To be annoyed that taking SSRIs for the rest of my life is the only option?

[Snowtigerss]

Just that really. I don't want to be on SSRIs for the rest of my life but my brain doesn't work properly without them. After 3 months without them, I'm a wreck.

Are there really no alternatives?

I think anti depressants can be a vicious cycle. I've taken them myself and yes I needed them and am so grateful they were available.
They worked but my gp was very focused on informing me they are a short term fix only.

As I became better and my energy came back it was drummed into me that I then had to make lifestyle changes to help prevent sliding backwards. I had to take some responsibility for my own health.

Exercise was and is the thing that helps me now keep on an even keel.
If I hadn't made lifestyle changes I would have never improved enough to come off them.

In many cases it is fear of the repeat of the illness that stops people wanting to come off them.
This is totally understandable.
My gp told me they re boot your brain but eventually your brain will be able to adapt its own chemicals.

Saying all this I would have no hesitation going back on them if I felt I needed to. But the boost in my confidence by coming off them has helped me enormously.

Have you spoken to your consultants about whether you’d be a candidate for ketamine therapy trials? For the estimated 40%-50% of people diagnosed with severe depression who are treatment resistant or for whom SSRIs and SNRIs are ineffective (I think saminlondon has been unfairly attacked here, overwhelming research supports the view that antidepressants are ineffective and non-medical alternatives effective for a large percentage of people with even severe depression), ketamine infusion therapy has shown significant effectiveness. If you’ve been depressed for a number of years, tried a range of antidepressants, and are still unable to recover once they’re discontinued, you’d likely be considered as a candidate.

My DH has been on SSRIs (currently citalopram) for over 20 years now and is likely to carry on indefinitely. It seems his brain chemistry/type of depression is not transient and needs ongoing treatment. He has made his peace with that. Like another poster he has found that at times he can go to a lower dose (10mg) for extended periods, reducing the side effects of 'numbing' etc, but sometimes his mood dips and he needs to go back up to a full dose for a while. Exercise, diet and social interaction all help him too, alongside the meds. If he misses a dose or two he experiences unpleasant symptoms (dry throat, brain fog). I would be fascinated to know from a scientific point of view what it is about his brain that means that he is like this, but in the meantime we are grateful that his condition is managed and that he can lead a good life. These days there is much less stigma attached to being on meds for mental health conditions, and that is a Good Thing.

@saminlondon wrong wrong wrong, sorry. You are mixing up.mild depression and moderate to severe major depressive disorder/ bipolar/ other life limiting mental health conditions.

I get absolutely furious when people wheelout this exercise and vegetables claptrap. It's, empirically, completely bollocks for people with moderate to severe MH conditions.

And as for St Johns Wort it contains the same chemicals as SSRI's but in different, unregulated doses. So its safer and more effective to take anti depressants.

Snowtigers - I thought the same for years. I was on them., switching them around, for well over ten years with barely a break. Then I came off them last summer and stayed off. Been off for about six months. My energy has come back. My creativity has too. I work hard at keeping my mood up. Cutting out alcohol and sugar helps. So does regular exercise. I now do power yoga once a week, swim once a week and walk several times a week. Not lost any of the Citalopram fat yet but at least my weight has stabilised again.

I expect to be back on them at some point, but taking a break from them is lovely. And working out lots of ways to stay sane while off them has been really effective and beneficial so far.

It's annoying having to constantly juggle the drugs but imo that's better than just staying on them all the time. I was a zombie on Citalopram, but felt so happy I didn't notice until my work life fell apart because I was so slow I couldn't focus or complete even basic tasks. Having regular breaks from medication but coming straight back on when you sense the low mood taking hold might be a bearable long term solution.

Counselling, dietary changes and exercise are all more effective than SSRIs in treating depression

here's the evidence for this? I read a book that claimed this was true on the basis of a scientific study at some US uni. It was dangerously misleading. The only people in the trial for whom this 'worked' were people who were deeply unhappy because of a bad time in life (bereavement/break up) not people who were clinically depressed for no reason. And yes, of course good self care helps recovery from sad events in life. As does time (the trial was several months long).

The clinically depressed in the trial found self-care effective alongside medication - a detail that was substantialy played down in the book.

emzw - if exercise is the best treatment for depression, how come so many sports stars suffer depression? Because they are not immune from real clinical depression.

www.theguardian.com/society/2012/jun/06/exercise-doesnt-help-depression-study

but on the other hand

www.theguardian.com/lifeandstyle/2017/oct/03/exercise-depression-disease-death-sit-less-move-more

I was on and off sertraline in my 30s. Got to 39 and wanted to come off, had prob about six-nine seriously wobbly/bad months but I found exercise helped (but q extreme: 5 classes a week at work gym - booked the time out in my diary and being signed up to the class made me go. I’m lucky I had this resource though).

I’ve had a couple of serious dips since then when I thought I might go back on them (bullied by an ex friend/colleague which was deeply unpleasant and hugely triggering) and since getting pregnant with borderline prenatal depression/anxiety. My life circs are much more stable now which has helped, I’ve also learned to take time for me and tell people/get help, plus my work provides (limited) access to free cbt counselling which is amazing. But I could easily have been back on them tbh, I just think I’ve been lucky with my life stuff atm (eg supportive partner) and had access to some really good resources. I will also have to be very careful about PND and am realistic that I might end up back on them because of that or some other reason.

I have friends who have been on ADs non stop since their twenties and aren’t sure they would manage without them, and others who see them as being like any other medication, which they are. But I get the not wanting to be on them forever.

I hope you find the right balance for you.

I'm on thyroxine for life and about to go back on AD yet again because I need them. I just accept that it's a drug that helps me to function. There's no shame in taking them and exercise just wouldn't have the slightest effect on me and neither would counselling.

I get absolutely furious when people wheelout this exercise and vegetables claptrap. It's, empirically, completely bollocks for people with moderate to severe MH conditions.

Fair enough exercise & diet can’t replace medications for severe depression. But surely it can’t hurt?

If meds have got you to a place where you’re thinking about coming off, why would you not try adding exercise into your routine & see if you notice any difference? I’m sure many posters will be along in a minute to tell me how impossible that is, but on a thread where OP is asking for advice on how to come off meds I think it’s valid advice.

Thanks for your experiences and helping me see the situation in a different way.

After a few days back on the SSRIs I feel much more positive. As the change has been so quick I do wonder whether 'discontinuation syndrome' might have something to do with it but I'm just glad I feel better again.
Diet and exercise are definitely important, but in my experience at least, medication for the brain is a very good thing when it's needed.

Glad you are feeling better OP.

It may have been some discontinuation issues but as you say - the only thing that matters is that you feel ok.

Completely unrelated but I stopped my thyroxine years ago. No problems. I had hashimotos.

Glad you are feeling better op. Perhaps that does mean it was discontinuation syndrome? Something that can wait til the new year to discuss with gp.

journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020392

Just one of many articles that challenge the persistent myth of the 'chemical imbalance' causing depression.

Other interesting points made - both St John's Wort and placebo have been found to be more effective in depression than SSRIs. And also that exercise is more effective than Sertraline in older adults with major depression. So looks like some of you owe an apology to @saminlondon.

Googling 'the myth of chemical imbalance' will bring up plenty of mainstream science. It's the 'chemical imbalance' theory that is hokum, not the doubters. Even the BBC has done a programme on how ineffective SSRIs are.

The only thing that helps me with anxiety, depression and OCD. I’m happy to take them forever if they keep me well, but I do worry they will stop working and i will run out of options

Hi OP. I guess you’re in the uk? If not, maybe look into Wellbutrin (it’s not prescribed in the uk which is a shame as I found it much better than ssris). I also had some success with tryptophan, plus diet and exercise, but I was never severely depressed, so perhaps not helpful. Anyway, thoughts are with you.

If you had a physical health problem, like diabetes or asthma, you would accept that your body needs the insulin or inhaler to work properly. It would be annoying, and you might try alternatives every so often, just in case, but really you'd get used it it being how you are. Some people can have marvellous results with diet, exercise, various therapies and supplements, but a lot will not and that's fine.

Mental health is the same. Don't beat yourself up about something your body needs. Be kind to yourself and have a lovely Christmas.

I won't be apologising to the poster who said exercise more effective because Cochrane say this is not so, and I tend to believe a systematic Cochrane review rather than some randomer on the internet. Just because the overly-simplistic chemical imbalance argument has been debunked (and it really has), this does not mean antidepressants don't work. The evidence is quite clear that they do.

OP, is it worth having your physical health checked? Even though a return to medication has helped, because there could be more going on, like Vit D deficiency.
Also, it is really worth seeing a psychiatrist privately for advice on drugs and dosage, as they have so much more experience and specific knowledge than GPS.

Some people are on them long term. I’ve been taking ADs for nearly all of my adult life. I just can’t function without them.

I do everything you are meant to do: exercise, healthy eating, minimal alcohol. For many of us, that can help antidepressants work effectively, but it doesn’t remove the need for the medication. In fact, medication is necessary to do all those things!

Nothing wrong with taking medication but it's not a panacea for all cases. Mental illness e.g. depression is often a sign of distress, stress etc that needs to be addressed for a full recovery to be possible.