Do Antidepressants Work? Maybe Not.

happy_life · Apr 4, 2016

Not everyone has time for therapy. I miss 2 hours of work for each 1 hour appointment, and that's assuming my appointment is at 8am. I have to make up the hours the same day, or use PTO. I get 6 hours of PTO a pay period. I get paid twice a month. Depending upon how the appointments work with my pay period, that's either 4 or 6 hours of PTO per check, granted it's usually 4. Since I'm a single mom, I usually don't make up the time the same day or I wouldn't get home until after 7pm. I put both meds and therapy off as long as I could (about 4 years). My primary care IS psych trained. I went to therapy twice, but ended up in the hole for PTO, which also has to be used for other appointments for both myself and my daughters. I just cannot afford to miss work like that.

I don't understand how you don't have time for therapy. Do you work all day every day? I work full time, married, and am working on my masters degree and I still go to therapy once a week and have never had to take PTO. My therapist has hours on Saturday too. It really helps.

fawnmarie, ASN · Apr 4, 2016

I can only speak from my own experience, but Prozac has been my saving grace for 13 years. Depression, binge eating, impulsive decisions, crying episodes, anxiety...I experienced all of these things before being started on Prozac, 20 mg per day, in 2003. I felt better almost immediately. The change in my mood was amazing. I do not want to go back to life without it. I recently went out of town for a week and forgot to pack my medication. I returned home cranky, irritable, and anxious. Prior to taking Prozac, I would deal with my anxiety by consuming huge amounts of junk food. I was working in a nursing home at the time, my very first nursing job, and was stressed out beyond belief. I would leave work at 1 am and head to the grocery store for ice cream and cookies, then go home and stuff my emotions with food. With Prozac, that incredible urge to buy and eat sweets vanished. I am able to eat like a normal person and deal with problems rationally. If I take it for the rest of my life, so be it. It works for me. I have never tried "talk therapy." The Prozac costs $10 a month and works like a charm.

TheNurseStudentMom · Apr 5, 2016

I don't understand how you don't have time for therapy. Do you work all day every day? I work full time, married, and am working on my masters degree and I still go to therapy once a week and have never had to take PTO. My therapist has hours on Saturday too. It really helps.

There are no Saturday hours. The hours are M-F 8 to 5. I work M-F 8 to 6 or even 6:30. Previously, at a different job, if I missed 2 hours on Tuesday, for example, I could make those 2 hours up any day (30 minutes x 4, 60 minutes x 2, whatever). Here, I'd have to work 10am to 6pm, and that's if I don't take a lunch. I wouldn't get home before 7, make dinner, do homework, and put my kids to bed by 9. If there were Saturday hours it would be different.

Ellekat2 · Apr 5, 2016

I also speak only from personal experience. After years of struggling with depression, I was prescribed Prozac 20mg daily. Prozac was controversial at that time. It did nothing. I continued with Paxil (10mg) Effexxor (37.5mg) and others over the years with no relief. Eventually, when I had gone so far as to make specific arrangements for my young daughter to live with one of her brothers with the thought of ending my life, a young physician who I worked with realized how close I was to suicide and ordered Celexa, building up to 80 mg relatively quickly. That drug and that dose is what worked for me. I did have the side effect of frequent yawning, but it was a small price to pay for becoming part of the larger world again. I think of this physician frequently even fifteen years later, thanking him mentally for having the courage to actually prescribe an effective dose of an antidepressant. The many other physicians I saw either did not understand or did not want to take a chance of a larger dose being more effective. I don't know if antidepressants work better than a placebo for others, I only know for me, that particular medication at that specific time did make a huge difference in my life. Perhaps we need to examine the efficacy of the doses prescribed and the types of antidepressant prescribed, as well as continue to examine placebo effectiveness vs medication.

CrunchRN, ADN, RN · Apr 5, 2016

The meds have their place, but shouldn't the priority be tackling the underlying issues that cause the symptoms in the first place?

CountryMomma, ASN, RN · Apr 5, 2016

The meds have their place, but shouldn't the priority be tackling the underlying issues that cause the symptoms in the first place?

In some cases (like mine) there isn't so much an underlying issue as there is an altered brain chemistry. Talk therapy, while nice, is not going to convince my neurotransmitters to behave and play nicely. Depression and anxiety is strongly inherited in my family - not all depressive episodes are "triggered" by an event.

fawnmarie, ASN · Apr 5, 2016

I also speak only from personal experience. After years of struggling with depression, I was prescribed Prozac 20mg daily. Prozac was controversial at that time. It did nothing. I continued with Paxil (10mg) Effexxor (37.5mg) and others over the years with no relief. Eventually, when I had gone so far as to make specific arrangements for my young daughter to live with one of her brothers with the thought of ending my life, a young physician who I worked with realized how close I was to suicide and ordered Celexa, building up to 80 mg relatively quickly. That drug and that dose is what worked for me. I did have the side effect of frequent yawning, but it was a small price to pay for becoming part of the larger world again. I think of this physician frequently even fifteen years later, thanking him mentally for having the courage to actually prescribe an effective dose of an antidepressant. The many other physicians I saw either did not understand or did not want to take a chance of a larger dose being more effective. I don't know if antidepressants work better than a placebo for others, I only know for me, that particular medication at that specific time did make a huge difference in my life. Perhaps we need to examine the efficacy of the doses prescribed and the types of antidepressant prescribed, as well as continue to examine placebo effectiveness vs medication.

I am glad to hear that you eventually found the right drug for you, and the right dose. I forgot to mention in my post that my MD increased my dose of Prozac in 2006, when the stress of being a new mom was dragging me down. As long as I take my 40 mg capsule each and every day, I feel calm and collected. I think before making choices, I don't dissolve into tears at the drop of a hat or freak out if I don't get a piece of birthday cake. I'm a different person than I used to be! The highest dose of Prozac I can recall administering to a patient was 80 mg, and it was to a severely depressed middle-aged lady who had lost her husband.

Farawyn · Apr 6, 2016

In some cases (like mine) there isn't so much an underlying issue as there is an altered brain chemistry. Talk therapy, while nice, is not going to convince my neurotransmitters to behave and play nicely. Depression and anxiety is strongly inherited in my family - not all depressive episodes are "triggered" by an event.

Yep. The awesome thing about depression, there doesn't need to be a "reason'. :sarcastic:

PG2018 · Apr 6, 2016

You cannot do andouble blind RCT for psychotherapy. You can do it with meds. They don't work "really well," they don't work for everybody, and many reports suggest they're equally effective regardless of the monoamines involved.

There is no chemical imbalance. It is ignorant to suggest that based on present research. Posited effects of antidepressants are "downstream" effects of neurogenesis, et al.

I prescribe them everyday with absolutely no anticipation that the patient will return in 4-8 weeks remarkably less depressed. It does happen, and that correlates with meds. I'm not at all convinced it is causative.

Farawyn · Apr 6, 2016

You cannot do andouble blind RCT for psychotherapy. You can do it with meds. They don't work "really well," they don't work for everybody, and many reports suggest they're equally effective regardless of the monoamines involved.
There is no chemical imbalance. It is ignorant to suggest that based on present research. Posited effects of antidepressants are "downstream" effects of neurogenesis, et al.
I prescribe them everyday with absolutely no anticipation that the patient will return in 4-8 weeks remarkably less depressed. It does happen, and that correlates with meds. I'm not at all convinced it is causative.

So... maybe?

PG2018 · Apr 7, 2016

So... maybe?

Maybe they're effective? Maybe so. Maybe not. LOL.

I just think it's absurd when people talk about "chemical imbalance" and comparisons of therapy v. meds. I'm all for therapy. Of course, I don't want to be a therapist -at all- however, I do believe that minor (situational and/or persistent) depression is better treated with psychotherapy than pharmacotherapy. I buy the research that suggests therapy plus meds yields better outcomes and is a more efficacious combination than either treatment alone, and I believe severe, profound depression needs medication. Statistically, most with MDD won't have a severe qualifier.

Farawyn · Apr 7, 2016

Maybe it is!

(Or, maybe not.)