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Mar 27 2014

On Being on Anti-Depressants Indefinitely, Very Likely for the Rest of My Life

So I have to rethink some things. Specifically, I have to rethink some things about mental illness and me.

As regular readers may already know, I had a recent bout with depression, starting in late 2012 when my father died and I was diagnosed with cancer. It wasn’t my first time at the rodeo: I’ve had two or three other fairly serious depressive episodes in my life. But I’m not someone for whom depression is a staple of my everyday life. My depressive episodes haven’t been trivial, but they’ve been intermittent. If I added up the months that I’ve been depressed, I’d put it at about 10% of my adult life.

And until recently, I thought of myself as a basically mentally healthy person, with something of a vulnerability to situational depression.

But apparently, I have to re-think that.

Wellbutrin_SR_tablets_150mgIn my last couple of sessions with my psychiatrist (I’m seeing a therapist weekly for talk therapy, and a psychiatrist every few months to talk about meds), now that I’m feeling better, we’ve started talking about my long-term care plan, and my future with meds. I’d been assuming that we’d eventually taper me off the anti-depressant meds, and that we’d just be discussing the when and how of that. But apparently, not so much.

Apparently, if someone’s had three or more serious depressive episodes in their life, the current standard of care (as my psychiatrist understands and interprets them, anyway) is for them to stay on anti-depressants. If someone has had three or more serious depressive episodes, the chances are very high that they’re going to have another one — and when that happens, it’s better, for a zillion reasons, to already be on medication. So the current standard of care is to stay on anti-depressants. Indefinitely. Forever.

Whoah.

I don’t mind being on the meds per se. Especially now that we’ve dialed down my dosage. I’m on Wellbutrin, if you’re curious, and the side effects for me are pretty minimal: I’m a little jumpier than usual, my attention span is a little spazzier, and my alcohol tolerance is lower (I can only have one drink per evening, one and a half tops). Big whoop. When I hear about other people’s side effects with their anti-depressants, I thank every non-existent god there is that I got off so lucky. The meds are fine. And I can absolutely see the reasoning behind staying on them. This is not a care plan that’s been foisted on me in any way: my doctor suggested it, but we discussed the pros and cons, and he made it clear that it was my choice. We decided on this plan together, and I’m completely in agreement about it.

But I’m definitely unsettled by it.

I’m unsettled because I now have to shift the way I see myself: from “basically mentally healthy person with something of a vulnerability to situational depression,” to “person with chronic depression who is going to be on medication for it for life.”

Some of that unsettlement is the stigma, for sure. There is a stigma attached to mental illness and the people who have it. As I wrote before when I first started on anti-depressants: Once I started taking actual psych meds for depression, it felt like I’ll have “Mentally Ill” stamped on me forever. That’s even more true if I’m taking those meds forever. But honestly, I’ve dealt with so many stigmas in my life, one more hardly seems worth worrying about. Given the stigmas against being queer, being bisexual, being kinky, being poly, being an atheist, and more — having a diagnosis of chronic depression, and being on meds for it, doesn’t add that much to the pile. I’m okay with that.

Smiley faceI think most of my unsettlement is the significant shift in how I see myself. I’ve always seen myself as a basically upbeat, optimistic, happy person: seeing the bright side, finding silver linings in clouds, putting the most generous interpretation I can on people’s behavior until I’m absolutely proven wrong, hoping for the best until it’s certain that those hopes have been dashed. Sometimes annoyingly so: I have a tendency towards reflexive Pollyanna optimism, and I’m not always good at commiserating or even just listening sympathetically without trying to find bright sides and solutions. And I’m awful to be around on election day. (“Prop 8 could still go down! The votes aren’t all counted yet! Don’t despair!”) But on the whole, seeing myself as a basically upbeat, optimistic, happy person… well, it makes me happy, and it works pretty well for me and those around me.

So now I’m trying to figure out how I can see myself as a basically upbeat, optimistic, happy person… who suffers from chronic depression, and who is going to be on medication for it for life. That almost seems like a contradiction in terms. I’m trying to find ways that it isn’t. (Maybe I could look at the meds as preventative, rather than as a treatment? Almost like a vaccine against depression?)

And I’m somewhat concerned about what seeing myself as someone with chronic depression is going to feel like: day to day, week to week, year to year. When I’m in the middle of a depressive episode, or when I’m coming out of a depressive episode and my mental health feels somewhat fragile, I make an extra-special effort to make time for mental health care — getting exercise, getting time outside, getting social time — even if I don’t really have time for it. Will I have to keep doing all of that forever? I mean, I like exercising and being outside and hanging out with my friends. But I also like staying inside for eighteen hours working and dicking around the house all by myself. I don’t want to have to give that up. Plus, when I’m in the middle of an episode or coming out of one, I do a lot of careful monitoring of my emotional state. “Is this a torpor that’s turning into a vicious circle, or am I just tired and needing to rest?” “Am I being anti-social and isolating myself, or do I just want to focus on my work for a day or two?” Do I now have to do that for the rest of my life? That seems seriously no fun.

In fact, it seems downright depressing. Seriously. I’m somewhat concerned that rigorous monitoring of my mental and emotional state, and constantly asking myself, “Am I depressed now? How about now? Okay, now?,” could itself contribute to my depression. And I’m somewhat concerned that simply seeing myself as someone with chronic depression might, in and of itself, be somewhat… well, depressing. Obviously, knowing the early warning signs of depression and knowing how to take action on them is a whole lot better, a whole lot less likely to result in a bad episode, then not knowing. I just need to find a way to do that — not just temporarily, not just while I’m in an episode or emerging from one, but as a permanent fixture of my life — that doesn’t result in hyper self-consciousness, hyper self-monitoring, and a re-assessment of my basic identity and character that is, in and of itself, depressing.

Of course I’m going to accept this reality. That’s what I do. Whenever I hear religious believer tell atheists, “You can just choose to believe in God,” I literally have no idea what they mean by that. I don’t understand how you could choose to not know something once you know it. So now that I know this truth, now that I know that I am someone with chronic depression, I can’t un-know it. Even if I wanted to. Which I don’t. And not taking the meds wouldn’t make that make this reality go away. In fact, it would make it a whole lot worse. I get that. I’m not questioning this decision. I’m just looking for ways to come to terms with it.

Thoughts? If you, yourself, experience chronic depression, how do you manage that? How (if at all) do you keep an eye on it without a constant self-conscious self-monitoring that is, in and of itself, anxious and depressing? And how do you accept yourself as a depressed person without it… well, being depressing?

Wellbutrin_SR_tablets_150mg image by SergeSF, licensed under Creative Commons, found at Wikimedia Commons.

51 comments

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  1. 1
    UnknownEric the Apostate

    Both my wife and I have chronic depression issues, so it helps us to sort of keep an eye on each other, rather than ourselves. That way, we don’t focus on our own anxieties and we can (hopefully) catch the other person before it gets worse.

    And, honestly, accepting my chronic depression and general anxiety has really sort of helped deal with both. I choose to see it as sort of an invasive force that I can fight against rather than as, “Well, I guess I’m just Eeyore.”

    I hope that made sense!

  2. 2
    kaboobie

    I’ve been on antidepressants for close to half my life at this point. I think of my natrual (unmedicated) state as the opposite of wearing rose-colored glasses. I’m more likely to give a negative interpretation to events. Medication removes that filter so I can see clearly.

    I also think of it as “raising the baseline”. When I wasn’t on medication, I could experience very severe lows which made it difficult for me to function. Due to my brain chemistry, my natural baseline just isn’t high enough to weather such lows.

    Though I can still experience major depressive episodes (and did as recently as three years ago, when things really started going downhill at the job I had at the time), the low isn’t as low because I’m starting from a higher baseline. That gives me the clarity I need to recognize what is happening and seek extra help, which is usually going back into talk therapy for a period of time.

  3. 3
    Infophile

    (Maybe I could look at the meds as preventative, rather than as a treatment? Almost like a vaccine against depression?)

    For now, that might be the best. Particularly as it sounds like it’s basically true with you – most of the time, you’re fine, and you’re just taking these so that if things do turn bad, they won’t turn suicidally bad. Of course, saying you want to think of it that way and actually doing so are different matters.

    I do have chronic depression myself, and I’ve had it for as long as I can remember, so my experience is a lot different from yours. I haven’t spent my life building up my self-image as being a “happy” person – quite the opposite. From that angle, my experiences and coping strategies will be a lot different from yours, but I’ll go over them briefly just in case it helps:

    -Most of the time, I simply don’t think about it. The medication works for me 99% of the time, and it’s only when something else comes along to push me over the edge that it gets to be an issue. So on the whole, I’m not a depressed person, just a person with a few depressive episodes.
    -When the episodes do come about, distraction is more important than anything else. The human brain is quirky, and it’s actually possible to trick it into forgetting about depression by trying to solve puzzles. They seem to take up the same parts of the brain, so it’s possible to push depression out of the way.
    -If that doesn’t work (it’s something that you don’t want to push out of the way, a legitimate reason to be depressed that needs to be dealt with), then at least find the right time for it. Make sure to talk with others and keep connected, to avoid slipping into a suicidal thought process (thinking about how my death would impact others is by far the best way to keep myself from considering suicide, no matter how depressed I get).

  4. 4
    moarscienceplz

    Greta, I have been fortunate to be free of serious depression ( knock wood), but I have arrived at an age where I know I can’t take health as a given. I am on daily blood pressure meds, probably for the rest of my life, and now exercise has gone from “well, it’s a good idea” to “do it, or die soon”. Everybody has some kind of medical issue, sooner or later. You are lucky in that yours can be controlled with just pills.

  5. 5
    ee2eyepi

    I am old so I have some false teeth. I also wear glasses. I have hearing aids. And I take SSRIs. O.k. so my therapist says I am not so much ‘depressed’ as ‘unhappy’ for very good reasons. The SSRIs (which I am happy to say my body tolerates very well) make life good. Why would I feel troubled by this? I need help and I got help. Dr. Panglos was wrong, this is not the best of all possible lives in the best of all possible worlds but still life is sweet.
    You write a lot of very good sense which helps a lot of us by your just putting it in the public domain. Please carry on and get as much benefit from the pills as you would from any other medical aid.

  6. 6
    Sarah

    It is a pain to take medication for anything, really. I don’t have any hang-ups about have a “mental” illness versus any other chronic condition- the stigma originates in others’ ignorance. The brain is an organ, and if you had diabetes, I think you’d be just as bummed out that you have a chronic condition which requires medication and/or strict diet and being mindful of blood sugar levels. I’m 46 and was diagnosed in my 20′s.

    I have major depressive disorder. I also have hypertension and high cholesterol. I don’t see them as different. They all require chronic lifelong treatment. And it’s challenging, the depression, hard because I have “treatment resistant depression,” which means finding the right medications is matter of trial and error, and just so you know- anti-depressants can stop working for anyone, and you may have to play with finding another.

    It’s work. But I don’t think you need to look at yourself any differently than you have been. Be yourself. YOU are not your illness. ;)

  7. 7
    kompani

    It’s been 10+ years since I hit the big brick wall and found myself not being able to function or leave the house. For the first five years I fought against having to consume medication and cycled on and off them every six months. I attended talking therapy and psychotherapists plus one psychiatrist. It was a battle between ‘it’, ‘them’, the pills and me.

    Finally I was referred to a great psychotherapist who basically said ‘get used to it, you have depression and anxiety, there is every chance it won’t be cured’. She taught me how to live with depression and anxiety. How to relax and accept what I can and can’t do dependant on whether I’m up or down. Take my pills without feeling like a failure. Most important was learning and accepting that I am not a dayglow green alien with ‘mental’ tatooed across my forehead.

    There’s enough in the big wide world to fight without having to fight yourself as well.

  8. 8
    Greta Christina

    You are lucky in that yours can be controlled with just pills.

    moarscienceplz @ #4: Just to clarify: Mine can’t be controlled with just pills. I currently control it with pills, therapy, exercise, socializing, time outside, meditation, healthy eating, and more. The pills are an important part of the equation, but they’re just one part.

  9. 9
    hexidecima

    having a manic depressive husband on meds for life (Zyprexa and wellbutrin), we both think of it just like insulin for diabetes. The brain doesn’t work right, so you need to fix it.

    it is a pain that it screws up sex though. Sigh…..

  10. 10
    sprocket

    I’ve considered this option myself on many occasions. The thought of having to put up with the side effects, cost and the routine of having to take pills every day is itself somewhat debilitating. The problem with my depression, (and I’m sure others) is that it tends to creep up on me and I’m not always aware of it until a much later point.

    The other options don’t work as well for me and my ADHD makes it hard to manage sometimes.

    I think in the end, it would probably be a good idea to go on the meds again and I have a good doctor who is helpful. Unfortunately, mental health care here is expensive and hard to come by where I live so therapy is out of the question.

  11. 11
    Gregory in Seattle

    I was diagnosed with dysthemia (a chronic, low level depression) about 20 years ago, although I started on meds for it only five years ago (Wellbutrin as well, sustained release so I take only one pill a day in the morning. A few side-effects, but they’re manageable.)

    One thing to remember about depression: it is a biological condition, and taking meds for it is absolutely no different from taking meds for cholesterol or hypertension. As with any long-term medical condition, you will have good days and bad days, and as with any long-term medical condition, there will be a learning curve to climb as you develop the habits for good management. What I have found useful is to focus on “illness” rather than “mental.”

    And, recognize that you will have bad days. Dialog with yourself to see if maybe you are just tired/grumpy/frustrated/hungry/annoyed-with-the-whole-damned-world, and if it really is a bad day, do what you need to do. If that means building a fort with the sofa cushions and hiding away with a mug of tea and a book, so be it: taking care of your health isn’t always convenient, but it is always necessary.

  12. 12
    cycleninja

    Greta, you have a midwestern fan here who’s rooting for you. I know about these types of experience all too well, and I hope you have as few of them as possible.

    Take care.

  13. 13
    Emma

    I’ve been diagnosed with Major Depressive Disorder for about 4-5 years now (but I’ve probably had it since I was about 11 or 12 years old, with milder depression as a child before that). Depression has always been a fixture in my life—through early childhood, to adolescence, and now to young adulthood. I have never known life without it at this point.

    It doesn’t really get any easier. For me, I check and gauge how I’m feeling pretty much every day when I wake up. Generally, I’ve narrowed it down to a few telltale symptoms that show I’m on the cusp of having a really bad day/week/month/several months. Am I more tired? Less interested? Unable to enjoy things? Am I more irritable, more distracted? It might help to identify those telltale signs, whatever they might be for you personally. It really is a process of checking yourself, even just once or twice a day…it doesn’t have to be a big production, and if you’ve had a really good period for a significant length of time (whatever length of time that may be for you), you don’t have to check yourself as often, I’ve found. Of course, nobody should take this as professional advice on my part; this is just what has worked for me as someone with severe, chronic, life-halting depression….and I’m a young person, who has to accept that this is going to be my life forever.

    I’m 21, and I’ve had probably dozens of major episodes in my life, along with hundreds of smaller, less significant ones. I do not remember not being like this, so perhaps it is more difficult for you to accept, Greta, because you have more of a point of reference than I do. Acceptance is hard; it’s really, really hard. There’s no nice way to put it, and yes, it can in itself be depressing. It’s depressing for me because I’ll never know what “normal” or “okay” is like for neurotypical people. I’ve never known that, and their lives, in comparison, seem so much easier, because they can just get up and GO and DO THINGS, you know? Whereas my life involves a ton of planning that other people never have to think about. But I don’t have their lives. I have mine. I have to manage this illness as if it were any other, and sometimes, it’s so hard because there’s so little support available in comparison to many physical ailments. Pretty much, there’s no easy way to accept it. For me, I’ve just had to roll with the punches, because there’s nothing else to be done. Keep going to therapy, keep doing anything that helps and makes me feel less like I’m about to die, at my worst moments. Be kind to myself, be gentle with my own feelings, and don’t judge myself so harshly. Understand that this is out of my control, to some extent. Accept the things I can’t change, i.e. having a mood disorder and suffering from the symptoms of it. Plan ahead. Budget my time with safety nets so that if I don’t get something done, it’s not disastrous.

    Hopefully this might be even a tad helpful…it probably wasn’t, because I don’t really have any more concrete answers than you do, but maybe it helps to know you aren’t totally alone.

  14. 14
    rorschach

    Wow, Bupropion? I only know that as a nasty drug used as a smoking cessation aid. It’s rzarely used outside the US these days. Quite an old drug too, from the 60s, it was taken off the market for a while because it tended to cause seizures.

    My understanding is that no antidepressant is a life sentence, and things should always be rewieved after 3-5 years of treatment, regardless of the number of previous episodes.

  15. 15
    Alverant

    My mother has depression and has to take medication for it. I probably inherited it since I take St.John’s Wort to help stabilize my mood. I expect at some point I’ll have to “advance” to taking a medication for it. I hope not. I wonder if depression is worse for Atheists because believing you have a soul means you can say that your spirit is normal, it’s just your brain that’s the problem while Atheists believe we are our brain so taking medication is changing something about who we are. Maybe “changing” is the wrong word, I try to see it as “fixing” or “improving”.

    I think part of my problem is that since I’m not as social as other people I don’t know what’s really “normal”. Are any mood swings I have the same things other people experience or is it a problem? Are the stresses and frustrations I go through on a daily basis just part of life or is my life a “special” case or am I making things worse than they are and in fact I’m better off than most? I have no measuring stick to compare myself.

  16. 16
    bluebell

    Hi Greta,

    I just got diagnosed with a chronic disease (Ulerative Colitis, of Nerdfighter fame), and I’m going through a similar adjustment of self-image. It’s been strange to go from being in perfect health and answering “no” to all the questions at the doctor to taking 12 pills a day for the rest of my life. I realize there are some very important differences between dealing with mental health and physical health, especially when it comes to stigma and self-definition, but I think there are some parallels as well.

    What it came down to, for me, was learning to differentiate having a disease from having symptoms. When I tell people I have UC, it’s not the same as when I tell them I am currently Ulcering and need to chill for a second. Similarly, perhaps it would help for you to make a clearer distinction between “I have chronic depression” and “I am currently depressed.” One is a statement of medical vulnerability to certain symptoms; the other is a current state of being. Granted, it may be hard for others to make that distinction – stigma against mental health is the dumbest – but if I understand correctly, this is more about you and your self-understanding. In short, your baseline existence is not depressed; it is upbeat/optimistic/happy/however else you view yourself. Then you layer on top of that the things that are variable – risk of getting the flu, risk of breaking your leg, risk of depression.

    In this sense, the meds are indeed preventative, and I think that’s a great way to view it. I’m currently symptom-free, and when I take my ridiculous handful of pills I go, “Woot, another day without symptoms!” I totally get that for you, it’s not so direct a fix, and the risk is still an ever-present and scary thing. Even so, I think you can see the meds as restoring your base state, not defining it.

    Anyways, I hope that helps; and regardless I wish you the best of luck with everything! Hugs from the interwebs.

    tl;dr – “I’m upbeat and currently depressed” is a contradiction, but “I’m upbeat and suffer from depression” is not.

  17. 17
    John Horstman

    In my experience, a generally upbeat, looking-on-the-bright-side attitude is often a coping mechanism for depression: when (nearly) everything seems ultimately hopeless, finding those small bits of possible upsides can prevent utter despair and suicide. That’s the case for both me (type 2 bipolar) and my mom (major depression), so I actually don’t see a contradiction at all.

    I think almost everything is shit becasue it is: for example, my comfortable lower-middle-class lifestyle is built on both historical and present slave labor (presently in the manufacture of my clothing, electronics, much of my food, etc.), as well as environment-destroying fossil fuels. Everyone who DOESN’T constantly think about how nearly everything is awful is engaging in willful ignorance, simply refusing to think about or at least not actively trying to learn all the bad outcomes their actions cause. The typing, posting, and redistribution of this comment is dependent on deforestation in the Amazon basin, for another example. Knowing how awful things are trained me to look for small glimmers of hope as a matter of course, a way to deal with an abject reality even when I’m not experiencing a depressed episode. The same coping strategy simply helped also survive depression.

    In fact, it seems downright depressing. Seriously. I’m somewhat concerned that rigorous monitoring of my mental and emotional state, and constantly asking myself, “Am I depressed now? How about now? Okay, now?,” could itself contribute to my depression.

    In my experience, it very much can. If you find that you’re becoming hypervigilant with respect to your own psychiatric state, I’d advise consciously avoiding this and relying on friends/family to help monitor your mood instead of engaging in constant, active self-scrutiny.

    So now that I know this truth, now that I know that I am someone with chronic depression, I can’t un-know it.

    Perhaps it would be helpful to re-frame this in a non-essentialist way. You’re someone who has a constellation of symptoms that current psychiatric/psychological science classifies as “chronic depression”. The label is simply that: a convenient way to categorize an observed cluster of symptoms; we actually don’t know a whole hell of a lot about the electrochemical mechanics of mental illness (and almost no idea about the mechanism of action of antidepressants), and “depression” doesn’t describe a particular cause, underlying condition, or mental state at all, but a collection of observed symptoms that we definitively know can have different root causes. It might be helpful to describe (and think about) yourself not as someone who has depression but instead as someone who has been diagnosed with depression. Scientific medical models are easily some of the best we have for considering human health, but they are still abstracted models (so they are necessarily reductive, oversimplified, and otherwise flawed), and when it comes to mental health, they’re not even particularly good models (but still better than the demon model, for example), as they’re ALL based on essentializing contemporary cultural norms of behavior and prescribed social roles. I’ve had three different classifications for my symptoms – the same symptoms – so far, none of which have involved any medical testing. This alone should really dissuade any essentialist thinking about mental health models.

  18. 18
    Al Dente

    Welcome to the depressives’ group. I’ve been taking Paxil for years. It keeps me stable and functional (except in sexual terms). It’s a pain to be on lifetime medication but the alternative is definitely worse.

  19. 19
    Philip Hansen

    I have been seriously, maddeningly depressed following the most outrageous behaviour I have ever engaged in. I’ll spare both you and me the details, but suffice to say I had doubts I could ever consider myself fully, rightly human again. I have had recurring problems with anger through most of my fairly young (24) life. I don’t go into a blind rage every 4 days, sometimes it’s a year between outbursts. When the outbursts do come however, I am simultaneously delighted and scared fuckless. I am completely swallowed up in the sheer physicality of losing it, and when I manage to calm down again I am usually reduced to tears.
    I have been clinically depressed, but my problem is different from yours, yet similar in the way which seems central to you – how does one think of oneself? What should the self-image be?
    I assume you have people around you, who know how awesome you are, even when you can’t see that yourself, I know I have people around me who know that I understand how fucked up my behaviour gets, but also find the place to consider me more worthy of companionship than I feel I deserve at times. For me as a young person, I stopped thinking about the ways in which I was shitty and a hindrance to the people around me, and started looking for ways I could be better for the people around me. I decided for my sake that I was as good as I was going to be, and I was going to try and be as happy as I could be. Some days I forget this promise, some days I remember, most days I just get on with life.
    It’s not like finding out you’re chronically depressed means finding out you can no longer be awesome and enjoy things. It just means now you have a better understanding of why your skies are slightly grayer on some days. I hope I don’t come off as a patronizing know-it-all, I just found that my way out of the unhealthy-selfimage, was to come to terms with being fully functional just 80-90% of the time.

  20. 20
    moarscienceplz

    @#8 Greta

    I’m sorry, my comment seems to have a tone I didn’t intend. I just meant that I’m glad for you that you don’t have to have many injections, or surgery, or other really unpleasant medical interventions.

  21. 21
    badgersdaughter

    Greta, two things that worked for me (and kept me off meds last episode, but you must have the meds if you need them) were to recognize that depression is something my brain is doing to me, and to think of the pain as sort of a “toothache of the brain”. In the first case, I can speak to my brain and say, “Thank you for telling me there is something to be sad about, you can stop now because I need to handle things.” And in the second, I locate the pain as something bothersome for which I need to take care of myself, not a failure of morality of stamina or intelligence or any other failure for which I need to blame myself.

  22. 22
    Otto J

    I have a post on depression in my health blog. Here it is:

    http://amateur-attempt-at-preventive-health.blogspot.com/2013/12/depression.html

    Hope it helps.

    Otto

  23. 23
    tychabrahe

    I understand that the doctors use “chronic,” but try to think of it as “intermittent depression” instead. You are still, mostly, that happy-go-lucky, optimistic person that you think of yourself as. But sometimes, something just doesn’t work, and you get a depressive episode. Now, normally, with something like a migraine that is episodic, you can take medicine when you feel it coming on. The problem with depression is that when it’s coming on, you feel less like taking care of yourself, less like doing something as “strenuous” as making an appointment to see a doctor, less like getting out of the house for the appointment. So the solution is to be on the meds all the time, to head off the flare-up. In this it’s no different from taking drugs for herpes.

  24. 24
    Greta Christina

    Wow, Bupropion? I only know that as a nasty drug used as a smoking cessation aid. It’s rzarely used outside the US these days. Quite an old drug too, from the 60s, it was taken off the market for a while because it tended to cause seizures.

    rorschach @ #14: No, it still gets used. It’s one of the few anti-depressants that doesn’t cause sexual side effects, which is why I chose it. Seizures are a possible side effect, but that’s very rare.

    My understanding is that no antidepressant is a life sentence, and things should always be rewieved after 3-5 years of treatment, regardless of the number of previous episodes.

    That’s not what my psychiatrist says. If you have some medical citations showing that “three or four episodes of serious depression suggest that someone should stay on meds” is not the current standard of care, I’d be interested to see them — but in the absence of that, I need to trust my doctor.

  25. 25
    Hatchetfish

    The vaccine idea is similar to my attitude on my depression and anxiety: I correct chemical imbalances so as to avoid having depression and anxiety. I’m never upbeat and cheerful, it’s just not my personality but in simple terms, I take the medication so that I am not “a person with depression”. I think of myself as someone with chemical imbalances and a tendency to thinking patterns that can cause depression, but because I medicate for the imbalances and avoid the thinking patterns with behavioral changes, I am only rarely “a person with depression”.

  26. 26
    keelychaisson

    I had my first depressive episode at fourteen. Today, that seems almost impossible to me–14 year olds are BABIES. How could I have been depressed then? Even crazier, how could I have been really depressed and hidden it successfully from my parents? It seems impossible, like I’m dramatizing typical adolescent angst. But there doesn’t seem to be an alternate interpretation for my memories, or the hard evidence–dozens of hard-copy journal entries in which I wished for death.

    After my first episode ended, I conceptualized depression felt as an outside force that had invaded my life. I’d always been a little on the pensive, melancholy side, but the oppressive weight of the darkness of that time was something altogether new to me. This was made particularly easy by the suddenness with which that first episode lifted (a story for another time).

    But depression came for me again and again, and eventually it didn’t feel like an outside force anymore. It felt like a permanent companion, a demon lurking in the corner of my mind, always waiting to consume me. After a few episodes, I stopped having complete recoveries. I would have darker periods and easier ones, but I never felt fully safe or recovered. I was scared of my own brain, constantly monitoring myself for signs of an impending crash.

    When I finally saw my first psychiatrist (in college, at 19), he diagnosed me with both dysthymia (chronic, low-grade depression) AND classical major depression. Effectively, my baseline mood was unusually low, and on top of that I had episodes in which I fell much deeper into my own personal hell. When he first said this, I was surprised, but very quickly I realized that the edges of my “episodes” had become much fuzzier over time, and that he was right–I was never quite normal anymore. I couldn’t even remember what it felt like to not fear my capricious brain.

    I really can’t tell you whether my “dysthymia” is something I would have had anyway, or whether if was something my fear and obsessive self-monitoring created. When I first went on medication, I had hoped that it wouldn’t matter, that the meds would both raise my general level of happiness AND stop the episodes. They would fix me.

    That isn’t what happened. I still take medication every day, and I still get depressed. Like one of the above commenters, I now think of the meds as “raising my baseline”, so that when the crashes come, they are less severe. I am, in fact, happier in between episodes than I used to be, and I do seem to weather the storms better when they come.

    But I’m not even entirely confident about that conceptualization, because there are other big things that have changed in my life other than taking meds. For many of the worst years of my depression, I was in an abusive romantic relationship, was fighting often with my family, and was often starved for positive social interaction. I also have improved in my coping/”self-care” skills, through both years of trial and error and spending many hours in psychotherapy. Who is to say that those things aren’t what “raised the baseline”–in which case, since I still have episodes, are the meds doing anything at all? The episodes SEEM less severe, but is that just because, as a self-supporting adult with a real job, I can’t get away with becoming almost nonfunctional for weeks at a time like I did several times in college?

    It’s honestly hard to tell. I know that at the time I went on drugs, they helped. I also take Wellbutrin, and when I started it for the first time, my depression noticeably lifted within DAYS. Since that wasn’t the first drug I tried (I tried SSRIs first, which were AWFUL), it seems unlikely that the initial effect was simply a placebo.

    I’m not particularly convinced one way or the other about long-term effectiveness of antidepressants based upon the available scientific studies, and so I remain on them mostly because I don’t KNOW how much they are helping, and I don’t have many side effects, so going off them to find out seems like an unnecessary risk. And because the professionals I have consulted seem to consider it a good idea. So I take my meds and try to accept that I will always need them, just as I will always need to do yoga (exercise + meditation in one!), make sure I get appropriate levels of social contact, and actively monitor my stress levels, in order to push off episodes as long as possible, and get through them quickly when they come.

    I try to tell myself that EVERYONE should do these things–take care of their health, get plenty of exercise–and that it only seems weird because the norms in our culture around self-care and work-life balance and the importance of exercise and social support are all fucked. Which is all true, certainly…. but the fact remains that my body and mind seem more sensitive to the effects of unhealthy living than those of most people.

    And that SUCKS, it really does. I hate that many people my age can work 10-12 hour days and eat shit and party multiple nights a week and do fine where as I start to feel myself slide into darkness after skipping yoga for a little over a week because the day job was stressful and I had a stack of freelance work to power through. On the other hand, I also worry that by accepting that I have these needs, I am accepting a view of myself as weak and less-capable than other people, and that in fact, I am holding MYSELF back. Having to deal with all of this seems grossly unfair.

    But then, I know a lot of people who struggle with this to a much greater degree than me–people with more severe depression, or with chronic physical illnesses. I even have a friend my age with cancer, who is currently schlepping through months of brutal chemo. And from what I’ve seen, those people also struggle with when to push themselves and when they need to “accept their limitations”, they also rail against the unfairness of it all.

    So is there a unique aspect of chronic mental illness that makes it particularly hard to wrap your brain around? Sure. Not being able to trust your emotions is fundamentally different in some ways than more obviously physical ways your body can betray you. But mostly, it’s like anything else. We all are the sacks of meat that we happened to end up with, and they all have their quirks and special needs.You only get to live your own life, and despite not having all the answers you want, you just have to keep doing the best you can.

    I know none of that seems like much of an answer, but hell… I’ve been at the depression thing 11 years, and the medically-managed mental illness thing for 6. If I don’t have answers yet, I have to presume that, at the very least, they aren’t easy to come by.

  27. 27
    keelychaisson

    RE: buproprion/wellbutrin, it is used VERY commonly. The seizure side-effect was a problem at MUCH higher dosages. My Aunt was actually on it in the days before it was withdrawn from the market, and she had seizures, so she was TERRIFIED for me when she heard it had been prescribed for me. When I researched, I found that the STANDARD dosage when she took it was higher than what is considered the maximum allowable dosage now. It was withdrawn from the market after the initial seizure issues were recognized, and reintroduced with much lower dosage recommendations.

    In my experience, most of the modern Wellbutrin horror stories come from either people who took it for smoking cessation, or people who had extreme anxiety from taking it. The smoking cessation problem comes, I think, from the fact that it blocks your ability to experience any high from nicotine, so as soon as the drug is in your system, you have gone 100% cold-turkey. That, in combination with the side effects that sometimes happen when you first start Wellbutrin, seems to pitch some ex-smokers into severe depression, or other rather dire mental states. I don’t know the numbers on how common this actually is, but even just a few true stories of wellbutrin-induced mental illness in smokers is pretty terrifying, so I can see why the stories persist… I just wish they were presented with more context.

    As for the anxiety issue, the drug has a stimulant effect, and so a lot of people are jittery on it. That effect is usually most pronounced when you first start taking it, and generally subsides. I actually had pretty severe anxiety spikes when I first went on it (I didn’t sleep much for about a week), but I was so happy to have energy and motivation and the possibility of pleasure again that I stuck it out. If the drug doesn’t lift your depression in any way but does make you feel extremely anxious, I can see why that would be scary and why people would run. Also, in some (I think fairly small) percentage of people, the anxiety never subsides much, so they can’t stay on the drug even if it helps. I can only take a medium dosage without causing anxiety problems myself–twice I’ve had docs raise the dosage to try to help with a depressive episode, only to set off a week of panic attacks.

    All of that said, the VAST majority of Wellbutrin stories I’ve heard from years of talking to other depressives include none of these dramatic issues. Most often, I hear “It helped me [a lot or a little], so I kept taking it” or “Meh, it didn’t really help my depression, so my doctor tried something else.”

  28. 28
    fmcp

    Greta, I don’t usually comment here, so I’m a complete stranger to you – I hope it’s ok that I weigh in.

    I wanted to comment particularly on the fact that you’re struggling with the contrast between having a depressive disorder and considering yourself an upbeat person. I understand how that could shake your self image mightily, which is the last thing you need when you’re dealing so much else. I wonder if you could reframe it, though, in a way that shores up your self image instead: I’m also a very upbeat person with a mood disorder (Bipolar II, with a stronger tendency toward depression than hypomania). I found that the most useful way for me to think about it was to see my cheerfulness as essentially “me” and my depression as distinctly “other”. It helps me to remember that the depression doesn’t define me any more than the rheumatoid arthritis that I will also have to treat for the rest of my life. With both illnesses, I get irritated that I have to take pills every day and that I’ve made some minor lifestyle changes, but I’m symptom free 90% of my life. The illnesses are a huge part of my life experience, and as such they have molded me, but they don’t define me or take away my essential self.

    Also, as a by the way, I’ve read a lot about Wellbutrin, in case it ever has to be added to my current treatment plan; nothing is perfect, but it seems to be safe and effective. It’s also offered commonly here in Canada. Of course people have idiosyncratic reactions to any medications – I’m not on the same medication as my friend with BPII, but I’m also not on the same medication as my friend with RA.

  29. 29
    mildlymagnificent

    One thing that struck me was that you’re on a minimum, maintenance dose. Presumably that’s so that you can avoid the usual take-this-tablet-wait-six-weeks and then we’ll check whether it works at all and whether the dose is right.

    In your place, I’d see it as a mental health seatbelt.

    We always use our seatbelts to reduce and avoid injuries. We don’t know for any particular journey whether it’ll be needed at all, or just to restrain us when the car brakes or turns sharply, or to save our lives in a major accident. Your medication at this dosage is ensuring you don’t have major problems from minor incidents. And that if you do have a major “incident” the system is all primed ready to reduce the impact on you and make it easier for serious rescue and repair work without waiting the obligatory try this one now couple of months to see whether/ which, what/ which dosage will help you.

  30. 30
    Greta Christina

    Just want to say a quick “Thanks” to everyone who’s been participating in this conversation. It’s helping a lot. IN particular, I’m finding it useful to think of myself as having “chronic intermittent depression” or “chronic episodic depression” rather than simply “chronic depression.” And I really like many of the analogies presented here, especially the seatbelt one. And of course, the straight up “That sucks, it sucks for me too” empathy helps a lot.

    Okay, Carry on.

  31. 31
    njosprey

    I am a recovering alcoholic (sobriety date July 1984). Chronic depression is an ongoing problem for people like me with long-term sobriety. I am sure that it contributed to my abuse of alcohol for self-medication.

    About 15 years ago, a friend who was also a recovering alcoholic was discussing anti-depressants with me. He committed suicide before he was able to get treatment for his depression. This motivated me to seek medical assistance. Like you, I sought out a psychiatrist and continued therapy for adult children of alcoholics.

    I regard the anti-depressants that I take as a preventative. It keeps the lows from getting too low. It allows me to be a good parent and responsible spouse (40 years of marriage this coming October). I do not think less of myself because I take anti-depressants. Like the dialysis that I recently began, I think of it as one more thing that I have to do medically to continue to enjoy my life one day at a time.

  32. 32
    InfidelAvenger

    As someone who not only struggles with mental illness myself (I am an Avoidant Personality, and struggled with PTSD for a decade after a hostage incident), I support whatever you have to do in this battle.

  33. 33
    gecko

    I’ve had dysthymia with episodes of depression (“double depression”) since age 12~13 and it’s really hard. It took me a long time to accept that I even had depression – I lied my way out of the diagnosis until I was in a research study that involved an intensive psych interview (apparently it took my respect for science to end my denial, couldn’t give them false data in good conscious hahha.) But yeah, I haven’t yet found a medication that works for me and I’m still having trouble accepting that I will likely have chronic depression for the rest of my life. It would be one thing if I was always like this, but what gets me is that I can remember not being depressed, I know what that felt like, and it’s probably the depression but that just makes me feel so hopeless. I’m skeptical about the effectiveness and safety of antidepressants long-term, and I hate being on venlafaxine because I hate being physiologically dependent on it (withdrawal is particularly horrific). But I take the meds anyways because I need to feel like I’m doing something and given my history/etc. this isn’t something I can fix with therapy alone unfortunately. So I try to not think about it too much and keep optimistic about improvements in psych treatment. Thankfully I have a good support network, I know that’s super important for dealing with any mental health issue.

  34. 34
    Stephanie Zvan

    Count me among the people who find it very important to not monitor my mood too closely. I suffer from idiosyncratic short-term (few hours to few days) episodes of suicidal ideation and self-loathing. Comparing my current mental state to my “ill” mental state is too close to being in that bad state and can put me there. Like infophile, I use puzzles to distract myself as necessary, or sometimes research.

    Instead, I monitor externalities. Did my appetite change? Does a shower seem like too much work? Have I gone a few nights without being able to fall asleep at a reasonable hour? Am I keeping up with housework? Those kinds of things help me know when a bad spell is coming.

    The same tricks might work for you if you find monitoring your mood directly to be problematic. A bunch of people are currently swearing by the Habit RPG app for encouraging regular self-care. I’d think it would also be good for making you notice when you stop taking care of yourself for too long a stretch of days.

  35. 35
    rorschach

    Hi Greta, thanks for your reply, and can I also say that I’m not at all trying to give you medical advice here, that’s for you and your doctor, but if you don’t mind then I will relay my thoughts as part of the discussion.

    It’s one of the few anti-depressants that doesn’t cause sexual side effects

    There is also Mirtazepine, which is particularly useful if there is a substantial anxiety component.

    If you have some medical citations showing that “three or four episodes of serious depression suggest that someone should stay on meds” is not the current standard of care, I’d be interested to see them

    With that we have to understand that there are substantial differences in best practice or standard of care between countries and cultures, and that the US standards might be very different from those practiced and recommended here(in Australia) or for example in the UK or Germany.

    I’m a bit tired but I googled a couple of citations that at least do not fully endorse the obligatory lifelong treatment recommended by your specialist:

    Recurrent unipolar depression requires prolonged treatment

    Preventing Recurrent Depression: Long-Term Treatment for Major Depressive Disorder

  36. 36
    Dana Hunter

    Tell you what, this shit is hard. It’s hard to face the fact head-on that something’s not right, and never will be right, and you’ll have to maintain rather than cure. But I like to think of it as any other chronic problem: sucks, but as long as it can be mitigated, whatevs. If I was a diabetic, I’d be on insulin, and it wouldn’t destroy my sense of self. I wouldn’t distrust my body: the rest of it’s ticking over nicely. My brain generally works fine, but it’s got this one thing that goes wonky and will have to be monitored and medicated for life. I’d prefer to be that person who doesn’t have to worry about that shit, but it’s better to face up to facts than let it get so bad it kills me.

    I’m on Wellbutrin right now, and I’m about to get off. I’m one of those people whose depression got better for a while, only to unmask anxiety, which it loves to enhance. So much fun. But it’s working brilliantly in conjunction with an SSRI for a friend, so I know it’s good stuff. Like most things, it’s not for everyone. And I know the truth about psychiatric meds: sometimes, the stuff that worked stops working, and you have to fiddle around until you find the new happy medium. I’m glad I know that. I don’t despair when something’s not working as well as it was, because I knew it could happen and I was prepared.

    I will never ever go off medication. I saw what happened to my mother when she did, and I know that at this point in my life, I am no longer able to control the depression and anxiety by channeling it into other things until it improves. I’m now in the chronic phase. It’s almost comforting: I spent my life waiting for the shoe to drop. It has, and I can stop waiting and get on with living with the new reality, which isn’t the best ever but is far from what I feared.

    One thing I’ve realized: the depression and anxiety were always there. Always. But I was still an awesome person with them. It’s not like that person when away when I started getting treatment. I can be confident and take-charge and strong and calm in some instances still, even when something’s pushed two fingers into the panic and depression buttons and won’t let up. I just know that there are some areas in which I will not be able to cope without chemical assistance, and I happily accept it, so that I can get back to being the me I like and hopefully stay there a good majority of the time. It’s hard to think of myself as mentally ill. Just like, if I were a diabetic, I don’t think I’d be running around thinking I was constantly sick. It’s not really so much sickness as it’s a chronic condition that sometimes makes me sick. And that thought has made it much easier to cope. I’m not looking for permanent healing that way. I’m not thinking of myself as less for not getting better. You treat chronic conditions, you don’t necessarily cure them.

    Don’t know if all that does bupkis to help, but at least you know there’s one more in your boat. ;-)

  37. 37
    Greta Christina

    I’m not at all trying to give you medical advice here

    rorschach @ #35: Then don’t.

    My doctor and I discussed several options for meds, including Mirtazepine. I chose Wellbutrin based on a number of factors, mostly which side effects I was willing to tolerate. Mirtazepine has other side effects that I would have had a very hard time with. Wellbutrin was literally the only anti-depressant that had no side effects I couldn’t easily cope with. I was extremely lucky that it turned out to be both tolerable and effective for me. Please stop acting as if you know what’s best for me, better than me and my doctor.

    I’m a bit tired but I googled a couple of citations that at least do not fully endorse the obligatory lifelong treatment recommended by your specialist:

    First of all: I looked at your links, and they both back up my current treatment plan. Second of all: Please knock it off with the amateur online psychiatry. You might be interested in this follow-up post: “The drugs are hurting us more than they are helping us”: How Not to Talk to People With Mental Illness, Episode 563,304. It says most of what I want to say to you here.

  38. 38
    Greta Christina

    I’m sorry, my comment seems to have a tone I didn’t intend. I just meant that I’m glad for you that you don’t have to have many injections, or surgery, or other really unpleasant medical interventions.

    moarscienceplz @ #20: Not to worry. I really just wanted to clarify.

  39. 39
    rorschach

    Please stop acting as if you know what’s best for me

    Huh. Never meant to do that. Sorry if you saw it that way. Over and out.

  40. 40
    Greta Christina

    Reading over the comment thread, and realizing that my most recent response to rorschach was a little over the top. I did ask for citations to research. But seriously: Please, please, knock it off with the amateur psychiatry. I’m asking for advice on how to reframe my identity and self-image given my current medical plan. I am not asking for advice on re-tooling that plan.

  41. 41
    karmacat

    Another issue that comes up is when a patient is anxious about being on more than one medicine for depression. Or the person feels they are sicker if they are on more than one medicine or need a high dose. Being on more than one medicine means that we haven’t been smart enough to find a way to combine the medicines into one for that individual.
    A difficult issue with mental illness is that there is no test that diagnoses a mental issue. There is also no test for what medicine will work for that individual. So an individual can’t show the doubters concrete evidence that he or she has depression. I’m hoping that the more people talk about mental illness the less stigma there will be.
    As a side note, if someone is worried about seizures from bupropion, your doctor can check a level and adjust the dose accordingly

  42. 42
    Gregory in Seattle

    My pre-medication situation was feeling tired, angry and/or frustrated with daily life; falling into a spiral of increasing depression; then finding myself at the bottom of a deep well with only my bare hands to get me out of it. What the meds do for me is construct a barricade around that well: I still feel tired, angry and/or frustrated with daily life, and I still occasionally hit the spiral, but I don’t fall down the well.

    I’ve known a lot of people who refuse to stay on anti-depressants because they don’t want to feel tired, angry and/or frustrated. Popular medicine is that meds work by keeping us from feeling sick, and if we feel sick anyway then the meds “obviously” are no good. Advertising prescription drugs on television has only made the situation worse, as the commercials are designed to push a “Take this and feel great!” meme rather than the more truthful, “Take this and feel less shitty!”

  43. 43
    Zinnia Jones

    I’ve dealt with similar things over the past few months – being diagnosed with depression for the first time, and taking antidepressants. In a way, I’m almost grateful for the diagnosis. Before, I had assumed that this was a related effect of gender dysphoria – as dysphoria had made me feel like this before – and I’d just have to deal with it, because there’s not much else you can do about that. But it was really getting in the way of me just being happy and content and capable of basic things in everyday life, and I hated it. So it was a big step to recognize that this might actually be something else, but also a relief to know that a whole new world of options had opened up.

    I feel like my experiences with dysphoria actually helped me handle this better than I otherwise would have. By this time, I was already used to having to admit that I had a condition (and a highly stigmatized one) that required treatment, and I had accepted that I was going to be on life-long medication for this, and I took the step of trying medication because I knew it was necessary in my situation, even as I wasn’t entirely sure of how it might affect me.

    So, once the depression came along… well, I’ve come out to doctors about other big things, and I’m already taking 9+ pills a day. I’ve accepted that as something I’m willing to do in exchange for my life coming back to some degree of normalcy and capability. And it’s been such a good feeling to realize that, yes, this actually is working for me and things are starting to look up and my life doesn’t have to feel rough forever. There seems to be this widespread undercurrent of thought in society – my mom was especially bad about it – that needing medication, particularly for mental illness, is itself the problem. It’s a baffling attitude to me, because in my life, my medications have been nothing but a solution – and a pretty darn good one. But it is definitely something that took time to accept: that there’s a situation here, and that regardless of any ideals I may have held before, the situation still exists and needs to be dealt with.

  44. 44
    karmacat

    I tell patients that the medications don’t make one a happy, but hopefully put a floor on one’s depression so one doesn’t get so low. Mood naturally goes up and down. Most people have reasonable expectations of medications but there are a few who want a magic answer. But then it is hard to go through depression or other mental illnesses and I can understand that wish for a magic pill. People are reluctant to go to therapy and I think we need to do a better job of educating people about therapy.

  45. 45
    Carlos Cabanita

    Needing to wear glasses, tooth braces, take insulin, blood pressure medication, antidepressants, what’s the difference? Unless we want to get back to the time when there were no solutions for lots of medical problems. When I was a kid I was shamed for being fat and wearing thick glasses. Why would a person accept shame or a hurt in her self image for treating a mental condition?

  46. 46
    Jerome McDonough

    Adjusting to chronic *anything* is a bit of a downer. With each new autoimmune diagnosis I received (Sjogren’s Syndrome, rheumatoid arthritis, celiac disease, lupus), I also got the warning that all autoimmune patients get: ‘there’s no cure for condition, you’ll be on medication the rest of your life to mediate it, and you will almost certainly keep getting worse as time progresses. Oh, and by the way, stress will aggravate your condition, so try not to stress out about it.’ Thanks, doc. :)

    Autoimmune is obviously not the same thing as depression, but both require self-monitoring and self- care, and celiac requires a fair amount of behavior modification (try attempting to eat breakfast while traveling in this country and also avoiding gluten — it’s better than it used to be but it still sucks). Things that help me cope: 1. routinize the specific medical treatment aspects (e.g., medication) as much as humanly possible, to the point where you’re not even thinking about it anymore. The aim for me here is to try to make the disease management process vanish into my mental background so that swallowing another dose of plaquenil involves the same mental effort as swallowing a multivitamin and isn’t a twice daily reminder of “if I don’t take this I’ll flare and be in fucking agony for 3 weeks.” 2. Ditto exercise regime and other modifications to life style (e.g., diet). My impression is that you seem to have mastered this better than I have already, so no worries. 3. Enjoy what I’ve got and not dwell on what I don’t. I can’t drink beer anymore – you know, hard cider is darned tasty stuff, and so is Pine Ridge Syrah, and so is the occasional glass of Knob Creek. I can’t eat pizza in a restaurant anymore – you know, I make a gluten-free pizza with goat cheese, leeks and duck confit that would easily pass muster with any NYC pizza aficionado. Doing that also helps remind me that what I’m having to give up is a long-chain protein molecule, and not life as I know it. Not sure what the equivalent is for depression, but I think my mental strategy here is aimed at the recognition that while I do have to accommodate the disease, my accommodations basically aren’t that hard to deal with. And having reached a deep-seated realization that my accommodations to the disease are relatively minor and easily achievable (certainly compared to what some other autoimmune people deal with), well, being a permanent autoimmune patient is pretty manageable.

  47. 47
    roses are red

    I’ve been dealing with depression on and off for 25 years. Mostly seasonal (SAD), but sometimes not. Unfortunately, I haven’t yet found any drug that I would be willing to take indefinitely. I take Wellbutrin in the winter, in combination with 5-HTP, and I exercise, use a light box, etc. It’s not enough to feel good in the depths of winter, but it’s enough to keep me going.

    I could probably use some mood support year round, but I have enough unpleasant side effects with the Wellbutrin that I don’t want to take it all the time. It’s tolerable in a lesser-of-two-evils kind of way. SSRI’s are much worse for me in terms of side effects. I refuse to take them unless I totally can’t function otherwise.

    Greta, I’m glad you’ve found a drug that works for you. For me, I’m not willing to commit to taking any of the drugs currently on the market for the rest of my life. We need better depression drugs. Not just repackaged old drugs, which seems to be all the drug industry can give us.

  48. 48
    ArtK

    A little late to the table here, but cudos for taking the steps you need to, to keep healthy. I’ve been on anti-depressants for, wow, over 20 years. It took my psychiatrist nearly 5 years to get me to try them. I’ve tried going off a couple of times over the years, but haven’t been successful, so I’m on this for life. Although it was an adjustment to how I saw myself, after this long time, the anti-depressants aren’t any different to me than the meds I take to keep my BP in check or stave off incipient diabetes. My body has these issues and this is how to deal with them.

  49. 49
    Clarien Luttig

    Thank you for this post, and for some of the wonderful comments. I also especially like the “mental health seatbelt” analogy.

    I tend to think of so-called “chronic” depression as a tendency towards depression, or – if you will – that the “immune system” that’s supposed to guard against it is just a bit weaker than it might be. Thus, the anti-depressants are a bit like anti-depression-immunity-boosters. Sorry, that sounds very clumsy, but it makes more sense in my head.

    Wishing you strength in the adjustment.

  50. 50
    karellen

    The TEDx talk Depression, The Secret We Share by Andrew Solomon has a perspective which may resonate with you. One of the central messages is “The opposite of depression is not happiness, but vitality”.

    (via Russel Coker)

  51. 51
    inquiringlaurence

    As a teenager with depression and obsessive-compulsive disorder for several years now (I’d estimate about 3-5, depending on what standard of diagnosis), I also take medication. The first thing I usually do when another annoying episode comes up is to attempt to accept the fact that it has, and go from there. That way, I don’t get taken aback or have that “Again…?” attitude every time I have a negative episode in the natural cycle.

    The thought of taking medication and having depressive symptoms as well as OCD is a bit daunting, but even if it has to come down to that, I think I’ll be able to live with it.

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