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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by wyoming_blues on June 25, 2004, at 12:08:48
hi, all...i am writing to ask if anti-depressants are a short-term bridge or a lifetime treatment? i'm sure many are helped by short-term treatments, but my therapist believes that i have had depression living in me for years, perhaps at a low level that i could deal with. i lost my mom to alzheimer's last year (she was relatively young and the disease ate her in less than 2 years) and a dear friend/mentor 3 months before that. this double-whammy is what my therapist thinks threw my brain chemistry so far off that i have needed psychotherapy and was on lexapro (20mg) for a year. therapist thought we had gotten through the worst, so we ended the lexapro and left therapy on an as-needed basis. one month after ending the lexapro, my depression roared back (though it had never totally left), complete with incredible anger, some anxietyand thoughts of exit strategies. so now we are starting effexor (starting at 75mg/day, building to 150mg/day in a week, then seeing where that goes). what i am wondering is if i will ever get my life back? and also could i need to be on some anti-depressant for the rest of my life? your thoughts please...
Posted by King Vultan on June 25, 2004, at 12:39:40
In reply to is this a forever thing?, posted by wyoming_blues on June 25, 2004, at 12:08:48
It seems that the longer a person has been depressed, the more likely they will need to take an antidepressant on a long term basis. I have suffered from debilitating depression for over a decade myself, and had severe anxiety and intermittent depression in the decade before that, and my depression has always returned whenever I've stopped taking a med. Sometimes I've been able to make it a few months before having to go back on, but without the meds, it just becomes increasingly hard to function after a while. I expect I will have to take something for the rest of my life unless modern medicine discovers a way to permanently fix my defective brain chemistry. Keep in mind that we've already come a long way and that people at least have the option of taking a variety of safe and effective antidepressants; prior to about 50 years ago, there was no such thing available.
Todd
Posted by partlycloudy on June 25, 2004, at 13:47:26
In reply to Re: is this a forever thing?, posted by King Vultan on June 25, 2004, at 12:39:40
I have had the same experience as King Vultan. I have been off and on antidepressants for over 7 years and each "crash" after discontinuing medications has been worse than the last. From my point of view, taking these medications every day allow me to be part of society and my community, and without them I would isolate myself entirely.
Posted by Racer on June 26, 2004, at 0:55:53
In reply to is this a forever thing?, posted by wyoming_blues on June 25, 2004, at 12:08:48
Whether or not any one person will require indefinite treatment with anti-depressant medication varies from person to person, so there's not really a simple answer to your question. There is a lot of opinion, but no real consensus about it yet. It all depends on so very many different factors in every case, from age through genetics through social and financial factors; other health issues if any; etc. Tolstoy wrote, "All happy families are alike. Each unhappy family is unhappy in its own fashion." The same sort of thing is true of depression.
For the past 10 to 15 years, though, ever since the SSRIs had had a chance to be seen in action, there has been one consistent thread to what I've heard from my own doctors and read in trying to confirm what they said to me: For a first depressive episode to receive treatment, it is safest to remain on the drug as a maintenance tool for two years past the point of remission. For many people, that period is enough to set things straight and allow the person involved to go on and lead an undepressed life. However, for many people, a shorter period of time does seem to leave them vulnerable to another episode of depression -- and then the episodes tend to become both more likely to come back and to come back more frequently. In other words, erring a bit on the side of caution and staying on the drugs a bit longer than initially recommended -- a 'better safe than sorry' sort of idea -- might be wise.
Of course, that's not true of everybody. That's just the trend that has been noticed and presented in some articles. The good news is that there are also studies showing that an adequate length of treatment with an effective anti-depressant that keeps the depression in remission for the entire time actually increases the size of the hippocampus, an area of the brain involved in depression. And, even better in some ways, someone whose knowledge in these matters I trust very much just recommended a book to me which presents some evidence that effective talk therapy can also do a very similar thing. Personally, although I am becoming more and more resigned to the fact that I'm likely to have to be medicated for a long time myself, I'm also hopeful that a combination of meds and therapy will make a lasting difference for me in the long term. I'm also a lot older than you are, on my fourth or fifth Major Depressive Episode to have received medication for over the last couple of decades, was not treated according to those "consensus" recommendations above, have almost always been "OK" between episodes until something new triggers the next one, etc. In other words, my experience is typical of *me* but not necessarily for you, if that makes sense? You've got a much better outlook than someone like me, though, because there are these discoveries being made, and there is so much more concensus about optimal treatment, and there are better treatment options available than when I was first treated.
Also, this Babble board is specifically about medication related issues, but there are other boards here, with a pretty varied philosophy about the issue. On the Psychology board, for example, you'll tend to find people who are leaning a bit more toward the "talk therapy" end of the spectrum, and here you'll tend to find people leaning a bit more towards the meds end. Does that make sense? My own best guess is that many of the people on the various Babble boards believe that some combination of psychopharmacology and psychotherapy is probably the most effective long term treatment for depression. It's also the hardest, the most labor-intensive for the patient, the costliest -- which can severely limit access to it, even for those with insurance -- and that really is only ONE way of looking at it. There are others which may be equally valid, but that combination treatment is my own personal belief.
(You know, I got long, but I really just wanted to reassure you a little -- you could be someone who just wasn't medicated quite long enough to push you over the crest of the wave, you won't know until you know, right? Be well.)
This is the end of the thread.
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