Do antidepressants work?

[sKePTiKal]

Hi SL!

The two sibs together go through about $30k a year of prescription chemicals.  I have to wonder if a program of cognitive or other "talk" therapy might have been more effective and much less expensive.

I'm glad you shared this. I always thought that the popularity of these drugs, was their cost-effectiveness. At my T's old rates (sans insurance) this amount would've bought over 2 years worth of hourly appts. (maybe that doesn't hold true in all cases, tho')... these days, everyone is looking for the most benefit from the least amount of cost, in health care.

Kinda touches on my philosophy-rant of "how to improve and contain costs of health care"... that being: low-tech, nutrition, exercise, meditation -- i.e., engage the patient in lifestyle changes (and provide the support needed to do that), and if no change -- only THEN, start to address the allopathic options. Those changes have a high failure rate if attempted solo -- without the emotional support element, whether that's one on one or a group.

And now, I start to wonder -- how many physical, medical problems have some emotional/psychological root-source?

[Hopalong]

You're welcome ((((TT)))). I am so glad you ain't feeling "broke."
Really neat that some of the info rings some chimes...

I am not overweight any more but still have apnea (though it's way better). It's just my throat/palette architecture. (Some desperate folks have surgery for that. Not me.) It's waaaaay better since I did lose, got down to my h.s. weight. (Partly ADD Rx, because they take the edge off appetite...and emotional eating isn't interesting any more. We won't mention the entire pint of Ben & Jerry's Cherry Garcia last week--must've been somebody else.) What's nice is that those cravings aren't daily any more. I think a lot of it is that I've added the green powder shakes and feel so much better than it's easy to keep the connection in my mind. So not as ahrd to (usually) be intentional about what I take in...feeling I urgently need to preserve my health, eat 95% seriously good for me stuff, not waste calories, etc.) Rambling...

Oh. Was going to say I dunno if I snore any more, since there's noone to tell me! Probably do. But my guess is that's way better too. When I was just 20 pounds heavier, I'd snore and gasp hard enough to wake myself.

What I was thinking about a sleep study (not that you need to worry about seeking out one...) wasn't for apnea for you, but because they'd record brain activity when you're in the weird struggle-to-be-fully-awake morning period.

Still, the best news is that you have (on your own!) actually figured out what sort of an Rx balance is effective for you. Don't worry about it pooping out...ain't inevitable.

You are some kind of impressive, TT. (I just research stuff like that since I used to do it professionally.)

love,
Hops

[SilverLining]

And now, I start to wonder -- how many physical, medical problems have some emotional/psychological root-source?

Hi PR.  I'd guess a lot.   My sister has a confirmed problem with "somatization disorder".  She is constantly going from Dr. to Dr. with complaints of various sorts.  They try to find physical causes and generally fail.  Even when they find a real physical problem and address it, something else pops up in short order.  So the usual answer is to send her on her way with a new pill.  I keep hoping she will finally get steered into some serious talk therapy, but it doesn't even seem an option anymore.  Even after she was finally diagnosed with SD, they just upped her drug dosages.   

I read somewhere that much of the basic medical research aimed at finding actual cures for diseases (mental or otherwise)is grinding to a halt for lack of funding.   Most of the interest now is in permanent conditions which can be profitably treated with drugs, such as acid reflux.     

[sKePTiKal]

SL... I'm kinda like your sister, in that much of my suffering - and also healing - affects my body in various ways. I think some of us turn so far inward... that it's our body which is our first boundary with the rest of the external world. Or something like that. The most beneficial thing I've found so far is getting signed up for and obligated to attend body work sessions... yoga, tai chi, something like that, that involves a new way of experiencing one's physical self... and boundary.

Wouldn't it be interesting, though, if there were treatment available that combined both mental/emotional therapies and physical, allopathic medicine? Chinese medicine is about the closest I've discovered so far... but even that is a bit weak on the therapy side. I wonder if there would be any significant decrease in the time of treatment to "recovery" with such a customized approach? Wishful thinking, I know... I guess I'm trying to invent something.

[SilverLining]

SL... I'm kinda like your sister, in that much of my suffering - and also healing - affects my body in various ways. I think some of us turn so far inward... that it's our body which is our first boundary with the rest of the external world. Or something like that. The most beneficial thing I've found so far is getting signed up for and obligated to attend body work sessions... yoga, tai chi, something like that, that involves a new way of experiencing one's physical self... and boundary.

That's how it's worked for me as well.  My AD program started when I went to a GP with a variety of physical complaints (fatigue, insomnia, and so forth).  At the time I was semi aware of my general "life dissatisfaction" but  hadn't really figured out the connection to my physical problems.  So maybe learning the connection was a positive outcome of the AD experience.  After that I really started trying to figure out my personal and family history, rather than just making frantic attempts to improve  external conditions. 

 

[Nonameanymore]

I once tried fluoxetine but I couldn't stand the spaced-out and drowsy feeling, so I didn't go through the whole therapy. My ex-fiance took them about the same time (history of taking antidepressants in his family) and I remember the first couple of days when he called me on the way to work to say that he felt really, really bad. A little later we broke up but he nevertheless shared that he had problems climaxing (sorry if this too graphic). I think he said that he couldn't 'feel' anything, maybe similar to what Dr. G. is talking about in his reply (numbness). My ex-sister in law was taking a cocktail of them as well and although she seemed 'happy', she was like a stepford-wife, the lights are on but nobody's home. We say in Greece that the eye of someone who is taking antidepressants resembles a fish that was caught 3 days ago: it forms a thick layer on the eye...
I have taken St. John's Wort for many years and it has worked, however when I tried to stop the worst withdrawal symptom was physical and not emotional, a lack of energy.
My layman opinion is that if one doesn't work on the underlying issue that caused depression in the first place, they won't get better even if they take them for the rest of their life. I feel that depression is a symptom. To me it's a good boost but only for a while. If one's life is a mess, it won't be sorted just by raising their serotonine levels...

I come from a family of suicides too (NM's side) and I am relieved to see that this is common. Not that I am happy about it ( ) but rather that I see that it goes hand in hand with N issues. My NM's brother did several attempts (once I found him and had to keep him alive until the ambulance came when I was 7 or 8 and I found out that he killed himself in 2007 after immigrating to America (I guess like me he thought that moving abroad will sort out his issues but they caught up with him at the end). Also many members in the family used suicide as manipulation means (let me do this, or do this or I will kill myself)

[BonesMS]

I once tried fluoxetine but I couldn't stand the spaced-out and drowsy feeling, so I didn't go through the whole therapy. My ex-fiance took them about the same time (history of taking antidepressants in his family) and I remember the first couple of days when he called me on the way to work to say that he felt really, really bad. A little later we broke up but he nevertheless shared that he had problems climaxing (sorry if this too graphic). I think he said that he couldn't 'feel' anything, maybe similar to what Dr. G. is talking about in his reply (numbness). My ex-sister in law was taking a cocktail of them as well and although she seemed 'happy', she was like a stepford-wife, the lights are on but nobody's home. We say in Greece that the eye of someone who is taking antidepressants resembles a fish that was caught 3 days ago: it forms a thick layer on the eye...
I have taken St. John's Wort for many years and it has worked, however when I tried to stop the worst withdrawal symptom was physical and not emotional, a lack of energy.
My layman opinion is that if one doesn't work on the underlying issue that caused depression in the first place, they won't get better even if they take them for the rest of their life. I feel that depression is a symptom. To me it's a good boost but only for a while. If one's life is a mess, it won't be sorted just by raising their serotonine levels...

I come from a family of suicides too (NM's side) and I am relieved to see that this is common. Not that I am happy about it ( ) but rather that I see that it goes hand in hand with N issues. My NM's brother did several attempts (once I found him and had to keep him alive until the ambulance came when I was 7 or 8 and I found out that he killed himself in 2007 after immigrating to America (I guess like me he thought that moving abroad will sort out his issues but they caught up with him at the end). Also many members in the family used suicide as manipulation means (let me do this, or do this or I will kill myself)

You're absolutely right that if the root cause of depression is not addressed and dealt with, the "happy pill" is NOT going to fix it!  I've tried telling that to the last therapist I saw and he wasn't interested in hearing it.  His main attitude was:  "Why can't you get over the past?  Here, take this pill and get a man too!  That should solve A-L-L your problems!"  (What planet was that therapist living on?????????)

Bones

[Nonameanymore]

Right on Bones! Lately more and more I believe that taking ANY pill is not going to solve the problem. Pain is here to show you that something isn't right in your body and you should check it.

Yes, I am familiar with the 'why can't you get over the past'. It usually comes from 'textbook knowledge only' therapists....

Talking about the 'get a man', I was also told by the psychiatrist who gave me the fluoxetine that even if I didn't feel like being intimate with my ex-fiance, it didn't mean a thing and that I should remember the song 'Yes, I am great pretender', as if saying 'no, we shouldn't look at why you don't want to have sex but that you should force yourself to do it anyway'. Jeez, I had completely forgotten about this one!

[sKePTiKal]

I feel that depression is a symptom.

I agree with this, wholeheartedly. For some types of depression (definitely not all*), it's best not to avoid those feelings - with all those useless coping strategies - it's way better to trace it all back and pull out the splinter that got infected so that the depression can heal on it's own. But our society sees something "wrong" if a person isn't happy, social, engaged with others, 24/7... the idea of balance with solitude, self-reflection, etc just isn't all that fashionable right now. So that becomes an additional burden or stigma for the person trying to heal. I just don't think MDs get enough training to diagnose what kind of depression they're dealing with, in a 15 min conversation with a patient. They want to help; don't know how or have the time; so of course they reach for a pill -- an emotional "antibiotic miracle drug" -- the anti-Ds.  "Take two of these and call me in the morning".

*For the majority of self-reported depression... which is most often a normal human response to temporary life difficulties that simply don't feel that temporary or outside of one's self.

[SilverLining]

I come from a family of suicides too (NM's side) and I am relieved to see that this is common. Not that I am happy about it ( ) but rather that I see that it goes hand in hand with N issues. My NM's brother did several attempts (once I found him and had to keep him alive until the ambulance came when I was 7 or 8 and I found out that he killed himself in 2007 after immigrating to America (I guess like me he thought that moving abroad will sort out his issues but they caught up with him at the end). Also many members in the family used suicide as manipulation means (let me do this, or do this or I will kill myself)

Hi  H.  Suicide definitely goes along with N issues.  I haven't gotten into this aspect of my FOO history on the board, but there have been numerous suicide attempts, the latest being two by my sister in the last five years.   Maybe her underlying N problems were the ultimate cause, but I believe the chemical treatment was at least a contributing factor.  She was trying to withdraw from Cymbalta when she made these attempts.  There are 1000's of comments on the internet about problems with Cymbalta, especially for those trying to quit.  

So after her suicide attempts  the response of the medical system was to up her dosages and add more drugs.   Not that I can blame "the system" because she is certainly an Nish hypochondriac and difficult to deal with.   I only hope that she finally learns enough from experience to get out of this trap somehow.  I have to wonder if she would have been better off if talk therapy was the only choice 25 years ago when the whole thing started.  Now she's pushing 50 and still looking for the easy chemical answer.  

[Nonameanymore]

Sorry to hear about your sister SL.

I don't really know much on the subject but uncle A who only threaten to kill himself was not an N, and uncle B who actually succeeded had a lot of N issues. And I mean a lot.

I sincerely hope your sis gets better somehow.
Can you not persuade her to seek talk therapy or some other form of help to deal with the withdrawal problems?

(This is from wikipedia: (I didn't know Cymbalta, but now I do...)
A suicide of 19-year-old Traci Johnson, a healthy volunteer in a duloxetine clinical pharmacology study, was highly publicized. For about a month she had been given high doses of duloxetine, and then she was switched to placebo. Four days after the switch, she hung herself in the bathroom of Lilly Laboratory for Clinical Research.[64][65] The New York Times article mentioned a withdrawal syndrome as a possible reason for this suicide)

[SilverLining]

I sincerely hope your sis gets better somehow.
Can you not persuade her to seek talk therapy or some other form of help to deal with the withdrawal problems?

Thanks H.  Like most everything with my FOO, it's a mess.  Withdrawal from AD's is complicated by her hypochondriacal tendencies.  Any discomfort drives her to seek an instant medical solution, which means she needs a drug to get her through the withdrawal from drugs.   And there is little help from the medical establishment, which barely acknowledges the possibility of problems caused by quitting AD's (withdrawal symptoms come from messy illegal street drugs, not the high tech products of the pharma industry).   Some medical professionals have suggested talk therapy for her, but none has(to my knowledge) ever even hinted of any possible downside to the chemical program. 

On the positive side,  she seems to be fairly stable lately, and the weird events with my mother in the last year have jolted the sibs into some discussion of the family issues.  So maybe this will be the start of some real brain "rewiring".

[Nonameanymore]

Sincerely wishing you a speedy 'rewiring' SL! 

[BonesMS]

Right on Bones! Lately more and more I believe that taking ANY pill is not going to solve the problem. Pain is here to show you that something isn't right in your body and you should check it.

Yes, I am familiar with the 'why can't you get over the past'. It usually comes from 'textbook knowledge only' therapists....

Talking about the 'get a man', I was also told by the psychiatrist who gave me the fluoxetine that even if I didn't feel like being intimate with my ex-fiance, it didn't mean a thing and that I should remember the song 'Yes, I am great pretender', as if saying 'no, we shouldn't look at why you don't want to have sex but that you should force yourself to do it anyway'. Jeez, I had completely forgotten about this one!

Thanks!

Made me think that these "textbook knowledge-only therapists" are complete IDIOTS!!!!   

Bones

[Meh]

Honestly I think a big part of my anxiety or depression in life has been essentially not knowing "where do I belong, where do I fit in, where is my home, who are my people, who do I belong to, where is my constellation that gravitationally holds my life together, maybe belonging and identity issues had a lot to do with the depression...and fear of the worst.

I hate to think that I have not experienced the worst yet, but I'm experiencing things I never thought I would ever so I guess I'm living out some of my fears and I wonder if that experience negates some of the depression.....I don't know.


Once I started getting the pills the only things doctors ever considered was increasing my dosages.

I don't take them now and even though I am very troubled in my life I don't feel that at this point they would enhance my wellbeing enough to justify putting the strange substance into my body any longer. I don't care if I get fewer tasks done. I get a few essential things done. Not every person is an energizer bunny...and why the heck should a person have to be?

There is a coffee sign that says "Do more stupid things faster". 

Maybe this is depression speaking but for God's sake A LOT of what goes on in life, in the human world is STUPID.

Tremendously important stupid stuff that MUST get done or else.