I now count it as a major life error that I didn't tell someone to try Prozac five years earlier.
For some people it doesn't work.
For others you see miracle-level improvements within days.
Just try it and see what happens.
For others you see miracle-level improvements within days.
Where 'days' indicates 7 at the very least and 14 would still count as a 'rapid miracle level recovery'.
I've tried SSRIs while not depressed and noticed mind-altering effects and physical side-effects immediately. This idea that SSRIs don't do anything at all until several weeks in just isn't true, even though that's how it works for most clinically depressed people.
I've tried SSRIs while not depressed and noticed mind-altering effects and physical side-effects immediately. This idea that SSRIs don't do anything at all until several weeks in just isn't true, even though that's how it works for most clinically depressed people.
Who said anything about not doing anything? You'll notice the most side effects in the first week, including mind altering ones. The most potentially beneficial effects of those that occur immediately can be expected to be in reducing any obsessive negative thoughts. Rather it is the symptoms of depression that start to alter only over the longer time scale.
Generic Prozac costs me $4 a month. It has improved my mood greatly over the course of two months. I was afraid of side effects at first. Then, during one bad period, I remembered what exactly it was I was trying to cure and decided all the side effects that regularly come with and more are worth not going through that anymore. So is taking this stuff for the rest of my life.
SSRIs have varying levels of withdrawal symptoms (Prozac's is low, Paxil's high).One study on SSRIs shows that for many people they are not more effective than a placebo, but for the most depressed people they are extremely effective. If your girlfriend has sever chronic depression, there's a good chance the condition is genetic, and there's no very good way to fix that aside from medicine.
Dependence on a drug that is cheap, has few side effects, and can almost completely cure chronic depression is a very small price to pay for never feeling as worthless as depression can make you feel. I'm sure you can find many, many more such testimonials. If the side effects bother her, she can change drugs--there are a lot of alternatives.
Thank you. What convinced you to take the drug? And where can you inform yourself about the withdrawal symptoms and the effectiveness?
I'm not the parent poster, but chiming in for crazymeds.us. They'll tell you in detail about the withdrawal symptoms, side effect, half-lives, etc.
I've been on venlafaxine (Effexor) for a few years. If I miss my morning dose (rare), by 1600 I'll feel pretty wonky (e.g. dizzy when I move my head). My shrink says if I'm to go off of it I can titrate the dose down to something low, then go on Prozac concurrently, reduce the venlafaxine to zero then come off the Prozac.
But that's pretty much the worst of antidepressant dependence, and others are easier to stop taking (though you would likely still need to work your way down).
As others have pointed out, they don't make you artificially happy, they "clear the fog" of sadness. There's evidence for this - antidepressants have no "street" value as a drug of abuse.
I personally started (with both meds and therapy) upon realizing I needed help, after spending a weekend interested in neither food nor sex. The meds have made a huge difference (not least in employability). Therapy is also a big help, as I can realize what's going on before getting too far down a depressive spiral.
Advice in fighting depression?
Vigorous aerobic exercise, Cognitive Behavioral Therapy, antidepressants and nutrition (Omega 3 and a multivitamin) in approximately that order of expected effectiveness.
The SSRE tianeptine seems to be more tolerable than the more typical class, the SSRIs. If taking SSRIs be wary of venlafaxine and paxil - the withdrawal symptoms of those two are a nightmare. Of the SSRIs I recommend escitalopram as more effective and specific than Prozac without the side effects of the two previously mentioned.
She says she never want's to take antidepressants because she fears to get dependent from them. I
Who cares? The status quo sounds terrible, the risks are minimal and typical antidepressants are not addictive. The biggest problem with withdrawing from most antidepressants is that you often go back to the depressed state that you were in before you started. If (generic) you end up on antidepressants for your entire life and they work for you then great!
Who cares? The status quo sounds terrible, the risks are minimal and typical antidepressants are not addictive. The biggest problem with withdrawing from most antidepressants is that you often go back to the depressed state that you were in before you started. If (generic) you end up on antidepressants for your entire life and they work for you then great!
This exactly.
It's also approximately what I've been doing to manage my own happiness, with great success. I've been meaning to thank you for writing that article, by the way; it wasn't a sudden revelation from out of nowhere, but I've definitely become better at being happy by pondering what you wrote, and following through with it.
It's times like this I wish I could upvote more than once.
Thank you! I read it a while ago, but i couldn't recollect it properly and it doesn't come up within the first 5 sites of search results with "depression" as key word.
As someone who has struggled with severe depression for . . . hell, is it really twenty years already? . . . I have exactly one word of advice: Medicate.
I was suicidal, to the point of making quite efficient, detailed plans that I simply couldn't be bothered to actually implement. I was crying almost every day. I was unable to laugh. Now? Now I'm just a bit more melancholy than the average person.
I'm not exactly sure what she means by "dependent", but they are not addictive, they are not uppers, they are not "happy pills". They are, purely and simply, anti-depression.
By the way, reactions can be idiosyncratic. My doc tried me on a half-dozen antidepressants before they found one (actually, a pair, Luvox and Trazodone) that actually worked. (Well, Prozac worked, and very quickly, but also gave me hives. I actually argued with my doctor that the hives were worth it; she said the allergic symptoms could get worse and kill me.)
I have exactly one word of advice: Medicate.
I was suicidal, to the point of making quite efficient, detailed plans that I simply couldn't be bothered to actually implement.
A couple of more words... the early stages of medication are actually associated with increased suicide risk. You allude to the reason here. If functionality is increased to the level of actually being able to execute plans before the 'wanting to actually live' catches up then bad things are more likely to happen. This is where therapy becomes critical.
As others have said, SSRIs really help. And it may help to say - it's not a happy-pill. A lot of non-depressed people seem to think it's something you take that makes you happy. If you're feeling down they'll ask if you've stopped taking your medicine, because if you're on them you should be cheerful, right?
This is not a happy pill. It doesn't fundamentally change anything. But it takes the sharp edge off the pain so that it's bearable.
Therapy is surprisingly effective too.
Over the past decade+ I've also found that an ability to monitor and hack your own mood is an incredibly valuable skill. Know what things trigger depression and either avoid them or work out a contingency plan to weather the storm. I keep my driving after dark to a minimum because cityscapes at night do this to me. Have a mind-killer available for when a spiral is coming and force yourself to use it. Obviously some are healthier than others (great books often work well) but the really important part is to shut down that introspection quickly. The more you do it, the better you become at it.
Another approach that works for some people is to develop the habit of being aware of oneself entering the spiral, and pay close attention to the process... to what my body is doing, what kinds of thoughts are entering my mind, what those thoughts are connected to, what external events are triggering them, what feelings they are eliciting, what memories/fantasies those feelings are evoking, and so forth.
For some people, that kind of introspection is not only a good way of causing the spiral to evaporate in the short term, but of causing the habit of spiraling to gradually subside.
(This is importantly distinct from identifying with and reinforcing the depressive thoughts and feelings themselves. That is, it's not "Everything sucks... I'm stupid and worthless... I can't get project X done... it's going to suck and everyone's going to yell at me... etc.", rather it's "I am feeling sad... I'm curling up in my chair... I'm judging myself... I'm thinking about project X... I'm fantasizing about failing at project X... I'm fantasizing about people treating me badly because I failed at project X... etc.")
That's an interesting technique; it sounds rather zen-inspired. Did you invent it, or where did you come across it?
As I understand it, Cognitive-Behavioral Therapy ("CBT") suggests arguing with your (sometimes negative) inner voice using all the rational-argumentation techniques at your disposal.
For example: "Everything Sucks" => "That would be an example of overgeneralization; if everything did suck, then like fish in water, we would have no word for it. The world is how it is, and there are positive aspects and negative ones. The features of the world that prompted my thinking 'Everything Sucks' may well be negative, but the world is big."
"I'm stupid and worthless" => "That's an example of emotional reasoning - believing something because I feel it, rather than because I have evidence, and possibly also fundamental attribution error. There are people, even relatively disinterested, professional people, who have described me as bright. Other people have described me as hard-working, which may be even more important to long-term success and capabilities than innate gifts. Fundamental attribution puts characteristics on people as if they were simple and unchanging from context to context and from one time to another. Actually, people are generally richly faceted, very situation-dependent and capable of growth."
And so on.
I didn't invent it, and it is in fact inspired by the mindfulness meditation that is part of certain kinds of Zen practice (caveat: I am not even a plausible approximation of a Zen scholar; I just take what suits me and leave the rest behind).
As I understand it, there are lots of schools of CBT out there; what they share in common is a focus on addressing the thoughts that underlie our emotional reactions to events. The argue-with-yourself approach you describe here seems consistent with that, though I'd be surprised if it were endorsed by all CBT schools.
Over the past decade+ I've also found that an ability to monitor and hack your own mood is an incredibly valuable skill. Know what things trigger depression and either avoid them or work out a contingency plan to weather the storm... Have a mind-killer available for when a spiral is coming and force yourself to use it.
This is basically exactly what I've been working on to overcome my own depression.
Reading Less Wrong and working on the basic techniques of the sequences has made a huge difference. And note that the "mind-killer" doesn't have to be a particularly healthy behavior - it just has to be better than the depression (at least to start on).
It sounds like your girlfriend is dealing with some heavy external stuff, in addition to chemical brain stuff. I've found it helpful to remind myself that that which can be destroyed by the truth should be, but the reverse is also true. For me, being able to feel the difference gives me huge leverage on eliminating the irrational kind.
Sadly it's often not taken serious and a big taboo to speak about.
Particularly for males - the status hit of admitting that kind of weakness is significant. This limits the options they have when it comes to breaking free of it.
I've been using Lexapro for some time and it has been great for me, without noticeable side effects.
I worried about relying on a drug for my happiness, but in the end I realized I needed to be more worried about being depressed than I did about being reliant on drugs.
As wedrifid said, if someone ends up taking drugs for the rest of their life, and that gets rid of their depression, great! Goal accomplished!
I think the big thing that helped me make the decision to pursue medication was all the smart technophiles that abound on Less Wrong. Realizing that using technology to make things better was the point of having technology in the first place, rather than trying to grunt and bear it myself.
First of all I want to point out that this post sounds very convincing for me. :-) I have already thought about the same things. As my boyfriend said I fear to get dependent from drugs. I think it would be useful to specify this statement. Relying on a drug for my happiness is exactly what I mean.It would make me crazy to know that I need medication for feeling happy instead of carrying it off on my own. I'm also a little bit afraid of how antidepressants affect me.There is one aspect more that makes me insecure. How do you know if you are "really" happy or just because of the drugs? I know it shouldn't bother me but it does. I often reflect on psychological stuff and try to find out what makes me and other people happy.That's why it would frustrate me to know that there is no other solution than taking drugs for me. Your conclusion that you have realized you needed to be more worried about being depressed than you did about being reliant on drugs puts me into a contemplative mood. And I admit that you are right. You can't always go it alone...
It would make me crazy to know that I need medication for feeling happy instead of carrying it off on my own.
The truth about whether you can pull off being happy on your own is separate from whether you take the drugs - and, more importantly, you don't get to choose whether it's true or not. If you can't be happy on your own, choosing not to take the drugs doesn't change that fact, it just changes whether you are able to be happy, or not. And taking the drugs for a while doesn't mean that you definitely can't learn to be happy without them, either. You can do both - take the drugs, and also go to therapy to learn to avoid thinking in ways that lead you to be depressed.
Thanks, that sounds logical for me. And I don't mean that I can't learn to be happy without them. I already have found out some ways on my own to cope better.But I can't "heal" it completely.And I have also started a therapy now.It seems like my psychotherapist understands me but I'm not really sure whether he can help me or not. ( I was only once there and my second date will be next week)
Perhaps another couple words might be helpful given what you're saying.
A few of the major symptoms of my depression included not having a lot of energy, being moody, and having a harder time just relaxing and having fun. It often felt like depression would come up and stand in the way of me being myself. That is really an experience of being controlled, where things were happening 'just because of the depression.'
The subjective experience I've had of starting medication has been beautifully transparent. All that has happened is that depression coming up and ruining my day happens far less often. It feels like I am allowed to be myself.
Obviously these things work differently for different people, but the experience that I've had has been great and I can't commend it highly enough.
I could talk a lot about it. So what exactly do you want to know ? :-)
I have the same symptoms. But the worst for me is that it is so difficult to keep myself under control ( like you have said that things are happening just because of the depression) I also often have weird thoughts,some kind of hallucinations. Most people equate depression with sadness. But it isn't only sadness. I would rather say it feels like inner emptiness. Or like someone dismembers you into pieces. ( I don't really know how to describe this feeling).Sometimes I'm even beside myself with rage. Therefore I get the urge to scream and to destroy things ( normally I'm a very calm person). And sometimes it hurts so much that I can't feel affection or love. That's getting me really,really down. I don't want to be so cold.
I have finally realized that I can't bear it anymore. It keeps getting worse and all my attempts to do something against it have failed. Sometimes I'm able to distract myself but I can't "heal" it.
First of all I want to point out that this post sounds very convincing for me. :-) I have already thought about the same things. As my boyfriend said I fear to get dependent from drugs. I think it would be useful to specify this statement. Relying on a drug for my happiness is exactly what I mean.It would make me crazy to know that I need medication for feeling happy instead of carry it off on my own. I'm also a little bit afraid of how antidepressants affect me.There is one aspect more that makes me insecure. How do you know if you are "really" happy or just because of the drugs? I know it shouldn't bother me but it does. I often reflect on psychological stuff and try to find out what makes me and other people happy.That's why it would frustrate me to know that there is no other solution than taking drugs for me. Your conclusion that you have realized you needed to be more worried about being depressed than you did about being reliant on drugs puts me puts me into a contemplative mood. And I admit that you are right.
SSRI's are effective for severe depression. AFAIK every double blind study has shown no statistically significant effect on people with non-severe depression.
General Point: Seek professional medical assistance as soon as possible.
In the UK general practitioners are very capable of dealing with it, and do so regularly, and can refer you to specialists if necessary, and in the short term supply medication. I assume the situation is similar where you are, (Germany?) as it is in all developed countries.
My personal experience is that putting off seeking professional assistance is one of the worst things I have ever done, it is an extremely difficult step to take but a necessary one that will help a lot. Unsurprisingly, people in extremely depressed states are not acting very rationally, and so prioritize things like social pressures, pride and so on above the need to get help. Particularly among intelligent people there is a strong cultural bias against seeking assistance, which is very harmful in this case.
In terms of treatment you can apply yourself. I have personally found that exercise is extremely helpful, walking at the very minimum and more strenuous exercise if possible (remember our brains are optimized to an ancestral environment of almost constant physical exercise). Also improving sleep patterns, healthier diet and reducing use of alcohol and caffeine can be helpful, though depend more on individual circumstances.
On medication, based on my personal experience and knowledge of the medical data I would strongly recommend it.
She says she never want's to take antidepressants because she fears to get dependent from them.
This is a worry shared by a lot of people, which while rational is based on a mis-perception of how depression and antidepressants work.
Roughly, we have a strong aversion to the idea of making people 'artificially' happy for whatever reason (see http://wiki.lesswrong.com/wiki/Wireheading). Probably justifiably. People generally associate depression with sadness, hence consider anti depressants as 'happy pills' and hence bad.
The mis-perception is that while depression can cause sadness it is not equivalent, depression itself is a physiological state of reduced and distorted brain activity, which results in an absence of natural emotional reactions, and hence feelings of detachment, low mood and self esteem. For a rough analogy, a healthy person should feel bad if bad things happen and good if good things happen, a depressed person would be indifferent to both.
Modern anti-depressants (SSRIs and SNRIs generally) work by enhancing neurotransmitter levels, and so allowing the brain to function more effectively and communicate signals better. Analogously to repairing a damaged processor on a computer so it works faster. (Disclaimer, I am not a Doctor and this is a simplification) From my personal experience I've found my brain works much better on medication, to the extent I can almost literally feel myself thinking faster, and while I still have bad periods I am capable of dealing with them. There are some minor adjustment side effects, but they are well worth it, and a doctor can guide you through them.
(Sorry the post ended up so long, hope it was helpful.)
There are serious discrepancies between the anectotal evidence for antidepressants (my own included) and the literature, which says they are only very slightly better than placebos for all but a few, very severe cases of depression.
The analogy to fixing a processor is a very poor one. Applying a single small molecule to a system like the human brain is more closely analogous to kicking a malfunctioning television. Seratonin for instance has diverse functions at different times and places. The "Seratonin Theory" of depression arose because compounds which increased seratonin were observed to aid depression. Recently, anti-depressants which lower seratonin have been observed. The theory has been compared to the conclusion that an absence of aspirin in the teeth causes tooth-aches. Drug companies are now moving away from small-molecule approach to treating psychiatric illness towards electromagnetic stimulation implants.
Anecdotal, I know several people who have taken antidepressants and believe the effect is simply to disrupt thought in general and thereby inhibit rumination. Most of them do believe the drugs helped, at least in the short term.
I say all this not to dissuade you from taking antidepressants but to warn you not to think of depression as a simple matter of "chemical imbalance". Even if one does exist, in some or all cases, there is no reason to believe it causative, rather than as a marker for some underlying process. Fixing yourself will not be a matter of kicking the television - you'll have to rewire it as well.
Can you point to a good summary or meta-analysis of the literature of you're referring to? From what I understand this is a hotly contested point - and very relevant to many people's choices!
We often go on walks to catch some sunlight and get her some exercise.
You might look into full spectrum lights as well. My father thought he might have some seasonal affective disorder going on and bought one. Take it for what it's worth, but wiki has some citations in the treatment section discussing the effectiveness of such treatments. They're a bit expensive (depending on your definition cutoff), but may prove to be easy and effective. I've read some on forums who turn it one while they eat breakfast in the morning.
This was definitely helpful for me while I was living in Bremen, where the weather was cloudy enough that I wasn't getting enough sunlight even in the summer.
You might look into full spectrum lights as well.
Or, just focus on the blue component, which is what matters most for this purpose.
My girlfriend suffers serious depression ... anorexia ... she considers herself very happy apart from the "depression periods"
The depression is very likely caused by some sort of dietary deficiency, and the depression periods are probably the periods when that deficiency is worst, so focus your attention on diet. If she isn't taking a multivitamin every day, fix that first. Then start keeping both a food log and a "daily mood" log. For the former, either write down everything eaten, or take a quick photo of it type up the log later using the photos. For the mood log, ask her to rate how she felt on a 1-5 scale and write it down at the end of each day. Then compare the two logs and look for patterns. Or publish the log and ask others to look for patterns.
Thank you. I think the anorexia is mainly a result of the depression. Her blood got checked a few months ago and everything seemed fine, but there is surely room for improvement. She eats very little meat, maybe she has a iron deficiency.
The main reasons for the depression seems to be the death of her father and the chronic pain, wich showed up long before the depression. Maybe there is also a genetic componence because her mother says about herself, that she has also very often "low mood". But she thinks it's just the way things are.
I will read up on vitamins. Do you think you can trust wikipedia in this respect?
She should see a psychiatrist and not just a therapist. I don't know how things work in Germany (your post suggests that's where you live), but she should see someone with a medical degree who can prescribe medication.
It sounds like she needs therapy. Antidepressants and exercise will help take the edge off until she can get the therapy, but mental illness needs to be treated by a medical professional.
Have you signed up to see the therapist? It sucks that you have to wait a month, but it sounds like this has been going on a lot longer than a month and it is likely to continue for a lot longer than a month, so it's worth going even if you have to wait a month.
So, I self-diagnosed as moderately depressive about a month ago, following a few months of an increasingly serious blue funk and greater than usual akrasia. Explicitly using the D word was an important factor in deciding to do something about it. Even so it took me a month to get off my butt and go see the family doctor, which I did today. She confirmed the diagnosis. Now that it's more or less official, I'm posting here to solicit advice and to offer data.
I have a prescription for Paxil, which I'm (provisionally, pending further info and/or advice) not intending to take, after reading up on undesirable side effects. All listings agree on the "sexual dysfunction" category, rated as "very frequent" - a probability of 15% to 60% depending on the studies. As a married man I see that as a showstopper. I also have a prescription for talk therapy, to which my response is "meh" - but I'll probably give it a try.
Any situation-specific advice on alternatives, or in general?
(N.B. I'll operate on the assumption that you're not a doctor and therefore not qualified to give medical advice, unless you state otherwise, so don't feel obliged to give that kind of disclaimer. Also assume I've read the rest of the comments here, and only repeat something if you think it's important enough to repeat.)
I recommend against taking your Paxil; antidepressants don't work for mild depression.
Running is a good idea; exercise, sunlight, and being outside all help.
Avoid dropping responsibilities, and if you must drop small stuff first and responsibilities to others last (so quit showering before you quit working overtime). Counterintuitively, you should keep yourself in motion and having hard stuff to do and triggers to do it everywhere; otherwise recovering is much harder.
Changes can mess up your trigger network, but generally help, especially when of the form "get out and do fun but moderately effortful thing X". If you find you're enjoying yourself more than current average, you're doing it right, regardless(-ish) of absolute levels.
How introverted are you? More social interaction is generally good, but demand alone time if it starts to drain you (can be hard, since you're married). In general I've found that quality of interaction is crucial (YMMV a lot): minimize being alone in a crowd, maximize the number of people who know your preferences and time spent with them. Love languages are a good first approximation.
By the way, I'll see you in-person at the meetup, so if you'd like a hug or a present or a chore done, be sure to ask.
Antidepressants are more likely to bring remission in mild than in severe depression, it's just that their superiority to placebo is slighter. Antidepressants are also vastly better than placebo at preventing future depression when their use is continued after remission. Beware the linked article, which is hopelessly underinformed.
Source?
Do you agree that mild and severe depression shouldn't be lumped together (but disagree with that particular claim)? (Also, do you agree that adolescent and adult depression are vastly different?)
Do you think Neuroskeptic is bad in general? It looks sound to me but I'm nowhere near a professional. If yes, where should I go for my psychiatry research needs? If not, how did he mess up that one article?
Continuing antidepressants after remission is a big cost - crazy meds suck donkey dong.
I approve of hugs in general, and a symbolic present (i.e. of no monetary value) would be timely as well as nice. :)
I'm an extroverted programmer: the kind who looks at your shoes while speaking. (OK, the serious answer: I don't know and not sure how meaningful that term is. I am a relatively private person who doesn't crave company, but I'm also comfortable doing things like speaking in public. I used to be more outgoing than I am in my present state.)
It's hard to know what would help without knowing the specific cause, but there are some comparatively-likely things to check: diet, micronutrients, exercise, sleep, and amount of social interaction. If any of these have changed recently, try changing them back. There is at least one blood test I'm aware of that should have be done (thyroid). You also might go back and ask your doctor for a different antidepressant without or with different side effects.
The only major change in these lately has been exercise - I went from none to running for an hour about three times a week - but that's post-onset.
Is it very bad being dependent on antidepressants? What would the worrying downsides of dependency be?
Exercise is widely recommended.
As far as I know Cognitive-Behavioural Therapy is the closest to having an evidence base for success, although I couldn't point you to the studies.
Healthy eating is probably worth an effort, and of course good for all sorts of reasons.
My girlfriend suffers serious depression. She has sleep disorder, anorexia, chronic pain, problems to concentrate, low selfesteem, daily low mood, listlessness and is very indecisive. On the other side she considers herself very happy apart from the "depression periods" and we have a great time together. We already consulted a psychotherapist, but there is waiting time about one month. I buyed her fishoil capsules, because she eats no fish and there is mild evidence that it helps treating depression (I don't think this will affect her depression greatly, but fishoil seems like an overall good idea). We often go on walks to catch some sunlight and get her some exercise.
She says she never want's to take antidepressants because she fears to get dependent from them. I think she might change her mind if there are very good arguments in favour of them. She is quite rational in spite of not knowing the LW-stuff. Does anybody of you know if there is any information of the succes rate of medicamentous (and psycho therapeutic) treatment available?
I highly appreciate any advice.
Furthermore i want to call attention to the topic of depression. A huge share of the population suffers at least once in their lifetime under depression (~20% in Germany). Sadly it's often not taken serious and a big taboo to speak about. Many people see it as self-inflicted. My girlfriend's mother doesn't believe in depression as a disease (see diseased thinking). It's a paradigm of irrationality that hurts people.