To ask how bad things need to be to take antidepressants?

[Walkerby]

Hello all, hoping for some advice/experience. Feel I could do with some help but don’t know if antidepressants are the answer.

We’re all down/stressed with lockdown, home schooling etc, I know. But I’m struggling when usually I’m very steady. Just no motivation, feels like a constant treadmill, snappy with the kids, feel no joy in anything, lost all interest in sex, just feel quite numb. Can’t even cry at times when I feel like a good cry would do me good. My business (self employed) is non existent through covid as events based so struggling financially too (one of the 3 million excluded from Sunak’s schemes).

I fell apart last Spring as was so stressed with the effect on my work and schooling the kids, since then I haven’t felt crushingly low or ‘actively’ depressed, but I certainly don’t feel myself. Tried exercise and mindfulness meditation which helped a bit but even finding the motivation for that is hard.

Keep getting to the verge of contacting gp and pulling back. Just don’t know if I feel ‘bad enough’ to warrant antidepressants but then I have no idea what that even means!? Anyone had similar feelings /experience and found something that works?

Thank you x

There are a lot of PPs saying to try non-pharmaceutical methods first, but from what I can tell, you already have.
It's also the case that sometimes you need to take the anti-ds just to get you to a point where mindfulness or talking therapy can help. Both of those can be useless or even harmful if you try them when too vulnerable.
Talk to the GP, make it clear you are familiar with mindfulness and meditation, so don't let them just push you that way without discussing the pros and cons.

I agree with the pp who said this is a really crappy time. Most people are feeling low, sad, "meh", unmotivated compared to 12 months ago. I absolutely 100% agree that depression is real, its an illness, and needs medicating when it is present, but for me personally, I'd have to be really really not functioning before I took this route. I accept that I don't feel like getting out of bed for another groundhog day of this shit, that I probably get cross / cry in front of the kids occasionally when I didn't before but that's a reasonable reaction to what is going on - it would be weirder if I was feeling normal. I think we have a quite worrying idea that we should always be feeling happy and calm and if we are not, we need outside help. In the end, you must do what you need to do, but from what you've described I personally wouldn't.

@GeidiPrimes

If I were you I'd keep an open mind about what might help because there is a lot of research to show that ADs really only act as a placebo and there's concern that too many people use them when they aren't rally necessary.

Yeah, claptrap. I was at the point of giving up a few months ago and now I feel like an actual human being again after starting ADs).

Just because someone offers a different opinion, doesn't mean it's claptrap. @GeidiPrimes

There have been many, many articles in the press from medical experts who are very concerned about the use of ADs and it may even be NICE guidance to offer alternatives first- but that costs GPs time and money to explain and set up, so it's easier to write a script.

Don't dismiss other options simply based on your own experience.

I have suffered from depression all my life, usually brought on by health anxiety. Anti-depressants have always worked in my case. The last instance before now was 2006 - so I was free from the Black Dog for 14 years (I am 52).

COVID brought it all back and last April I went completely down with overwhelming depression. Crying, not eating or sleeping right, complete feeling of utter dread. Luckily for me I knew it was the big D - so got prescribed Sertraline.

3 weeks later and I was my old self again. Yeah, I still worry, and get sad, and cry (watching It's A Sin!), things aren't great, but I can function.

So if you have not had depression it's hard to know if you need meds.

Bottom line - speak to your GP.

That sludge feeling. That being unable to respond. That if there was a button to press to just end it you would.
The tablets make that go away. They give you yourself back a little to roll your sleeves up and do some of the things the "don't take drugs" brigade are talking about. The diet, the walks, yada yada. Because those things def do help - but when you can't do them because of depression it's a no win situation.
That's why some people take them short term and some need longer because of their brain chemistry.
I won't lie the first couple of weeks might be topsy Turvey. And I know that hanging on by your finger nails feeling that makes you resist going backwards. But you will get through it.
And then life starts to feel worth living again. The cloud passes. And that's worth the struggle.
Your libido can come back with a bang tho so watch that.

I have a line for myself and if crossing it know I need to see my GP and that anti depressants are probably indicated. I wouldn't advise anyone else to take my own "this is bad enough for meds again" measure and apply it to themselves. It's personal. It depends on so much.

One thing I will say is that I have never regretted taking anti depressants. I have struggled with side effects a fair bit, I have come off them earlier than the drs think is best a few times, I have allowed myself to be made to feel like shit by people who spout rubbish about anti depressants being the easy/ weak/ lazy option and wittered on about it being wrong to depend on them long term, but when I weigh it up using them has always been the right thing. Not least because I am alive!

@Walkerby

If you are still reading, you might find it helpful to read the guidance for GPs from NICE on treating depression. Obviously no one on a forum can tell how bad you are feeling.

This is the advice

www.gponline.com/guidance-update-nice-guidelines-depression-adults/mental-health/mental-health/article/1452701

If you look at point 3, it does say that in mild- moderate depression the first steps are CBT and exercise/ group therapy (obviously that is hard at the moment) and that ADs are not especially effective.

NICE tells us that there is little evidence for antidepressants in this group but that cognitive behavioural therapy (CBT) – in person or computerised – or a group physical activity programme may be helpful. Many areas now have exercise on referral and this is worth considering for patients who would previously have been coded as ‘low mood’ and just given general advice. The same principle should apply to treating those with mild depression, as it is only at the threshold for moderate or severe depression that initial treatment with antidepressants is recommended.

Exercise referral is a useful option for patients with subthreshold depressive symptoms. Antidepressants should be considered for patients with subthreshold symptoms or mild depression only when the treatments above have failed to work, if the symptoms persist for two years or if there is a past history of moderate or severe depression. They are first-line for patients with moderate to severe depression, an SSRI being recommended as the usual first-line treatment along with CBT or interpersonal therapy (IPT). IPT focuses on how a patient interacts with other people and guides changes of behaviours that are causing problems, whereas CBT focuses on internal thoughts and beliefs, and how these need to be changed for the patient to have better mental health

Important! Initial treatment with antidepressants is not recommended for patients with mild depression.

Lol. She perhaps doesn't have the energy to read that stuff because she's, you know, depressed.

Op I hope you are ok . I think the numbness is a classic sign of depression. Why don't you discuss your concerns with your gp? You don't have to decide before the appointment. You don't have to decide right up to the point of swallowing a pill.

I'm feeling very much the same way ATM but I am nervous of ads although I think I may need them. I don't feel remotely sad, but my motivation had gone and my depression (if that's what it is) seems to be quite physical. It takes such an effort to move. I just want to stay apart from everyone and lie down in a dark room basically! Obviously I can't do that all day, so I'm soldiering on but I feel beyond exhausted. I'm worried that ads will make me feel even more sluggish though?

@RedWelliesAreHot I think your bold quote is slightly out of context and oversimplifies the NICE guidance, in fact.

The NICE guidance (in keeping with the evidence) says that ADs should not usually be a first-line treatment in low mood (sub-threshold) or mild depression, not that they should never be used in these groups.

The situation is different for moderate to severe depression and the NICE guidance certainly does not say that ADs are not especially effective for moderate depression.

It's important that there is clarity on this issue, because misrepresentations of the evidence can do lots of damage - mainly, putting people off getting treatment that could really help them.

And OP, I hope that whatever you decide to do, you start feeling a lot better soon. It's such a difficult time at the moment :(