“It’s really hard to withdraw from antidepressants,” said New York psychiatrist and pharmacology expert Julie Holland. In some cases, “people feel like cold water is running down their spine. They can feel their brain sloshing around, or electric zaps in their head.”
Dang.
If it's true as claimed that medications only help half the time, this seems like a strong encouragement to try things like exercise, yoga, and lifestyle changes before going the medication route.
Unless you're so depressed you honestly can't make those changes... as commenters have mentioned, sometimes medications are absolutely helpful, needed, and life-saving. I've heard of cases where being on a medication just for a short time helped people break out of a rut.
If you're getting a prescription, it seems worthwhile to ask docs for options that are less problematic to get off of.
Especially for depression, prescribing medications is about stabilizing a patient's mental health and building a safe platform from which the patient can work to minimize the negative consequences of their depression (or many other mental illnesses, for that matter) on their daily life. No psychiatrist is going to suggest that there's a magic pill, dosage, or regimen that will make the depression go away. What medication can do, though, is help keep a patient's depression from overwhelming them. Ideally, medication gives the patient both time and enough separation from those negative emotions and consequences to make changes that become well-reinforced habits. That can be through traditional talk therapy, cognitive behavioral therapy, simple exercise, changes in diet and sleep patterns, etc. Medication can serve as a sort of barrier between emotions that can overwhelm you and keep you from getting out of bed at all. It doesn't make those feelings go away entirely, but it gives you the breathing room you need.
Of course, the public doesn't necessarily see things that way. There's a common belief that the right medication will 'cure' the problem for you or, barring that, make it go away. After all, that's how other medications work! Blood pressure problems? Take a pill. Bacterial infection? Antibiotics, and poof, it's gone! That's a huge problem for psychiatry, and it's one that's probably not going to go away anytime soon. Your GP might be willing to prescribe an antidepressant, an ethical psychiatrist is almost always going to be the better choice precisely because treatment isn't about just receiving a script and heading to the pharmacy.
Of course, I've also heard psychiatrists call me irresponsible for going off medication that was actively holding me back from the energy and motivation I need to work well (and feel good about my life).
There is certainly a diversity of opinion amongst practicing psychiatrists even what the role of the medication is.
Did you go off the medication without any input or supervision from a doctor? I've had doctors accuse me of being irresponsible for doing that, and I have to agree.
It can be chicken and egg. I imagine that for many personal lifestyle changes are more difficult than popping a pill. Once they start to feel the benefits of medication then doing things out of the norm may come easier. In my own anecdote, it was over the counter stuff like St John's Wort and valerian that helped me do the life change stuff. Also, no one lives in a vacuum. If your husband/wife and kids are all used to you not doing things like yoga, exercise, and whatever else they may subtly make comments or behaviors that make lifestyle change difficult to near impossible.
For me, as someone that's been through it, and as someone that other people in my group of friends come to for help, the thing about exercise, cleanliness, and diet is that you're right, it is a hard lifestyle change. For most people. But I notice that almost everyone gets to a point when they hit their own personal rock-bottom, and they're willing to try anything. One of my best friends said something similar when we were talking about his wife, who suffers from PTSD and bouts of depression. He said she wouldn't want to try it because she is stuck in bed all day. And I told him to tell her that the change will be almost immediate, and it will keep up as long as she keeps it up. She got out of bed. Maybe some people don't want to change. But in the pits of despair that I have been in, and my friends have been in, people are willing to do almost anything to make the pain go away. Exercise, cleanliness and diet are not cures for everyone, but they do help, and they help immediately, for long enough to make it to your doctor's appointment. For some reason, I get pushback from people on the internet about this, but it works. The only cure for this is time, and that's just an unfortunate fact. But when people are told those things make positive changes immediately, almost everyone gets out of bed or off the couch to try it. It all comes down to whether or not the person wants the pain to go away. If they do, they'll make the change, even temporarily.
Much of that pushback is because that same advice can be twisted into a sort of "just will the depression away" suggestion that's kind of tone deaf and insulting to people suffering from depression. It's not uncommon for people to say exactly that, as if it's little more than a light switch that needs to be flicked off. And most of the time, those sorts of comments are pretty patronizing, along the lines of "just man up and get over it." Not yours, but I can see how people might interpret it that way based on the way others have acted towards them in the past; basically, your suggestions were judged by the words of others.
You're looking at exercise, social activity, and other lifestyle changes as a means of combating depressive symptoms. That's absolutely true, and there's a wealth of peer-reviewed evidence to support that. Almost anyone with a depressive disorder would benefit. For that matter, almost anyone would benefit. And the social aspect, with friends and family pushing and supporting you as you set out on those efforts, can absolutely play a profound role in mitigating those symptoms (assuming those around you notice; it's quite common for people even with severe depressive disorders to be able to mask their feelings from even those closest to them). But for the worst cases, and even many that aren't as severe, those first steps are the difficult on a level that those who don't suffer from depression can't really conceptualize.
Imagine a mental pain so severe that it cuts through to your very soul; an existential despair so pervasive that simply envisioning a life without it is nearly impossible. I remember a professor of mine discussing a former patient of his: the patient described her depression as an overwhelming hopelessness so great that even suicide was too much of an effort despite wanting to do just that. Obviously, she managed to get help at some point but I remember feeling goosebumps along my spine as those words were repeated to us. It was a chilling description of an inner hell that nobody realized this woman was living in.
At some point in their lives, almost every single human being will feel a sense of hopelessness, despair, sadness, etc. Even the shitty emotions are part of the human condition. It's when they start to interfere with your ability to function in everyday life, and/or they persist for a longer period of time, that you start to look at a problem beyond the norm. Depression isn't about simply hitting rock bottom; it's more about not being able to see anything but. But even that's a bit of a generalization.
This is the other thing I don't understand. People seem to have it all figured out, when it comes to other people's feelings. I'm not sure where in my description you get the impression that I don't know what depression is like. I wasn't hitting rock bottom after a bad week at the office. I was laying on my living room floor drinking for a couple of months after my fourth combat tour. When I tell people to try taking a shower, doing some laundry, exercising, and eating something healthy, it's because it works as well as anything that isn't time -- which, again, is the only real cure. It took four years for me to get back to a point where I could have a bad week at the office.
I'm sorry if I gave you that impression. Actually, I'm pretty upset I made you feel that way to begin with. Talk about ironic, given the point I was trying to make. I kind of took your comments as a segue to respond to the sort of un-thinking ignorance I mentioned your comments getting compared to/judged by/fighting against. It wasn't you I was suggesting don't know what depression feels like, but generic "suck it up" thoughts I was thinking about in response.
That said, I still absolutely agree with you. Lifestyle changes can have a profound impact on depression, and perhaps more importantly, can help support other behavioral changes long-term. They might not make the problems go away, but they'll absolutely help people get through the worst aspects, even if other treatments (medication, therapy, CBT, etc.) are needed alongside them.
The other problem with exercise as treatment for depression is that it's pushed as nearly magical cure that will strongly help everyone with depression.
It'd be easier to take the advice if it was pushed as "it helps some people a lot. It might help you, if only a bit".
Medication works best in combination with therapy. A med check takes 15 minutes once a month while therapy might be 2 hours a week. You can guess which insurance covers.
I tried a low-dose of anti-depressants for a year while I was going through a rough patch. They helped quite a bit but the withdrawal symptoms -- especially the brain zaps -- were quite unpleasant.
May I note there is one drug that is relatively safe from addiction and unhealthy side-effects, and it is good that since last Tuesday, it is becoming legal in more places.
It can also enormously exacerbate symptoms of depression, and despite claims often made by its cheerleaders is no more a panacea than exercise, SSRIs, or indeed anything else.
Yeah, did a quick google, only reputable thing I could find is this[0].
Yes, a tired meme, but what is asserted without evidence can be dismissed without evidence...and at a rung above no evidence, can be eviscerated with a link from a first pass at a google search.
Everyone seems hung up on causation. I'm just talking about how something that glues your ass to a couch isn't necessarily the best thing to combine with a disease that also saps volition.
Sure, you don't feel it so strongly while you're high. That's one of the nicer things about that particular drug, paranoia aside. But that only works while you're high, subject to the same habituation process as anything else - and it's not the same as actually doing something to help yourself.
I don't doubt there are people with depression for whom marijuana has been a substantial help. That's great! I'm glad for them, and that legalization is making it easier for people whom marijuana helps to maintain access to it. I also think it's reasonable to approach marijuana with the same caution as any other potentially beneficial drug. Arguing that, because there's no uncontested evidence that marijuana causes depression, there's no harm it can possibly do a person with depression - does not seem all that cautious to me.
There is a lot you can do with diet and other lifestyle approaches. Though this site is mostly about managing my physical health that way, I blog some about managing mental stuff that way here: http://miceats.blogspot.com/
I am posting this here in hopes of making it available to people reading comments here who wish they had alternatives to medication, but just do not know how to make that work. It isn't guaranteed to work, but it's a place to start getting more informed.
> If it's true as claimed that medications only help half the time, this seems like a strong encouragement to try things like exercise, yoga, and lifestyle changes before going the medication route.
Medications help pharmaceutical companies make money all the time.
There is a huge incentive for this path and it's hard to come-by adequate science, since a large percentage of funding for long-term and expensive studies comes from the very same pharmaceutical companies.
All I can say is, I was fit, ate well, while living healthy, and I still needed the medication to help me get through a tough spot. Living a healthy life, and needing medication are not mutually exclusive.
"nearly 1 in 4 white women ages 50 to 64 is taking an antidepressant, according to federal health officials."
This is the saddest thing. My wife remarked that there was a weird sense of expectancy that if you were a white female of middle age you were expected by your peers to be taking anti-depressants.
Out of the other 3 in 4, how many are self-medicating with something else?
Coincidently, my mother has three sisters, and all of them are in this age range. Two are on antidepressants. Two of them drink a bottle or two of wine a day. There is some overlap there.
I'm just going to throw this idea out - although I have no evidence either way, but: is there something in the water?
Durango's water supply is the Animas, which is downriver from Silverton, and many old, abandoned mines and basically SuperFund sites (even though there's pressure to not call them that - or get that Federal $$$ to fix the problem, for fear of tourist dollars leaving). Are there known correlations between the types of acidic chemicals and heavy metals found in this type of polluted water and mental health?
I ask because Durango is a beautiful, sunny place. It's hard not to be there in the summertime and not feel wonderful. Yes, in the winter, it's a little more clausterphobic, and you ARE in the middle of nowhere, but it doesn't have the depressive anxiety feeling of a place like Leadville used to have, when their main Moly mine closed down.
The city of Durango does not normally pull its water supply from the Animas River but rather the Florida River which is not known for a large heavy metal load. Animas river water is used as a backup supply.
Long ago, a cousin of mine and her husband raised their family in Durango. I think they all felt it was a great place to grow up, especially because they were passionate about exploring the wilderness around them. Attempting to settle there as an adult with only a high school education and build a life is another matter. Three of their four sons moved to the Front Range to go to college, raise their families, and pursue careers.
Having traveled through this area of colorado, I'm not surprised that depression runs rampant. There is literally nothing out there, no industry, no jobs, nothing. When travel through these towns it's as if you travel back in time and the majority of these people are stuck there. They have no way out. I'm not sure what solution is for towns like these.
Maybe depending on the person and which side they come from. Personally I come from the side of defaulting to doing nothing. Deciding against action is easy to me. Defaulting to action means avoiding the doldrums of apathy. I imagine more are like me than otherwise.
I'm curious how significant this is. The article sounds like it might be abuse of subgroup analysis as in https://xkcd.com/882/ i.e. check every state, check a dozen demographics in each state, and one of those is going to have higher suicide rates than the rest. Doesn't mean it's some feature of that demographic instead of random chance.
You should be able to calculate the stddev and how many from the mean western Colorado is if you have a federal data set for all the subgroups. I'd be somewhat surprised if they hadn't, but you're right that I don't see any mention of it.
Am I the only one who react when they write in the article
"Although more men than women take their own lives, the rate of suicide has nearly doubled among middle-aged white women since 1999..."
And the whole article is about women who take suicide. The writer is a woman but this is typical for big publishers like Washington Press. They very seldom write about mens problems and challenges.
Men die more often than women. But women have started using more lethal methods than they used to, and women make more attempts. This combination - increased lethality of method and greater number of attempted suicide is worrying.
Newspapers often report the fact that rates of death by suicide are rising. (It's a bit more complicated than how they report it - there was a decline in rates for many years). Most of the rise is in women. In the UK rates of death for men have dropped a bit, but rates for women have risen a bit, causing the overall number to rise.
Washington Post has written before about the disproportionate number of male deaths by suicide, so they're not ignoring it.
Altitude apparently shows up both as an increase in depression and a decrease in ADHD. One researcher hypothesizes that altitude affects both serotonin and dopamine production, decreasing serotonin and increasing dopamine.
There is really no substitute for family, and for coming to know God. The government or this-or-that philosophy will not give our lives purpose and direction. The Mormon missionaries can help. Really.
Do you have any evidence that there's a lower rate of death by suicide for people in the LDS church?
One group at increased risk of death by suicide are LGBT people (at all ages). Religious groups tend to do badly by these people, and anecdotally there's a few news article about deaths by suicide of LGBT teens who were part of LDS church.
Thanks for your polite response. I've seen references debating general suicide levels in Utah, USA (one interesting, later debunked I think), but I think people tend to believe what they want, and I haven't researched it. My personal experience seeing a wide variety of situations in my own family and others, including many problem types that people experience in life, strongly bears out the quote (Tolstoy?) that happy families are all alike, and miserable ones are each miserable in their own way. Following certain principles leads to the predictable results. We all have hard problems; having the life tools available to deal with them and use them as building blocks instead of being crushed by them, makes me feel very fortunate.
I hope you don't mind if I add, to to try to somewhat dissuade others' anger: Some people respond harshly when one who is not atheist simply says what one knows personally from experience. It's usually good to hear a variety of viewpoints. I just know what I see, etc and how it all relates. So I just try to keep going forward with purpose and direction, because I know where it leads, and the things I can't control will be OK eventually.
ps: I certainly don't mean all sadness is one's own fault, or that medication is never warranted, nor do I wish to minimize the realities we can all face as individuals. But life decisions, perspective, forgiveness, knowledge of purpose and answers to the big questions, support systems, etc etc, seem to matter most of all.
No, men die of suicide at 3.5x the rate of women. But there have been similar articles about the general trend of increasing suicide rates, and the highest rate being among white men. Whenever there's a gender or race break-out, there's opportunity for specific articles as people dig deeper into the data and start finding out the rates for other sub-populations.
But women attempt suicide more often than men. And women have started using more lethal means than they used to. And the combination - more suicide attempts, more lethal methods, is worrying.
Right. The way I look at this, suicide attempts are just the tail, the extreme cases -- even more people are not quite that desperate, are suffering at a level that's only almost unbearable.
Please, I beg you not to let go of your compassion for human life. These people obviously had troubled lives and went through great amounts of pain. There is a time and a place for debates about gender equality, but I don't feel like it is helping anyone to do it here. With that said I understand your frustration and sincerely wish you well.
...but women in that age group have more suicidal thoughts, and have more suicidal behaviour (planning, preparation), and have more suicide attempts than men.
If women switch to more lethal methods - which is what this article says is happening - they'll soon overtake men in numbers of deaths, especially in this age group.
It really would be news, if any cohort of women had a higher suicide rate than the same cohort of men. That isn't the case, however, and men's rates are ticking up just like women's. TFA offered no evidence for the "more lethal methods" claim.
Depression is a label for a wide range of complex illnesses. I am sure that what you say is true for some people, but in some cases it simply isn't. I've got friends who have been helped by medications, and I've got friends who have tried medication and it didn't help. One thing that is counter productive is to assert that these medications don't work ever, because they do appear to be extremely effective in some cases. Which figuratively and factually is a life saver.
It works around half the time. So, yea it can cure depression though it does not cure everyone of depression.
It's kind of like rebooting a computer, it does not always work and sometimes it makes things worse. But, comparing the cost vs benefit it's generally worth trying.
Your insistence on evidence for a "cure" is nonsensical.
Doctors don't have a cure for depression at the moment, it's true. They also don't have cures for HIV/AIDS, or diabetes, or asthma, or lots of other chronic medical conditions (see https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... for a list of the most common ones).
But they do have medications that can make it possible for people with those conditions to lead long, productive, more or less normal lives. Are you suggesting the people with these conditions should be turning those medications down? That they should refuse any treatment short of 100% removal of the underlying condition, even if by doing so they reduce the length and quality of their own life?
Why, exactly? Why on earth make the perfect the enemy of the good like that?
I did not suggest that people should turn down medication, or refuse treatment.
I didn't say anything other than that medication doesn't cure depression - which I stand behind.
Let me turn the tables on your indignance for a moment - why don't you care about the causes of depression? If the incidence is on the rise, the causes must be getting stronger. How can you condone simply restoring people to productivity with drugs when there is an increasingly serious problem harming them in the first place?
You are trying to redefine terms here. Depression is not the same as the underlying cause of Depression. You can go from Depressed to not Depressed without becoming normal or happy.
Further, it's not clear that the actual incidence is on the rise or if this is reversion to the mean etc. We have shifted what people call Depression and how willing people are to seek treatment. The age adjusted suicide rate was actually higher from 1950 - 1980 than it is today.
In 1950 the rates of suicide for 75–84 years old people was 31.1 in 2010 it was 15.7. If you look at the actual rate by age it's all over the map. http://www.infoplease.com/ipa/A0779940.html
It's actually unclear what your argument is here. Remember that these comments are in response to an article about rising incidence of depression treated with multiple medications.
It sounds like for some reason you are now just trying to say that depression isn't really on the increase in certain places.
I have excessive hope, and that is one of the many causes of my depression. Another cause is apparently a chemical imbalance in my head, which certain drugs have helped with.
How would you suggest I go about curing my hope problem? I have too much of it. It's a double-edged sword in that it keeps me down, but it is also the only thing that stops me from 'pulling the trigger'.
Feeling depressed is a valid emotional state and a necessary one at certain times. It can help prompt change. Feeling hopeless or negative about the future can jolt you into action, overcome ingrained behaviors, etc.
Like many other things too much depression for too long becomes clinical depression. Then it is no longer serving its proper function and becomes a pathology. People with clinical depression can't "hope" their way out of it anymore than someone with eczema or cancer can "wish" those conditions away.
Imagine we used the term "stomach bug" for both food poisoning and stomach cancer. Now imagine you have stomach cancer and everyone keeps telling you to drink plenty of fluids, rest, and it will go away. That's basically what your post is saying.
If you can provide a source showing either that a deficiency of medication is the cause of depression, or that medications do cure depression, then I will provide a source.
From personal experience: medication stabilised my last depression 7 years ago. After his stabilisation me and my therapist decreased and finally overcame it using EMDR therapy (very interesting technology by the way). This after 18 years of on-and-off depressions in which unaware of my condition.
Actually no, the burden of proof is not with me. I am claiming that something doesn't exist - I.e. A medication that cures depression. This is similar to saying 'there are no unicorns'. Neither statement can be proven by citation since there is always the possibility that a unicorn (or a medication that cures depression) has been overlooked.
If there is such a medication, it should be trivial for savanaly to point it out.
I think a lot of people are getting confused about 'cure' vs 'management.' In my case it helped with neither.
SSRIs only /treat/ (not cure) a deficiency of serotonin, which for some people is all they need. I think some people have a strong genetic predisposition to depression, however that doesn't mean "therefore medication."
But depression comes in a lot more forms than just a simple serotonin deficiency, it's also thought that dopamine and norepinephrine play important roles. Personally, antidepressants never helped me, though a combination of physical exercise (https://en.wikipedia.org/wiki/Neurobiological_effects_of_phy... - seriously read that, I used to think exercise was just about living longer and being "healthy" in some abstract sense, which were the opposite of what I wanted at the time) and meditation has helped. It hasn't made me happier but I think it's effectively treated my depression.
When someone doesn't have the ability to "lift" themselves out of their depression, there isn't suddenly a binary "either they need an SSRI/SNRI or RIP tough luck". Some people have hypothyroidism (this was my case) and no amount of psychoactive drugs is going to help with that because the neurotransmitters aren't even being manufactured in the first place and even if they were you'd barely have the energy to utilize them. Other people just don't respond to SSRIs but would still respond to the massive boost of not just serotonin but dopamine and norepinephrine caused by daily (especially aerobic or HIIT) exercise (it also rewires the reward centers and dozens of other things, read that article). Some people might have bottled up emotions or physical influences increasing their cortisol - high cortisol can make you feel depressed too. Meditating lowers that and brings out your emotions so you can cry if needed (which FURTHER decreases cortisol). That was kind of the last component for me.
Some depressed people need someone to not just give up after trying an SSRI but actively get them doing the lifestyle changes, whether that's self-applied in CBT as in Feeling Good, exercise, meditation, getting out more, whatever. Like they seriously need to be guided to do it in real time, they can't just be expected to even remember to do it. Also blood work and hormone tests are simple to do - it might just be a lack of micronutrients or hyper/hypothyroidism (especially in this age group of middle aged women. personally I'm 20f)
Dang.
If it's true as claimed that medications only help half the time, this seems like a strong encouragement to try things like exercise, yoga, and lifestyle changes before going the medication route.
Unless you're so depressed you honestly can't make those changes... as commenters have mentioned, sometimes medications are absolutely helpful, needed, and life-saving. I've heard of cases where being on a medication just for a short time helped people break out of a rut.
If you're getting a prescription, it seems worthwhile to ask docs for options that are less problematic to get off of.