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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.

[User Picture]From: pozorvlak
2013-02-21 01:20 pm (UTC)
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.
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[User Picture]From: andrewducker
2013-02-21 05:42 pm (UTC)
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.)
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[User Picture]From: pozorvlak
2013-02-24 10:55 pm (UTC)
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!
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