pinenutcasserole

Oh yeah, want to share a fantastic website. Free yoga videos. Found the yogini on youtube on a search for 'beginning yoga'. She does short sequences, and has kookily useful ones, like 'yoga for a bad day', 'yoga for a hangover', among others. The lady's got a very calming energy - I swear my blood pressure goes down a couple of notches just hearing her voice. Check her out at
Yoga Videos and Yoga Poses at Yogatic with Esther Ekhart

insatiableone

Pinenutcasserole--first, what an interesting username! LOL. I called myself after a song by a band I love, but realized belatedly it fits my appetite. I really am the insatiable one sometimes! :X

I am still on antidepressants and I DON'T want to be. This entire year, I've felt lows as bad as before I was ever on them, which makes me think that they're doing me more ill than good. I know how dangerous it is to quit them cold-turkey--I tried that once in early 2008 and ended up crying in class and having terrible nightmares and just feeling like life wasn't worth it. I actually began to taper off my dosage in October by snapping one of my two pills in half and have felt better since then. I'm going to try and get myself down to one pill. I've been on Zoloft for years now--I tried Cymbalta again at my erstwhile drug therapist's advice, and even though I TOLD her I knew it'd make me a little ball of anger and hatred, she made me try it anyway, and when I was right, she concurred and put me back on the Zoloft. It's the only one that hasn't caused massive weight gain and the only one on which I've been stable. And I know that being stable on an AD is kind of a crapshoot since NO ONE KNOWS HOW THEY WORK, which has ALWAYS bothered me.

The GP who prescribed me them was an idiot. I no longer see him because of how much his happy-go-lucky Rxing screwed me up. I saw dedicated mental health specialists for a couple of years to get me where I am today. I take 200mg of Zoloft a day, or did--I've been at 150mg for 2 months now. Like I said, for many reasons, I want to taper myself off them. I'm hoping when I get more exercise in my regime (walking around a gorgeous city!) and am away from the toxic influence of my parents, I won't NEED them anymore, but I also don't want to rush myself off them. It took you a year and may take me as long or longer--I've been taking them for 6 years, nearly 7 now. :\

I thank you so much for your advice! My relationship with my sister IS a strong one, you're right. I think she's probably the best influence I have in my life currently, although a couple of my long-distance friends are into exercise and when I visited them, I was more into it myself. I really think environment and influence is everything when it comes to lifestyle changes, given my experience and the experiences of others, like yourself.

Oh, your commentary on blunted affect strikes home with me, too. I feel I've become such a disaster on medication. I take a lot of pills for a 24-year-old (singulair, celebrex, zoloft, zyrtec, levothyroxine all daily, Xanax when I need it and naproxen several times a week) and I want so much to whittle that down. My sister takes no prescription drugs now that she's gone to her herbalist and while I'm not sure I'm down with the hippie thing, I'm going to see what he says about me on the 17th. My sister said he's a really good listener and has a Western medical degree in addition to his Eastern studies and will draw on both for a diagnosis. he focuses on lifestyle changes, too.

I don't feel like you've rammed your opinions down my throat at all! You have good suggestions, many of which I've considered myself. Thanks so much for your advice! I'm definitely heartened by your experiences since you were in a very similar place to me at one time. Thanks again.

J.

cjohnson728

Antidepressants are a tool, one of many, to combat depression. The degree to which people tolerate them and benefit from them varies enormously.

I think, that with respect to psychotropic medications, it's truly a case by case basis, the same as it is with dieting. People can tout low-carb and show me study after study about how healthy and effective it is, but it does not work for me and I doubt it ever will.

Some folks need antidepressants to give them the energy and the motivation to make other changes in their lives. Some people respond very well to them, and some depressions are largely biochemical in nature. Some folks, including a close relative of mine, don't react well to them at all, and find that none of them works for them. In the interest of full disclosure, I'm a psychologist. I don't prescribe; I would rather people do the grunt work of therapy and lifestyle changes as opposed to just running to the prescription pad, but there are times when it is optimal to have both.

I am not disagreeing with anyone's opinion, but I know that a lot of folks on these boards are on such medications and I wanted to point out that there is another side to the coin than the one pinenutcasserole eloquently presented.

One thing you will find me saying again and again on these boards is that if it works for you, do it. If it doesn't work for you, don't do it. Within reason, there is no "right" and "wrong." Another thing I say quite frequently is that you can find anything to support any position on the internet or in the library; you can quite easily find a study contradicting something you just read. So really, there is no ultimate answer for a lot of this.

If you are on the medication route, listen to your doctor, be open and thorough with your doctor...and if you don't completely trust your doctor, find a new one.

And as always, keep sharing your thoughts and experiences, because you never know when one will be an "ah-ha" moment for somebody!

pinenutcasserole

Hi both,

Stepping on a soap-box, with respect:

I share your concern, J, that SSRIs were put to market without robust investigation of, or consensus on, their underlying mechanisms and effects. In the 90s, the serotonin hypothesis was seductive - and certainly, initial outcomes appeared to prove its validity. It's now being revisited. The knock-on effects of serotonin reuptake inhibitors on other neurotransmitters remain unknown and continue to be largely unstudied. It took over a decade for wildly confused patients, who'd previously suffered in isolation, to organize the critical mass of lawsuits it took to get GSK to admit that suicidal ideation, weight gain, and discontinuation syndrome were linked with paroxetine (my drug... I don't know much about Zoloft, but they're in the same class of drugs). Obviously, part of the problem was bias - patient experiences were discounted, since their initial diagnoses cast doubt on the cause of the symptoms.

I find it unacceptable - to put it very mildly - that all this had to emerge in a clinical context, in the open market. Trials for paroxetine have been no longer than 12 weeks at 40 mg. I don't know much about Zoloft, but it's the same class of drug, and imagine the protocol was similar. As we've experienced, J, clinicians prescribe it for *years* at much higher doses. The 'empirical' tack. "Hey, it could work, let's see what happens." And patients like us are often in no position to be critical healthcare consumers when we first approach practitioners. Most of us just 'want it to stop', whatever it is.

I'm not suggesting there's a conspiracy. Doctors (and we're usually talking about overwhelmed GPs, who then refer to psychiatrists) want to treat patients as much as patients want to be treated. Their mutual desire to believe in drugs' efficacy converged with pharma companies' interest in selling to a (sadly increasing) market, and was expedited by the unbelievable practice of advertising the stuff on television, creating a demand-led prescribing culture. The economics of health care (even in Canada, where I'm now based) often mean that in practice, too many patients are handed out drugs in the first instance ("cheap", even if it isn't) and in lieu of, rather than in conjuction with talk therapy (expensive). I'm really pleased to hear you've found solid support.

Cassie: you're right to encourage people to be critical of studies. There's a fair amount of sensationalism in science journalism, and too many studies are less rigorous than we'd all like. (Including, I might add, some of the ones that established SSRIs as the 'gold standard' drug treatment for affective disorders.) Also, few academic journals - and this extends to disciplines outside of psychology - were/are interested in publishing the null hypothesis. This is, I think, more a question of sociology and economics than anything nefarious ( 'x didn't happen' is less sexy than 'y did', to both editors and readers). (Though in the case of the FDA, it's hard not to think of it as being a question of influence.)

I'm not sure I buy the distinction between biochemically based depression and any other kind. (Former medical anthropology/philosophy of mind student.) I'm not trying to be glib or rude, or bring up the tiresome (and outworn) nature/nurture debate... but aren't all experiences biochemical, at bottom? I mean obviously there are many kinds and causes of depression... but even fMRIs can't offer insight into causation. The brain of someone whose depression is exogamous bears the impact of social causes. As you know, researchers are finding that we are neuroplastic - for others, change in response to experience - well into and through adulthood. To a greater or lesser extent (we still don't know enough to know how much), it seems our brains reflect our lives, as they are lived. Which is hopeful news for us both, J!

I haven't meant to be argumentative or disrespectful to you, Cassie, and I'm not against all pharmacological treatment. It's true that many people are helped by drugs. It's just that we don't yet have robust enough research to make better guesses about who will, and who won't - and in the meantime, the unlucky ones suffer. And this new suffering is compounded by more familiar pains. It's unjust, and theoretically preventable.
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J: Bit winded after all that, but briefly now, I truly empathize with your struggles. Your post has called me to remember the long road I've travelled, but if it helps, that time (and the feeling of that time) is very far away from me now. It's true you've got some tough days ahead, but you're an equally tough cookie. You've already been a strong advocate for yourself, through the avenues available to you so far. It'll be something to see what you will do when you're in your new situation!

I'm glad to hear you're taking it all as slowly as you need to, and hope as others do that you stay kind to yourself. You sound tremendously frustrated right now. Lean on those helpers, lean on your sister. I absolutely agree that situation, proximity, & modelling have a tremendous influence, for good or ill. I can imagine it will be hard to generate the wherewithal to get going on much, if there's not much activity or healthy eating happening at home, and your sleeping and sense of well being are where you've said they're at. I'd like to take the liberty of recommending a few very practical things:

- Get a dawn simulating alarm clock. Magic, if you do your best to practice sleep hygiene. First time ever I've woken up painlessly. I have this one, it rocks.
- January = a new semester. I've suggested to someone else on this board something that really helped me, which is taking a night class in something fun. (You're a precise and moving writer... maybe something like short story writing? Which I'm guessing you might have already tried... Or maybe something you don't have a history with but have wanted to try. )

I'll repeat my argument for it: it's a weekly appointment that will *make* you get out of the house. It'll be in the evening, so perhaps less of a challenge in terms of time management. It's a class and therefore structured, which in your case (my case, of old, and still) may be a good thing. And in the days after a class, if you're like me, you might find yourself 'kick-started', just sort of feeling intuitively that you want to do more of other things ...

- Something physical that doesn't make you feel like a failure. I'd suggest walking, but in the suburbs, where only the most intrepid cats and maybe the elderly dare venture out, it might feel a bit daunting. (Did me anyway.) Personally, I find DVDs hugely helpful. Easy to do at home, low investment, little gear or hassle involved. Sometimes I just do em in my pjs. There are some that are aimed at rehabbing folk, which might better accommodate your fibromyalgia issues.

I hope your meeting with the herbalist goes well! And am glad I was able to be helpful, thank you for letting me know

Crikey, I've written a novel. And most definitely thrown some opinions around.

nx

ps - pinenutcasserole is just me being literal and stubborn. I was actually looking at a pine nut when I registered, but the name was already taken.

pps - i don't mean to encourage people who are happy with their drugs to leave them, but, j, for you (in the absence of a discernible pm'ing function): I found this site helpful in terms of information on tapering. It's to do with paxil, but many on there are on other SSRIs.

cjohnson728

Well, I wrote a huge post, and FitDay ate it, which sometimes happens. Basically, the high points are as follows:

I personally don't have experience with antidepressants, or any other psychotropics. My conclusions come just from my profession and what I've seen over 15 years in practice. I've seen antidepressants work. I've seen them not, and I've seen them come with wicked side effects.

That being said, my Ph.D. is a research-based degree, but I have a clinical practice. I do therapy, not research. I have the background of the science, but I'm not in the pocket of any drug company and never have been. I never, ever, advocate using medication without therapy, and often do therapy with folks who do not need and/or do not want medication. Most of my patients are not on medication.

I always advocate starting with therapy and lifestyle factors. However, in the case of vegetative depression, suicidal depression, or intractible depression, medication can be helpful. I have seen patients who don't have the will or energy to get out the bed, let alone process their issues using insight-oriented therapy, and if an antidepressant can get them to where I can work with them, then I'm truly okay with that.

My main concern was that, given that this is a newcomers' thread, that no one feel isolated or criticized because he or she happened to choose medication as an option for him- or herself. A lot of folks on here have done just that, and I would hate for someone to read this thread and think that they would not be accepted because of a personal choice that is their right to make. Consequently, I simply presented the other side of the argument.

I am not saying that your post was dogmatic at all. However, we sometimes have some individuals who post with the attitude that their way is the only way (search for Zorba's posts if you want an example), and it is quite polarizing; I tend to be very hyprvigilant for that. It is wonderful to be passionate about one's point of view, and I don't disagree with the basic premise of yours, but in the long run, there are two sides to every issue, shades of gray for every black and white, and exceptions to rules, and I felt that it was important to state them for others who may be reading through, if only to illustrate that everyone needs to do what's right for them, provided they're being honest about what that is.

Lizzycritter

My own personal soapbox on the whole herbal/holistic market in a nutshell is this: Herbs are untested, unregulated drugs. Cocaine is an herbal product if you want to be technical about it. As with everything else in life, buyer beware. Herbal therapies do help some people, but there are a lot of claims out there with nothing but anecdotal evidence to support them. My personal opinion is a combined approach is best. My persoal background is in traditonal/western medicine, but the whole person treatment approach and the mind/body connection that eastern/holistic medicine addresses does have merit. You cannot treat one symptom without affecting many other bodily processes, and how a person feels emotionally does have a physiological effect.

In my case, I am no longer on antidepressants. I weaned myself off of them because I wanted a second child, and because physical therapy got me to a place where I could get relief without them. I started taking them because of nerve pain that was keeping me from sleeping, the lack of sleep was causing me to be depressed, and I was very close to a major breakdown. My depression was physicological. The particuar one I was prescribed eases nerve pain as well as depression, and I was on it for about 2 years. I agree with Cassie that antidepressants can be a useful tool in conjunction with therapy. I don't think simply throwing pills at a problem can make it go away, but medication can be the crutch needed to get a person to a place where the problem can be addressed. Once the person is well enough to stand on his/her own, then the crutch can be set aside.

pinenutcasserole

Sorry, InsatiableOne, for so diverting this thread... would just like to briefly respond to Cassie.

I was unclear above, in mixing comments to InsatiableOne and yourself - when I spoke of 'we', I meant to refer to IO, as we're both consumers of care.

In no way did I mean to suggest that you personally were a 'pill-pusher', or prone to 'big pharma' manipulations... in fact I wish more care providers (GPs & psychiatrists in particular) were as conscientious as you evidently (by your care in balancing the picture here) are. I would guess that your patients/clients are among the lucky ones.

My gripe is with pharmaceutical companies that I feel didn't do due diligence in their research; insurance companies, which place constraints on length of treatment, and bias or even force some practitioners towards drug-heavy treatment plans; and finally, with pharma-minded doctors.

As you well know, there are many cultures among psychological carers. GPs, psychiatrists, psychologists, social workers, and counsellors each have a different scope of practice, and different orientations. I think the GPs struggle to deal with affective issues because they're not specialists, they're dealing with shingles and bronchitis and god knows what else - I suspect that many find it easier to view - and manage - depression as a strictly physical disease, given their orientation. And much of the continuing professional education that's most easily accessible is sponsored by drug companies. I even think more of them would probably like to offer insight based therapies, but are overwhelmed. I think that culturally, because of limited time, non-specialists take older research for granted. And I think many patients are familiar enough with psychology - through advertisements, and other popular media - to present themselves as worst case scenarios, therefore needing drugs; to perhaps exaggerate some symptoms, in the belief that only a drug can cope with their depression. I don't see this whole exchange as malicious, just - very often - misguided. I feel it's a structural and systemic problem. I'm sorry if I in any way suggested otherwise.

I'm sure there are many who have found balance too. Personally, I found community and help among people who did not have that experience. Probably those who are pleased with their treatments are unlikely to go on about them in online forums and elsewhere - they just get on with their lives.

Lizzie: agree that herbal treatments should also be standardized (in their production) and vigorously tested.

I hope everyone here who is struggling with sadness or depression finds what they need, where they need it.