I would probably be dead if I hadn’t found the right antidepressants.

Sounds like a dramatic statement, eh? That’s because it is. And it’s true. If not for the two I’m currently taking, I’m confident I would either be dead or in a state hospital by now.

How about you? Do you take an antidepressant (or two or three)?

PATIENCE REQUIRED

The worst thing about antidepressants is that it can take up to a month (and possibly longer) to figure out if they’re working. That’s a long time to keep suffering.

I know it’s frustrating, and I know waiting is one of the hardest things to do. You get your gumption up to make an appointment with your doctor or a new psychiatrist, you go to the appointment despite your depressed state and the incredible fatigue that usually accompanies it, and then they hit you with the cold, hard truth:

Now, we wait.

According to the Mayo Clinic, there are five different classes of antidepressants:

1. MAOIs, like Nardil, require you to follow strict dietary guidelines and can have serious side effects. They aren’t used much these days.
2. Tricyclics have less serious side effects than MAOIs, but more side effects than the rest on this list. Tricyclics include amitriptyline (Elavil) and nortriptyline (Pamelor) and aren’t often used anymore.
3. SSRIs are a newer class and have fewer side effects. This is the most prescribed class of antidepressants. Prozac, Zoloft, and Celexa are three commonly used SSRIs.
4. SNRIs are also a newer class of antidepressants with fewer side effects and include Cymbalta, Effexor, and Pristiq.
5. The final class is called Atypical antidepressants, medications which simply don’t fit in any of the other categories. Examples include Trazodone (which is also widely used for sleep), Wellbutrin, and a newer med called Trintellix.

Unfortunately, they all have that one thing in common – you gotta wait and see what happens.

Whether or not they work depends on several factors: your body chemistry, what dose your psychiatrist starts you at, and how much (and how quickly) she increases the dose, to name a few.

Waiting for a medication to start working is maybe the hardest thing of all. Any hope of feeling better is fading. You’re *this close* to feeling better and you’re tired of feeling like shit. And it’s just not fair that you have to wait and see.

Unfortunately, that’s the reality of psych meds. Whereas some medicines can work almost instantly – like Xanax (a benzodiazepine) for anxiety or Excedrin for a headache – psych meds are notorious for taking a long time to work.

TRIAL AND ERROR

I was in my early thirties when I had my first substantial experience with a psychiatrist. I was very, very sick with depression and anxiety at the time and was on a leave of absence from my middle management job at a large nonprofit in the beautiful Bay Area of California (boy, I wish I could move back there; alas, it’s WAY too expensive for me!)

I lost track of how many psych meds I tried over the next seven or eight years, but I know it was more than twenty – antidepressants, mood stabilizers, anti-psychotics, benzodiapines, even anticonvulsants (or antiepileptics), which are used to prevent seizures and treat bipolar disorder.

I kept a list for a while, but I lost track of it a long time ago. I think I took at least one psych med from every class. I was prescribed different doses and different combinations.

None of them worked.

I must admit, I was desperate, and I did not always wait four to six weeks to ask for a higher dose or a different med, and my psychiatrists (I’ve been through a few) often obliged. But after being massively depressed and suicidal for so long and after several psych unit hospitalizations, I couldn’t afford to be passive about it. I was what you might call a squeaky wheel. 😉

As someone used to tell me, you have to be your own advocate. That goes for your mental health, physical health, spiritual health, education, principles, relationships, everything. Yes, there are certainly people out there who can help, but I believe it is up to us to get to the bottom of things if we think we’re being jerked around or not getting the full picture.

RELIEF IS A GIFT

From the time I first went to see a psychiatrist in 2001 at age 33, until 2015, I was MISDIAGNOSED as Bipolar, Type II. (I will never understand why she gave me that diagnosis.) As a result, my psych med history is probably a little more colorful than most peoples’; after all, with a diagnosis that didn’t really address my severe and chronic depression, I was treated with the wrong kinds of drugs.

Assuming you are correctly diagnosed at the outset, which can, admittedly, be tricky, I sincerely doubt you’ll have to go through as much trial and error as I have.

For me, it all came together – finally! – in 2015, after I started seeing yet another psychiatrist. This one, the fabulous Dr. Nelson, of the Minnesota Nelsons (hehe), took his time interviewing me and my then-wife during my evaluation. After a comprehensive two-hour session, he re-diagnosed me as having Major Depressive Disorder. That sounded much more accurate to me.

A correct diagnosis meant that I would now be treated with the correct types and classes of meds, which has been a game-changer. In fact, I’ve been on my current regimen for more than ten years now.

And though there were two very short periods in the beginning where I felt obstinant and didn’t want to take my meds, I quickly realized that they were, indeed, helping and that yes, I do need them.

It’s tragically funny, isn’t it? You don’t know if a drug is working unless you stop taking it – which, by the way, is not recommended. It can really mess you up. Based on my history, I’m pretty sure I’ll need to take psych meds for the rest of my life.

But I don’t care.

It doesn’t matter to me if I need to take them until the day I die. At least I can be confident that I won’t die by suicide.

ARE ANTIDEPRESSANTS RIGHT FOR YOU?

Many people with depressive issues are treated with a combination of medication and talk therapy. For more chronic, severe depression, other types of treatment are sometimes indicated: TMS (with which I’ve had incredible success), Deep Brain Stimulation (which I’ve never had), and ECT, aka shock therapy, (which totally fucked up my brain and my memory and did not help my depression) come to mind. Ketamine therapy has also gained a lot of attention recently, but I don’t know enough about it to have an opinion of it yet.

Have you tried any of these treatments? What was your experience like?

I’ve met a lot of people over the years who try to convince themselves they can get better on their own. Either they try to think positively, they pray a lot, or they live in denial about their depression.

While I appreciate these efforts (except maybe the denial), my experience has been that professional help is most effective. On the other hand, no treatment works for everyone; therefore, alternative treatments are sometimes worth a try, especially when nothing else has worked.

But most people who ask for help start on psych meds first. You can talk to your family doctor about it, or you can find a psychiatrist who will help you. After all, psychiatrists are specialists in the conditions of the brain that manifest as mental health issues.

So, to answer the question, “Do you need an antidepressant?”, I can only say that it’s up to you and your loved ones and your doctor. Many primary care physicians will start you off on one for a while but will refer you to a psychiatrist for longer-term treatment.

My opinion? It can’t hurt to try. Follow your doctor’s directions and don’t skip any doses. I find a pill box to be quite helpful in remembering if I’ve taken my meds or not. And remember – every body is different; the med that works for your Aunt Karen may not do anything for you.

But don’t give up. The right meds – and a load of relief – could be right around the corner!

IN A NUTSHELL…

1. The right antidepressant(s) can save your life.
2. They can take a month or longer to start working, so you need to hang in there.
3. Patience really is a virtue!
4. DON’T STOP TAKING YOUR PSYCH MEDS WITHOUT TALKING TO YOUR DOCTOR FIRST. (Apologies for the all caps – this is terribly important!)
5. You are your own best advocate – so ask questions when you have them. And get a second opinion if you’re not sure about the diagnosis the first doc gives you.
6. Antidepressants have come a long way, baby.
7. An antidepressant may or may not be right for you. Talking out the pros and cons with close friends and family members can help. Ask your doctor for more information. You’d be surprised how many people you know take an antidepressant!

As always, thanks for reading, Warrior. Let’s Keep it Real out there!