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Antidepressants [Feb. 20th, 2013|04:04 pm]
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I've been on the antidepressant fluoxetine (better known as Prozac) for nearly a year now, and I thought I'd write about what it's been like. I've heard a lot of scaremongering about how awful antidepressants are and how they don't actually work and they all have terrible side effects ranging from permanent impotence to a constant emotional numbness to suicide to rampage killings, and I'd like to provide my own experience as a counterpoint to that. My experience of fluoxetine has been overwhelmingly positive, and I wish I'd tried it years earlier. I had to get to a very low point before I decided that however bad the drugs were they had to be an improvement; in retrospect I put myself through years of suffering needlessly. Of course, we live in the 21st century and data about prevalence of side effects and outcome rates and so on are available online (at least if you have a university account) and I could in principle have looked at all that, but yeah, depression. Anyway.

The first thing to explain is that fluoxetine didn't take away the negative thoughts or the self-loathing. What it did was to stop me caring about them. "I'm a terrible person and everyone justifiably hates me" turned into "I'm a terrible person and everyone justifiably hates me but ah, fuckit, it doesn't matter." It may not sound like it, but this was a huge improvement. That on its own would be enough to turn me into a raving fluoxetine evangelist, but it also gave me the emotional space to recognise that the negative thoughts were symptoms rather than accurate reflections of reality¹, and to learn and practice techniques for dealing with them.

Annoyingly it hasn't made me as functional as I'd hoped: "It's too scary and I can't face it and everything's going to go wrong AGAIN" is gone, but "ah, I can't be arsed" has taken over to some extent. But barely-functional and meh is, I repeat, a huge improvement over barely-functional and miserable. And I am more functional: I'm writing more code, I've booked a skiing holiday in a foreign country in a couple of weeks' time, I've got through a whole job application process without freaking out and giving up, I went to Fontainebleau last October with less than a week's notice. No way could I have done any of those things a year ago.

Side effects: there have been a few, mostly pretty mild. But the great thing about a drug that makes you stop caring about things is that you don't really mind the side-effects. I have some difficulty reaching orgasm, but not enough for it to be a real problem. Slight loss of libido, but that's if anything a feature. And you know what else reduces your libido? Depression. So it's pretty much a wash on that front. Of possibly more concern is what Johann Hari calls "antidepression": a pervading sense that things don't really matter, which leads you to take unnecessary risks and get yourself into trouble. Unlike Hari I haven't run up huge debts, but my financial management has been noticeably laxer over the last few months (from a not very high starting point) - I've paid my credit card bills late on several occasions, for instance². I've been neglecting my research and my Future Career Development, and the "I'm barely holding my shit together here, it can wait" excuse is wearing increasingly thin. But, once again, it's hard to care. I've written a few things and thought "Should I post/send this? Maybe it's a bad idea. Ah, fuck it" and clicked "Submit", and it has indeed subsequently turned out to be a bad idea. This post may be one such. But a year ago I'd have started writing it, decided that the whole thing was shamefully narcissistic, that I was an Awful Person for thinking anyone would care about this stuff when there are people out there with Real Problems, Dammit and abandon it half-finished in a depressive spiral.

This post lacks a conclusion. Sorry about that. But I don't particularly care.

¹ Well, I hope they're just symptoms, anyway. You'd tell me if you all hated me, right? I'd much rather know, and however low your opinion of me I can guarantee I've thought much worse things about myself. This, incidentally, is part of the reason I get upset when people start complaining about people who aren't present: it makes me wonder what terrible things they're saying about me when I'm not around.
² I've now set up a direct debit for the minimum payment and added a calendar alert to pay off the bill, so this problem should now be solved. I hope I haven't messed up my credit rating too much.
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Comments:
[User Picture]From: andrewducker
2013-02-20 05:44 pm (UTC)

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I'm entirely in favour of antidepressants as a method of pulling people out of a downward spiral. Anything that stops you creating a smoking crater is good.

Are you getting help with sorting the root problem while you're suspended in mid-air?
[User Picture]From: pozorvlak
2013-02-21 01:20 pm (UTC)

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Some, but NHS mental health services are badly overstretched and I'm a pretty mild case. I did a five-week CBT course at the end of last year, and I've read a book about it. It's mostly homework, is the thing, and I need to do that myself. To the extent that I've learned and practiced the techniques, they seem to be helping. I've also made some concrete changes in my life like getting involved in an open-source project and joining my local mountaineering club: getting out and exercising in the hills has a huge positive effect on my mental state.
[User Picture]From: andrewducker
2013-02-21 05:42 pm (UTC)

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All of that is good. Glad you're getting out more and involving yourself in the world.

In my experience CBT is awesome if your problems are largely down to negative feedback loops, whereby you think that you're worthless, and therefore interpret everything badly, and therefore cause yourself distress, and therefore think you're worthless. Breaking that cycle is incredibly useful, and simply changing your actions so that you move away from that attraction point into a different stable pattern is great.

If, however, your problem is down to something more deep rooted, then sometimes that needs to be dealt with. If you have unpleasant emotional tangles/baggage, PTSD (childhood or adult related), or one of a variety of personality disorders, then working with a good specialist who can help you unpick what you can, find good strategies for dealing with what you can't, and help you work things through, can be incredibly useful.

Oh, and to be thorough, there are some things that are chemical/genetic in nature, where you can't fix it through any kind of emotional/psychological intervention, and you're going to need to take drugs, or some other physical intervention, at least some of the time, in order to cope better. I have friends with SAD, for instance, and there's not much they can do about that apart from learn to recognise it kicking in, and make sure they spend lots of time with bright light.

Working out what proportions of your depression are down to each of these three factors, and therefore which approach is best suited to helping you, is up to you, of course :->

(I spent a year and a half working through option 2, untangling all sorts of unpleasant baggage that had tied me in knots. Well worth the money I spent on it. And it doesn't have to be that expensive if you can find a decent place that bases their fees on income.)
[User Picture]From: pozorvlak
2013-02-24 10:55 pm (UTC)

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I don't *think* I have any trauma deeper than "did a PhD in a subject I thought I was good at, got badly stuck for 2.5 years, then got a succession of jobs for which I wasn't qualified". Though given what figg says below about social situations, I'm wondering if I'm further along the autistic spectrum than I'd realised.

Sorry to hear that you've suffered from this awful disease, but I'm glad to hear you're doing better these days!
[User Picture]From: figg
2013-02-20 06:41 pm (UTC)

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As an internet doctor, and someone who has also tried fluoxetine: Congratulations, it sounds like you're having a better experience because of the medication. Hooray and other good news sounds.

(Fwiw The dangerous SSRI is normally seroxat, not fluoxetine. Citalapram apparently has milder effects. Personally, Prozac made me hypomanic)

> I had to get to a very low point before I decided that however bad the drugs were they had to be an improvement; in retrospect I put myself through years of suffering needlessly.

Although the drugs are helping, do you think this logic applies to other things you are doing in your life? Are there other improvements or changes you've been considering, but putting off due to a plethora of negative thoughts?

>The first thing to explain is that fluoxetine didn't take away the negative thoughts or the self-loathing. What it did was to stop me caring about them. It may not sound like it, but this was a huge improvement.

It's a huge improvement. Being able to handle negative thoughts without being overwhelmed is a fantastic step in the right direction.

> it also gave me the emotional space to recognise that the negative thoughts were symptoms rather than accurate reflections of reality¹, and to learn and practice techniques for dealing with them. [[This, incidentally, is part of the reason I get upset when people start complaining about people who aren't present: it makes me wonder what terrible things they're saying about me when I'm not around. ]]

Fwiw I do not think you are a terrible person, not even for your choices in programming language. I guarantee you someone with long term depression will always have lower and more destructive opinions of themselves than their friends do of them. It doesn't mean you're the best, or a utopian creature, but it is hard to be reflective without losing some semblance of balance and objectivity.

As for people talking behind your back. If they're being negative in front of you, that means they trust you, and can get away with saying things that would be hard to talk about openly—like problems with jobs, doctors, coworkers, friends. If they're being negative behind your back, well, generally those people rarely talk to you in the first place. It's a bit of the classic geek social fallacies of rejecting social ostracisers. Social groups often have a common antagonist over a common cause.
[User Picture]From: figg
2013-02-20 06:42 pm (UTC)

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> Annoyingly it hasn't made me as functional as I'd hoped, [...but ] barely-functional and meh is, I repeat, a huge improvement over barely-functional and miserable. And I am more functional: [...] No way could I have done any of those things a year ago. Side effects: there have been a few, mostly pretty mild.

For some, medications are a good treatment for depression, and in some cases the best solution in the long term. I don't think it sounds like a good time to worry about if they are the right choice in the long term for you yet, but certainly in the short term, it sounds fantastic. Don't worry about the long term, see how you feel later on about things, especially if the side effects change, or become frustrating.

> Of possibly more concern is what Johann Hari calls "antidepression": a pervading sense that things don't really matter, which leads you to take unnecessary risks and get yourself into trouble.

A sort of nihilistic fuelled hedonism is fun, but as an internet doctor i'd consider it similar to hypomania. For me, SSRIs made me take risks, and still come home in tears. It doesn't like you've gotten close to that stage, as really, paying credit cards bills a bit late and setting up doesn't sound like you're being too self destructive. Worth keeping in check.

As you've said, prozac helps with the depression, but it doesn't make it go away. You're going to have to introduce new structures and habits to effectively manage depression.

> the "I'm barely holding my shit together here, it can wait" excuse is wearing increasingly thin.

It can wait, although it is hard to make this call without some context. Depression for some, is not something you snap out of after a few months, or a few years, and can be something you will be dealing with for the rest of your life. You still have a sizeable proportion of your working life ahead of you, so putting somethings off in the short term won't undermine the rest of your life.

You're still beating yourself up, and then beating yourself up because of it. Paralysed by feelings of uselessness, uncertainty and low self confidence, you avoid opportunities. Then you make yourself feel worse for giving into the depression. This is a bit of a cycle that is hard to break. You're not a calvinist, You don't have to burden yourself with every mistake you make or chance you didn't take.

> This post may be one such. But a year ago I'd have started writing it, decided that the whole thing was shamefully narcissistic, that I was an Awful Person for thinking anyone would care about this stuff when there are people out there with Real Problems, Dammit and abandon it half-finished in a depressive spiral.

Post seems ok, mostly about your experiences, without trivialising, or dictating others experiences. It sounds like prozac has been a good choice for you.

> This post lacks a conclusion. Sorry about that. But I don't particularly care.

It has no conclusion, but then again your treatment for depression isn't over yet.

I think if you keep on it, and the cognitive behavioural trailing—realising when you're spiralling and not getting sucked in with your thoughts—Things will keep improving, although things won't be perfect. You'll still take some risks, avoid others, feel a bit shit now and then and second guess the motives of the people around you, but you won't be overwhelmed by life as much.
[User Picture]From: figg
2013-02-20 06:44 pm (UTC)

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tl;dr depression is terrible, you're not, glad the meds are working out, but keep working on your sad brains, it takes time.
[User Picture]From: michiexile
2013-02-21 07:30 am (UTC)

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You're still beating yourself up, and then beating yourself up because of it.

Wow. Yeah. This is me too. So often it's almost painful to think about.





oh wait…
[User Picture]From: pozorvlak
2013-02-21 05:13 pm (UTC)

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Third-level beating yourself up!
[User Picture]From: pozorvlak
2013-02-21 01:44 pm (UTC)

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> A sort of nihilistic fuelled hedonism is fun, but as an internet doctor i'd consider it similar to hypomania.

*Googles hypomanic symptoms*
Nope, I don't think I've ever felt like that. Well, possibly during Edinburgh Fringe rehearsal weeks, which are basically ALL GO ALL THE TIME with fun people all around you. So I think we can write that off as situational. I'll watch out for hypomania, though: thanks!

> Paralysed by feelings of uselessness, uncertainty and low self confidence, you avoid opportunities. Then you make yourself feel worse for giving into the depression.

Oh hell yes, this is exactly what depression does to me.

> It has no conclusion, but then again your treatment for depression isn't over yet.

Good point :-)
[User Picture]From: pozorvlak
2013-02-24 10:50 pm (UTC)

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> It can wait, although it is hard to make this call without some context.

The context is that my current contract runs out in April 2014, and that allowing a year to find a new academic job is, if anything, cutting it fine. Not that I particularly *want* another academic job, but academia is at least preferable to not having a job at all. And if I want an academic job (or even something to put on my CV to explain what the hell I've been doing for the last three years) I need publications, and if I want to get publications I need to do some research, and... I'm sure you see how this is going.
[User Picture]From: pozorvlak
2013-02-21 01:40 pm (UTC)

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Thanks very much for such detailed feedback!

> Are there other improvements or changes you've been considering, but putting off due to a plethora of negative thoughts?

Hmmm, good question. The obvious one is choice of job: I applied for a non-academic coding job recently, but should probably apply for more. A bigger step would be leaving the computer industry entirely; not sure if that's such a great idea, especially while I'm my household's main breadwinner.

> I do not think you are a terrible person, not even for your choices in programming language.

Heh :-) The last language I wrote code in was Scheme, does that help?

> If they're being negative in front of you, that means they trust you

Huh, so I misread that kind of situation entirely. How interesting. It still seems a rather distasteful way of bonding, IMHO.

Edited at 2014-05-28 06:30 pm (UTC)
[User Picture]From: johnckirk
2013-02-21 01:58 am (UTC)

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That's interesting, thanks. It sounds similar to what I tell people about Entonox (an analgesic gas): "This won't make the [physical] pain go away, you'll still be aware of it but it won't bother you." I'm glad to hear that this has worked well for you.
[User Picture]From: michiexile
2013-02-21 07:28 am (UTC)

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I recognize most of what you write a lot from my ~6 weeks now on fluoxetine. Libido and orgasm issues? I have them. Reduced caring, makes me not actually freak out about it? Yup, that too.

Since I have a history of bipolar-spectrum problems, I have been on the lookout for hypomanic reactions for a while. I had one, probably more psychosomatic than anything else, flash of manic-spectrum mood swings on my first day of medicating — but my mania has been keeping itself in check as well.

You'd tell me if you all hated me, right? I'd much rather know, and however low your opinion of me I can guarantee I've thought much worse things about myself.

I count you among some of my most important friends. Spending time with you is an absolute joy, and picking your brain is delightful. Srsly.

Finally: I'd love to see this on Depressed Academics. It'd be a perfect fit for what we do there. Ian has already upbraided me for contemplating rewrites because I thought I was being narcissistic — DA has as a house rule that we're not allowed to NOT focus on ourselves, praise ourselves, et.c. because of such worries. :-P
[User Picture]From: shuripentu
2013-02-21 09:57 am (UTC)

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I find it interesting that fluoxetine's primary effect on you is apathy, which in your case seems to be a very helpful thing. I was on paroxetine for several years, and I eventually asked to come off it shortly before my last exam season because it also made me apathetic, which was generally fine (and significantly better than constantly suicidal) but not so helpful when I really needed to pull my finger out and acquire some sort of degree. So I came off it, the self-loathing and anger and wanting to smash all the things came back in spades, but I got a degree. (I also took the most exciting overdose I have ever taken and landed myself in hospital again and then there was hilarity and also police, but swings and roundabouts.) For me, antidepressants helped me get through a particularly difficult several years, and stopped me from being a constant major clusterfsck (and ensured I was instead merely a constant minor clusterfsck with occasional major outbreaks of clusterfsckery), but I think their usefulness for me is now past, and it is perhaps now time for some actual hard work in the mental retraining department in order for me to get any better than I am now (which is to say, borderline non-functional in terms of everyday life but also not smearing blood on the doorposts).

I actually had anorgasmia. I am pleased to report that it goes away once you come off the meds. Ditto the brain zaps.
[User Picture]From: pozorvlak
2013-02-21 01:45 pm (UTC)

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*offers hugs*
*is glad to hear the anorgasmia has gone away*
[User Picture]From: stronae
2013-02-24 05:54 pm (UTC)

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The road to wellness is not usually short, but I'm glad you're taking steps, and I'm also glad the side-effects are not more serious. I'm cheering for you, if it helps. :)
[User Picture]From: pozorvlak
2013-02-24 10:51 pm (UTC)

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Thanks!
[User Picture]From: half_of_monty
2013-02-24 09:38 pm (UTC)

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I don't have anything useful to add, but: very sorry to hear things were so bad, glad aspects are getting better, and it was lovely to see you last summer. Talking to you at 2am by the fire was actually one of the best bits.
[User Picture]From: pozorvlak
2013-02-24 10:51 pm (UTC)

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Thank you very much! That means a lot.