Common Psych Meds. Chapter 2: Antidepressant Medication
Antidepressants. Yummy. The right one can be delicious. Maybe even considered a delicacy.
Antidepressants can be multitaskers. They are used to treat symptoms of depression and are also used to treat anxiety disorders, Obsessive Compulsive Disorder (OCD), and Post Traumatic Stress Disorder (PTSD). Some antidepressants are used to treat chronic pain and I have also seen them used to treat depression and anxiety that manifests itself as chronic stomach issues, headaches, and sleep walking. Yep, just a little pharmaceutical overachiever.
As mentioned in the earlier post, no one really knows what causes mental illness, but it’s definitely not caused by mental weakness, character defects, or lack of intelligence. And unfortunately, tests such as an MRI or x-ray cannot pinpoint mental illness on a monitor. We have to rely on observation and reports from the individual to diagnose a mental illness.
The American Psychiatric Association publishes something called the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which details all of the current mental health conditions including symptoms. It has its advantages and disadvantages, but it lists criteria for diagnosing people with mental illness. A doctor will most likely keep the information contained in this book in mind when treating a person for a mental illness. Don’t get too attached though because a new edition will be dropping soon. It’s the remix to the fifth edition.
When an individual experiences depression, it may manifest in several ways. During my time in undergraduate, I took a meditation/mindfulness class from a man who definitely participated in the Summer of Love, but probably has no recollection of it. He started one class by saying: “Depression is like a deep ass funk deep within your soul.” I felt that. However, some other common descriptions can also be used. For example, many people will experience a profound sense of sadness, inability to concentrate, changes in sleeping and eating patterns (too much or too little), trouble making decisions and concentrating, increase in substance use, irritability, pain in the body, loss of interest in activities we used to enjoy, a feeling of emptiness, thoughts of death and suicide, and much more.
So, of course, historically, people who experienced depression were thought to be possessed by demons and devils and shit. Treatments throughout history included (I shit you not) spinning a person in circles, speedballs, enemas, beatings, bloodletting, and starving the individual.☹️ In the early 1900s psychiatrists began using something called Electroconvulsive Therapy (ECT) sometimes called “shock treatment.” Mention of this may conjure up images of R.P. McMurphy (played by Jack Nicholson) in the movie One Flew Over The Cuckoo’s Nest. While there is no denying that, in the past, ECT was used to punish people and was performed, at times, very inhumanely (to say the least) without anesthesia, there are people that have found it beneficial (including Princess Leia, btw). These days, an individual who gets ECT will be put under anesthesia and will be given anti-convulsant medication so they do not thrash about as seen depicted in movies.
Many people are vehemently against ECT and many people have found it helpful. Both are valid reactions. Getting ECT is a personal decision and an individual should be given ample information about it before they receive it. Unfortunately, when an individual is given the option of receiving ECT, they are experiencing an intense amount of depression and they may not be in the best place mentally to make decisions about ECT; some people may hear the option and are desperate to no longer feel unending despair. Psychiatric doctors, nurses, and counselors that are working with an individual who is a candidate for ECT should make sure to explain it thoroughly to the individual and check back in with the patient for any additional questions that need answers because severe depression often comes with cognitive issues. Ask as many questions as you want if you are considering ECT. It may be helpful to write down questions you think of when not in the doctor’s office because if you are like me, I suddenly become a scholar the minute I leave, after sitting there scratching my head in the office asking questions like- “what medicine doing?”
In the 1950’s, doctors discovered that a group of medications intended to treat tuberculosis were improving people’s mood during the course of treatment. These meds are called Monoamine Oxidase Inhibitors (MAOIs) and they interact with the norepinephrine, serotonin, and dopamine neurotransmitters in our brains. They are not usually the first course of treatment because of potential for a very serious side effects of low blood pressure. Also in the 1950s, doctors began using a class of medications called Tricyclic antidepressants which interact with the norepinephrine, serotonin, and acetylcholine neurotransmitters in our brain. In the 1980’s they blessed us all with Prozac and more meds of this class known as Selective Serotonin Reuptake Inhibitors (SSRIs). This was followed by Serotonin–Norepinephrine Reuptake Inhibitor (SNRI) in the 1990s.
If an individual were to go to a psychiatrist for the first time with depressive symptoms that are unable to be resolved with things such as group or individual therapy and medication was needed, a psychiatrist would most likely start the person on a SSRI med. If that first med was unable to resolve the symptoms, the doctor would probably switch to a different SSRI. If that was not enough, they may try another SSRI or may try an SNRI. SSRIs and SNRIs are considered “first line” antidepressants which means they will be tried first. From my understanding this is because they have the least side effects. If SSRIs and SNRIs fail to lift the depression, the doctor may move to a Tricyclic (considered 2nd line) and even further down the line, a MAOI (3rd or 4th or 5th line- depending on who you talk to). For some people who don’t respond to medications right away, it will feel like they are just throwing medications at us to see which one will stick. You are not alone with this feeling.
One of the rudest things about antidepressants is that it takes one to three months to start feeling some benefit. That’s a long time when you are feeling so horrible that it warrants an antidepressant. You would think that researchers and doctors would work on that along with some of the more common side effects that people experience which, according to the Cleveland Clinic, include agitation, nausea, sexual problems, dizziness, headaches, insomnia, increased anxiety, dry mouth, tremors, constipation, increased fatigue and sleepiness, weight gain, drowsiness, and more. MAOIs have some foods an individual has to avoid (among them chocolate- wtf…) because low blood pressure could occur. Some medications carry a black box warning because there is an increased risks of suicidal thoughts and behavior in young people. Additionally, doctors and pharmaceutical institutions will deny it, but if an individual has to stop taking an antidepressant they will experience withdrawal or discontinuation syndrome which can include flu like symptoms, anxiety, insomnia, “brain zaps,” and more. A doctor should slowly wean you off of these medications.
Other alternative treatments are becoming more popular and accessible. Ketamine, an anesthetic medication and “recreational” hallucinogenic drug has become more prominent in treating depression. It can be given as an infusion or as the new FDA approved nasal spray called Spravato. Unfortunately, I don’t know if we will see much push to get this to the common folk because ketamine is very cheap and already generic, so pharmaceutical companies have no way of making a shit ton of money off people who are already suffering. I hope I am wrong. Transcranial magnetic stimulation (TMS) is another available therapy. According to Kirsten Nunez, TMS is a “noninvasive treatment that uses electromagnetic pulses to stimulate nerve cells, which may improve symptoms of neurological or mental health disorders.” Other drugs that people have tried include ayahuasca and psilocybin-assisted therapy. Just don’t have a bad trip and freak the rest of us out, ok? 😉 Do whatever you want…
So, did we learn anything or did we get dumber?
- Depressive symptoms can manifest in a ton of different ways in a person’s life and body and historically, there have been some bizarre and painful remedies forced on individuals with mental illness.
- Some of the most common antidepressant medications are called MAOIs, SSRIs, SNRIs, and Tricyclics. There’s a possibility for many different side effects- some more dangerous than others- but many people have found these medications helpful.
- New treatments are becoming more available from some groovy, consciousness-expanding substances that have been overlooked in the past. Cue the Grateful Dead music.
So… are antidepressants right for you? Idk. I am not a doctor and this is not medical advice. It’s just another little thing I put together because I had a hard time finding information for my clients that is genuinely truthful and straightforward. A decision to take an antidepressant (or any medication) is going to be a personal choice that an individual will need to make with the assistance and guidance of people who are trying to support them. Try to get your information from sources that present honest information collected by scientists at reputable institutions. And make sure to see that the information is up to date as things change often. Remember to ask for assistance when you need it especially if mental illness is affecting your ability to think clearly. Good success and I’ll catch ya on the flip side.
Depression medications: Types & side effects. Cleveland Clinic. (2019). Retrieved April 3, 2022, from https://my.clevelandclinic.org/health/treatments/9301-depression-medicines
Nunez, K. (2021, January 20). TMS therapy: What it treats, benefits, side effects, and costs. Healthline. Retrieved April 3, 2022, from https://www.healthline.com/health/tms-therapy#What-is-TMS-therapy?
