My 20 Meds
After reading Merely Me’s post on her experience with medications, I realized that my story of recovery wouldn’t be complete without going into my own history with antidepressants. I never had much resistance to taking these drugs, simply because I was so constantly plagued by depression and desperately needed to feel better. So I went along with the recommendations of the psychiatrists I consulted.
Their prescriptions led me through an extensive tour of the drug scene. Together with other types of drugs sometimes prescribed with the antidepressants, the total reached 20 (at least, those are the ones I can recall). All but one of those were taken in the last 16 years.
Why so many? Because most of them didn’t work very well, and trial and error became the method for finding the right one.
Why keep taking them? For one thing, psychiatrists don’t seem to regard not taking drugs as a treatment option.
I was also afraid that if I stopped, however depressed I might feel when on the meds, I’d sink even deeper into depression.
The most important reason, though, was the fact that I had some good early experiences with antidepressants, though the effects didn’t last very long. I kept hoping that I’d find another that worked as well. In fact, I assumed for a long time that medication could cure me completely.
I’ve come to see that much more than the right pill has been necessary for me to get better. I needed to heal as a whole person, not just make some chemical changes in my brain. But for most of my life, I didn’t realize that. If the psychiatrist said, “Take this drug,” I took it eagerly.
My medication history started way back in the mid-1960s when I had a major breakdown. I suppose the episode would now be called “reactive” or “situational” depression. I didn’t much care what it was called at the time. It was bad, and I knew I needed help.
In my nonfunctional state, I went right to a psychiatrist. He prescribed my first antidepressant, and it helped me through the crisis. That drug was Elavil (amitriptyline) - a relatively new antidepressant back then. However, my experience with it was limited. The doctor stopped the drug after the two-month crisis was over, and I took no further antidepressants for the next 25 years.
That doesn’t mean I didn’t live with depression during that time. Major depression, recurring by itself with no reference to what was going on in my life, was my companion for almost all of those years. I saw several psychiatrists, but none of them prescribed medication.
Today, psychiatrists prescribe drugs as a matter of course, but the prevailing psychoanalytical-based thinking in the 60s and 70s - at least among the doctors I saw - didn’t seem to favor it. According to the psychiatrist and author, Peter Kramer, depression was thought to be a useful tool for getting at the “real” problems buried deep in the past, and the depressive episodes were seen as “self-correcting” anyway.
If you had the sort of emergency that I did, became suicidal or completely non-functional in extreme depression, you would, of course, get meds and likely be hospitalized. But for many patients, depression wasn’t treated directly.
As a result, I never gave medication a thought during all those years, even though I was often in terrible shape. The subject just never came up in therapy.
By the early 90s, psychiatrists had a whole new generation of drugs to work with and, in my case, started making up for lost time. The first of the 19 drugs I tried in the next 16 years was Prozac.
Almost immediately after starting the drug, I felt as if my life had been restored. I was upbeat, full of energy, responsive again to my family, generally in fine shape.
Unfortunately, in the early years of Prozac’s use, many doctors, include mine, believed that the drug could correct the chemical imbalance in the brain in a few months. Your neurochemistry would take care of itself after that. Since I felt so good, I thought - hey, it’s done its job. Now I can stop. And I did.
Big mistake! I went steadily downhill, and after a year or so started taking Prozac once again. I stayed on it for a long time but found it getting less and less effective. Even in the early months after resuming the drug treatment, I never felt as good as I had the first time. It turns out that this is a common problem with antidepressants. By stopping and then starting the same drug again, many people experience far less relief the second time around.
I can’t discuss here each of the other drugs I took (they’re listed below), but I can quickly summarize the effects of those I took for a year or more. Their benefits were quite limited, and their side effects were considerable. They seemed to take the edge off the worst despair to allow me to function, though at a level well below my norm.
The price for that, however, was a general numbing of all feeling and a sense of being disconnected from everyone around me. I realize that this inability to feel is a common symptom of depression, but until I started taking these drugs it had not been nearly as serious as it became while taking them. My next and most effective experience with antidepressants seemed to confirm that. The numbing of feeling is no longer a problem with the current combination of meds.
Here are the antidepressants that had this combination of effects. There were several others, but these are the ones I took for at least a year each, over the next eight years.
- Effexor (Venlafaxine)
- Paxil (Sertraline)
- Strattera (Atomoxetine) - only in combination with the others
- Zoloft (Paroxitine)
- Lexapro (Escitalopram)
- Celexa (Citalopram)
Emsam and Lamotrigine
About four years ago I started taking the antidepressant Emsam. I soon felt a tremendous increase in vitality, which I think of as the opposite of depression. I felt restored once again.
The effectiveness of this medication is interesting because its active ingredient is Selegiline. This drug belongs to one of the earliest types of antidepressants, known as MAOIs. That class of meds is considered a last resort because its use requires dietary restrictions. If those are not followed, a very serious, perhaps even fatal, reaction can occur through a sharp spike in blood pressure. Obviously, that’s nothing you want to take a chance on unless you have no other alternative.
Emsam, however, sharply reduces that risk by delivering the drug with a skin patch directly into the bloodstream. The risk of adverse reaction is much greater if the drug is taken by mouth, as it has been with MAOIs generally, and goes through the small intestine. That’s where the chemical reactions take place that can induce the worst side effects. At low doses, Emsam does not require the dietary restrictions.
I’m taking the highest dose and do follow them, but apparently there have been no reports of the dangerous side effects from anyone using the Emsam patch. The restrictions on what I eat are not a problem, and the trade-off is well worth it.
However, the effectiveness of the drug started to wear off after about a year and a half. That prompted my psychiatrist to add a drug normally used to treat bipolar disorder but which has now been approved to supplement antidepressants in the treatment of major depression. After a disastrous reaction to the first of these (lithium), I tried Lamotrigine (the generic name for Lamictal).
That did the trick. This combination brought back the vitality I needed to continue with the process of recovery. As I’ve said before, that is the role medication has played - reducing the worst symptoms so that I can get on with inner work.
There isn’t any drug that can restore a sense of purpose, repair broken relationships, build self-esteem or generally help me heal as a whole person. But effective medications can set the stage for that work to begin through the use of other therapies and constant practice of their lessons in daily life.