Help! What does success with antidepressants feel like?

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This is a question and a vent, which is basically the back story to the question.

The question:

What are you supposed to feel like when the antidepressants start to work?

The vent:

I have Asperger's and am taking the meds for anxiety. I have been unable to tolerate SSRI’s in the past so my doc has me on 15mg mirtazapine. I’ve been on the meds for six weeks. We have not yet increased the dose because I have been sensitive to medication before.

I’m not enjoying the side effects. They’re better than the SSRI’s, but that’s not saying much. In short, since being on them I’ve gone from being highly anxious to not giving a squirrel’s fart about anything, except during the most intense of anxiety-provoking situations, during which I can feel a powerful frustration or anger that scares me. Most annoying of all, I have to sleep around 10 hours a night to feel okay the next day, but even if I do I still feel tired for most of the day. I feel ‘out of it’ and at a distance from the world.

The thing is, most of the mental health ‘team’ I’m working with don’t seem to see a problem. My GP is a better listener than my last one, but says that I have to decide how I’d prefer to feel: anxious or sleepy. Not satisfied with that, I asked her about medications specifically for anxiety or combinations of medications. None of these are things she can handle, so I asked for a referral to a psychiatrist (via the public system because I can’t afford to see one privately). As part of entering the public system I met with a social worker for an hour in a room that was like a police interview room with better chairs. During the barrage of questions I explained about the medication, including the side-effects – or tried to. When she said, “It sounds like the mirtazapine is working then,” I looked at her with confusion and said, ‘Except for the side-effects.’ She said, ‘What side-effects?’ I gaped at her and said, ‘The ones I’ve just explained to you.’

I was already feeling pretty uncomfortable thanks to the room and the interrogation she was putting me through – plus there was also that ‘I don’t give a squirrel’s fart’ thing I’m experiencing from the medication. It added up to a powerful feeling of wanting to get out of there. I know I should have tried to emphasise the side effects, since that was the whole point of being there. I even realised at the time that I'd forgotten to mention a couple of them. But I just answered the rest of her questions as best as I could and left. She now has to write up a report. What happens next depends on that report… ah well. I was pretty distressed, frustrated and angry right after that interview, but now I’m back to being uncomfortably numb.

Anyway, I feel like I’m missing something. The GP and the social worker seem to treat the side-effects as something normal, or at least unimportant. Do antidepressants all give you side-effects that you’re expected to put up with? Only my psychologist seems to agree that I shouldn’t be feeling like this on medication. I refuse to believe that my only two choices are fighting the anxiety or fighting the side-effects of the antidepressants that are supposed to help me with the anxiety.

I gotta believe it's different for everyone. But my experience with them is months later they made me feel, well...nothing. No longer was I feeling anxious or irritated but also things that used to excite me, or make me laugh didn't! It's as if I lost my soul. This emptiness inside didn't feel good nor bad but deep down inside I hated it! So I gradually stopped. I rather feel emotions whether it be miserly, sadness, happiness, hysteria than nothing at all.

No, that's not normal for antidepressants. My Mom has taken antidepressants for most of my childhood, and is a good responder to them, and she's certainly not been 'out of it' or sleeping excessively. She's been acting normal, except for the occasional bout of anxiety that the antidepressant can't stop.

She went off the antidepressants when I was 7-8 years old because she was having my brother. What I noticed then was that she got upset more easily than usual and tended to wake up at 3 am and not be able to fall back to sleep. (Especially once my brother was born, since he'd cry for a meal at 3 am.) She got more sleep-deprived than most new moms, and it made her mood worse.

Antidepressants are not supposed to make you sleepy or unable to care about anything. They're supposed to make your baseline mood normal. My guess is you're either on too high a dose or you just can't tolerate that med. Since you say you've been sensitive to meds before, maybe your doctor misjudged how sensitive you'd be, and you need an even lower dose.

As for your doctor's responses, if they won't listen to you, tell them that you want to stop the med and don't let them convince you otherwise, just ask them how to stop safely. Then go find a different doctor, one that listens and takes what you're saying seriously.

I was on mirtazapine a while ago for insomnia and dysthymia (chronic depression). It did diddly squat for the dysthymia, but it helped with sleep for a couple of months before my insomnia rose to the challenge and over powered the drugs so I came off them again. They do have a tendency to make you feel more tired throughout the day.
Most medications may have side effects, it's all a case of weighing up the pros and cons, which do you find more tolerable the side effects of the meds or the anxiety the meds are being used to treat.

When do you take the mirtazapine? If your taking it just before bed, maybe you can try taking it 2 hours before you go to bed. But be careful of the drowsiness/dizziness this may cause. If I sleep to much, then I'm tired for the day as well. I would maybe try it in smaller periods from your bed time first : i.e. take it half hour before bed and see how you feel, then increase the time if you feel ok. I'm not an expert though, just started mirtrazapine myself. just thought I would make a wee suggestion.

Ideally, it shouldn't feel like anything when antidepressants work, but unfortunately some side effects are pretty common. I don't know anything about this particular drug or how common this extreme sleepiness is. Given the problem being treated, sometimes the good outweighs the bad. Also, some times the side effects are only temporary when you're taking the medicine long term, e.g. they'll go away in a few weeks or days. I'm concerned that your doctors and social workers aren't taking the side effects seriously, even though it's pretty severe.

Thanks for everyone's responses, I appreciate them.

@schots: I'm taking the mirtazapine one to two hours before bed because I discovered that even though they were making me feel sleepy, I couldn't actually sleep until around an hour after I'd taken the medication. It hasn't made any difference to how much sleep I need at night or how sleepy I feel during the day.

Thanks for sharing your mum's story. It puts my side-effects into perspective - that they're not normal. I'd be willing to put up with a few mild side-effects if I felt otherwise okay, but these side-effects are like swapping one set of problems for another.

Unfortunately, if I 'fired' this doctor for not listening she'd be the second one in less than six months. To be honest, I prefer her to my previous doctor. I get the feeling she believes me when I say I'm struggling with the side-effects, whereas the other one was inclined to blame 'underlying depression' for every single side-effect I mentioned. My current GP is also pretty good when compared to some of the other doctors I've seen throughout my life. The problem is that she's reached the end of her knowledge when it comes to psychiatric medications. The thing that annoyed me was that she seemed content to let me choose between the anxiety and the side-effects rather than seek another solution. Being the actual person faced with the choice, I refused to accept that and asked for the referral to the public mental health system. Knowing how difficult it is to find a half-decent GP, I'll stick with her for now. I don't have much choice about who I see in the public system. Fingers crossed that goes somewhere and soon.

With mirtazapine, smaller dose actually makes it more sedative, so that small dose might make the apathy and tiredness worse. When mirtazapine is prescribed for insomnia, it is prescribed pretty much always in 5-15 mg dosage, not higher than that.


http://www.med.ucla.edu/modules/xfsecti ... fileid=967

Thanks, Suomalainen.

I'm increasing the dose to 30mg now for that very reason. So far, no change - in fact I feel worse - but it's only been a week. I'll give it another two to three weeks. If the new dose doesn't improve matters, I am going to titrate off the things because I can't afford to be feeling tired and apathetic right now. I'm in a pretty crucial year at uni.

The doctor will not talk much about side effects and moreover someone that is depressed and negative.
He/she is negating your side effect because you may be in a state of depression.

My prescription with fluoxomine gave me drowsiness and excessive sleeping which then changed to fluoxetine a lower dosage.

I still have excessive sleep and feel tired easily. I still have panic anxiety attacks and wonder if the medication is working. but I feel slightly less sad.