiveness have shown mixed results. They do establish that your likelihood of having a recurrence of depression is much less with antidepressant treatment than without it. However, people with mild depression tend to benefit very little, while those with severe symptoms tend to benefit a great deal.
Here’s his overall conclusion. “The bottom line is that these medications appear to have a relatively small effect in patients broadly classified as having depression. In some patients, perhaps those with more severe clinical conditions, they appear to be essential for remission. Clearly we need to know more about who will and will not benefit.”
4. What We Know about Depression:
Part of the reason that antidepressants aren’t more effective is that depression isn’t a single condition. Given the pick-and-choose clinical criteria for a diagnosis, Insel points out, two people sharing only one of the nine criteria for depression could receive the same diagnosis. That’s a pretty stretchable diagnosis, but the clinical criteria are only one set of differences.
At the biological level, “depression likely comprises scores of different disorders.” (My emphasis.) When you add in the individual differences in the length of depressive episodes, the frequency of recurrence, family history, the presence of other illness or any of a dozen other factors, it’s no surprise that antidepressants don’t work for everyone.
5. The NIMH Research Agenda
Like every thoughtful observer, Insel emphasizes that treating depression is more art than science and that none of the methods we now use should be ruled out. However, when he turns to the new NIMH research direction, it’s all about biology.
There’s a program to identify biological signatures for depression that would make it possible to personalize treatment. Another program will figure out how to link the present clinical criteria for depression to neuroscience and gene research. A third focuses on developing more rapidly acting antidepressants.
That’s all fine, but funding for psychotherapy research never comes up. I have a hard time understanding why this approach to treatment – proven to be at least as effective as medication – doesn’t rate when it comes to financial support. I know that most research money comes from pharmaceutical companies and that they have no interest in psychotherapy or other non-drug treatments. Still, you would think that government funding could be spread around more evenly.
There’s a lot of concern about the high rates of relapse after initial success with antidepressants as well as concern about the many people who get little or no benefit at all from medication. Despite this mixed record, the push is always for newer, better, faster drugs, and there is always a promising new medication in the works.
I doubt this situation will change anytime soon. All the more reason for those of us who get no help from antidepressants to keep trying other methods. They may not be considered evidence-based, but that’s partly because researchers don’t spend time or money trying to figure out how effective they are – or how to improve them.
I hope you’ve had better luck than I have with antidepressants. Have they worked for you? Do you consider them the mainstay of your treatment?
I was diagnosed with schizophrenia and severe recurrent depression at age 37, even though I’m positive it all began in childhood. And now at age 62, after years of multiple medications of every description (often many at the same time) it is so interesting, if sad, to consider whether it was all necessary. The first psychiatrist I ever saw (at age 37) took no more than 5 minutes to diagnose me as “either bipolar or schizophrenic” and prescribe Depakote and something else, I forget what. Then she passed me to a different psychiatrist for “treatment.” He took up the label of schizophrenia, changed it variously to bipolar and schizoaffective and back to schizophrenia. He pumped me full of one category of psychoactive medication after another, hardly pausing to give each time to work before switching it or adding something. Then the side effects of these required additional medication. Then some of the medications caused hypothyroidism and high blood pressure and low sodium, so more meds were added. Before I knew it I was on 10 Rx a day and feeling awful. It wasn’t just depression and psychosis anymore — it was an entire compendium of cause and effect and symptom and treatment and experimentation.
And all along I knew depression was the real problem. I think it led to the psychotic thinking due to insomnia and worry. I think the antidepressants are actually what actually catapulted me into mania and thus the bipolar label.
My doctors kept saying it was “The Illness” (which one?) that was the problem, not the medications. They assured me the medications were what were “helping keep me well.” And if I went off the meds, they said, I would be right back where I started. Well, hallelujah. Get me back to where I started and I swear I will never EVER see a psychiatrist again. Right?
Slowly with a doctor’s knowledge (but not support) I began to taper off of all the psych meds. And I was doing so much better more than one family member said, “What has happened to you? I feel like we have the old you back again! It’s so good to see you laughing and not walking around with a blank stare on your face.” Risen to life. I’m definitely NOT saying no one should see a psychiatrist or that all psychotropic meds are bad. I believe a short course would have helped me. But not a lifelong debilitating course.
My advice: be careful out there. Go forth with full knowledge and understanding (or as much as you can gather) and don’t let anyone talk you out of doing so. Don’t let a doctor dissuade you from reading up on medication side effects and effectiveness. Keep checking the latest literature and scientific data as to what is known and what is knowable.
Donna, I’m glad to hear that you’re doing so much better. I’m on very little psych meds myself now, just need a little help to sleep.
I have ended my antidepressants that have not worked in 25 years. Trazadone I am wheeling myself off one pill a night for the week and I am done. Nothing helps me I have gained 150 pounds over the years. I am done with all of it..I am angry at the care I slipped through the cracks of the system. If I die I die done done done.
Thank you for sharing that I was on anti-depressants for 20 years they all work for a while and they stopped working the side effects of gaining weight falls well being delusion into thinking everything was OK when I was going into bankruptcy unaware made me decide to get off of them it took 3 months for me to feel better overcome withdrawal symptoms of itchiness and shaky but I am okay now and have even lost some weight from cutting out breads for a few months hopefully I will continue this and not be dependent on anything again good luck thanks for sharing
I have been on every anti depressant for 30 years. I don’t even know who I am anymore. I have wheeled myself off of almost everything. I am done with all these Medes. I will be who I am and find myself again. Done, Done. The professionals are playing with our minds, with these wonder drugs. Well they are not for me, I had to get angry first and believe in myself that I could do this. Next is trazadone down to two a night soon 1 per night then none. I refuse to be a Ginny pig for these drugs.
Doctors are faced with depressed patients everyday. People who are suicidal or unable to get through the day without bursting into tears.I have been both. What a terrible position for anyone to be put in. Does your doctor give you antidepressants or suggest that you use non medical treatment ( start a new hobby, mow the lawn, join a group….) How do you think giving you the latter advice, he would feel if in a short time after that you ended up committing suicide? Yes are pressured into giving into their patients expectations that the Dr can fix the problem with medication.
I have been suffering from “bi-polar”/depression/anxiety for close to 30 years. I’m comforted to see that I’m not alone in my suffering. I was just recently taken off EMSAM and topiramate and suggested to start Latuda until the 14 days have passed of being off EMSAM. I’ve been put on almost every drug out there and still nothing has been effective. Sometimes the effects can make you feel worse than before, others seem to wear off, and still other medications require other medications just to counteract the side effects. Doctors seem to forget or maybe they just don’t know what it’s like for the patient those couple of days or weeks when they’re in between medications. Right now I’m suicidal and not wanting to go on with this never ending trial and error of drugs. I’ve been disappointed so many times and just don’t think I can do this anymore. I sometimes think it would be better to just end this madness, but the guilt of leaving my husband and my son keep me from following through with the actual act. Still I wonder what good is coming from this. I haven’t been able to work for over a year, I can’t leave my home because of paralyzing fears, we’re losing our house and filing for bankruptcy because of the loss of my income. I’ve filed for disability over a year ago and if you know anything about the government, it can take years before getting any kind of help. So until that happens I feel I’m in this continuous spiral down, all these stressors just feeding my depression.
I now wonder if I should continue staying off the drugs and “wait and see” what happens, or do I get on the next drug in hopes that maybe this one will be it or at least keep me going for another couple of weeks. I find myself confused about so many things that I can’t trust myself to make a decision on my own. I feel I’m at the mercy of others to include my doctors. I feel that my life is no longer my own. It’s such a lonely disease, but I’m glad I accidentally came across your blog, for at least a moment I didn’t feel quite so alone.
I can see both sides of this issue. I think there are two other big problems with depression. It can be a symptom of other problems that if there is a family history of mental illness doctors ignore the possiblity of other disease that depression is a symptom either directly or indirectly. Had this one happen twice. When someone figured out I had asthma for years but it had gone undiagnosed because it was assumed I was out of shape (shame on my parents for not standing up for me and saying hey she coughs all night deal with it what is the problem her and shame on the doctor for not catching it) When I got that under control mysteriously I weaned down on antidepressants the first time. I had also alwasy had heavy periods I got off when they got under control. When they went back out of control and post partum the depression came back and didn’t resolve until post surgery to correct the bleeding issue and I got off hormones. Now I’m stuck at a crossroads, the med that had worked for so many years caused so many side effects it had to go and I’m curious as since their last experiment with a new drug (I have been on a lot of them and had failures where they got me into deep trouble instead of helping) which ended in rash, itching and upset the asthma. Am I now a case of support sleep and control through CBT skills and next time it comes up maybe the last drug that worked will work again or someone will have come up with something else and screen me for other problems that might be the underlying cause.
The other problem is doctor monitoring/and inept doctoring. When I was a kid atleast my parents were able to get me into a psychiatrist quick because the family doctors sometimes don’t have a clue as to what they are doing. Unfortunately that doctor moved and I had been doing well off so she suggested therapy only instead of both. Tried and failed, most therapists in the area are idiots and instead of teaching skills they wanted to control my life. They misunderstood some things and it did way more harm than good so I got out of it. (had the nerve to tell me at 25 I shouldn’t date anyone seriously and that I should deal with my insane mother who she wasn’t understanding I’ve done all I can do she made some bad choices that she needed to live with. Why should I jeopardize my life anymore for someone who nobody will listen to me needed some major help. Should she also not be grateful that at that age I was on my own not needing parental guidance help. What we both should sink because nothing was ever enough for her? I had a hard time getting into one of the reputable doctors in town due to my mother’s mess, (BPD in my opnion and one therapists opinion) where she should have been locked up in a hospital and not allowed to run free. It wasn’t until post partum after I wound up in the hospital twice due to med screw ups that I found a psychiatrist who knew what he was doing with me. (Family doctor put me on meds that made me suicidal and had a hard time realizing/adjusting, first time in the hospital I had a bad apple psychatrist who snowballed me with lithium and made a few other bad med choices I had to go back because I was in the same state) So that warning on those medications is real they can make you suicidal. Did find one decent therapist post partum who had the sense to teach me skills and let me on my way. That is what terrifies me about medication, some of these meds designed to help you can actually kill you.
So while I’m for medication if you need it, make sure it’s needed and not other medical problems masquarading as depression/anxiety, but go to a reputable specialist who has a clue as to what is going on, not some looser who just barely passed the boards. Also be aware the meds come with risks
Patty Taylor says
At 43, I am pretty sure I would not be alive today is not for the SSRI’s I started taking 20 years ago. They are the only class of antidepressant that ever worked for me. Yes, I experienced side effects, but they were much preferable to almost constant suicidal ideation. Unfortunately, I think they stopped working for me at least three years ago and maybe more, so I’m really having to focus on every other tool available to manage and prevent another depressive episode. The increased awareness of depression over the past 20 years has been a double-edged sword for me. I can be more open with those close to me about my major depression and generalized anxiety disorders, but all the people with only mild to moderate depression being prescribed medication by non-psychiatrists seem to have taken something away from me. With new studies on the ineffectiveness of antidepressants, the people reporting on this are not being very clear that the ineffectiveness pertains to people with mild to moderate depression and not to people like me with life threatening major depression who are literally still alive because of medication. I hope the popular press clears this, but I’m not very optimistic they will get around to making this distinction.
John Folk-Williams says
Hi, Patty –
Yes, everything I read – and many personal stories – emphasize that the meds work best for severely depressed people. Publicity around the studies is usually fairly clear about that, but it has no effect on advertizing or prescription practices. The studies that challenge the general effectiveness of antidepressants or attribute much of the effect to the placebo effect make many good points. Unfortunately, there is so much high intensity advocacy that it’s hard to get an independent evaluation of the available evidence. But your experience is what counts. I’m sorry the SSRIs have stopped working – as I mentioned in an earlier post about Emsam, it worked well for a couple of years, then with renewed effect after being supplemented by lamotrigine. MAOIs are supposed to be the most effect antidepressants but have been avoided because of the dietary restrictions and danger of hypertensive attack if they are not followed. But the patch eliminates most of that problem by avoiding the GI tract. Might be worth a try.
Patty Taylor says
My psychiatrist gave me a list of options about a year and a half ago, and yes, I avoided the MAOI’s because of the restrictions. I found one drug on that list that worked better for me than any SSRI had worked, but unfortunately, I starting gaining a pound a WEEK on that medication, so I had to stop taking it. I was counting calories very closely, and when I ate enough to meet my daily needs, I still felt like I was absolutely starving.
I did read a post where you mentioned Emsam, and since I’d never heard of it, I glossed over it, but with the way you explain it, it’s worth checking out with my doctor. Thanks!
John Folk-Williams says
Hi, Patty –
Since Emsam is a patch, it avoids the GI tract and lessens the danger of the hypertensive attack problem that can happen if you eat certain foods. Lessens but doesn’t eliminate the possibility. I had the best results combining Emsam with the mood stabilizer Lamictal (generic lamotrigine), but that’s a matter of trial and error. I hope you find something that helps.
I’ve been on nearly ALL types of anti-depressants (and most of the brands) for severe, medication-resistant depression, anxiety, and cyclical mood disorders. I’ve even tried ECT and Ketamine treatments without long-lasting success. The EMSAM patch has been on Me for almost a year now (12mg transdermal Selegiline), and while I will never be a champion of any antidepressant or pharmaceutical substance, I do find that I have blessedly fewer “side effects” from the patch than I was expecting. I do NOT have to stay away from Tyramine, a common amino acid that interferes with the inhibition of Monoamines, and I have been lucky to have minimal other issues as a result of switching to EMSAM. I do find it limiting to have to wear the patch in what are extremely visible locations (4-6 options on your chest, arms, legs, or back) and I am so physically active that I’m lucky to get 12 hours of stickiness out of it. I don’t like that the dosage and medication name is printed on the label, because while this might inform a first-responder of my medication intake, so FEW medical professionals are truly familiar with EMSAM and it’s potential drug interactions, that I do not trust them to dose me with anything without the input of my psychiatrist; I have been given medicaitons (for back spasms, as an example) which the ER/attending docs hoped wouldn’t interact, only to be told by my own doctor to “stay awake, stay with someone for the next 12 hours, keep the phone close because you might go onto Serotonin Syndrome”. However, like all medications I’ve ever tried, I am starting to feel the EMSAM losing its effect. I have been exploring alternative healing techniques, such as acupuncture, meditation, Pranayama breathing, and other Eastern medicinal practices and I wonder if these are working for me just as much (or little) as the EMSAM. I fully believe that some people cannot be helped without the assistance of medications, and so my comments are not meant to discredit anyone’s pain or suffering. But I do think that jumping from one phantom pharmaceutical to the next without understanding the long term effects has inhibited my BODY’S natural ability to balance and heal itself, which is built into every creature. If I’m honest, I resent being ushered onto medications so early in my life (most of my 33 years have been experienced through the lens of some kind of prescribed regimen of anti-depressants, mood stabilizers, sleep aids, anxiety reducers or energy boosters) because most theories and doctors support me STAYING on them forever. It is hard to find doctors to trust because even those with the best of intentions are seeing a minute portion of humanity, and a minute portion of “science”, and the truth is NOT ENOUGH TIME HAS PASSED TO STUDY THE LONG TERM EFFECTS OF THESE DRUGS and companies don’t make money by initiating short-term treatment plans when it comes to pharmaceuticals. I would caution anyone reading to do your homework by asking lots of questions, read actual studies, and try not to feel pressured or scared into taking something that you’re not comfortable with. Just because a Doctor prescribes you something, doesn’t make him right. Then again, doctors, psychiatrists, and pharmacists are not (always) demons here to trick us into pain and suffering; There’s a a reason they dedicate their lives to caring for others. Even though those of us with mental illness don’t always experience it, there is a BALANCE to medication, treatment, and coping with pain and suffering. Sticking EMSAM on your arm won’t cure you, but quitting all foreign substances could be harmful to your health at the same time. I wish I could offer more cohesive conclusions, but I am struggling alongside all of you. At best, I hope my experience will help inform someone who is struggling with their own.
All the BEST,
We are such an overmedicated nation, it just concerns me beyond anything I can express. I am menopausal, have had some anxiety and was given Lexapro to help with the symptoms. After just 3 doses of that demon drug, I ended up in the ER diagnosed with “serotonin syndrome” and am lucky to be here today, since that condition is life threatening. After my recovery, I became angry at what happened to me and even more shocked that people would not accept that what landed me in the hospital was the drug and not something else. They just would not believe me or my doctors. That’s how brainwashed we have become about these drugs. Studies show they work no better than a placebo in most trials, but the drug companies do not want that exposed. People used to know how to cope. They didn’t expect to be happy 24/7. They knew that life was a challenge and they accepted that. Today we have somehow convinced ourselves that if we are not just happy as little pigs in poop all the time, then we must be mentally ill. Psychiatrists are now trying to label grieving as a disorder. We have a mess in the making!
I have recovered from anxiety drug free and will NEVER again ingest those horrible drugs. They are as dangerous as street drugs in my opinion!
I’m sorry that this happened to you, but I think there is no one answer for everybody regarding medications. Some people find them life-saving; some people have bad reactions to certain drugs and not others. I get what you’re saying and why, but I think depression is experienced in very individual ways and managing it ends up being unique to each person. And I think grieving CAN be a disorder if it goes on and on without relief – it’s very painful to those going through it. Sometimes grieving can trigger a depressive episode. Anyway, I’m not trying to minimize what you’re saying about your experience, only saying that what works for one person may not for another and vice-versa. I’m glad you’ve recovered from your anxiety.
John Folk-Williams says
Hi, Jane –
I’m glad to hear that you’ve recovered. That’s the most important thing. I agree that there are a lot of wrong-headed attitudes toward milder forms of depression, anxiety and other behaviors that are coming to be viewed as illness. The definitions of mental disorders get looser and multiply to include all sorts of things that sound like variations of normal behavior when you read the symptom lists in the diagnostic manual. However, the most careful studies show that meds are most effective in treating the severe forms of depression and anxiety. They at least take the danger out of extreme behavior when hospitalization and drug treatment become necessary. But routine prescriptions as the first and often only form of treatment are also a cause of concern within the psychiatric profession. Despite all that, many people swear by medications as essential to their normal functioning, and I have to respect their experience, as I respect yours and those of many others who can’t take meds without severe problems. We don’t know nearly enough about the biological dimension of depression to rely exclusively on medication, but here we are. I’m hoping that people can be get more balanced information instead of the all or nothing sort we hear these days.
Life Coach says
Treating the symptoms is often not the best the solution, focusing on what we do want will always lead us in the right direction.
Wendy Love says
Another well-written article. You make some good points both for and against medications. We must each make this journey alone, and we all have unique reactions to our treatments. I had a period of time when antidepressants worked for me, for awhile, and then I would have to switch due to side-effects. Every single medication I have tried, and I think I have tried them all, gives me unbearable migraine headaches after awhile and so I must persevere without the help of meds. Sometimes this is a blessing. When I have certain symptoms, I know that they are really the symptoms of this illness (bipolar) and not some weird side effect of medication – because I no longer take medication!
But oh there are days when I wish there was a med that would help, because I need all the help I can get. I have to stick to a fairly rigid lifestyle management plan which includes regular exercise, healthy eating, lots of self-talk, blogging and being selective about social activities. Mostly I lead a quiet life in order to keep my moods in control. Sometimes it works, sometimes it doesn’t.
The medication discussion is a controversial one. Certainly the side effects are questionable and need to be considered. But if someone out there has found a med that has given them a better life then I would say ‘Go for it!’ and enjoy it while you can.
John Folk-Williams says
Hi, Wendy –
You’re so right about the controversy. Blogging about medication is getting to be like touching the third rail – and as a former New York subway rider, I really know what that means. There are so many people who have been saved by medication from suicidal depression that it’s clear the drugs can work. It’s unfortunate that the response to meds seems to be so unpredictable, but that’s the state of our knowledge right now. As you say, people should do whatever works for them. I’m sorry to hear that the side effects of medication have been so severe for you. Lifestyle changes have also made a big difference for me, though we’ve both found out that no approach works all the time.
I wouldn’t even know where to start with this one. I had major depression for years (including constant suicidal ideation) before I even had a name for it. I was diagnosed with both major depression and schizophrenia early 1995, and I don’t know how the medications for each interact or influence each other. The schizophrenia and depression both began to ease up in 2004. I had taken a myriad of medications for each with no luck, up until 2004. Were the medications responsible for my substantial recovery? Or did I just naturally move toward a lessening of symptoms? I often wonder. For many years, I have been taking Wellbutrin. About 3 years ago it stopped working as well and my pdoc added Zoloft. The two together work well for me. But I have noticed that even small deviations in my medication schedule wreak mental and emotional havoc. So I don’t know if or when I will be able to do without them at some point…I hope so. I hate taking meds. But since I was hospitalized 18 times, attempted suicide 3 times, had 19 ECT treatments, I can only assume my depression was of the severe category. I never want to go back there. To me, schizophrenia was never as bad as depression. But I’ve found the right medications for me right now. I make sure I don’t miss them because I know I’ll feel awful if I do. I wish now I could deal with the anxiety, but I probably need to go back into therapy for that.
This is a very interesting topic to me, since I have been on antidepressants for over 20 years. I have tried stopping them once but could only make it a couple of months before the return of severe symptoms. My latest attempt was this fall, when I tried decreasing the dosage to the minimum, despite my doctor’s concern that maybe it wasn’t the best time of year to try that. That didn’t go so well, either. I try to reserve the highest dose for times of crisis and then sometimes I’ve had to add something else. I’ve talked about this issue with my doctor but he thinks my depression runs in the moderate to severe range so that the medications are probably helping. I do believe they help me be able to do some deeper work in therapy which I am hoping will get at some of the roots, but I also think some of this is biological. Sometimes it IS hard to figure out if the depression causes the brain changes or whether whatever causes the changes contributes to the depression. It certainly is complex. I also have PTSD, so it doesn’t take much to trigger the symptoms, anyway.
To some degree, I think I’ve come to a point of acceptance that this is what I’ll have to deal with for the rest of my life, but then another part of me can feel despair that maybe this is the best it’s going to get, which I don’t feel like “settling” for. I’ve tried a lot of alternative therapiest, as well, which have all helped in their own ways. And then I can get into the place of “beating myself up” for being no better than what I am, after all the time and energy I’ve spent on trying to heal, not to mention the money. I know I’m not alone in that, but it’s hard just the same. I keep looking for the things that give me hope, for the things that make me feel there is a God and for the places where maybe I can make a difference for someone else, whether a family member or a stranger because I’m thankful for the people who have made that difference for me.
John Folk-Williams says
Hi, Judy –
Your history with meds sounds much like mine, but I didn’t have much evidence for years that they were doing anything at all. I never even asked a doctor about stopping, probably because I imagined that I’d be even worse off without them. Sometimes I felt like a subject in a vast and uncontrolled experiment. Full recovery for me seemed to happen after I got rid of the major source of stress – professional work I wasn’t well suited to. I stayed with that for years and years after I should have quit. Maybe depressives are gluttons for punishment and self-torture. But I am completely grateful that you have applied yourself at making a difference to others. Your writing always does that. Thank you!
Hi John, drugs have saved my partner’s life several times. I am in favour of them. It is just that the bio-medical model is so limited – reducing people and their experience to a bunch of chemicals.
I have yet to find a medicine that I can take. I feel like I want to kill myself all of the time and that i am hanging on by my fingernails. I keep asking for help but there isn’t any. I cannot find a counselor to help me either. Are you at all aware of a legitimate online support group? I do not leave the house anymore. If I didn’t think I would burn in hell I would be done with it right now.
John Folk-Williams says
I hope you’ll reach out for help without delay. Suicide hotlines like the National Suicide Prevention Lifeline (Phone: 800.273.8255) really work and may also help you find online resources. Here’s an extensive list of hotlines by state at Suicide.Org. There are also online support groups. One is SuicideForum.com. A great place to start is at the Depression and Bipolar Support Alliance (DBSA) – they’re the foremost sponsor of both online and face-to-face groups around the country. Here’s their guideline page for online support.
Janet Singer says
Excellent article. My son took anti-depressants to help him battle obsessive compulsive disorder. He had a severe case and I remember thinking, “If he’s this bad off with medication, I hate to think how he would be without it.” Well, long story short, he recovered from severe OCD..once he was off the medication. It did him more harm than good. He hasn’t taken any meds for three years and his OCD is classified as mild. As your article suggests, I’m guessing his story is not so unusual. Thanks for bringing this issue to the forefront.
John Folk-Williams says
Hi, Janet –
I’ve heard about many recoveries that happened after ending medication. It’s terrible to think that they could cause more harm than good. There are many cases of multiple prescriptions designed to cover all possibilities that later turn out to be destructive – and far too many misdiagnoses. The worst, however, would be if the “gold standard” drug for a correctly diagnosed condition turned out to worsen the illness. From the reading I’ve done, that seems to happen when meds are continued indefinitely, even without evidence of what the long-term effect of the medication might be. As Insel points out in his article, it’s a rare study that looks as far as a year into the course of treatment, let alone the 5, 10 or 20 years that people may take a particular drug. Aside from the drugs themselves, I find it hard to imagine a really thorough recovery without a therapy component that helps you learn how to change how you live, think, feel, interpret everyday experience.
I worry about the impact of this article, but I don’t know the readership. The problem with self-assessment is that I may not be satisfied with how much the medication helps, but I forget the pre-medication suicidal despair. These are not “stories.” There is too much medical history indicating that going off of the medication might bring back that horrid despair, AND worse, that for some reason, going back on the medication is not effective. The Psychologists know about these “stories,” so I think we should trust them.
John Folk-Williams says
Hi, Carl –
I understand your concern about the danger of getting off medication for the wrong reasons and falling back into suicidal depression. That’s why I mentioned the danger of fooling yourself into stopping and advised planning carefully with a doctor. During the three-year period of self-observation in my case, I was seeing a psychiatrist regularly and frequently discussed the idea of stopping the medication. I didn’t – and wouldn’t advise anyone – to rely completely on self-assessment. Also, I hope you understand that I never use the word “stories” disparagingly. I only wish that researchers and other physicians were not so quick to dismiss stories people tell about their suffering as “mere” subjective impressions.
I disagree that the research conclusions about going off medications are definitive. The research itself on depression recurrence is not the issue – yes, it’s a real danger, but the conclusion that antidepressants should therefore be continued indefinitely is not. S. Nassir Ghaemi, a psychiatrist who wrote an authoritative guide on the treatment of mood disorders, directly challenges that conclusion and suggests that the evidence could just as easily support the opposite conclusion – that antidepressants should be used for shorter periods of time. And the article I refer to by Thomas Insel, one of the foremost psychiatric researchers in the country, is clear about the limitations of what we do and do not know about antidepressants and depression itself. One of the research conclusions that has to be respected – and I’m surprised it’s a relatively recent one – is that antidepressants are most effective for people with severe depression and should definitely be used, especially if there are suicidal tendencies. Self-assessment could be catastrophic.
Thank you for your reply. I didn’t mean to come off critical of the article. I was reading it from the basis of my own fears. My impression from the studies is that they show us that we know very little about treatment, either pharmacological or therapeutic, so sometimes it almost seems to me as if I am seeing a witch doctor and I think my doctor would laugh at me in some agreement, but without that therapy, I’d be toast. Your thorough study of the topic warrants careful and thorough respect.
John Folk-Williams says
Hi, Carl –
Critical is fine. The concern about how a post like this might affect readers is one I’m a little touchy about. Too often, the writing on this subject goes to extremes, and you get slammed if you’re not following either a pro or con medication party line. So sometimes I over-react – sorry if I came across that way. You’re right about treatment – witch doctor or crap shoot, even the top psychiatrists admit finding a medication that works at all is arbitrary.
This is a timely article as my anxiety medication was just changed this week, and though I expected severe withdrawal issues, they have been pretty minor. I was diagnosed with PTSD four years ago when my marriage started its freefall into divorce. I was severely depressed, I basically experienced a mental breakdown. My doctor tried anti-anxiety drugs first to see if that would help stabilize the symptoms that had presented, but they weren’t working. He finally realized I was depressed and prescribed first one medication then a different one. The second one worked pretty well — once I got through the initial sleepiness side-effect (ugh!).
Because I have other health issues that do not allow me to take many of the medications for depression, I can only take SSRIs. The experience I had with that was not a good one and I ended up with a case of serotonin syndrome and was immediately removed from the drug. After two months of withdrawal migraines, the depression and anxiety came back and the doctor prescribed various medications, most of which did not work well — except Xanax. I’ve been on it for three years; however, one of my personal goals this year is to get off medications and treat the effects of PTSD (which I will have to deal with forever, unfortunately) with talk therapy and yoga. Generally, doctors don’t like to prescribe Xanax for long-term treatment because of the addictive nature of the drug and the fact that it doesn’t act as a good long-term mood stabilizer. Obviously, it wasn’t working for me, and though I didn’t “require” more and more of the medication to treat the anxiety, my mood swings were pretty severe.
I am now on another longer acting medication that seems to work pretty well. I haven’t taken Xanax in three days (yay!). Though I’m still not sleeping well, I have found that my moods are more stable, and that is a huge relief to me. Will I continue to take it? I hope I won’t have to, but for now this is my life. I’ll give it a few months to see how it goes.
John Folk-Williams says
Hi, Lisa –
I’m sorry to hear about your severe reactions to some of the medications – and that you’ve only found out about them the hard way. Even for those of us who don’t have that problem, it can take years of trying one med after another to get to one that works – and remains effective over the long-term. I can understand your personal goal of treating your PTSD without medications, but sometimes they are necessary to keep extreme symptoms from interfering with psychotherapy. Jonathan Shay, who has specialized in treating combat-related PTSD, makes this point in his book, Odysseus in America. If the worst symptoms – like extreme anxiety – are not brought under control, with meds if need be, it’s impossible to focus on the therapy as deeply as you have to. A physical therapist made that point to me once when I was recovering from hip surgery. You can’t do the exercises if you’re in pain, so take the pain meds before the session starts. I just mention this because of my tendency to beat myself up if I fail to meet a goal I’ve settled on, even if the goal is unrealistic. Sorry if that’s an unnecessary warning in your case.
I would be interested to know the name of the longer acting medication you mention as working well. Thanks for this comment.
“Evidence Based Medicine” is just the bio-medical model re-badged: it has not addressed any of the many and profound problems with this model. I get impatient and angry about this.
Congratulations on getting off the drug. And good luck with coming off the next one.
John Folk-Williams says
Thanks, Evan –
I try to be balanced about the biological approach since it has saved many people from suicide. But I don’t have much use for the pharma companies, their propaganda ads and their method of repackaging slight variations of drugs to retain patents. And every time I see the sixty plus drug company affiliations of the most prominent psychiatrist researchers, I have to ask – who are you kidding?