to anti-d or not to anti-d

[Lindenlass]

I can't make a decision and I'm hoping some wise MNetters might have some words of wisdom to impart!

It's a v. long story but I'm now having counselling which has identified that I've always suffered from depression which has flared up here and there. I have had enough sessions now to see that it is going to make a difference, but I am struggling to know what to do in the short term.

If I have a session that is particularly harrowing, I find the days after it really difficult to get through - I'm very tearful and cope really badly with minor problems. If I've had a really good session, life is fantastic. For the last 2 weeks I've been really well, but had a session on Friday which has left me very tearful.

I have a GP appointment today to get anti-depressants to even out my mood a bit, but I just can't decide whether or not to take them - whether the potential side-effects will be worth it.

I've read they take 3-4 weeks to start working - well DH is off work for 2 weeks in a week's time so is there any point? But then, I don't know how long this counselling will need to last and how many more difficult spells I might have.

TBH, the thought that I'm ill enough to need anti-d's makes me even more upset! Will they even out my mood so much that I don't feel overjoyed at the times I normally would? But I guess that's small sacrifice in terms of protecting the children from my black moods.

Someone help me decide please!

if you had any other long term illness you would take the medication.

i found ADs in conjunction with counselling extremely beneficial, but it was a bit of a slog to get the right dose.

If i had know then what i had known now, i would have asked for a referral to a psychiatrist to get the right meds at a dose that worked, rather than endless tweaking of meds from a GP.

see how things go, but i would definitely go for it, yuo have to take a holistic approach with depression i think.. meds, counselling, excercise, etc... and take all teh help you can get

depression is also to do with your brain chemistry, adn if it is out of kilter, then you need meds to realign everything

From my very personal perspective, I would take them. I avoided ADs for a long time and as a result made some decisions which were very bad. Now taking ADs, I feel better than I have done for years.

The first 2 types I took had very little impact but the third (fluoxetine) worked a treat and I am still taking it.

Have to say they have had the effect of not making the highs as high as they would otherwise have been but for me, this was an acceptable compromise. I am able to take joy in my children for the first time in years.

Sorry to hear that you're feeling low, Lindenlass. I went through the same quandary as you a couple of years ago. I resisted going to my GP for months, all the time getting steadily worse. Even when I got the anti-ds I didn't take them for about a month. Eventually I gave in and started taking them. Felt a bit rotten for a few weeks (insomnia was the worst side effect for me) but after that wore off they did work, and they were invaluable. They didn't leave me feeling like a zombie, just took the edge off the way I was feeling to allow me to work on the reasons I was feeling so low. I took them for 7 months, coming off them very gradually with my GP's help. I've been off them for nearly a year now, and I'm so much better. So based on my experiences, I'd say bite the bullet and give them a try. Good luck.

Would agree with what Lulumama said about a referal to a psychiatrist - they are very good at working out what works for you.

That's all really helpful, thank you all. I'm still v. nervous of the side-effects! I'm tired enough as it is - insomnia would be awful

How long do psychiatrist referals take? I think it would be helpful for me as am bfing and co-sleeping and need the right drug.

Hi Lindenlass,
I have had 2 bouts of depression in the past so I really sympathise with you.

For what it's worth, the first time I took medication, I too was horrified that I was ill enough to need them. Unfortunately they didn't work so I gave up (I think it suited me to stop because of my perceived stigma about it all. We are so daft when it comes to anti-depressants aren't we? If I have a headache I think nothing of taking a couple of paracetamol, or a course of antibiotics for a water infection). Instead I joined a gym and took lots of brewers yeast (for the B vitamins which keep the nervous system healthy - warning - very bad taste!). This did work, but I also had a lot of social support and was able to move back home, which helped me too. I also think that by this point I was recovering anyway.

The next time I did stick with the medication and although I needed to try a couple of different drugs to feel the benefit, it was well worth it. My GP was very good and saw me every week to monitor my progress until she was satisfied that I was on the right drug/dose and this weekly contact helped me feel supported too. The side effects weren't so bad (newer drugs have fewer side effects to contend with) and the worst I had was a bit of constipation. Of course, experiences can differ - but your GP should be able to tell you what to expect. Some side effects can be ok too - my GP gave me a drug which was very slightly sedating to take the edge off my anxiety and help me get a good nights sleep.

The drugs definitely helped and made me feel more like my old self again. there was a definite lift of the black cloud that hung over me and a feeling that I was once more part of the world and not just looking in from afar.

I used the drugs to help me get my head above water while I waited for an appointment to see a psychologist for counselling. I had a course of Cognitive Behaviour Therapy (CBT) which was very helpful and helped me to learn strategies to overcome my depression. The following link explains a bit about it if you need to know. www.mind.org.uk/Information/Booklets/Making+sense/MakingsenseCBT.htm

I stayed on my medication for about a year - it's usual to stay on medication until completely well and a bit longer to make sure - and when the time was right, I reduced the dose gradually (GP helped here) until stopped. Addiction is not associated with antidepressants, but the slow withdrawal makes it less likely that symptoms will return.

I don't know if this is helpful, but I hope that you can make the right decision for you - we are all different and need different things at different times in our lives. If I ever felt ill again, I wouldn't hesitate to consider taking anti-depressants because I know that they can be part of the solution.

You don't say if you are pregnant - this needs extra consideration, but again, depends on the individual and the costs/benefits.

With very best wishes to you. Let us know what you decide. xx

Lindenlass, I was BF too at the time and I was prescribed Lofepramine which was recommended as a safe anti-d to take when BF.

Lindenlass - I've been on antidepressants for a while now, and like you, I've recently been diagnosed as having suffered from depression on and off for many years (since my teens).

Insomnia was one of the main elements of my depression, and I really understand what you are saying about not wanting insomnia as a side effect of the antidepressants - being so tired makes everything seem so much worse.

I am on citalopram, which I take in the mornings, because it can cause problems with sleep if taken at night. I wasn't told this at first - it was a pharmacist who pointed it out to me, and since starting to take the tablets in the morning, the side effect of insomnia has gone.

I find that the citalopram has evened out my mood - it is still pretty low, but I'm not suicidal any more (which is a good thing), and it enables me to function and to get things done around the house. I'm on a waiting list for psychotherapy, and long-term, I hope to be able to beat the depression and function without the tablets.

I did read an article in the paper a couple of weekends ago that suggested that there are particular minerals that, if you are short of them, can make depression more likely/worse, so I have started taking supplements - partly because it helps to feel that you are doing something, however small, to help yourself. The things that the article said were key in depression were iodine and selenium, together with omega 3's, so I take a vitamin supplement that includes these, plus the omega 3.

I hope that things feel better for you soon.

well, to be the opposite point of view, I would heartily not recommend them (this is based on my own experience and the fact that their efficacy has been somewhat disputed by recent research). I tried several, little difference, horrible side-effects at times. For me it was a matter of looking at the underlying issues, I've therefore changed job, exercise now v v regularly and watch my diet like a hawk (lots of oily fish, vit B, bananas, nuts etc not too much alcohol/coffee etc). It worked for me and may for you.

It takes time to make such lifestyle changes but is more effective imho in the long-term. Good luck whatever you decide to do anyway.

They work brilliantly for some (me!) not at all for others (e.g a friend of mine). The only way you can tell which you are is by giving them a go.

They made my life worth living at a difficult time and I am now off them and feeling fine.

Don't be put off by the delay, the sooner you start, the sooner they kick in, and they don't stop you trying other things too.

Exercise (running) works well for me too.

Just one person's point of view

I only saw how much they helped when I came off them and was awful.

Thanks again for your opinions. I am already working on the long-term fix - that's the psychotherapy. I need something for the short term - something to protect myself and my family from my black days when they come.

Anyway, went to see the GP and she was, to put it bluntly, rather useless. We are registered with lovely lentil-weavery doctors, which is great most of the time, but very annoying today. I think I need to get my counsellor to get in touch with them.

She said 'try St. John's Wort' (I am already),

then she said 'psychotherapy's all very well, but it often only shows you why you're depressed and is a long-term fix not a short-term one' (which, of course, I know, and which is the reason I'm asking for anti-ds).

'I think you need to try something else short term instead - I think art therapy would be good'. Right, um...and when am I going to find the time to do that????? I have four very young DCs who I have to struggle to find childcare for while I do my counselling sessions to help prevent the depression in the future - I won't be able to find even more childcare (currently lovely friends and family) to do flipping art therapy .

'Hm...well maybe you need some more time away from the children then' At this point I'm trying not to cry and scream 'FFS woman - it's not my children making me depressed, it's my childhood, which I am trying to sort out and which you'd understand if you'd actually listen to me!!!'

'Fill in this questionnaire and come back next week - I never give anti-ds on the first visit'. So I am crying by this point - I mean I've been putting off this appt for ages and ages, and now I finally get here she won't even give them to me! If I'd known I had to have a series of appointments and jump through hoops to get the damn things I'd have started ages ago

Anyway, that was all this morning. I've calmed down now and have to decide whether to go back or not. I'm going to talk to my FIL who is a psychotherapist, and also to my counsellor at my session on Wednesday.

DH has two weeks off starting on Sunday, and his work have granted him 2 days of compassionate leave before then too, so from Friday he's all ours for 17 days! 17 days where the children will be protected from my black days when they come

Thanks for listening (anyone who got to the end of it!), and thanks for your help. It's very much appreciated. I am terrified of the side effects, but also terrified of messing my own children up...

The hardest thing about being a mum is not being able to take time off sick - I've known a fair few people who've taken time off sick with depression.

you know, it's hard but she actually sounds like a good GP, she's taking her time with you. So many reach straight for the ADs without really even looking you in the eye (in my experience at least), even though current NHS policy is to try to look for other options instead/as well as first, CBT for example.

I know ADs work for many (arguably as a placebo as much as anyhting but if it works, fair enough) but a lot of research has disproved their efficacy, this may explain her reluctance. They're honestly not a quick fix and I guess yr GP is trying to help you realise that. sorry if i'm being blunt!

Is there any way you can get a little more time away from the children? I know you say this isn't the issue, but 4 young children must make it v hard to think straight let alone deal with issues from yr own childhood.

i hope I've been of some help anyway.

Everyone is different and what works for one person may not work for all but this is my experience.I avoided AD's because of the "perceived stigma" I had about mental health issues and AD use.Eventually (because no amount of talking therapy alone could help me and I was not able to function well enough to look after the DC's or myself) I accepted that I needed medication ,although the first two types of AD (from GP) did nothing for me .Luckily I was referred to a psychiatrist who immediately prescribed two meds for severe Generalised Anxiety Disorder and depression(hereditary disposition towards this also).Initially I was terrified to take them but within 2-3 weeks I was returning to my old "sane and level-headed" self. I could not believe the turn around.It was only then that I was stable enough to think about lifestyle changes and make sense of what had happened to me.That was 18 months ago and after a slow withdrawal I am now 1 month off all AD'S and (touch wood ) seem OK so far.Don't completely dismiss AD's ,they don't always have to be forever and won't necessarily make you feel like a zombie. Could your GP refer you to a psychiatrist?Mine definitely got the cocktail right to sort out my brain chemistry mess,they could also decide if CBT would work for you.....PS Lindenlass anyone who is bf and co-sleeping (and I've nothing against either), as well as dealing with mental health issues must be a saint in my book.How old are your dc's? Remember to look after yourself too.(sorry to ramble).

The study which was widely reported as showing ADs don't work has been challenged on several counts;

• the studies only followed up patients for a few weeks and it is well known that AD's don't reach full efficacy until 6-8 weeks.
• side effects are also stronger at the start of the treatment so it is not very surprising that not everyone was feeling the improvements.
• It also looked almost exclusively at severe or very severe depression. Effects on moderate depression were not really tested in this study.
• Also the results consistently showed that those on ADs had greater imrovements than those on placebo but that these differences were not big enough to meet the NICE criteria which is largely based on whether effects are big enough to be worth the NHS paying for...

The media seized upon it as definitive word that ADs don't work, but this wasn't really justified IMO (professional and personal )

well, I'd hardly say that the media seized on this, I think there was some quite comprehensive reporting at the time and many within the NHS (i worked for some years in it) are similarly doubtful of their benefit.
As i've said before, if it works for some, fine but the OP wanted to open the debate as to take them or not. I think it's worht bearing in mind their considerable downside as well as any possible benefit.

Hills, I absoultely accept that there are side effects, and that they don't work for everyone (see my earlier post). Only wanted to say that this particular paper didn't necessarily settle the issue once and for all, as a few people have mentioned it.

I have no doubt that ADs worked for me - it was a very unmistkable feeling of the sun coming out over my head.

Didn't work at all for other people I know.

Don't think people should be frightened to try them though...

I was very against trying Ads because of the stigma and the side effects but have to wait 6 months for any other therapy so my GP persuaded me to try them. Have only been taking them for 10 days but already my mood has begun to lift. At the moment am feeling nauseous and have had an upset tum & terrible night sweats. Am hoping these will settle down - am on a months trial so will give them the full month & then see how i feel.