Posted by mair on February 10, 2005, at 7:23:26 [reposted on February 12, 2005, at 0:21:23 | original URL]
In reply to Are we chemically dependent forever?, posted by rainbowbrite on February 9, 2005, at 22:22:25
Rain - I have a limited understanding of how or why certain drugs work, but I've often asked the same questions you are now asking. This is my very imperfect layman's understanding. Someone on this Board several years ago posted that depression can result from a chemical reaction to environmental triggers. Some people can handle alot more without producing the chemical reaction; it doesn't take alot for others. Depression tends to be a remitting-relapsing illness. The name of the game, in the view of my ex-pdoc, is to lengthen the period of time between episodes, and take steps to make sure that the episodes are neither as long nor as intense as they might be otherwise. I think the drugs give us greater protection in that they make is less likely that a stressful event, say, will trigger the dreaded chemical reaction or maybe the chemical reaction triggered isn't as acute. (I'm getting pretty fuzzy here) CBT and other therapies help people manage the symptoms when they do come along, so maybe an episode isn't as long or as acute, but I also think, theoretically, that they make it less likely for us to react to environmental factors in a way which will lead to the chemical response.
I think people who have had just one discrete episode which had a pretty identifiable cause are not likely to be kept on meds, particularly if the meds and the therapy have been highly effective. The more episodes you have, the greater the likelihood that you'll continue to have multiple episodes. I wasn't on drugs between major episode #1 and major episode #2, although now I wonder if #2 might not have been as bad if I had been. I've been on drugs ever since major episode #2, which was about 10 years ago.
Some pdocs might rearrange things depending on how you're doing. In other words they might have you on a lower maintenance dose, and then ratchet things up when things get bad. If you wander over to the meds board, you'll probably see lots of people complaining that a drug that worked once doesn't work as well anymore so I guess that must happen too. The "poop out" effect.
My pdocs have always told me that I'm not jeopardizing my health by taking these things long term. Of course the long term studies done by most of the drug companies were for considerably shorter periods than what we would consider long term. And maybe the argument is that whatever their effect, it's less than the problems which can occur if you're not treated.
I used to really struggle with the drugs-for-life concept. Now I hardly even think about it anymore, particularly when things are going well. Sometimes I do get these urges to take myself off everything because maybe I start thinking that the drugs blunt my ability to feel and enjoy things, but those usually aren't the healthiest urges, and tend only to come when I'm otherwise really down on myself. I've been on one of my drugs, Wellbutrin, for at least 7 or 8 years. It's been effective, but it's never really been enough by itself and I've been through alot of trials of other drugs to find a better augmentation agent to Wellbutrin. However, I think it would take alot for me to take myself off WB altogether to try something else because of a fear that if that something else didn't work, WB might not work the second time. I have heard horror stories like that on the meds board although I have no idea if there is a scientific basis for that.
I'm what my T refers to as a partial responder. Drugs make a difference but there has been no magic bullet. I relapse alot, so depression for me is really a chronic problem, but there is no question that my episodes, if that's what they are, are definitely of much shorter duration. (it's been posited also that I may be dysthymic as well, so maybe that's why it seems so chronic) Fortunately it's been this way for a long time now which means that when I do feel really depressed, I can nearly always convince myself that it's only temporary. This is a huge improvement for me. Depression used to have a much more permanent feel. That I now don't consider the worst depressive feelings to be permanent, I assume is partly the result of the protection I get from my imperfect drugs, and partly that years of therapy have made me a little more resilient. There's probably also a benefit to me to having someone I can really look to for support when I'm particularly down, which is why I've been in therapy for a long time too. CBT was never particularly effective and I've never really developed the skill to draw on support from others. My T does tend to be my bedrock when I'm at my worst.
I hope this helps. Again, I'm pretty much of an idiot about anything science-based so I could be pretty far off, but this is the way it's been explained to me.
Mair
poster:mair
thread:456629
URL: http://www.dr-bob.org/babble/20050207/msgs/456630.html