Without antidepressants I'd be fully housebound from agoraphobia.
They work. Not perfect. And tolerance at different dosages build over time. But it's not a placebo effect.
They work. Not perfect. And tolerance at different dosages build over time. But it's not a placebo effect.
This is obviously a corner case that doesn't apply to the vast majority of people on antidepressants but it brings up some worthwhile discussions.
Your actual perceived "mood" is generally the "last" thing to change with basically all flavors of traditional antidepressant, since it's more or less your calibration of how much life sucks over time, and it takes a while of noticing it sucks less to recalibrate.
So every doctor I've ever had has given me a very similar lecture about being very cautious, because depression is more or less characterized as having reduced or no ability to actually drive yourself to do things, and then you feel like shit as that keeps happening and your frame of mind goes sour. But conversely, if the antidepressant affects the "underlying" problem, your inability to turn thought into deed, it will take time (and possibly therapy) for you to recalibrate again, and then you have a window of "I want to die, nothing will ever improve", coupled with a newfound ability to successfully turn thought into deed.
It's one reason things like ketamine and psilocybin are seen as wild - when they work, both generally improve at once, so you avoid that problem.
Since that's completely outside their experience, they often conclude you're lying, not "people work differently".
What goes up must come down, to use such analogy.
Take a look at many psychoactive substances. Sudden cessation after prolong usage typically presents as symptoms that are the opposite of whatever the substance provided.
I can think of quite a few substance which result in harm with sudden cessation after prolonged usage -- Alcohol, benzodiazapines, antihypertensives, etc.. Perhaps medications like: antipsychotics, anticonvulsants, immunosupressants, etc. as well?
Obviously individual reactions vary and nothing is a guarantee in medicine, but I believe many substances can cause noteworthy issues with sudden cessation that are greater than just the reemergence of the underlying condition being treated. However I am probably more wrong than right on most topics, so (anyone) feel free to correct me if I am mistaken.
Not a doctor and this is not brain health advice, but SSRIs take several weeks to start working.
If they work because “more serotonin in the brain treatments depression” they should start working instantly. The two week lag indicates that they work based on a secondary effect caused by long term elevation of serotonin. And it’s maddening that we don’t seem to know what that effect is.
When I tried Zoloft again years later, during another bout of depression, I felt nothing: not right away, not for weeks after, no change at all.
I suspect that there is not really any such ailment as depression, any more than there is any such disease as fever; that is, the pattern of symptoms we see represents a reaction to some underlying problem, and many different kinds of problems may cause similar symptoms, while requiring different solutions.
(I got prescribed it for anxiety)
This may sound pedantic but I see this blanket assertion all the time from people who take psych meds and have them work for them. There is a very large group of people for whom they do not work, and others in which they cause serious harm. I’m glad they work for you, but please don’t assume that they work for everyone. They don’t.
I don't see a claim by OP that their experience generalizes absolutely. I'm also having a hard time seriously believing you don't think people are aware that folk can have varied reactions, people become aware of allergies as a concept usually well before psychiatric medication.
Just to be clear - I don't mind you adding in that additional context/reminder, I think additional perspective like that is frequently helpful, but I do resent you demanding others add it in your stead like they've missed an obligation or made a mistake.
In the developed world, yes. In much of the world (perhaps even most of the world) you can simply walk into a small local pharmacy and buy pretty much anything. Antidepressants, valium, antibiotics, whatever. Only uppers tend to have stricter controls, but I've heard you could find them with a bit of legwork.
- many people are unwilling to wait the proper amount of time "4-6 weeks" for efficacy to manifest *especially* when for the first 2-3 weeks you many times feel much worse than baseline.
First month on Effexor made me feel miserable. More anxious but much, much more irritable and depressed. Then one day a month in I'm sitting at my desk and I suddenly feel high as a kite lol. Melting bliss.
That feeling too fades and then you just feel better than baseline until you build tolerance to current dose. Raise, rinse and repeat.
Better than having to be near an exit whenever inside a structure!
Those 4-6 weeks are when your brain is adapting to an ever increasing serum level of antidepressants, and it takes about ~2 weeks for serotonin receptors to downregulate in response. That time can be very uncomfortable, specifically because SSRIs indirectly activate 5HT2C, leading to dysphoria, anxiety, etc, before the receptor is sufficiently downregulated.
tl;dr: it can take longer than 4-6 weeks for efficacy to manifest
First and foremost because you take them at a point in your life where you're, well, depressed (used as a blanket term here). So patiently waiting for the effect to manifest is a burden in itself, in addition to hoping it works and not being sure if you're experiencing a placebo or actual effect.
But what scares me more, personally, is that it takes such a long time to get on and ween off. It seems to fundamentally change something in the human body or brain. As opposed to e.g. amphetamines, and benzos, which may have long lasting effects from prolonged use, but otherwise appear to be pretty straight forward.
Having never needed antidepressants, I'm curious if others who have taken them, worried about this before or afterwards?
I've experienced worse withdrawals from other drugs, but I've read that some people do get PAWS-like symptoms from SSRI, and especially SNRI, withdrawal.
A friend working in rehab said benzos are very difficult to end taking - because of the way one gets addicted to em.
[1] https://www.hopkinsmedicine.org/health/conditions-and-diseas...
But over time, my thinking and behavior became more and more erratic. I became highly unstable, doing bizarre and unsafe things I never would have considered prior to Effexor. So I needed to come off. Ok, then I had to endure a month of brain shivers, where moving my head made the world stutter like there was a strobe light. After getting through that, I developed dystonia, which lasted for the next fifteen years.
This is why I said that the statement needed clarification. Everyone that had them work for them thinks “they work”. Bullshit. They worked _for you_.