ask: my antidepressents dont wrk anymore,im very depressed but have hyper phases, these do not last very long anymore but i have suffered this since i was 12. im now 33 and at the end of my tether. i cannot function properly and that makes me very depressed pl

As I understand it there are different types of depression: situational, chemical imbalances, and bipolar. I have been in all three catagories at one point or another. Right now it is a situational depression with a lot of symptoms of GAD (Generalized Anxiety Disorder. I am on Sertraline, Viibryd, Clonazepam, and Trazadone for sleep. I have been trying with three different psychiatrists to change the Sertraline but none of them will change it and I don't understand why. It does not work well, I've been on it for 5-6 years now. I guess they think it is a good SSRI. and feel there is nothing in that category of drugs any better. I was a severe BIPOLAR as a child and teenager and young adult but untreated as a child. Then I was put on an antipsychotic for many years. I've had 50+ ETC treatments, to no avail, except for lost of memory. I have spent a total of 5-6 years in hospitals, 30 days at a time, minimum. I was also diagnosed with Schizo-affective Disorder. At the time, I was under the care of an excellent doctor, but she stopped seeing patients and ever since it has been a toss up as to my diagnosis treatment. I am confused and not getting any better because of a stressful living situation and several incurable, but treatable, chronic conditions that I am not adapting to very well. The symptoms are getting worse and I get very little support any more. I do know there is no cardiac component! My pulmonologist and neurologist are following me closely and doing what they can. I am just so tired of being everyone's caregiver and having no one to support or help care for me. (A note of self-pity, if you will.) A very dear friend and one I did a lot of caregiving for, as she was an invalid, passed away just before Christmas. I flew up for the memorial service and stayed on to help the widower to go through her things and clean and rearrange furniture. It was physically and emotionally challenging and I spent 3 days in bed recovering. But, I am trying very hard to focus on the small things in my life for which I am very thankful. God has been very good to me and He watches over me. Keeping me safe. Providing food and medications, and good medical care. I lack on friends, but I am to focus on Him and His provision, so I do. Depending on humans leads to disappointment so many times . God never lets you down. bbnrse

Different drugs and have different effects. At the same time you may need to change the drugs also. consult your doctor immediately..

If you are homeless try to go to a psychiatric hospital ER, explain your situation and they have to help you or refer you to care available where you are. They may admit you so they can evaluate you and get you the proper treatment, medications and counseling. I don't know where you live but that is the way it works in America. They may also be able to refer you to a free clinic that can help. I pray for the best for you. Try not to focus on your current problems but on the One who can solve All problems. Stay focused on those positive things in your life and not the negative. There is always something good in our lives we can be thankful for if you just look for them. God's blessings to you and try to keep your chin up.
bbnrse

If you can see a psychiatrist who can offer counselling not just medication that would be a good start. Medication has many limitations, but good counselling - it doesn't work overnight - can make a real difference.

im still taking the meds as prescribed sertraline, but i can feel myself slipping again. i dont no what to do, im th person that originally posted the first question.i think iv actually had enough. i think i had some sort of breakdown, because of a berevmant, bieng homeless and gaining allmost 12 stone in a year. nothing can get worse . help.

Thank you. I'll look for some help. bbnrse

bbnrse, that's a good point. Having someone to help you work through the issues is probably a prerequisite to getting off meds, as is working with a psychopharm person to help you get off them (and that part comes later, anyway.) Probably the best thing for now is to focus on doing the best you can in the current situation.

Thank you, Dr. Heller, your explanation really helps me understand the process much better. Do you think there is ever a chance I could get off the antidepressant (Sertraline) or the antipsychotic (Abilify)? or should I just leave well enough alone. It has been too many years. I really need a good social worker or psychologist to help me work through some issues that I've never worked through before, for one reason or another. They are hard to find and I hate "trial and error" method. There has to be a better way. Anyway, thank you so much for your good information. bbnrse

Hi bbnrse - no, they don't make them addictive on purpose. It's that the way they affect a person's brain makes it hard to get off of them. So, while depression is much more complicated than just serotonin and neurotransmitters, something definitely does happen when you start changing the balance of serotonin and neurotransmitters that makes it hard for your body to re-equilibrate or to find its own balance once the drugs are removed. It's kind of like stepping off of a boat after being out at sea - even though the dry land is completely stable, your balance mechanisms have gotten so used to shifting seas, you might feel like you're off balance. Only with depression, that transition is acutely discomforting instead of just disorienting.
I have had success helping people get off antidepressants using the amino acids 5-HTP and Tyrosine, which are neurotransmitter precursors. I used to think that these were valuable as depression treatments, but based on the new evidence I don't think so anymore.
As I mentioned, the drugs do appear to work for severe major depression. However, the studies that indicate this appear to mostly have lasted 4-8 weeks, so they don't tell us much about what happens when you're on the medications for years. I am hoping to find some studies that examine longer-term usage of antidepressants.

Dr. Daniel Heller
PMS Comfort

I was diagnosed with recurrant major depression and have been on one antidepressant or another for over 40 years. I have also been on antipsychotics as deemed necessary by the psychiatrist. At one point it was felt I was bipolar as well, and have schizo affective disorder for which I got my disability. I was no longer able to keep working and it was well documented. It has been impossible to get off the antidepressants and maybe the reasons you site, Dr. Heller, are why. Do they add stuff to them to make them addictive? or are they just that way. I have to change meds every 2-3 years because they become ineffective and I sink into that deep dark hole that I cannot climb out of. Just a few words from the peanut gallery. bbnrse

Hello Anon, bbnurse, Daisy, et al:

I have two main thoughts here, and I hope sharing them will be helpful.

One, depression that includes "hyper" episodes, which sometimes get described as anxiety, could potentially indicate bipolar disease. Bipolar is a very different condition neurologically than unipolar depression, and conventional depression meds will either make bipolar worse, or simply have no effect. What seems to work in bipolar are mood stabilizers, which are very different from antidepressants.

The second issue is much more delicate: what is emerging from years of research into antidepressants, including newer (since the 1990s) SSRIs, but also tricyclics and other meds, is that they are not any more effective than placebo in the majority of cases. This means SSRI antidepressants are ONLY effective for Major Depression, which amounts to only a fraction of the prescriptions made (though perhaps people reading this post do in fact have Major Depression and not the mild to moderate variety.) That, and that no lab or researcher or scientist has ever been able to demonstrate that the theory behind these medications (the neurotransmitter theory of depression) is accurate, verifiable, valid, or worthwhile.

This comes as a shock to patients with depression as well as other conditions that have been treated with antidepressants, like PMDD and PMS, as well as to doctors, psychologists, and concerned individuals who know people with these conditions.

I realize how difficult it is to accept such a shocking conclusion. Here is some recent coverage of this emerging scientific paradigm shift:

http://j.mp/JYTX5C (New York Times)

http://j.mp/Kj9phs
http://j.mp/K39BuK (New York Review of Books, articles by former editor in chief of the New England Journal of Medicine)

http://j.mp/IBiJId (from the PMS Comfort Blog, my brief commentary on this subject as it may relate to PMDD and PMS)

One very important point made by Professor Irving Kirsch of Harvard in his book "The Emperor's New Drugs" - while antidepressants may have no advantages over placebo for treating depression, they do have one notable disadvantage: coming off them exacerbates depression, which can lead doctor and patient to conclude that the medicine was working or is necessary.

As you might expect, there is some pushback against this new understanding, but it comes mostly from drug companies; doctors and practitioners who believe the evidence they've seen but don't have the perspective available from the studies that examine tens of thousands of patients, rather than one at a time - and that include placebo and other treatments; and from patients who are shocked and dismayed to hear that the information their doctor has given them may not be correct.

The main takeaway here, in my opinion, is that if being on medication isn't working, or feels like a rollercoaster or merry-go-round, it's not your imagination or your fault. The brightest scientists in the world would say your experience is more normal than you might think. Another takeaway is that if you DO want to to get off psychotropic medication, you are justified in this desire, and your doctor should work with you. Also, if you want to get off medication, you absolutely MUST work WITH your doctor to get off it, since it's not easy, and getting off the medication can make things worse.

Finally, if your medication is working, and you're happy with it, you certainly can stay on it. Getting off of it might be more complicated, even though the long term effects of these medications don't appear rosy, and are underpublicized (of course!) by drug companies. On the other hand, there are things that appear to work as well as medication: placebo, which is a belief in and hope for getting better; exercise, which is excellent for your mood and brain; and counselling, which is more work and harder than taking one pill per day, but works better than medication, especially in the long run.

Whew! Long post. I'm interested in your thoughts and concerns, and would be happy to continue this discussion.

Dr. Daniel Heller
PMS Comfort
http://j.mp/JNLEIY

I too have been on various antidepressants, antipsychotics, and even antiseizure medications for depression over the last 21 years. Right now, my GP is handling the meds as I am stable but I do have a psychiatrist in the wings if I start to falter. I would highly recommend seeing a psychiatrist. As stated previously, they have the extra training to know what types of meds work well together to boost us. Hope this helps!

Hi Anon,

Welcome to EmpowHER.  Sorry to hear how you are feeling.  It might be good to talk to your doctor about you feel and also seek help from a psychotherapist. 

Here is a link on depression, of articles and groups that you can find help and support from others feeling the same. Please don't give up and visit this site, you will find help here.

http://www.empowher.com/condition/depression

http://www.empowher.com/groups/Depression

Best,

Daisy

I have been on one antidepressant or another for the past 53 years! I have also taken antipsychotics as needed. I have found over the years that after awhile, usually a couple of years, the antidepressants stop working and I need to change to another one. This generally takes care of the problem, but there are times I've needed to add an antipsychotic to boost it's effects not necessarily due to psychotic symptoms. When I added Abilify to my antidepressant it seemed to work much better for me. Also, I would like to say that the family doctor or GP does not have the training that a psychiatrist has so does not know the interactions and effects of various psychiatric drugs, so you may need to see a psychiatrist for better treatment. Anymore they don't talk to you they just prescribe medications so you don't have to worry about being "shrunk". I hope this helps you. bbnrse