5 Things No One Tells You About Taking Antidepressants
Let me say right off the bat that no medication has ever helped me as much as my sad face-repellent pills, and that includes the anti-worm meds they gave me in the '90s after I ate a live pig at an Anthrax concert. This article is in no way intended as a warning that you should give up your medication. But there are some things you should know about antidepressants so you don't end up in a fetal position, clutching your tinfoil hat and writing love letters to pickles. For instance, before I was balls-deep in my own meds, I didn't know that ...
They Can Make You More Depressed
As a general rule of thumb, the average person who needs the help of antidepressants can expect to be on them for about a year. Those are typically cases of people who have short term depression and need a little help with correcting some chemical imbalances or suppressing their urges to silence their peers with flame. If that level of depression took the form of entertainment, it would be an Adele song, or maybe the weeks following Luke Skywalker's discovery that his dad was a murder robot.
Long term depression and its treatment is more like a full season of Game of Thrones, your mind frantically trying to organize and prioritize rapid images of throat slitting, disembowelments, fucking, and bare penises into some semblance of order. It is chaos, and it needs a much longer management plan. Here's the problem, though:
Clearly, not enough fucking.
Recent studies have found that prolonged use of antidepressants actually promotes depression. There is some science behind it that I don't understand because I'm an idiot, but don't feel bad if you don't either, because the researchers themselves aren't quite sure what causes it. So, at least in this instance, we can all say that we're basically as smart as scientists. And I'm going to.
Anyway, it's something you have to take into consideration when talking to your doctor. If you've had problems with depression most of your life, I think it's pretty safe to assume that you'll be a likely candidate for long term treatment, so you're not exactly going into the conversation blind. It's easy for us to think that because this person is a doctor, she knows everything there is to know about the medication, but that just isn't true. There is a ridiculous amount of meds out there, all with a billion side effects -- it's impossible to have them all memorized. Even with the help of a computer, there will be some things that will be overlooked. Some of these studies are so recent that the doctor may not have heard of them yet.
"Penicillin? Are you sure you're not just making that word up?"
But the point is that it's perfectly OK to say, "I was reading recent medical articles on the subject, and there are some legitimate dangers in long term medication. And now that I've done part of your job for you, I demand that you pay me for this visit. That'll be one billion dollars."
They Can Make You Suicidal
In 2004, and again in 2007, the FDA required a "black box" label to be put on all antidepressants that warned of increased suicidal thoughts, particularly in children (later extended to the 18-to-24 age group), and especially in the first two months of use. You may recognize that label as the same one they use at the beginning of Dancing With the Stars. It has saved many a life.
If you're like me, your first thought jumped to "Well of course they're at an increased risk of suicide. They're on antidepressants, which means they're depressed right out of the gate in this study!" But those of you who are smart will read the study and see that the participants were groups of depression-afflicted teens who were given medication and placebos. The ones who were given the latter showed fewer occurrences of suicidal thoughts than those who were on the actual medication.
Here we see a teen taking her "Prozac."
For that reason, anyone under that age cap needs to be closely monitored when taking pretty much any of this type of medication. And just to be safe, most doctors monitor all patients, regardless of age. Except the ones they don't like, obviously. They give those people extra prescriptions and tell them that swimming with sharks is a great form of stress relief.
If you're on any type of antidepressant and you find yourself having suicidal thoughts or feel that your depression is worsening, you need to talk to your doctor right away. Don't put that shit off, because there's a very good chance that you're feeling the effects of a bad match between your brain and that chemical, like your mind knows that you need more Star Wars but completely shuts down during the prequels. And for the love of Zod, don't stop taking them abruptly -- that can be just as bad, if not worse.
"The sarge wants to see you. Bring your doctor."
Combining Them With Common Medications Can Kill You
I am on two medications: venlafaxine (an antidepressant) and tramadol (pain management for a bad back). When the doctor originally prescribed these, she told me that the two could be taken at the same time without any problems, which leads me to believe that I'm one of the patients she hates, because I later found out that it can cause serotonin toxicity, which can fucking kill you.
Understand that I've been taking the two without dying very often, so I'm not saying that the combination is guaranteed to be lethal. But the chances aren't zero, either -- in 2005, 118 people died from it. Like most drug interactions, it has levels of severity, including -- wait for it -- worsening of depression! Yay! Yet another thing that hands your original condition a pool cue and tells it that you called its mother a whore.
You gonna just take that shit, Big D?"
This is the part that I ran into not very long ago. I had what appeared to be serotonin toxicity to a minor degree, as well as the ill effects of prolonged antidepressant use, and I just mentally crashed. I hadn't felt that bad since I was a teenager, high, alone, and listening to the Cure, thick layers of jet black eyeliner running down my pasty white face. At least I think that's when I was a teenager. That very well could have been last Thursday. Time gets fuzzy when depression takes you into the valleys. It's pretty easy to go in fully clothed but walk out the other side wearing nothing but a sequined cape, David Hasselhoff's face tattooed across your ass.
The point is that it's a good idea to not only ask your doctor and pharmacist about the drug interactions, but double check it when you get home just to be sure. Even taking something ordinary like ibuprofen in combination with my antidepressant can cause easy bruising and excessive bleeding. That's why I had to give up my heavyweight championship belt after my last UFC victory.
Now I just invite my kids' friends over and challenge them to matches.
Finding the Right Medication Is a Guessing Game
Cracked writer Mark Hill touched on this point in another article when he explained that we don't know a whole lot about depression. Yeah, we're learning more about it every day, but as of right now, we don't have it down so well that we can hear a list of symptoms, prescribe the appropriate medication, and then let the drugs do CPR on our broken rainbow generators.
Certain types of depression require specific types of medication. Couple that with the fact that each person reacts to those chemicals differently, and you basically have to set up a dartboard, prescribe whatever you hit, and see what happens.
The real trouble starts when the patient gets frustrated, not understanding exactly how long it takes for these things to show any sign of working. As Mark explained, it can take up to six weeks to have even the faintest clue. Meanwhile, the patient thinks, "I've been taking these things forever, and they're not helping. This is a fucking sham. I'm going to contact that witch like I should have done in the first place."
Witch it right on up; I can feel it working!
Those who stick with it often find that they have to try three or four different meds before they land on the right one, each of them taking just as long to find out if it does anything. So it can take several months just to be prescribed the correct treatment. After that, it's a matter of continuing the treatment even after you feel better. It's an enormous process that takes massive amounts of time and dedication, and often the patient will feel much worse before they feel better. I think giving up on that process in mid trial is why we still have so many depressed people vocally against the idea of treating it with drugs.
It's like putting a vacuum on the wrong setting and then saying, "I tried to clean my living room floor, but that vacuum barely worked, if at all. So I put it away, and a week later my floors were even dirtier than before. This whole thing is bullshit."
My floors are clean, but I still thirst for the screams of the lamented.
Meds Alone Often Don't Fix the Problem
When you've gone to the doctor long enough, you get used to a pattern: Your balls started itching after having sex with 12 prostitutes. It appears to be crabs. The doctor prescribes you some cream to get rid of them. You have your pool boy apply it a few times a day, and booyah: no more crabs. Here are the symptoms, here's the cure, get the fuck out of my office, slut.
On top of the problems mentioned in my last point, many people don't understand that medication alone is often not enough. Relying solely on pills is usually a disappointment; although they do help relieve some of the anxiety and stress caused by depression, they don't address the underlying mental issues. So when a patient shows up to the doctor, lists off his symptoms for brain crabs, and doesn't walk out with a cure-all pill, he gives up on the process and resigns himself to the depression until it (hopefully) passes on its own.
"Have you tried not being a pussy?"
Depending on the cause and severity of the condition, many people need counseling in conjunction with the medication. Because let's face it: Unless you have an incurable, chronic problem, you can't keep taking pills for the rest of your life as your go-to coping device. There are often things outside the realm of a physical chemical imbalance that need to be addressed. Work is too stressful. You're intimidated by large crowds. You're afraid to sleep because your husband thinks it's funny to Dutch oven you several times a night. Those things need to be talked out and confronted. Pills can't do that for you.
But that idea of pills = cures gets us every time, and we end up confused about why we still feel like shit months later. Medication will help fight infections after leg surgery, but physical therapy is what gets you walking again. Counseling is physical therapy for your brain. Go get it some exercise and then kick the world's ass with it.
Be sure to check out If Error Messages Had a Sense of Humor.