Should I Return to Antidepressant Medications?

Reader’s Question

I have been dealing with mild symptoms of depression all my life (trouble concentrating, unexplained stomach aches and slow digestion, fatigue, low self esteem…). Since my second child was born, two years ago, the symptoms have been exacerbated: the aches and pains have gotten worse, I have more trouble concentrating, I have lost all interest in sex, and I am in a constant bad mood; I am impatient with my children, angry and aggressive with everyone. I have not yet consulted a specialist or taken medication for the following reason: As a teenager (I am now 42) I suffered from severe depression and was put on anti-depressants. While on medication, I felt great. After 6 months on medication, however, the doctor told me to stop taking them, and the world fell apart. Mood-wise I felt as bad as I did before taking anti-depressants (even worse) and, in addition, I experienced a series of pyshical symptoms I had not felt before (extreme fatigue, among other, and stomach problems). It took me 5 years to (more or less) recover from that — alone, with no medication, this time.

Science has developed since I was a teenager, and so has my knowledge on the issue, and I know now that anti-depressants should not be stopped suddenly (or ever?). However, what if they cause some unwanted side-effect and I must stop taking them? Right now, I am able to lead a more or less normal life. Those around me would be better-off if I were less depressed (stressed, angry, in particular), and I may not enjoy myself as much as I should, but the disease is not crippling. I am afraid that, if I were put on medication and had to stop it, I may not be able to lead a normal life anymore. That is, once I move forward and seek treatment, there will be no way back. I may find a solution to my problems or, if things don’t work, I may go to hell.

Psychologist’s Reply

I’ll start by clarifying that I’m a psychologist and don’t prescribe medications. I do have many years of experience working with antidepressants in clinical settings. That said, as you describe, antidepressants should not be abruptly discontinued and should not be discontinued using some random decision such as 1) She’s been on them long enough, 2) She feels better now, etc. There are many clinical factors that are used to determine if an antidepressant should be increased, decreased, or discontinued. In my experience, abrupt termination of antidepressants is more often found when the physician prescribing the medication is not a psychiatrist. General/family medicine and OB/GYN physicians actually prescribe more antidepressants than psychiatrists despite the fact that the psychiatrist is better trained to manage an antidepressant medication treatment program.

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As you know, you would benefit from the use of an antidepressant medication. You are exhibiting classic signs of depression as well as some prolonged post-partum (after delivery) depression features. Antidepressant medications have significantly improved over the last twenty years and there are many to choose from — some also addressing anxiety or poor concentration for example.

I would recommend consulting with a psychiatrist in your area. If a psychiatrist is not an option, then consult with your family physical or OB/GYN, but discuss 1) your previous experience, 2) concerns about discontinuing too early, 3) side effect issues, and 4) options for various antidepressants currently available. I’d also review various antidepressants available and decline the use of the antidepressant you received many years ago. I suspect I know which antidepressant you received and the discontinuation syndrome of that medication ranges from very uncomfortable to horrific.

As you review your concerns about beginning treatment, there’s something very important to remember. As a teenager, you were the involuntary patient who was prescribed an antidepressant under the custody and supervision of your parents. Now, at age 42, you are a patient who is capable of participating in your treatment — logically discussing issues with your physician, exploring treatment options, and remaining active in your own care. Your first experience no doubt created a sense of fear and helplessness that now surfaces as you consider a return to treatment.

From a mental health standpoint, your depression can be easily treated. I’d recommend researching depression, symptoms, and options for treatment. You can then discuss and participate in your depression treatment without problems.

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