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Mental Health How do I know if an antidepressant is working?

Opi_Kid_Rock

Opi_Kid_Rock

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Sep 13, 2018
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Lost. Always have been it seemed.
The first SSRI I took I threw up my entire lunch in violent fashion; flushed those down the toilet. On Wellbutrin SNRI 3 weeks and random nausea every few days and so today is my last day. They’re gonna try a different one for me starting tonight.

Question: Arn’t all these antidepressants pretty much the same? 60% effective rate vs. 65% or what have you and when you compare it to the placebo group, it’s even less impressive to me. The downsides are what exactly? How are they even addictive? How can I experience withdrawal from what seems to be poison? I feel sick mostly. I get nauseous and vomit.

My mood didn’t drop to my usual “depressed” on the SNRI but they’re going to change my med.
 
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Hey Opi, sorry to hear you are a bit in no mans land it seems. Often times unfortunately, things can and do feel like your symptoms worsen before they will ease off. If you can, you really need to aim for an 8 week mark in your head, I found this very useful if I tried a new one like you.

It will depend on what needs to be balanced out really. E.g Usually it’s a question of, are you low on Serotonin, norepinephrine, dopamine or bits of both or all 3. Other catecholamines can be the problem also. I had no real success with SSRI, SNRI, NDRI, or any other newer compounds that are first line treatment.

I settled on one of the old TCA’s specifically Amitriptyline. It was noticeable in less than a month, irritability and ruminating thoughts cut in half and is also great for sleep and general anxiety in a morning. Don’t be discouraged you will find one I’m sure. Fire me a DM anytime ?
 
No probs mate anytime. I as well as many others I know have been in the head scratching position, wondering why get worse before better. I cannot stress enough to hang in there if you can. Just in case you weren’t aware, Wellbutrin is more focused towards dopamine reputable inhibition, as oppose to serotonin. May I ask which ssri’s you have tried?
 
So you are planning to ask your dr again or you have something already?

Examples of SSRI’s include, fluoxetine (Prozac) Citalopram (Celexa) SNRI’s include Venlafaxine (Effexor) Duloxetine (Cymbalta) then there are other variations, plus as mentioned, older varieties like TCA’s (Tricyclics antidepressants) hope this helps!!
 
I'm sorry to hear you didn't have any luck with Wellbutrin. That shit was a life changer for me. Minor point, but it's an NDRI not an SNRI. I can't (or at least I shouldn't) take any drugs which affect serotonin as I have bipolar, but Wellbutrin along with Lamictal worked really well for me. I noticed increased energy and decreased appetite within a couple weeks and it started really working (along with intensive therapy) on the deeper depressive symptoms like anhedonia, self-loathing, feelings of worthlessness, and suicidal ideation after about 4-6 weeks. Lamictal really helps with mood swings and keeps me out of mania territory. I still deal with symptoms on a daily basis but Wellbutrin and Lamictal gave me my life back, I no longer live in fear.

SSRIs ruined my life though, antipsychotics just made things worse, and benzodiazepines made me not care until it was almost too late.

Psychiatric medications are a tricky thing to get right. There are hundreds of drugs and every individual has a unique brain chemistry. Keep on keeping on and I really think that some day you'll find a plan that works for you! Just also keep in mind that regular therapy is a lot more important than drugs. You can get better on therapy alone, but on drugs alone your life just spirals further out of control. What ever happens, just remember that "this too shall pass".
 
^did you start the wellbutrin or the lamictal first? or same time?

ssris definitely cause gi issues like nausea and diarrhea.
 
Well said @Factualist, I find here in the Uk they try and roll out the same same old for anyone who turns up to their go with any mental illness. As you say there are many faces of depression etc, it is not one size fits all. I think the whole world needs to wake up to that fact, and drs need educating on the pharmacy that are readily available.

Good read ?
 
@hydroazuanacaine Lamictal first. When I was last in the hospital, they took me off Lexapro (which my last GP gave me despite the fact I was already diagnosed with bipolar, I had no idea I couldn't take it, no one told me) and Abilify (which makes my anxiety totally unbearable) and put me on Lamictal and Seroquel. Well, I quit taking the Seroquel after a few days because fuck that. Lamictal is a drug you have to titrate up on so I started on 25mg and went up 25mg a week until I got to 200mg. A month after that I had a follow up and I still had a lot of depressive symptoms. My new provider knew what they were doing and said she couldn't believe the last people put me on Lexapro. So we went over options for antidepressants that I could use without going manic and settled on Wellbutrin. I had a lot of fatigue, anhedonia, trouble concentrating, lack of motivation, low energy, etc. which Wellbutrin helps a lot with. Another big thing was appetite, which was way too high and binged and purged a lot, really helped with that. It's just now starting to help with some of the deeper symptoms like self-loathing, hopelessness, and suicidal thoughts/actions. I was on 150mg XR for a month then upped to 300mg XR and I've been on that for almost a month now and I'm really making strides.
 
Sorry to be obvious but you know because you start to feel better.
SSRI's gave me *intense* anxiety and awful side-effects but got through it by taking half what I was supposed to for the first week. The side-effects go away after a week or two and then I felt a massive positive change.
 
Good point CE, but I think Opi is just trying to navigate when things have turned that corner, from “worse or no response feeling”, “bedding in period” and actual symptom relief. I have been the same that situation years ago.

All I was told is hang in there for 2 months at least, and you may or may not see a difference ?. Not helpful at all general practitioners with this kind of thing!!
 
Shortec Stublue!! said:
Good point CE, but I think Opi is just trying to navigate when things have turned that corner, from “worse or no response feeling”, “bedding in period” and actual symptom relief. I have been the same that situation years ago.

All I was told is hang in there for 2 months at least, and you may or may not see a difference ?. Not helpful at all general practitioners with this kind of thing!!
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I was lucky, I felt better (actually, I was hypomanic) after just 3 days on Setraline (Zoloft) and didn't really get any side-effects. Citalopram (Celexa) however made me so ill I couldn't take any after the first dose. I literally had an 18-hour panic attack with it. Thank God my grandma had a couple spare Lorazepam.
 
Factualist said:
that's how it be, i can legitimately abuse Sertraline, taking a lot even just once will always without fail throw me into mania
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Yeah, I take 150mg as prescribed most days but if I'm particularly down I'll take anywhere from 200-350mg that day and feel a whole lot better.
 
Yeah that's how I felt when I first started on SSRIs. I had this feeling like "holy shit I'm getting so much better" and then a couple months later I realized my life had completely spiraled out of control and I felt high all the time even if I didn't do any other drugs, Come to find out this was because I had bipolar not depression. Good thing to know innit?
 
It’s too individual it seems, My Mum swears by Citalopram, yet other similar AD’s are useless or too many side effects.

It’s about time there was a more clear and successful approach and options for people. Some people need help and need it now. For someone suicidal, imagine having the courage to ask for help, and then you are told it may take weeks or months, and you may feel “worse before you feel better” shocking. They should be given a nice dose of Oxy, addiction maybe, but still alive wins I think!!

Bi-polar sounds a minefield too Factualist!!
 
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Can you get Bupropion in the UK. I too have bipolar and I'm on Lamotrigine, Aripiprazole and Mirtazapine. I'm kinda stable, but I feel really strange. I wonder if kicking out the Mirtazapine and Aripiprazole in favour for just Lamotrigine and Bupropion would be a better option.
 
I think it is available as either simply generic or under the brand name Zyban here in the UK Chris.

I really do believe this area of diagnosing and prescribing is very inadequate, and also kept at a very small number of medicines as first line treatments. There are hundreds of specifically tailored compounds, that people in dire need never get a choice of. As @Factualist said, you cannot band bi-polar in with normal clinical depression. There is no one size fits all.
 
Shortec Stublue!! said:
It’s too individual it seems, My Mum swears by Citalopram, yet other similar AD’s are useless or too many side effects.

It’s about time there was a more clear and successful approach and options for people. Some people need help and need it now. For someone suicidal, imagine having the courage to ask for help, and then you are told it may take weeks or months, and you may feel “worse before you feel better” shocking. They should be given a nice dose of Oxy, addiction maybe, but still alive wins I think!!

Bi-polar sounds a minefield too Factualist!!
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Great feedback from all around explaining that it takes such a long time before I can gauge if a particular AD is actually working. I’m continuing to take Wellbutrin plus they added something that reduces the overproduction of dopamine while reducing nausea(I’ll get the name of it on my next outting pass). I jumped off the 2mg Suboxone today. Just mild muscle pain that went away after a shower. I don’t feel nauseous today for a change. I’ll also go get the name of the SSRI that made me puke years ago.
 
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