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Forum Name: Antidepressants

Question: Will Antidepressants Work For You?


 Dr. K. Eisele - Tue Mar 04, 2008 1:57 am

User avatar Welcome to the Antidepressant Forum!

The Psychiatry Team has started this new thread to answer any and all questions you may have about symptoms of Depression and its treatment. In the UK this past week, headlines have appeared that the SSRIs (selective serotonin reuptake inhibitors) don't work any better than do placeboes. However, the research that these headlines are based on has some weaknesses. Please see the article under the "Home" tab about this study for full explanation.

At any rate, please be patient as we update the antidepressant database with the most recent accurate information based on solid research.

To introduce this new thread, a basic description of the symptoms of Major Depressive Disorder and of Dysthymic Disorder, along with definitions of certain terms, follows.

Major Depressive Disorder (MDD)
Common symptoms of MDD include:
    1. Depressed mood - mood refers to the prevailing feelings and is persistent over a period of at least days
    2. Anhedonia - lack of motivation to do anything, including bathing, eating, doing activities you previously enjoyed
    3. Poor concentration - cannot stay focused on any task long enough to complete it as compared to your usual functioning; indecisiveness
    4. Feelings of hopelessness and worthlessness - loss of hope that you will ever feel any better, feeling that you are a failure
    5. Feelings of guilt that are excessive to the situation - feeling that everything that has gone wrong is your fault, such as "carrying the weight of the world on your shoulders"
    6. Change in sleep pattern - either sleeping much more than usual (hypersomnia) or the inability to fall asleep and/or stay asleep (insomnia)
    7. Change in appetite - either a marked increase in appetite (hyperphagia) or a marked decrease in appetite (anorexia) with a change in baseline weight
    8. Fatigue or loss in energy
    9. Feelings of physical and/or emotional agitation or slowing
    10. Thoughts of death or suicide
      In addition, the disorder must not be caused by a drug of abuse, medication, or general medical condition. Criteria for mania/hypomania have never been met, and the disorder causes clinically significant distress or impairment.

      Dysthymic Disorder
      Common symptoms of Dysthymic Disorder include:
        1. Chronic symptoms of depression (see 1 - 10 in MDD)
        2. Symptoms must last longer than 2 years
        3. Symptoms generally are less severe than in MDD

          Everyone is different and there are many, many different presentations of depression. In some people, depressed mood is not even part of their complaint. Instead, it is the lack of motivation to do anything at all that brings them to seek treatment. Sometimes, it is the presence of other symptoms (called co-morbidities because they occur along with depression) that are distressing, such as anxiety, which is a close cousin of depression.
           WLWeaver - Wed Apr 08, 2009 4:18 pm

          Dr. Eisele,
          I appreciate your listing of the requirements for the diagnosis of major depressive disorder. I think that you made it much clearer in regards to the severity of symptoms required for a diagnosis. For example, anhedonia - lack of motivation to do anything including bathing, eating, etc., as well as the things we normally love to do. I think we all go through periods of time where life events make us lose our appetites, gain and/or lose weight, such as in response to normal life events such as the death of someone close to us. I have noticed that many patients who are experiencing major life changes (divorce, death) are being prescribed antidepressants as a way of reducing the associated suffering. I have mixed feelings as to whether this is even a good idea at all because of the profound changes that antidepressants can make in those who need them just to maintain normality.
          When I first started taking medication, I had been in weekly counseling for 18 months. As I learned to adjust to a background of growing up in an alcoholic family and learned invaluable skills to deal with things I did not have control over, I still found myself sobbing often, feeling that I was worthless beyond description, etc. I had always gone through this and at age 21 experienced a worsening and lengthy period of symptoms. I began sleeping throughout the day, could not get out of bed to go to work and lost my job, quit attending classes at college, ate significantly more and gained weight. I was elated beyond description to begin taking an antidepressant and noticed immediate improvement in every aspect of my life. I no longer felt that I had a dark cloud over my head, that everyone thought I was pathetic, that I was useless, etc. I always knew in my heart that I was a wonderful person with incredible amounts of empathy and compassion for others. This just did not match the emotions I experienced with my severe depression.
          I wanted to post this here to say yes, antidepressants do work, at least for some people. I cannot live a normal life without them. I have gone off of antidepressants after long periods of time thinking that I may have gotten so used to being happy and well adjusted that I no longer needed them. Sadly, even after 3 long months of being off of them, I was exactly as miserable as I ever was before. I slept a lot, I avoided any and all social contact, felt that people who looked at me must be able to tell what a loser I was and thought I was pathetic, etc. I also experienced the usual nightmares and extreme self-deprecation I was so used to in my pre-antidepressant years.
          I realize that there is a lot of discussion and ongoing research about whether antidepressants work better than a placebo. The simple answer is yes. Do they work for all depressed patients? Perhaps not. But my success with them cannot be a placebo effect. I wanted so much not to have to take the medication again and I believed that my years of treatment with it allowed me to build strong relationships, successful social interactions, etc. - enough that I would be just fine without the medication. I tried so hard to be okay without it. I wasn't and I simply am not.
          Feel free to share my story with anyone it might benefit if you would like. There is simply no other way to describe the "me" before and after antidepressants except that it is the difference between a black and white world and one with color, light and darkness, a sunny day and a hurricane.

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