Will I have to be on an anti-depressant forever?

[BetThisUsernameIsntTaken11]

I'm mid 20s, I've dealt with depression for probably 10 yesrs or more now. I never took any medication for it until maybe 4 months ago. I was diagnosed for the first time. Clinical depression. I had known this whole time though without needing to hear it from a doctor. I tried an SSRI for about a month and a half but tapered off of it. Never really accepted that I needed a pill to make me feel normal. Now, my symptoms seem to be slowly coming back. Not near as severe as they had been, just feeling down. But I guess it's more complicated than that. I feel like serotonin plays a huge role in my depression. If that is the case will I ever be able to not be on an anti-depressant? I'd like to be able to manage my depression without one but I think my depression may be out of my control and a pill is needed. Any advice? I feel like I'll have to take an anti-depressant forever.

[maureen820]

Hi, I mostly agree with everything Paxiled has said. He/she seems to be very well informed. I have bipolar disorder and 'have' to take medication for the rest of my life, but I would far rather swallow a pill than get sick again. I also agree with Paxiled, that therapy and lifestyle changes are often just as helpful as medication. One very interesting thing you might like to think about: I recently read an article (wish I could remember the reference) that was debating whether depression was caused by a chemical imbalance in the brain? I go to a local clinic and meet a lot of people with depression, many of whom say it is a chemical imbalance (like bipolar). I do not agree with this. The article said that the mental health profession has come to a general consensus that depression has nothing to do with chemicals or wiring in the brain. In fact, they say that SSRIs (that deal with Serotonin) are popular now because the pharmaceutical industry wants to sell drugs. The article says when you have a headache it is normal to take Asprin, but that is not because you have a lack of Asprin in the brain. Other than that, it is really up to you what you decide to do.

[Paxiled]

This is some real truth, here.  But the fact medical research hasn't yet found a chemical imbalance or other biological problem doesn't mean there isn't one, it just means everything that so far was claimed to be the cause was advertising and lies.  The notion that serotonin has anything at all to do with causing mental illness was a lie put out by Eli Lilly when it came out with Prozac.  But that doesn't mean ssris don't help with the effects of anxiety and depression.  It's exactly like taking aspirin for a headache -- isn't the cause, but it can help you live with it.  Now, headaches usually do have a cause that eventually can be found, but mental illness has proven to be very resistant to that.  But research is going on.  For anxiety, much of the focus is now on a primitive part of the brain called the amygdyla.  For depression, it's glutamate receptors.  But they've been digging into these things for a long time and so far no solutions.  My only point is, it still might be the wiring, but which wiring just hasn't been found yet.  So you can't say it's a chemical imbalance yet because that imbalance hasn't been found in anyone -- people with mental illness don't have a lack of serotonin or dopamine or whatever.  But it still might be that what we have isn't working as it should.  We don't know.  Doesn't mean we'll never know.  

[artemesia2]

My question is if  there is  a deficiency or imbalance in a mental illness , especially depression why take an Rx drug.  Why not ingest an amino acid  For example tyrosine and phenylamine are proven to improve depression.    Please note if one is being treated for melanoma these aminos can worsen  this type of skin cancer.   IOW why take prescription meds when there are effective natural treatments?   I'd suggest a health practitioner who is knowledgeable and objective with altnerative modalities.

[Paxiled]

I believe we just said above that nobody knows if mental illness is caused by a chemical imbalance.  If it is nobody has discovered which substance is out of balance.  While tyrosine and phenylalanine can help some who are depressed, they can also aggravate anxiety, so must be used with caution.  If you're taking medication you also have to be careful with these.  More proven is the use of tryptophan, which is the precursor along with other cofactors of serotonin.  But it isn't because those people are lacking serotonin, so why it works is probably the same reason drugs work -- it helps with the symptoms, not the cause.  I agree, it's better if natural medicine works because it generally has fewer side effects and is easier to stop taking, but it doesn't have no side effects.  It's also usually used in combinations, so you wouldn't usually just take an amino acid, you'd combine it with herbs, a change of lifestyle and eating habits, therapy, diet, exercise, etc.  While some people can get a good result just taking one of these amino acids, remember, they are also pharmaceutical medicine -- there are no amino acids floating around out there in isolation from food.  They didn't work very well for enough people, so drugs were invented to try to accomplish the same things but in a stronger fashion.  With this came worse side effects, some of them permanent.  So while I agree with the premise, if you aren't expert at natural medicine, you will need professional help.  You will need a lot of experimentation.  And if it doesn't work, you will still perhaps end up on medication.  But it is worth a try.  By the way, the form of phenylalanine that is usually used for depression is a form that is a metabolite form, DLPA, because it's not as stimulating as the L-form, the way it is in food.  This is to reduce the chance of anxiety.  But anyone going down this road needs to do their homework first, as there are risks.  Fortunately, they are almost always solved by stopping the supplement.  But also know these only work by having sufficient B6, and some who take too much of that can get a neuropathy that is not gotten rid of easily.  Do your homework, folks.  Be safe out there, but also have a more open mind than just medication, which is where I completely agree with the above post.

[specialmom]

A lot of people do stay on antidepressants long term throughout there lives. There is a belief that the more episodes you have, the more chronic in nature the condition is and that treating it without interruption makes sense. No shame in that in my opinion.  The goal is to have a functioning and full life.  So so so many people do that up and down thing of starting their med because things are bad, deciding it wasn't necessary and then taking themselves off of it and then getting depressed again and going back on the med and it continues.  That's really probably not the best way to handle it.  But also, just taking medication isn't the best way either. All the OTHER things are very helpful in feeling better. Therapy to learn coping skills, life style changes, exercise, etc. all are of benefit.  Let us know how you are doing, we're here to talk you through it!

[Paxiled]

And I would add to this, some of us just don't respond to therapy.  I'm one of those people.  If your problem is bad and chronic, as mine is, sometimes you just have to take medication long-term.  If nothing else works, you do what you have to do.  My difficulty came with not knowing or being told anything about the medication and how it works and how it affects many of us when we stop taking it.  So again, be informed, your doctor might not tell you what you need to know.  Being prepared is a wonderful thing.  And if you have to keep taking meds, well, you'd have to do that if you had diabetes, right?  Mental illness can be just as much of a long-term thing as any other illness, but because many do get better, it's always important not to let medication be the only thing you try.

[del677]

It depends what works for you.

After trying MANY different antidepressant medications, none of which worked, we FINALLY found one that actually worked wonderfully.

Now I'm fine, and I never think about it. We tried stopping my medication and I went downhill. We tried other antidepressant medications, none worked. Eventually I begged my doctor to put me back on the medication that worked, and I slowly got better again.

We repeated that experiment 3 times over the next many years. (We weren't very smart back then.) Every time the same result. On the medication I'm fine and normal and don't think about it. Off the medication my life slides downhill into hell and it's all I can think about.

So for me it's going to be medication for life, and no problem because it works great.

I've asked my psychiatrist this question, do other people have to take it for life. My psychiatrist said well some people if they've been taking it for a year, then they can try going off the medication and see what happens. It depends on the patient. Some do fine without the medication. Others slide downhill and need to go back on it. It's an individual thing.

My psychiatrist did say they like to wait a year before going off a medication that's helping. The longer one stays on the medication, the more likely it will be they can successfully go off the medication. A year seems to be the time frame doctors settled on as the minimum amount of time one should stay stabilized on a medication before trying to go off it.

I used to think medication was a horrible stupid idea. Sounded totally artificial, like covering up a problem with pills. Instead I discovered when I found the right one for me, it fixed whatever was the underlying problem, and allowed me to recover and feel 'normal' for the first time ever. I was astounded, as I had never felt 'normal' before. I just assumed everyone suffered like me but was good at never mentioning it.

[Paxiled]

Actually, it's the opposite.  The longer you're on a medication, the harder it is to go off of it.  I think what your doctor meant was, staying on the medication long enough to get some distance from the bad emotional thoughts is how medication works best in that area, but because these meds can be very hard for many people to stop taking because of how they affect the brain, staying on them longer makes them harder to stop.  It's a conundrum, but when you get stuck in life, you have to do something that works or you stay stuck.  The main problem with medication is, it doesn't do anything to cure the underlying problem, it tamps down the bad effects of the problem.  If you fix what was wrong in the first place, however you find a way to do that, then you can slowly taper off the med and go on with your life.  If you don't fix it then it will probably come back again.  But people are different -- for some, they just hit a rough patch, and some quiet time is what they need.  Medication can provide that.  Everything depends on the person and what's really behind how they're feeling.  But everyone does need to be informed about all the aspects of being on medication so they can make an informed decision.  

[del677]

Some medications do cover up problems. These are nice to have temporarily while one is trying to find the real medication that will fix the underlying problem (if the underlying problem is a biological one which medication can help with).

The difference is the "cover up my problems and make me feel good now" medications work fast; pretty much when you take them is when you notice the effect.

The "fix the underlying medical problem" medications work slow, in that they typically take 2 - 6 weeks to start working (or so I've been told, which is why we tested each medication that didn't work for 6 agonizing weeks before giving up on it and trying another. When we found the medication that worked for me, I think I noticed before 2 weeks that it was helping.)

Recovery with the "Fix the underlying medical problem" medication is slow and progressive and full recovery can take a full year. (Though for me after the first 2 weeks at least I'm out of the hole and can stand being alive again, and I have a "This is working and it's just going to get better so ride it out" hope that keeps me going.

True just taking what I call the "Band-Aid" quick fix medications for an extended period may itself cause problems. One needs to stay in touch with the doctor and give feedback. My experience is they definitely don't provide anything like "being well". They may help to "take the edge off" and make life a little more sufferable tolerable. They are welcome when I'm suffering badly. Anything when I'm suffering badly.

When I'm well I never think about it. I have no need for the "Band-Aid" meds, no desire for them because I'm fine. I just take my regular medication, without really thinking about it, because I'm fine.

That became my criteria for knowing when I'm well. I'm well when I don't think about it. If I'm thinking about it, then I'm not well.

I found I never think about it now because it's not an issue anymore. It was a period in my past when I was really bad off. Fortunately my memory doesn't care to remember the details, other than I know it was really, really bad, but I don't suffer from memories, because I'm fine I don't think about it.

[Paxiled]

No, this isn't accurate.  No medication cures mental illness.  Nobody knows the biological cause of mental illness or even if there is one.  They are looking hard, but so far no cause has been found.  So no drug can treat a cause we haven't found yet.  All meds, whether short term relief or long-term relief, just tamp down the symptoms, they don't cure anything in the field of mental illness.  I don't know where you got this info from, it might be old info that was marketing lies spread a long time ago when Prozac first came out, but nobody has claimed this for a long long time now.  The current consensus is that serotonin has no role in causing mental illness but playing around with it can help you feel better.  If it cured the problem, then you would be able to stop it and the disease would be gone, as with an antibiotic, but that isn't the case.  Most of the research right now is focused on the amygdyla for anxiety and glutamate for depression, but no cures yet.  But we hope.  In the meantime, we do what we can.  The only cure known so far is through therapy, spontaneous remission, and lifestyle changes which take a lot of work but sometimes work.  If none of that works, drugs can give us a life and that's important but they do not cure.

[del677]

I only speak from my own personal experience, with my own depression.

The antidepressant that works for me works so well I'd say it cured me, except I can't use the word "cure" because that implies I can now stop taking the medication, so I need a different word that means "total complete recovery, as long as I continue to take the medication."

It's not an instant cure. It took a full year each time to reach that "Full Recovery" state where I'm now totally well and eager to get a job.

It's also not a "Band-Aid" quick fix cure that just covers up the symptoms. The symptoms are completely gone.

I still do need to take care of myself, as I am still susceptible to mild depression, probably more than most people. I do the self-care things. Go to groups I enjoy going to, to get my quota of socializing in. Keep myself busy. Get some walking exercise in. (I should exercise more.) Watch what I eat. (Amazing how food can affect my moods. If I get depressed now my first thought is, "What did I eat for lunch?")

There is hope for people suffering.

[specialmom]

I agree del677.  Thanks for sharing your story. There are no absolutes but your experience is similar to many I know as well.  Glad you are doing well and most definitely, there is hope for those that are suffering.  

[Paxiled]

This is a better explanation.  The only reason I often bring this point up is that, and I was one of these people, when we take a med and it works for us even if only somewhat, we stop looking for a cure.  The problem with this is, sometimes you have to stop taking a med and sometimes it stops working and then you have that to deal with plus the original problem, which hasn't gone anywhere.  But the results for therapy, while unknown, in the one type that can be studied well didn't come out so well overall.  It often takes a lot of tries to fix these things.  For you, given what medication is doing for you, that's what you should be doing.  I wouldn't change a thing.  But I would keep trying to fix it so if that day comes when the drug poops out or the side effects lead you to have to stop taking it, maybe you'll have actually cured it.  People do.  They just don't do it with medication.  For me, meds are the only thing that ever helped even a little.  But I keep hoping that others will have better luck, and I know people who have had better luck.  It's not a knock on meds, it's just a clarification for anyone reading this not to confuse a cure with a treatment so they keep looking for that elusive cure.  And no knock on band-aids, they prevent infection.  In the same way when nothing else is working or our lives have just gone completely south that drug can prevent further harm and let us have a life.  

[del677]

Thank you for sharing your story. I appreciate hearing other people's stories.

Which reminds me of support groups. I enjoy them. They are one option for people who find them helpful. DBSA hosts support groups across the nation. www.dbsalliance.org I have a Mental Wellness Center in my town that hosts support groups.

A little walking exercise helps me. (I've heard of people who go all out on exercise and will run many miles a day just to keep the depression away. A bit extreme but it works for them.)

Mindfulness Meditation has helped me. There are groups in town that do that. (Buddhist places usually host a  meditation class. I also know some people who swear by chanting, which some Buddhist places also do. I've tried it but am not attracted to it. It works for them. I'm guessing it's a way of clearing the mind by filling it with song. Which makes me think a singing group might also be helpful.)

Even though I'm "totally well" (I'd say "cured" but that implies "done, no more work to do") I still actively do these other things to help keep me well. It's always a work in progress, going to support groups that I enjoy, going to meditation groups, forcing myself to get out and walk a little (which I often lag on). keeping my life balanced. Not overworking myself. I can really only do a 7 hour work day. Fortunately my workplace is flexible, and they realize my need to not burn out. If I burn out then it's over. I'll need a 2 month vacation to recover.

I still have adjunct PRN (take as needed)("band-aid") medications which I rarely take, but they are available, and I do take them once in a while when everything else doesn't work. It's definitely an invisible disability. (I do check the box saying I have a disability on the employment form.)

Best wishes!

[Paxiled]

First, there is no proven link between serotonin and depression.  What is known is that altering how your body utilizes serotonin can make an anxious or depressed person feel less so, but that doesn't do anything to cure the disorder.  So no, nobody "has" to take an ssri to combat depression, and many antidepressants don't target serotonin or target it exclusively.  Second, normal is a relative term.  We're all individuals, and while we have much in common, we also have much that is unique to us.  Being down isn't depression, it's feeling down.  Depression is when you feel down chronically for no apparent reason to the point where life becomes unpleasant and hard to live.  The only known cure for depression is talk therapy.  Different psychologists use different methods, but that is the only method known so far to cure depression.  Because therapy doesn't work for everyone, medication comes in when life is just not going anywhere.  It can help you live a more pleasant life and also stop you from sinking further and further into your funk.  If life becomes that bad, medication is there, and can help.  It does have significant downsides, as does all invasive forms of medicine, but at some point when life isn't liveable anymore you have to try something.  There's also the field of natural medicine, which is harder to do than just taking a pill.  It requires a commitment to a holistic program of supplements, therapy, lifestyle changes, dietary changes, etc. with a lot of experimentation.  Some people find relief in religion.  Many people just get better as mysteriously as they got sick.  Try whatever you think will help, and if it doesn't, don't worry that you might have to be on an antidepressant -- you wouldn't feel that way if you had any other illness that nothing fixed and only medication controlled.  But bottom line, yeah, lots of people get over depression without medication.  There are other ways.