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Antidepressants - Beware of the Train [entries|archive|friends|userinfo]
pozorvlak

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Antidepressants [Feb. 20th, 2013|04:04 pm]
pozorvlak
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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: figg
2013-02-20 06:42 pm (UTC)

> 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.
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[User Picture]From: figg
2013-02-20 06:44 pm (UTC)
tl;dr depression is terrible, you're not, glad the meds are working out, but keep working on your sad brains, it takes time.
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[User Picture]From: michiexile
2013-02-21 07:30 am (UTC)
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…
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[User Picture]From: pozorvlak
2013-02-21 05:13 pm (UTC)
Third-level beating yourself up!
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[User Picture]From: pozorvlak
2013-02-21 01:44 pm (UTC)
> 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 :-)
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[User Picture]From: pozorvlak
2013-02-24 10:50 pm (UTC)
> 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.
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