You know, I have talked so much about the recent angst about my adviser and my grad school stuff, that I really don't have the energy to recap it all. I'm pretty sure that most people that actually read this blog are caught up on it. If you're not and you're dying to know, ask, but I'm going to pick up with current things rather than wallow through that.
Current thing: Ever since ever, I have been super resistant to being medicated for mental health issues in any way. I have had so many medical professionals of all stripes recommend any number of prescriptions for anxiety, depression, sleeping, etc etc. Call it part of the disorder, but I really cringe at the idea of putting something in my body that changes the way it works in ways I can't control.
However, yesterday I had a long conversation with my physician (she's been so key lately that she deserves a pseudonymous initial; let's call her R). I trust R. more than any other physician I've had. She has been open about the fact that she dealt with an ED when she was younger and is really on top of monitoring all the potential health complications, even when my weight is out of the immediate danger zone.
Yesterday she seemed to really be jonesing to get me on an SSRI (Zoloft or Prozac specifically). Again, my knee jerk reaction to this has always been "hell no." Because, stubborn. But I do trust her. And H. has been trying to medicate me since I was 20 and was THRILLED when I told her about that conversation. So I'm thinking about maybe maybe trying it. By maybe maybe I mean I'm not 100% no, but still very hesitant. H. swears that if I gain a few more pounds and stay there then my anxiety would get a lot better, but seems to still be an advocate for meds. I have always been so obstinate about this issue but I think the fact that my brain is.never.ever.calm is just starting to wear me out . . .
So, readers, please comment with anything and everything you have to say about your SSRI experiences. I've been warned about the sexual side effects and that's something I'll have to think about. But anyway, not looking for a "you should do it" or "pitch the pills" type response, just interested in what experiences other people with similar issues have had on them . . . thanks.
Love y'all.
5 comments:
I'm really proud of you for being open to new possibilities, whether you choose to do something different or not. As I mentioned when we texted, I have been helped tremendously by my SSRI (Zoloft). I've found that it does take time to start working, and getting the right dosage is key. I understand your hesitancy, and I'm certainly not going to give advice, but I will share my experience.
It's clear to me that I have chemical imbalances that go along with and are part of my mental illness. It's biological. For me, one of the ways to treat that is medication. I view it no differently for myself than taking a multivitamin or calcium supplement. I am doing what I can to help my brain function at its best. I have found for myself that the best treatment system is: therapy, medication, enough food, EMDR, and my support networks. Therapy alone has not been enough for my chemical imbalances, nor do my medications alone provide enough support for me.
It's only when I can bring my best self to therapy (enough food and meds), that I can get the real work done. My anxiety and PTSD are under control enough for me to not be paralyzed by them, but to work on deeper issues and work on rewiring the harmful pathways in my brain. Some relief from the anxiety and PTSD allow me to do self-reflection without endangering my safety (from myself). It allows me to have more choice about my mental state on any given day. My meds don't "make me happy," but they do allow me enough relief from all the nasty stuff to make choices about my mood.
Like I said, I'm not going to say "do it" or "don't do it" because that's an individual choice. I know a lot of people have conscious or unconscious negative feelings about medication for a variety of reasons. I think it's also worth some self-reflection about some feelings you have about medication that you might not be fully aware of. I'm proud of you for being open to thinking about change, and I hope we can continue to talk about it. Hang in there!
I have a personal opinion on and a more academic opinion, so take from that what you will. In terms of my experiences, I do think SSRIs have been helpful with anxiety, but not so much depression. I'd always been anti-meds but both of the times I caved and started an SSRI were because my anxiety was totally out of control to the point of it really interfering with my overall functioning and quality of life. I had a stint on Zoloft in spring 2011 (only 2-3 months I think) - came off because it was starting to dry out my eyes (dry mouth is a well documented side effect and the dry eyes went right along with that, plus I was already prone to dry eyes). Switched briefly to Effexor (SNRI) which was worse for a variety of reason, tapered off completely within a few months (withdrawal from Effexor was HORRIBLE). Then a year or so later (summer 2012, I believe) things were falling apart again anxiety-wise so I agreed to go on Celexa, which I stayed on for about two years. It helped massively with anxiety - I noticed a difference almost immediately (though that may not be the case for everyone; I think you are supposed to give it a few weeks to assess the effects) in terms of the general overactive worrying nature of my brain just quieting down a bit. It's hard to describe. But the difference was noticeable and positive. I did not notice any effect on depression.
In terms of side effects - I presume the main one you care (besides libido-related) about is weight gain, because that was really the only one I cared about. And to be honest I am still not 100% sure what the verdict was. I gained steadily (not rapidly or dramatically, but slowly and steadily) throughout the time I was taking Celexa. It's hard to say how much of that was just normal weight restoration, because my starting Celexa coincided with me starting to intentionally gain weight. I suspect that I may have gained a little faster than I might have drug-free, because I never really got to the big weight-gain amounts of calories and still gained XX pounds over two years. THAT BEING SAID.....I came off Celexa right around the time I had reached the goal weight set by my old dietician, so it may just be that I naturally gained to my set point and that would've been the case drugs or no drugs. I've been off Celexa for over a year now and my weight has stayed basically the same. So..hope that doesn't add to your worries.
In summary: SSRI's helped tremendously with anxiety, not so much with anxiety, and weight gain may or may not have been affected, but either way it was not dramatic and I am at a healthy and stable weight now.
So that was all very much based on personal experiences and lots of emotional decision-making. In terms of my academic/professional opinion, there is no right answer. SSRIs are lifesavers for some people, but for others - especially those who are functional anxiety/depression sufferers - it's a tougher call. One thing that became really obvious to me is that picking an AD is basically trial and error. Which is kind of scary and unscientific, but that's how it is. Being the risk averse control freak that I am, that was almost too much for me to handle - because who knows if it would work for me, or what the adverse effects might be??? But if I were to evaluate the overall impact of SSRIs at the population level I would be very much in favor of having them as an option. So, hello cognitive dissonance.
Hope this helps. Most of this is documented in some form or another on my blog, and I'm happy to answer more questions or talk it out in real time. Good luck!!
So after reading Alie's comment I'll add something else: medication can be a necessary but not sufficient adjunct to any treatment regimen. It won't make you happy if you aren't already pretty happy. It also won't change your personality. It can help bring you up to a functional-enough level that, in combination with therapy and all the other stuff, you start to make improvements overall. Re the chemical imbalance thing - I definitely agree, but I also think the hardest part about mental illness is that it isn't all biology. I am becoming more and more convinced, having gone through so many iterations of depression/anxiety etc, that yes of course part of it is constitutional (e.g. my brain likes to run worry loops on repeat).....but that it is also the everyday ins and outs of your stress levels, your behaviors, your interactions, etc. that help shape your mental health and resiliency. That really helps motivate me to do things like eat right, engage in therapy, manage my stress, etc. Medication should be used as a means of supporting yourself to cope with life and maintain healthy levels of stress and anxiety, but a med won't do it all by itself. I also do not think medication has to be a necessary part of any treatment plan. You have a great support system and a brilliant mind and one of the most open, generous hearts I know. You will be okay whatever choice you make.
I hope it didn't come off like I think meds are necessary for everyone. I was speaking for myself only. I agree with Kaylee that it's not completely biological. That being said, for me, I think certain genetics and brain chemical stuff set me up for greater general anxiety, which has been compounded by life experiences and trauma. Also, Kaylee's totally spot on about meds not changing personality, etc. For me, they stabilize my anxiety enough for me to do self-care, reach out, talk about hard stuff in therapy, and ultimately do things that make me happy.
Basically, I believe Fluvoxamine (bit unpopular SSRI) saved my life when I was 15, very ill from anorexia and OCD. Apart from ED, I have a bipolar disorder that makes my experience not relevant for you and generally I am very much for "do it!" but I wanted to mention an another aspect of your post:
(this is just my observation about myself - I do not want to judge and everyone's pro/contra reasons may differ a lot!!) I think that being very unwilling towards medication was/is a simile for- or maybe a symptom of the ambivalence towards recovery in ED and a simile to our fear of losing control.
I have rarely seen patients with moderate or severe anxiety, OCD or depression who suffered with so much hesitancy regarding medication. Usually they simply want a relief from their symptoms (and SSRI is - as Kaylee wrote - only one of the factors that contribute to relief).
But the ED is more insidous with its fear of recovery. I sometimes have similar feelings about mood-stabilizing meds as I miss being hypomanic and really really productive. My usually rational brain somehow ignores the facts: the suffering from ED and depression, the ton of evidence and literature, even its own experience and damage I have done to it by not getting appropriate treatment for a long time or going on and off with the medication.
I try to see my medication-unwillingness as a symptom of the disease that I have to fight. Usually I try not to overthink it much and just take my meds (I guess I am getting old and experienced:)) If it gets hard, I try to see the evidence, go to pubmed, listen to kay redfield jamison's videos on youtube and stop the magic thinking (medication will make me dependent and obese and dumb while it is helping milions people to sleep, think, work and have a fulfilled life).
I hope this was not somehow insensitive....
From more technical point of view: it is important that SSRIs are not all the same and not for everyone (sometimes, SNRIS or good old tricyclic antidepressants are even better. The "activating" antidepressants may be not ideal for someone who is rather hyperactive, ruminates a lot and can not sleep. For example I have very good experience with amitriptyline for really bad insomnia.) Also it is important not to give up when the first antidepressant is not working. It may be a second or third and it has to be titrated well, but I believe if you and your doctor find the right substance in the right dosis, you will definitely feel it and profit from it.
Fingers crossed!
Misa/"Ola"
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