Despite all the backlash antidepressants get from those that have used them, many people find them helpful. In fact, some people with various types of mental illnesses such as depression, anxiety disorders, and OCD may end up having some of the best times of their lives while medicated. Those that had never been able to function without depression until using an antidepressant may end up literally becoming an entirely new person while medicated.
Although antidepressants can be very effective for managing depression, most people do not really know how to properly use them. From an objective standpoint, the proper way to use them simply involves taking them in accordance to medical instructions. From a subjective standpoint, there may be some intricacies that people (especially first-time antidepressant users) are not aware of.
Several details that are not often addressed prior to treatment include: how to react if the antidepressant stops working, whether a person will be on the medication “forever,” and how to properly withdraw from the medication. Additionally, most doctors do not make it clear that antidepressants should be used as a tool to aid in the process of change rather than be used for the sole purpose of a safety blanket. This is because the “safety blanket” effect may vanish should an antidepressant stop working.
Who should use antidepressants?
Prior to learning the best strategy of antidepressant treatment, you should know if you really need one in the first place. It is always recommended to try other available treatment options, especially those that are natural before subjecting yourself to psychotropic medication. Assuming absolutely nothing helps with major depression, antidepressant treatment should be pursued as it is effective for many people.
- Those that have already pursued natural cures for depression.
- Those that have tried supplements for depression without benefit.
- Those who haven’t found relief from safer options.
How to Use Antidepressants
It doesn’t take a rocket scientist to get a prescription for antidepressants. All it takes is a trip to the doctors and a complaint of feeling especially sad, down, or depressed. If the doctor determines that the depression is severe enough to warrant medication, an antidepressant is prescribed. Unfortunately most first-time users aren’t sure what to expect from using antidepressants nor are they sure how to properly use them. Below is a list of tips that I’ve learned (many the hard way) throughout my treatment.
1. Find one that works
The first step in the treatment process for depression is finding a medication that actually works. Something that essentially elicits an “anti-depressive” effect or takes away your depression. As long as your depressive symptoms improve while taking your medication, it is working. A major problem is that finding a medication that works is difficult.
For this reason, it is highly recommended to seek the help of a psychiatrist rather than a doctor. Although psychiatrists are not a utopian option, they do have significantly more knowledge regarding the intricacies of psychotropic medications that are prescribed to treat depression. Therefore you will likely have more success working with a psychiatrist as opposed to a general practitioner.
In time, you should eventually find a medication that actually works. You will notice your mood improve and perhaps your confidence in other areas of life. Your energy levels may increase, and life will probably be better than it was prior to you taking the medication.
2. Behavioral / Lifestyle Modifications
Once you have found a medication that actually works, the most important thing you can do for yourself is to make lifestyle changes that you were incapable of making prior to taking the drug. In other words, pursue as balanced of a lifestyle as possible – connect with people, make new friends, and certainly do things that you may have been afraid to do prior to taking the antidepressant.
- Be active in the community – If you are capable of volunteering and/or offering help of some way in your community, do it. Getting involved in the community will help you network and build social connections. If your depression were to come back, at least you’ll have something to do that will keep you busy.
- Carpe Diem – This is an old expression that loosely translates to “seize the day” or enjoy the day. In other words, make the most out of the time that your antidepressant medication is working.
- Healthy activities – While on your medication, try to be as healthy as possible. Make sure you are getting some exercise, eating healthy, and taking care of yourself.
- Learn new things – For some people, taking antidepressants can actually improve cognitive function. Take the time to learn new things such as a new hobby or anything you might be interested in.
- Make new friends – Some antidepressants have a powerful pro-social effect, meaning they naturally make you more outgoing than before. This will give you a chance to meet new people and make new friends. The neurotransmitter changes help some people become more comfortable in social situations.
- Try new things – This involves trying things that you maybe previously couldn’t do because you were too depressed and/or anxious. Things that fit this billing would include asking a girl on a date, entering a relationship, going to social events, or doing something you were scared to do.
While the drug is working, you need to milk the “antidepressant effect” for all you can. Keep working on your personal development and surround yourself with positive social influences. These lifestyle changes may be minor for some people, but for others, the changes that they are able to make while on an antidepressant medication can make all the difference.
Think of an antidepressant medication as a tool to help you get where you want to be. Let’s say your depression was so severe that you couldn’t get out of bed in the morning, go to school, and/or hold down a job. If a medication starts working, you may want to push yourself to wake up early, get a degree and/or apply for a job that you want. Assuming you work towards the things that you couldn’t while you were depressed, your reality will start changing.
3. Realize antidepressants may not work forever
Many people are able to get significant benefit from antidepressants for weeks, months, and in some cases, years at a time. However, it is important to realize that antidepressants may stop working and that most will not work forever. At some point in time, you may need to face antidepressant withdrawal and function without the assistance of a medication.
Most people that go on an antidepressant aren’t generally fully informed – they haven’t done their research. Like most people, first-time users basically assume that antidepressants are drugs that will make them feel happy and will work forever. Unfortunately many people end up with shattered expectations when out of nowhere their antidepressant stops working.
Before you take a medication, always be aware of this fact. No matter how good you may feel on your current drug, there is a chance (a pretty good one) that this feeling of happiness will not last forever. While it is somewhat depressing to think about this fact, you can use this knowledge to your advantage by making the most out of the duration for which the medication did actually work.
4. Hitting a “turning point”: Withdrawal / Discontinuation
At some point throughout your antidepressant treatment, you will likely come to a crossroads. This will involve either: a decline in the efficacy of your medication and/or intolerable side effects. In some cases this turning point may even be characterized by a personal desire to discontinue treatment.
- Drug-free desire: Many people end up taking antidepressants, feel good, and then believe that they are naturally feeling happier without the help of the drug – this is a mistake. Typically when a person goes on a drug and their depression improves, it is a result of the medication working. The person will come off of the drug and realize that they feel absolutely awful, and the withdrawal symptoms make it extremely difficult to function. In any regard, some people are determined enough to fight through withdrawal because they want to be “drug free.”
- Side effects: In some cases, people may come to decide that the side effects associated with their antidepressant significantly outweigh the benefits they are getting. For example, if a drug isn’t working that great for depression and a person is also gaining a lot of weight as a side effect, they may decide that the drawbacks outweigh the benefits.
- Tolerance: Some individuals will eventually notice that their antidepressant has diminished in efficacy and/or just isn’t working anymore. At this point, it’s a likely possibility that they’ve become tolerant to the effects of their medication. For this reason, many people opt to withdraw from their medication as opposed to considering other options.
5. Always maintain behavioral changes
The changes that you made while taking the medication will be extremely difficult to maintain when you come off of the drug. In fact, some may be downright impossible to maintain, but do your best to “hang in there.” Even if you start feeling extremely depressed and/or anxious, simply forcing yourself to socialize and keep up healthy habits is an extremely good idea.
All of the positive changes that you made while taking your antidepressant should be maintained to the best of your ability when you come off of the medication. In other words, keep up with friends, socialize, and stay involved in work and/or the community. By practicing maintenance of the behavioral changes, you are forcing your brain to rewire itself to function in these situations that were previously comfortable.
Your brain knows that it handled these scenarios before while under the influence of the medication. Although a medication may help, at this point you came off of it, went through the wicked withdrawal, but are a slightly different person because your habits and environment are different. Assuming you used the antidepressant medication as a tool or igniter to help you make lifestyle changes that you weren’t previously able to make.
You may struggle with the upkeep of these behaviors that you engaged in while taking the medication, but you can keep them up if you work at it. Technically, it should be somewhat easier because you may have some social circle and some comfort around people or situations that would’ve previously caused discomfort.
For some individuals, simply maintaining these new (hopefully healthy) habits that were developed while on the medication is enough to provide antidepressant relief. Now that you’re enmeshed in a social circle, maybe have a job, maybe have some volunteer work, and go to the gym, you are feeling better about yourself. In this case, you used the medication properly – to help you make changes that could be maintained for an antidepressant response long after you’ve quit the medication.
6. Alternative: “Antidepressants for life”
There is one alternative option for some people and that involves staying on antidepressant medication for the rest of their lives. Those who can afford to stay medicated and enjoy the effects of being medicated should stay on treatment for the rest of their lives. Heck, I think if my Paxil never stopped working back in the day, I would likely still be taking it… this entire website wouldn’t be in existence though.
Others may be able to get away with staying on an antidepressant medication for years or even a decade before it stops working. Although long-term antidepressant treatment is a valid option among individuals that aren’t really affected by tolerance, there are a couple of drawbacks. The first major drawback involves side effects – these can often develop over the long term and/or become worse over time.
The second major drawback is that you will likely eventually have to titrate up your dose. So if you started at 5 mg of a medication, it will likely wear off and you’ll eventually have to bump up to 10 mg. With each titration upwards, the likelihood of side effects increases because more of the drug is influencing your physiological functioning.
If you are going with this particular strategy, it is always recommended to titrate up at as slow of a rate as possible. In other words, always take the minimum dose to prevent significant increases in tolerance. It is also important to always conduct a cost-benefit analysis throughout treatment by determining whether the current benefits are outweighing the costs (e.g. side effects / lack of efficacy, etc.).
With this strategy, it is also important to keep in mind that newer, more effective treatments may eventually hit the market. When these more effective options become available, you always can transition to the better medication essentially “upgrading” your treatment. Below are some things to keep in mind when considering treatments.
- Cost-Benefit analysis: It is important to always conduct a cost-benefit analysis prior to taking medications as well as throughout treatment. You should be aware of any potential antidepressant side effects and always think about whether the medication is useful throughout treatment. Ask yourself whether the drug is helping your depression and whether you are able to tolerate the side effects.
- Eat fish: There is new evidence to suggest that eating fish increases the efficacy of antidepressants – this is very significant. Although it is difficult to determine whether dietary factors influence the efficacy of medications, there is some preliminary evidence suggesting that it does. To maximize any potential benefit derived from the medication, you should always be eating a diet optimal for mental health.
- Lowest effective dose: Whatever medication you start with, always ask your doctor for the lowest possible dose. Not even necessarily the lowest effective dose, but the lowest possible dose. The best way to take antidepressants is by starting low, and working your way up until the medication starts working. The reason starting with a low dose is recommended has to do with the fact that certain people are more sensitive to medication and starting too high may result in the medication not working or eliciting too many side effects. Additionally, higher doses tend to result in increased tolerance at a quicker rate.
- Slow titration: If you plan to be on a medication for as long as possible, it is important to always titrate at a slow rate. If you titrate your dose by doubling it each time the previous dose wears off, you are increasing your tolerance at a quicker rate than necessary. This is like an alcoholic who has one beer everyday for awhile – eventually the effects wear off. The next logical step would be to have like a beer and a quarter or beer and a half. However, with antidepressants, some people essentially keep doubling their dose – equivalent to jumping to 2 beers. This results in more initial power, but is a worse overall strategy that builds quicker tolerance.
- Time-scaling: Predict how many years you will get benefit from the medication. Many people won’t know, but a good estimate can be made. If you predict that you’ll only get benefit for a few months before the drug stops working, then it may not be worth pursuing.
- Upgrading treatment: If you’re currently taking a medication that works well, but it isn’t perfect, you should always look for the next big thing. Although newer medications are not generally a panacea, it is important to stay informed on the latest treatments so that you aren’t missing out on a more effective medication with less side effects. In this case, it is important to keep upgrading your treatment if you know for sure that superior treatments are available. Always do so cautiously and maintain the belief that newer is not always better.
Verdict: Antidepressants are a temporary “tool”
It is important to realize that antidepressants are generally not a great long-term solution. Sure they may work for a year or several years. Some people end up staying on them for life, but many of these individuals accumulate side effects over time and/or aren’t getting nearly the same antidepressant effect that they were getting at the beginning of treatment – this is due to tolerance.
Although a person can stay on an antidepressant for as long as they wish, in some cases, the drug stops working and/or flips a neurochemical switch after several months and symptoms become even worse than they were “pre-treatment.” The takeaway message is that antidepressants should not be considered a lifelong treatment strategy because in a majority of cases, they simply stop working as you develop tolerance.
The most important message though is to not only enjoy the antidepressant effect while it works, but to make lifestyle changes that will stick with you long after your antidepressant wears off. It may take some effort on your part to maintain the friendships, lifestyle, etc. that you created during treatment, but it can be done. By maintaining beneficial behaviors and habits after you’ve discontinued your medication, you may not be as depressed because you are staying busy, are involved, and have social connections.