[disc] Your experience with SSRI's.

[Guest]

Hi all,

I've had my first dose of antidepressants today (It's called Escitalopram, if that's at all relevant). I'm taking it as per my counselor and university doctor's recommendations, as they're hoping it'll...jolt me out of looking/feeling "flat", I guess. I've been told that the drug's positive effects won't kick in until after 2-3 weeks and that I'd have to be weaned off of it slowly if I chose to discontinue with the medication.

I've read 'round these parts that these drugs tend to manifest different side effects for different people. I was hoping to read about any good or bad short term/long term experiences with having used SSRI's.

Thanks.

[reboot]

I took them for about 2 years. I did not notice any side effects. There might have been a libido decline, but I was such a hot mess at the time I would not have noticed. For reference, I was taking generic Prozac, no idea what dosage, but I think it was the standard one because it never changed.

It did help in that it got me far enough out of the slough of despond to start doing everything else that had to be done. Not a magic bullet or anything, but very useful at the time.

[Prajnaparamita]

I've been on Zoloft and am currently on Lexapro (though I've also been on a bunch of different SNRIs and different psych meds). I'm not really sure the Zoloft did anything, and likewise I don't know about the Lexapro--certainly I'm doing better now but I'm also just moving into a different, and better place. I guess the thing I can mostly likely attribute to it is that the constant self-hate has faded (I used to spend hours thinking about how much I hated myself and where I was) so I can focus instead on my crippling anxiety--yay! So the greatest positive impact it has is on my relationships, as friends that I pushed away in those really dark days are now willing to talk to me again as I'm a much more pleasant person. But of course, YMMV, no two people or two depressions are the same.

Oh hey wait Escitalopram is the generic name for Lexapro! Okay, listen up, because I'm going to be speaking here not only from my own experience but what I've heard of the experience of friends as well. Getting off Lexapro is shit. One of the things about SSRIs is that because you go on them and usually stay on them for awhile, your brain gets dependent on them, and then if you take that away, it goes into withdrawal and goes haywire . It's not the same as an addict going into detox (cuz you're not going to have cravings to start popping Lexy, let me tell you that) but if your brain is used to having a certain chemical and then doesn't have it anymore, it will be unhappy. If you choose to go off Lexapro, take it slooooowwwly and be aware that for a few weeks you might think and feel things that you wouldn't be thinking about if you weren't currently in meds withdrawal.

Another thing about Lexapro is that it can cause a spike in anxiety when initially started. The first time I was on it, my doctor (general practitioner, not a psychiatrist, thus the mistake) just gave me 10 mg pills and didn't slowly dose me up and I would have full-blown panic attacks.

Lexapro comes in incriminates of 5 mg, and that's the dose you'll start at, for about two to four weeks. Few people respond to that low level of the medication. After that, you'll be increased to 10 mg, and have a similar wait period. If you don't have a response to that, it'll go up to 15, and then 20. Most people have 15-20 as their final dose. (If the person isn't slowly dosing you up like that, or is starting at 10 or higher, or not taking at least two weeks before bumping you up in your dose again, RUN! That isn't safe psychiatry, and can put patients at risk.)

When I was properly ramped up on Lexapro, I didn't have the full blown panic attacks, but for 2-3 days after the first dose was started, and then after every time it was ramped up, my social anxiety had an increase and I became paranoid and convinced that everyone hated me. However, with each increase this was more mild and faded faster. Basically, one of the best things I can recommend for you if you're starting on psych meds is to get a really good sense of your baseline, and what spikes in anxiety/sadness/anger/ect are normal for you, and what seems new and not normal for you. It can be really hard, but being able to tell what's you and what's side effects is really useful for your psychiatrist to know, as well as helping you cope through the initial turbulence that comes with any new psych med. (For instance, when I realized that the paranoia came with every increase in dose, and faded after a couple of days, I could be like "oh yeah this is happening again, I know it feels really horrible now but I know it will fade, so for now I'm going to be kind to myself and not push myself to do anything challenging until it passes.")

Finally, you DO NOT want to miss your doses on Lexapro. No no no. I feel rattled and unsteady if I miss one day, a total wreck if I miss two in a row. It was hard for me, but I now has a system that works for me when I keep my meds in a weekly pillbox by my bed, so I take them as soon as I wake up, and I have a checklist that I present to my therapist every week where I indicate whether or not I took my meds, which has worked to keep me accountable and much more stable.

Anyway, basic summary is for me Lexapro I think helped reduce my thoughts of self-hatred and worthlessness, which helped my relationships with friends and also allowed me to engage in therapy more productively (because rather than constantly thinking "I suck, this will never work because I'm such a horrible stupid person" I could actually listen to what she was saying and try to engage with it). Obviously that's nowhere near a cure-all, but it has helped. But as it is a SSRI, it has its side effects and risks as well.

[Werel]

What Prajna said about going off Lexapro is spot on. It sucks.

I was on it for a while, both by itself (2? years) and in combination with Wellbutrin/bupropion (3? years), and I had the following troubles with it:

1) It sometimes plateaus in effectiveness after a few years, i.e. stops working as well as it did at first. For some people. Sometimes. For some reason. Psychiatric pharmacology is not an exact science yet.
2) It murdered my libido.
3) It caused some weight gain (nothing major, though, maybe 5 pounds).

It definitely did help manage undue anxiety and cut through the worst of the "zero neurons firing" fog; my main quibble with it is the tendency to plateau (generally a risk you take with SSRIs) and the libido effects. But YMMV wildly, which is basically the bottom line for all conversations about antidepressants.

[jcorozza]

I also take Lexapro. And I took it with Wellbutrin for about 3 days. The Wellbutrin was awful for me - it seems to be very hit or miss. The Lexapro, on the other hand, is one of the more popular SSRIs right now, partly because it has fewer side effects, and also because it seems to work for a decent amount of people. I haven't noticed any drop in libido.

Prajna is right about being careful about doses. My mom takes it as well, and her wonder dose is 5mg. Mine is 10mg. My psychiatrist kept trying to up my dosage because I wasn't ecstatically happy, and the higher dosages actually increased my anxiety. The thing is, no anti-depressant is going to make anyone "happy". They take the extreme edge off of anxiety attacks and depression and make them more manageable.

If you got it from a psychiatrist, just don't let them convince you that you need dosages/other medications that you do not feel that you need. They tend to be a bit pushy in this regard.

[Solvi]

I'm currently on Sertraline (Zoloft) 150mg, and my experience with it has been largely similar to Prajna's experience with Lexapro.  I'm less than happy with the side-effect that the Sertraline has on my libido (it comes and goes, but when it goes, my mental desire for sex is still there, but my body refuses to cooperate), but I haven't experienced any weight-gain effects.

And, yeah, skipping even a single day can get pretty wild.  Earlier this week, I skipped two days by accident (was stuck in a wall-to-wall work situation clocking in ~18 hours a day right when I ran out of meds, so I couldn't get to the pharmacy for a refill until the deadline crunch was over), and it was fairly terrifying.  By day two, I was having a constant out-of-body experience (like my movements were lagging my brain by about 2 seconds or so) that I've only previously experienced when heavily intoxicated or when in the deepest, darkest throes of suicidal ideation.  Not very positive experiences, in either event.

As far as my moods go, the Sertraline smooths over the worst of my depressive episodes while also greatly reducing my number of anxiety attacks.  But it doesn't totally eliminate either of those, and it has done nothing at all for my self-esteem issues (not that I was really expecting it to, but still...).  I've been taking it now for just under a year and a half, and while I wouldn't describe myself as a happy person (even now), I am a much more functional person than I was before going on the medication.  I can actually get stuff done now, most days, which is a massive improvement from before.

[reboot]

Yeah, for me it got me out of living in a fog and sleeping any hour I was not working. Which was very helpful, but it was not a cure all. More a get me to a place where working on my situation was possible. I feel like SSRIs and SNRIs are not meant to make you happy, per se. They are intended to get you functional.

[PintsizeBro]

I took citalopram (which is a different drug in the same class, not a different name for the same drug) as a teenager and I tried it again in my early 20's. I've also taken St. John's Wort, which even though it's available over the counter in the US, functions much like an SSRI.

When I took it as a teenager I was in an unlivable situation and it helped me get through it in one piece.

When I took it again in my early 20's it was no longer a workable solution.

This wasn't because the drug affected me differently at different times. At both times, I felt like my head was in a bubble and nothing was real. As a teenager, this may have even helped me more by giving me a sense of distance from what I was dealing with. But as a young adult in a better situation, the sense of dissociation became more crippling than the depression I was trying to treat.

So... they might work, they might not, and they might work at one point in your life and not work later. I feel so helpful.

[Conreezy]

Yeah, for me it got me out of living in a fog and sleeping any hour I was not working

I am the opposite--depending on the dose, Zoloft made me constantly tired. Halving it got rid of that effect.

[InkAndComb]

Ok, so! Giving lexapro another shot actually, just started.

But here is what happened last time:

I started taking it, didn't notice anything. I started trying to monitor my diet, doing yoga at home. Nothing too intense, my anxiety and depression were pretty bad. I had already stopped smoking marijuana for a month (I wasn't a regular user at the time, but I was about 21 and did occasionally). Therapist was concerned; I wanted to give up but he encouraged me (Bad experiences with meds before/no effect).

My dose was upped twice; I'm not always very sensitive to medication.

Then, one day, I stepped out of the counselling office and I realized...

Everything seemed colorful again. That voice in theb ack of my head? it was in the BACK OF MY HEAD. I didn't feel like my intrusive thoughts were so overwhelming; yes they were still there, but holy crap I could apply my CBT skills without feeling like I was drowning in my own issues.

It was honestly, honestly magical (not in a "high" sort of way, just like a "oh my god it's WORKING kind of way).

5 monthes later it just...stopped working.

Apparently some people get this affect. Upping or lowering dose did nothing; I was devastated, but in a good enough place that I assumed I could find something else.

I never had withdrawals; I literally just ceased medication once it stopped working.

I am trying again, after about 4 years, in hopes I can find that effect again and seriously get my CBT and Mindfulness skills back in action.

I know this isn't hte case for everyone, but for me, medication is so hit and miss. It's so frustrating to finally have symptoms at a manageable level, and get that ripped away while you're just starting to make progress.

Since then, I've tried Effexor XR (terrible, terrible personal choice), Wellbutrin (no noticeable positive effects but had issue with heartrate and increased anxiety so had to stop), Seroquel (Nada) and some sort of anxiety medicine that is also an allergy medication (made me dizzy and tired but didn't help anything else).

My doctor is about to prescribe me Celexa if this round of Lexapro doesn't work. The alternative is BuSpar, which I have no experience with and don't know anybody on.

On the other hand, I just switched from Concerta to Adderall, and I find the latter is very awesome in treating my ADHD and ALSO a bit of my depression! Not in a 'high' way but in a 'hey, the thoughts are here but the fatigue and numbnessare held at bay a bit easier, and I can focus better in spite of my gloom and other issues'.

I am not saying adderall is good for an antianxiety/antidepressant, but the anxiety caused by my inattention isn't as present and the numbness that bedlocked me isn't there anymore. Also, concerta made me angry and grouchy for some reason, and adderall doesn't do that (I can also sleep again!).

I am down to recall more detailed any of my other medication experiences, but a lot of them are ineffective or negative, and I don't want you to take my body chemistry as your own. Effexor and Prozac were the worst; Zoloft and escitalopram were the least harmful, for me. Strattera was...ok.

[Werel]

While we're comparing meds: I don't know if it's on the market in Australia, but Viibryd is far and away the best experience I've had with antidepressants. I've been on it for four years now (since it came out, I guess), and it sure as shit handles depression for me. HANDLES it. Kicks all the worst physiological symptoms (hypersomnia, brain fog, slurred speech, exhaustion) more effectively than any SSRI I've ever been on. I remember my prescriber telling me that it's a slightly different mechanism than other SSRIs, but I'm not a pharmacologist & couldn't explain how. Its only side effect for me is occasional morning nausea, and withdrawal is brutal (literally like living in molasses), but I'm extremely impressed by its efficacy overall.

[Izmuth]

I took citalopram too.

It made me extremely tired. Didn't really improve my mood.
(I used very low dosage, so maybe I didn't go high enough)
(Also never had diagnosed depression)

Didn't kill my sex drive, which I kinda hoped it would.

[kath]

I was on citalopram to basically manage anxiety when I was in a really terrible terrible job (especially when I was just starting it and it was both horrible and unknown). I started crying on the way in to work on the bus and just at my desk, and I was told it was to kind of give me the room to have the emotions but not be like laid waste by them (so I would not like, be happy about my terrible job, but I wouldn't be crying uncontrollably about having to go to it and getting sick on Sunday evenings and stuff).

It definitely did that. At first I was jittery and nauseous, but I did get over that in a few weeks. I think after I was over my probationary period at that job, I felt secure enough I guess that I was able to go off the SSRIs, and after what I felt was a reasonable time for my first job out of university to have lasted, I found a different job and quit.

[Guest]

**The story so far**

Since my initial post, I've had my doses for Lexapro increased from 5 to 10 and later to 20mg. over a period of about 5(?) months due to not experiencing any notable changes (Actually I have some doubt over my doubt about any changes, but maybe that's just paranoia and a sign that there really was no effect period).

As a result I was started on 35mg's of Efexor (SNRI) about 2(?) months ago, and since that too didn't seem to be the right therapeutic dose I've currently been taking 150mg's of the stuff.

I'm set to meet this new psychiatrist next week at my uni. to get some advice on alternative medications that might help me. Just wondering if there's anything in particular that I need to keep in mind or be wary of at this point before I go.

Thanks.

[Izmuth]

Hey Hermit,

They're testing ketamine as an alternative for people resistant to multiple forms of conventional antidepressants:

https://clinicaltrials.gov/ct2/show/NCT00088699

You could discuss with your doctor if that's something you can try. They would have to be comfortable at prescribing it off-label and there haven't been long term studies dealing with effects of chronic use, though.

[Werel]

Keep in mind that finding an antidepressant that works can be a long process, involving a lot of trial and error. If the first few meds/doses don't work, keep trying, as miserable as the "trying" process can be. It's not you, or a failure on your part to be chemically compliant; it's that a lot of psychiatric medicine is still a little bit of a crapshoot, and it takes patience and luck to make it work for you.

I would recommend some circumspection about requesting experimental treatments until you've tried a few more of those which have some clinical research behind them. There are new (FDA-approved) antidepressants coming on the market basically every year, and some of them do seem to represent marked improvements. See if there are any newish drugs like Viibryd or Fetzima that they think might work for you. Me and my brother have both had problems finding an SSRI/SNRI that worked for us consistently, but Viibryd has been great for me and Brintellix is doing well by him. If you keep finding that you're resistant to most drugs out there, and you are actually down for being a human guinea pig, there are always the bleeding-edge trial drugs like ketamine. I would just be cautious around them, as the long-term effects of most new psychiatric drugs can be unpredictable. A friend's dad was prescribed lithium as an antidepressant back when it was the Hot! New! Wonder! Drug! in the 70s, and he hasn't really... been all there, ever since. The doses they gave him were nuts by today's standards. Not intended as fearmongering, just always be cautious with letting folks tinker around in your neurology before there's a ton of research done.

Alternatively, just try a couple good hits of LSD and see where it leaves you.

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