Considering SSRIs or reentering ketamine therapy and im scared

[badfish45]

Hi all

Im a 28m. My life has had a lot of ups and downs in the past few years. Ive suffered from depression for nearly 14 years now but have always been able to manage okay. I used drugs (psychedelics, some ketamine, occassional coke but never really got into it) throughout my life but never to excess or great detriment, save for cannabis.

A few years ago after a difficult breakup my depression started getting bad and I chose to enter ketamine therapy. at the the time it was effective in getting me on my feet, I started heavily practicing mindfulness meditation and it helped a lot.

Last year I had some difficult experiences and chose to reenter therapy, Ive had a great therapist and see her weekly. My social life began slowly improving.

About 2 months ago I quit caffeine because I was getting a lot of anxiety from it. I began to taper off weed as well because it was making me extremely antisocial and triggering depressive episodes. I also began experiencing suicidal ideation far more severe than I had in my life. I am currently over 2 weeks without weed and plan to go back to it once a month after a long break. I have quit before with very minimal issues regarding my emotional wellbeing.

However my depression is slowly spiraling into a completely unmanageable state, and it has been for this entire year. I can go to work and go through the motions but each day I struggle with a desire to not want to finish out life. This isnt a philosophical struggle. I find deep meaning and purpose in being alive. My job is good. I am very active, eat well, sleep well, have a great support network and pets I love. I volunteer, skate, and get out for walks daily. But the spiral keeps going down and im beginning to fear for the worse. I rarely use any substances now aside from nicotine and MDMA once or twice a year.

I feel like im running out of options. Im considering reentering ketamine therapy but it is a huge burden to commit to it reguarly, as it requires a commute and time outside of my busy schedule. The antidepressive effects are generally a week max aside from when I did a 3 week series of 6 sessions.

If things dont improve in a few months, Im considering SSRIs and im terrified. Im not against them but Ive read so much about the side effects and the process, as well as witnessing them go horribly wrong for my brother. Again, I cant reiterate how scared I am, I truly feel like im running out of options with nowhere to go. I feel all I find on the internet is anectdotal crap about just living healthier, but guess what thats all I do. People make fun of my for my healthy eating habits, not drinking, not staying out late, etc. But Im scared SSRIs could make this even worse. Im truly looking for advice or someone who has gone through this, because Im just not sure im going to make it if this keeps up.

 

[Dougie Doozer]

Defamed catroonist Scott Adams actually has a few really helpful books about reframing mental states like "Reframe your Brain". Maybe use a light and sound machine like a Proteus every 3 days. Combined with exercise, time in nature, and meditation could hopefully work better than ssris with no side effects. Although Proteus gives a hangover after 3 days so that's why I say every three days.

 

[AlphaMethylPhenyl]

Hi,

Thanks for reaching out!

I'm pretty impressed with all you're trying to do to be healthy. I wich I was that functional. Can't think of many bases that you haven't covered.

You jumped right to ketamine therapy? I was under the impression that it's only indicated after two or more antidepressants have been given good chances to work.

Cannabis can definitely make people antisocial and depressed, especially after a lot of use. I know that in most it definitely doesn't increase productivity, and usually does the opposite, which can lead to both of those issues. I am much happier for not using it. I guess in some it does help people, but it's never recommended to use it at least until one's meds are titrated well.

As for SSRIs, they've been a godsend to me. They help my depression, anxiety, and social skills a lot. And they're very safe medications usually, though suicidal ideation can increase in the short term. I think giving each some four to 12 weeks to work is pretty standard. And there are also other antidepressants that aren't SSRIs like mirtazapine and bupropion that help a lot of people. A good idea to tell your doctor about your brother's experience, regardless.

Basically, imo, if you consent to be the guinea pig for a psychiatrist, they can help you almost for sure. No idea how long that will be for, but keeping the faith in it will probably end well.

 

[badfish45]

Defamed catroonist Scott Adams actually has a few really helpful books about reframing mental states like "Reframe your Brain". Maybe use a light and sound machine like a Proteus every 3 days. Combined with exercise, time in nature, and meditation could hopefully work better than ssris with no side effects. Although Proteus gives a hangover after 3 days so that's why I say every three days.

I might look into it, as much as that dude makes my skin crawl lol. I havent heard of a Proteus before but Id be interested in doing some research on it, have you tried this yourself before? I think my issue isnt necessarily a perspective one, though it could be, I see life as beautiful and worth living I just often feel disconnected from that, and dead inside for lack of a better term.

Hi,

Thanks for reaching out!

I'm pretty impressed with all you're trying to do to be healthy. I wich I was that functional. Can't think of many bases that you haven't covered.

You jumped right to ketamine therapy? I was under the impression that it's only indicated after two or more antidepressants have been given good chances to work.

Cannabis can definitely make people antisocial and depressed, especially after a lot of use. I know that in most it definitely doesn't increase productivity, and usually does the opposite, which can lead to both of those issues. I am much happier for not using it. I guess in some it does help people, but it's never recommended to use it at least until one's meds are titrated well.

As for SSRIs, they've been a godsend to me. They help my depression, anxiety, and social skills a lot. And they're very safe medications usually, though suicidal ideation can increase in the short term. I think giving each some four to 12 weeks to work is pretty standard. And there are also other antidepressants that aren't SSRIs like mirtazapine and bupropion that help a lot of people. A good idea to tell your doctor about your brother's experience, regardless.

Basically, imo, if you consent to be the guinea pig for a psychiatrist, they can help you almost for sure. No idea how long that will be for, but keeping the faith in it will probably end well.

Thank you for your reply. It gives me hope seeing it does work well for people if given a chance, I just am afraid of physical and potential side effects. And the process, trying one, having it not work, weening off then trying another. My brother had a doctor prescribe him drugs after a 15 minute talk and it was first lithium which was terrible for him, so Im going to do my due diligence in finding the right one for me.

I did jump into ketamine therapy because it seemed overall safer, didnt require me to consistently take it, and I was familiar with it. I had been unofficially diagnosed but both my therapists and I are pretty certain its MDD. So I was able to qualify for a clinic. To be clear these were injections, not Spravato.

If you dont mind me asking, what antidepressants are you on?

 

[AlphaMethylPhenyl]

I might look into it, as much as that dude makes my skin crawl lol. I havent heard of a Proteus before but Id be interested in doing some research on it, have you tried this yourself before? I think my issue isnt necessarily a perspective one, though it could be, I see life as beautiful and worth living I just often feel disconnected from that, and dead inside for lack of a better term.




Thank you for your reply. It gives me hope seeing it does work well for people if given a chance, I just am afraid of physical and potential side effects. And the process, trying one, having it not work, weening off then trying another. My brother had a doctor prescribe him drugs after a 15 minute talk and it was first lithium which was terrible for him, so Im going to do my due diligence in finding the right one for me.

I did jump into ketamine therapy because it seemed overall safer, didnt require me to consistently take it, and I was familiar with it. I had been unofficially diagnosed but both my therapists and I are pretty certain its MDD. So I was able to qualify for a clinic. To be clear these were injections, not Spravato.

If you dont mind me asking, what antidepressants are you on?

Dang, all of 15 minutes. Shaking my head.

I tried many of them. Had a good two-year streak with Wellbutrin but after getting off of it and then back on it, it wouldn't work.

I take fluoxetine. Should have stayed on it, but got too hungry and shot myself in the foot looking for a better one, spanning the whole antidepressant buffet, basically. Simple answers sometimes, and I continued to make things more complicated, story of my life. But I attribute my relative success to healthy habits that the fluoxetine gave me space and will to build.

 

[deficiT]

Hey, it's good that you're checking in and reaching out. Like someone else said, damn, on the outside, your life seems great and manageable. But that's kinda how depression works right? The creeping malaise just has a tendency to push its way through... No matter what we're doing. That is why it is sometimes frustrating to hear people suggest things like exercise and jogging, when the nature of the disorder you are dealing with can very much prevent you from doing those things.

I can't really suggest what you should do, but I can tell you some of my story. I started taking meds when I was 18, with paroxetine. Just 10-20mgs I believe, and yeah after a couple weeks, I did feel better. But the problem was that it removed a lot of my inhibitions and better sense. Put simply, they made me manic. At the time that didn't stop me, I bounced around my young adulthood off and on various meds, I really fucked up my life well and good.

Turns out I was dealing with undiagnosed ADHD and bipolar, I was also dealing with a pretty serious substance abuse issue, so yeah all those things never mix. I don't really attribute any of those issues to the meds I was prescribed though, I think I was just incorrectly diagnosed so I wasn't getting the proper treatment.

I have been on most of all the major classes of psychiatric drugs, from SSRIs to Antipsychotics. At this time in my life, I no longer drink, and I'm prescribed Vyvanse (ADHD), Fluoxetine (SSRI), mirtazapine (atypical antidepressant) and Trileptal (anticonvulsant/ mood stabilizer). It sounds like a lot really, but in comparison to other times in my life, I am on a pretty manageable dose of everything, and my moods have truly relaxed a bit, and my executive dysfunction is getting better every day.

Anyway, there were times in my life that I was in a really dark place, and just taking some meds was a quick shortcut to life being liveable. Obviously it can't be everything, but it can be very helpful when you're in a dark place. I don't think you have anything to be scared of. It your having ideation at all then it's a serious problem and you should be treating it seriously. Just be mindful of anything you are prescribed, any condition you've been diagnosed with, and ultimately just keep all that stuff in your control. Talk with your therapist, and even your family if possible, about what you're taking. They'll be able to help you notice if there's been some drastic change in your mood.

I think those are the most important things to look out for when taking any medicine, drastic changes in mood quickly. Generally getting onto a psychiatric med will be a nice gradual change into something better, so just be mindful of moods. Sounds corny but you can document how you're feeling in a note every night. Generally speaking, normal antidepressants like SSRIs, Bupropion, or Mirtazapine, aren't really going to have unbearably crazy side effects, for MOST people. Stuff like that your body adjusts to. You just have to take the pros with the cons.

I'm not a doctor, but this is just my opinion, I would maybe try something like bupropion if you've never taken an SSRI. See if that works. It's a lot less of a commitment, with an SSRI it takes a few weeks to work, and then getting off them is a little more of a process. Same with mirtazapine. They are both atypical antidepressants that work well with limited side effects and commitment. Ssri's work for what they do, but those are the downsides with them. I kinda wish I had been started on something like that as opposed to an SSRI.

I'm really sorry that was a novel, I just started going I probably have more to say but won't continue

Anyway yeah don't take this as medical advdice, this is just my thoughts as someone that's been there and dealt with psychiatry

 

[badfish45]

Hey, it's good that you're checking in and reaching out. Like someone else said, damn, on the outside, your life seems great and manageable. But that's kinda how depression works right? The creeping malaise just has a tendency to push its way through... No matter what we're doing. That is why it is sometimes frustrating to hear people suggest things like exercise and jogging, when the nature of the disorder you are dealing with can very much prevent you from doing those things.

I can't really suggest what you should do, but I can tell you some of my story. I started taking meds when I was 18, with paroxetine. Just 10-20mgs I believe, and yeah after a couple weeks, I did feel better. But the problem was that it removed a lot of my inhibitions and better sense. Put simply, they made me manic. At the time that didn't stop me, I bounced around my young adulthood off and on various meds, I really fucked up my life well and good.

Turns out I was dealing with undiagnosed ADHD and bipolar, I was also dealing with a pretty serious substance abuse issue, so yeah all those things never mix. I don't really attribute any of those issues to the meds I was prescribed though, I think I was just incorrectly diagnosed so I wasn't getting the proper treatment.

I have been on most of all the major classes of psychiatric drugs, from SSRIs to Antipsychotics. At this time in my life, I no longer drink, and I'm prescribed Vyvanse (ADHD), Fluoxetine (SSRI), mirtazapine (atypical antidepressant) and Trileptal (anticonvulsant/ mood stabilizer). It sounds like a lot really, but in comparison to other times in my life, I am on a pretty manageable dose of everything, and my moods have truly relaxed a bit, and my executive dysfunction is getting better every day.

Anyway, there were times in my life that I was in a really dark place, and just taking some meds was a quick shortcut to life being liveable. Obviously it can't be everything, but it can be very helpful when you're in a dark place. I don't think you have anything to be scared of. It your having ideation at all then it's a serious problem and you should be treating it seriously. Just be mindful of anything you are prescribed, any condition you've been diagnosed with, and ultimately just keep all that stuff in your control. Talk with your therapist, and even your family if possible, about what you're taking. They'll be able to help you notice if there's been some drastic change in your mood.

I think those are the most important things to look out for when taking any medicine, drastic changes in mood quickly. Generally getting onto a psychiatric med will be a nice gradual change into something better, so just be mindful of moods. Sounds corny but you can document how you're feeling in a note every night. Generally speaking, normal antidepressants like SSRIs, Bupropion, or Mirtazapine, aren't really going to have unbearably crazy side effects, for MOST people. Stuff like that your body adjusts to. You just have to take the pros with the cons.

I'm not a doctor, but this is just my opinion, I would maybe try something like bupropion if you've never taken an SSRI. See if that works. It's a lot less of a commitment, with an SSRI it takes a few weeks to work, and then getting off them is a little more of a process. Same with mirtazapine. They are both atypical antidepressants that work well with limited side effects and commitment. Ssri's work for what they do, but those are the downsides with them. I kinda wish I had been started on something like that as opposed to an SSRI.

I'm really sorry that was a novel, I just started going I probably have more to say but won't continue

Anyway yeah don't take this as medical advdice, this is just my thoughts as someone that's been there and dealt with psychiatry

I actually really appreciate your response, it gives me a lot of perspective. Truthfully I think whats made it so hard to get help is I seem to have it together. So its easy to tell myself I can get through and Im okay but its become obvious to me im not. I always figured I was functional enough to not need to resort to meds but after 6 months with my current therapist and years of therapy and treatment before that, its obvious theres something wrong and I need extra help.

Its hard that so many of my days turn grey, it makes me sad how often the thought of wanting to die runs through my head because its truly not what I want at all. I feel so empty and dead inside, even when broken up by brief moments of beauty and joy when I am doing what I love and being with those I love. Even as I struggled in my past, I felt so much more at peace, but now I so often feel troubled, out of place, empty. I dont sleep much, if at all some nights.

Im happy to hear you are finding what works for you and getting help, it really helps. It brings me a lot of comfort to read your post because it gives me hope this can improve.