Anti Depressants and Side Effects

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I just had another go around with my doctor. The Seasonal Affective Disorder has kicked in fiercely and I'm in need of something to regain some balance. I tend towards lots and lots of side effects of any medication, even at very low doses, so I'm extremely wary of all drugs. But I also know when I need a helping hand. I can't even begin to explain how weird it is to be desperately depressed but to NOT have depressing thoughts. Usually, its a package deal.

Anyway - my doctor suggested that if I experience side effects that that is a sign that I need to take a higher dose. In my experience, more is bad. Side effects turn even more debilitating when the dose is increased. That suggestion sounds completely counter intuitive and illogical. Has anyone encountered that? Increasing a dosage to counter side effects? I'm highly skeptical but if a psychiatric director is suggestiing it surely she must have some experience or research to back her up yet I cannot find anything to confirm her suggestion.

I value actual experience over book knowledge any day. I'd be especially curious to hear from anyone who also has a problem with drugs and side effects.

Unless she thinks that the side effects you are getting are really symptoms of your depression, then I cannot see the logic in increasing the dose. However it can depend on what tablet you are on as some side effects differ at different dosages, so maybe that is what she is thinking of.

IE I am on mirtazapine. Now at the lower dose of 15mg it is supposed to have a sedative get the munchies effect (I have heard it called the 'legal cannabis' at that dose) At 30mg it is supposed to be less of a sedative and more of an antidepressant (although you can still get a never ending appetite). Personally I find 30mgs makes me semi high and angry, 45 mgs gives me a tremor and 15 mgs just makes me wonder around all day constantly eating and saying 'peace man' to everyone I encounter whilst trying not to spit my mouthful of food everywhere lol.

On the downside I have gained 7 stones on the tablet since I started taking it many years ago, and I do spend a lot of time feeling dopey. I'd exercise but I am too chilled out for that kind of activity. However the number of trips I make to the fridge a day does help as I do have to get up to walk there and back lololol.

I am trying to get off antidepressants. It would be nice not to feel drowsy.

It seems to vary from medication to medication.

I don't know about increasing it, but I'm not a doctor. It would probably depend on the drug. I haven't read through the responses yet, but I've seen on here that TambourineMan loves reasearching pharmaceuticals, and he might be able to answer you better. If he doesn't answer you, maybe pm him?

I've dealt with seasonal affective disorder myself before, and one non-drug way that helped me deal with it was going to a tanning bed. Around here you can buy a package of 300 minutes for about $35. There are different types of beds, so it's not always one of those lay down "coffin of lights" kind that can produce claustrophobia, and also take longer. I would go to this walk in one, that you stand in and are surrounded by lights. You stay in there 9 minutes tops. You are in and out, you make an appointment, so there's not a lot of waiting around, although sometimes you may have to wait 5 or 10 minutes for your bed to be free, but that's all.

Also, burning incense during this time of year helps me too. I can't afford the tanning bed this year, but I'm really sensitive to smells. There are a few types of incense that I love, and the smell of it helps me. If you don't like incense but like the idea of using smells, there are scented oil burners, or you could put a bit of essential oil on a light bulb and turn the light on.

Frances

Definitely, Physical dependence or addiction can develop even when using the drug as prescribed, since the body builds up a tolerance and more of the drug is needed to maintain the desired effect. Medication is only meant to be taken for a short length of time in which a person undergoes treatment such as Cognitive Behavioral therapy or coping strategies, I don't think taking any medication for a long period is healthy or productive and tends to make people addicted.

I imagine that the doctor thinks that your side effects are depression symptoms. Real effects (both specific and side effects) will follow a dose-response curve (although this can level off at one or both ends, or shoot upwards dramatically when you reach a certain threshold etc.). I would be very wary about taking any more. To be honest, I would be wary taking any at all. Antidepressants (particularly SSRIs) have been a bit of a scam by the drug companies and there is plenty of evidence indicating that they don't work any better than placebos or enhanced placebos (placebos that give similar side-effects so people think they are definitely being given the drug). Most of the negative evidence was suppressed by the drug companies until recently, which is why most people still think they work (including mental health professionals) and why most people still believe the serotonin imbalance hypothesis of depression (in fact the main evidence for it was that SSRI's seemed to work in depressives [although now we know that is probably not true] - a bit like saying that pain is caused by a lack of stimulation of the opiate receptors because that is how morphine works)

However, the placebo effect is strong and real, particularly for symptoms with a high psychological component. It can also work to some extent in people that know about it, so in theory you could try to use that (perhaps you could take some multi-vitamins and tell yourself that they are going to make you feel better - it might work, even if you are skeptical as you could be lacking in certain vitamins, particularly vitamin D at this time of year). Personally I never found anti-depressants to work at all, but they did give me unwelcome side-effects, including on one occasion a few days of a sort of manic inability to stay still - which later the doctor attributed to 'my illness' even though it is well known that anti-depressants can cause this and I certainly wasn't like that before.

My general impression is that they don't really work for depression (mood wise), but they might do something for a lack of energy. If this is your problem then it may be worth sticking with them, but I would advise a lower dose not a higher one - low doses can be more effective if the high doses are crippling you with negative side effects, and I think particularly autistic people are very sensitive to drugs, so best to start low.

Ideally you should try therapies which are not drug-related, given that there is so little idea of what causes depression and how to treat it. SAD is apparently effectively treated with a light box - I don't know whether this is placebo or not, but it does make sense and won't have any negative side effects. This is probably the ideal therapy, but may be too expensive.

Personally I would recommend exercise- this has been shown to be at least as effective if not more so than antidepressants for mild-moderate depression. I have been an exercise obsessive for half my life - it started after my first depression and I do wonder whether I became obsessed with exercise because I realised on a subconscious level that it was good for my mental health. I'm not quite so obsessive nowadays and can take days off etc., but do still get upset if my weekly routine is messed up (but that is a rather Aspie thing anyway). I do swimming 2-3 times per week, yoga once a week (great techniques for anxiety if this is a problem and you get a good teacher and not just one who doesn't stretch you, or stretches you too far without the correct warnings) and lots of walking, plus a gym session 1-2 times a week. I am fairly sure that without my exercise routine I would have spent a lot more time depressed than I have done - my impression is that a one off exercise session when you are feeling down doesn't really do much (although it may for you, particularly if lack of energy is your problem - swimming or yoga or a brisk walk outside can energise you, maybe not the gym though), but a regular programme of exercise works wonders. My moods are very variable since my second major depression 5 years ago (something I attribute to the drugs I was on to be honest, screwing up my brain chemistry), but they rarely get too low and I have learnt to recognise that even when they do, it doesn't last much more than a few weeks and the worst only a few days. If you can't face exercise right now, then I would suggest that next summer (when you are feeling good again) you start up an exercise programme and try to keep it going - you might find that you don't feel quite so bad when winter starts.

However, surveys suggest that up to 75% of us might be affected by changing seasons in some ways, so I wouldn't expect a miracle cure to ever happen. It is a case of managing it as best you can, ideally without drugs whose effect on your brain is an unknown and possibly a risk. Maybe not the most positive conclusion, but I realised a few years ago that there would never be a miracle cure for my depression, and in fact that I can manage it myself without drugs as long as I don't get too stressed - the lows are a part of life that you have to deal with yourself for the most part, and (given that the help is not that good) not rely on medical care or drugs apart from when you really can't handle it any more. Good luck.

That's an oversimplification -- that is not true for all drugs. Drugs which directly interact with target receptors tend to suffer from that effect (downregulation). OTOH, SSRI's, tricyclics, SNRI, NRI's are reuptake pump inhibitors, which work by utilizing the downregulation to achieve their target effect (which is one reason that antidepressants take so long to work -- you have to wait until the downregulation to occur). So, you can't develop tolerance to Prozac the same way you can to morphine or Adderal (which is a reuptake pump reverser, so what I've written above is still an oversimplificaton). SSRI's are known to stop working sometimes, but it's a different phenomenon.

As far as the doctor saying that side effects means you should increase the dose -- my guess is that he/she is thinking that once the drug 'kicks in' the side effects will be seem like an acceptable price to pay. IOW, right now you're only having negative effects so, overall, it sucks, so he's trying to force the beneficial effects to happen sooner and more strongly.

As others said, I can only imagine maybe the doctor was talking about depression "side effects."

With negative side effects I've experienced from Zoloft, going higher only increased said side effects.

This is where I'm confused. We went back to Prozac which I have taken the longest and have a fairly clear track record with. At very low doses, it's like flipping a switch - fast. I'll get noticable results in a few days on a 5mg dose which is nearly unheard of. But, almost a decade ago, while taking Prozac I ended up with suicidal ideations - upon stopping it, the thoughts disappeared immediately. In fact, having those thoughts was so alien to me it shocked me into immediate action and got me on the phone with my doctor within days. In retrospect - that may have been my 'signal' that it was time to come off it. I didn't have depression issues for 6 years after that incident. But that incident was enough to scare me off of Prozac when the issue cropped up again.

The fact that they still haven't figured out HOW SSRI's and SSNRI's work isn't really bolstering my confidence in psychiatric medicine.

OliveOilMom- I've been using self help strategies all along - probably since I was 24 (that was back in the 90's kids). After two years of unsuccessful self help, I turned to meds and literally - 2 years of depression just lifted like magic in one week. 10mg of Prozac. I'm one of those people that can feel the chemical war waging in my head as I take these meds.

So many self help methods are slowly but surely being taken out of my grasp. I have fibromyalgia so exercising is double edged sword - it can help both depression and fibro BUT I need to deal with the inevitable pain even light exercise brings. I did exactly that for four years until I crashed and burned. Causing yourself pain for that long is beyond draining and that is a big reasons I'm struggling to find a balance now. Tanning beds are out of the question for my skin. Scents are a good suggestion but can be a toss up - if I get one that is all chemically derived I'll do nothing but give myself a migraine. Lightbulb rings with essential oils actually worked well in the past... until lightbulbs all went energy efficient. I'll have to see if I can find an oil burner. Thank you for that reminder! Lavendar has gotten me through quite a bit in the past but especially headaches and mental exhaustion.

wolfheart - thats what I don't understand - at low doses I do get the intended benefit. She doesn't want to increase the dose to increase the benefit - only to alleviate the side effects. If it is working as advertised for the condition it is being prescribed for at the lowest possible dose why would you increase it? At too high a dosage all SSRI's run the risk of causing added psychological conditions like xenophobia and suicidal ideation. I'm just highly confused.

CBT and therapy just don't work for me. I have some major disconnect in how or why these things work. I logically know WHY they are supposed to work for others but I just don't get how they apply to me personally. My attempts at them have made my depression worse so I avoid them.

merrymadscientist - I have a stong distrust/dislike of medication of any sort - I would think my placebo effect would be 'no effect' instead of working even better than advertised. Honestly, I've spent a lifetime with doctors telling me what I feel, how I react and what I experience is 'wrong' or isn't possible because 'thats not what the book says' that I just don't bother listening to anyone suggesting 'it's all in my head'. Waking up on the operating table because sedatives are ineffective on me is not in my head. I have altered reactions to all medications. They still can't explain why I taste metal for days after getting an IV. Even as a kid, things that were supposed to knock me out made me hyper and vice versa. In my experience, I believe that I do have an actual serotonin imbalance but the over prescription of these drugs to people without actual brain chemistry issues has damaged the reputation of these medications that can be effective in the right cases. I can't deny the effectiveness of the medications but I'm also extremely leering of the side effects. I choose, reluctantly and begrudgingly, to chance the side effects because of how effective they can be.

I actually have a full spectrum light box... it is only marginally effective. Seasonal affective is not my only depression issue but it sure doesn't help at this time of year. This year is particularly bad and I'm not sure why. More rain days than usual? Are the days even shorter than usual? It sure seems so when it starts getting dark as 4:15 pm.

My dosing can't get much lower - 5mg is only possible because I split 10mg in half. And there's a decent chance I'll still get side effects from even that. I'll know within the week if they are worth it.

I completely feel you on the depression. Mine isn't always SAD, it comes anytime during the year. Meds work fast on me, and I can usually feel an improvement within five days. I've tried different ones, and some didn't work at all, some gave me panic attacks, some made me suicidal. I know the ones I need, and the dosage, but sometimes doctors hate to be told what to give you and refuse to give you that. One chick told me she thought I sounded like I was drug seeking because I asked for Welbutrin and Lexapro, so she was going to try other things first. I told her that those really have no psychoactive effects that would cause drug seeking in the sense she was using it, but because I was coming to see her specifically to get a prescription for antidepressants I was drug seeking in the literal sense of the word. She did not like that at all. I don't care, she was more wrapped up in her own image of being the all knowing healer than she was in her patient. I was 45 when I went to see her and she was in her mid 20s and she was a resident. Drug seeking for Welbutrin and Lexapro? Come on now! Ego, ego, ego lol.

She gave me one that kept me knocked out, I can't remember which one it was. Then when I called her a week later, when I was still sleeping 16 hours a day and less functional than I was when depressed, she switched it to Celexa I think it was, which made me suicidal. Luckily I knew antidepressants can have paradoxical reactions because I seriously wanted to die. I cried all the time and thought only about killing myself. I knew it was probably the drug, but I kept taking it for almost two whole weeks and on the day when I ran a tub of bathwater, grabbed a kitchen knife and a bottle of benadryl and my husbands blood pressure medicine, planning to take the pills, cut my wrists and float off into eternity, I was able to give it a second thought and say "Wait, this is the medicine!" and I called her, told her that I was suicidal but didn't go into details because by then I was able to see that I didn't really want to die and didn't need an ambulance, and she put me on another one. Which didn't work. Two weeks later I went back to see her and told her that I had willingly tried all of her ideas and if she didn't give me the two that I've taken before and I knew worked for me, I would have to speak to her attending.

I got my meds. They worked. By the next week I was almost back to normal and kept getting better and better until I hit a nice level about a month later.

My point in all this is, you know what works for you and what doesn't. Trying something new doesn't usually hurt, although sometimes, ie; the Celexa for me, can. Depending on what your side effects are, taking more may help them stop or it may make them worse. If it's something that you can deal with getting worse, it may not hurt to try your doctors idea. If it's not, then it's perfectly ok and actually very good, to insist that he either change you to something else or you will see another doctor. It's not like you have a small cut on your finger and are at the office insisting on Oxycontin! These are meds that aren't abused and you know how your body reacts. It's not like you are "working up" to something that is actually psychoactive in a buzzy sort of way.

As for the tanning bed, if you can't do that, I've actually read about a certain type of room light that you can get to put in your lamps that gives the type of light that your brain needs in the winter. I don't know how much they are, but if the depression is dependent on the lights, it might work.

Something else I just thought of. Exercise did help you, you said, but you can't do it physically now. I wonder if those same endorphins would be released if you watched a really scary horror movie, if those things scare you that is. Does the brain release endorphins then too, or only adrenaline? I've heard that chocolate can release endorphins, and also sex. Although when I'm depressed, I don't want either, so it's not an option.

Are you able to keep up with things at home? Is your environment neat or chaotic? Do you have a nice neat bed to sleep in with clean sheets and your bedroom fairly straightened up, or have you let that go? Do you shower on a regular basis right now? I'm asking this because those things are the first things I let go when I get depressed and sometimes forcing myself to keep up with them helps my depression from getting worse while I'm waiting to go to the doctor or for the meds to kick in. Sometimes getting at least my bedroom neat and having fresh sheets on the bed and showering will give me more of a lift than I thought it would. I've been known to, when I can't get to the doctor and get meds, to just keep my room neat and clean and myself neat and clean and stay in my room with the door shut for a day or two, in bed reading or on my ipod. The environment in there helps get me out of the worst of it for the moment, then I can leave my room for an hour or so at a time and tackle problems in other areas of the house. Environement is a huge thing to me anyway, but when I get depressed it's even more so. Things like certain CD's and incense and certain sheets on my bed and keeping them neat and not rumpled and myself clean and smelling good go a long way toward helping me feel at least a little better. It's only a small help, not a cure, but it's something.

I hope you get to feeling better soon, and I hope if you don't want to try your doc's suggestion that you talk to him and be firm about it. It's no skin off his nose to try something else for you.

Frances