A young woman who calls herself blue­berryoctopus had been taking anti­depressants for three years, mostly for anxiety and panic attacks, when she recounted her struggles with them on the Web site Experience Project. She said she had spent a year on Paxil, one of the popular SSRIs (selective serotonin reuptake inhibitors), but finally stopped because it destroyed her sex drive. She switched to Xanax, an ­antianxiety drug, which brought back her libido but at the cost of renewed symptoms. Then Paxil again, then Lexapro (another SSRI), then Pristiq, a member of a related class of antidepressants, the SNRIs (serotonin and norepinephrine reuptake inhibitors). At the time of the post, she was on yet another SSRI, Zoloft, plus Wellbutrin (a cousin of SNRIs that affects the activity of dopamine as well as norepinephrine), which was intended to counteract the sexual side effects of Zoloft. “I don’t notice much of a difference with the Wellbutrin, but I’m on the lowest dose now,” she wrote. “I’m going back to my psychiatrist next week, so maybe he’ll up it. Who knows.”

This is the typical trial-and-error approach to prescribing anti­depressants, not only for depression per se but also for related disorders such as blueberryoctopus’s. The tactic, Andrew Solomon wrote in The Noonday Demon, his landmark book about depression, "makes you feel like a dartboard."

8 Comments

1. 1. Walt129 06:56 PM 2/16/12

   Your article (mental health drugs) was on the mark but did not present a very bright future toward a positive approach to change for the better, in my view. From " the old days" of asylums to today's "on the streets," is not nearly the corrective that could have been tried. It seems obvious that society has a long way to go, and perhaps science might try a new tack, such as to think in other categories. For instance, what if psychiatry and clinical psychology were to sit down together and create a structure that resembles the Law Profession's paralegal helpmates? What might be done freely on the internet, under well considered and tested approaches? Perhaps it sounds simplistic, but I am thinking back to my childhood in which the street in front of my home was unpaved, ruts in winter were literally a foot deep, and Model T's, once caught in them, were forced to follow their imprint until the driver chanced upon a relatively dry few yards to regain steering control.
   

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2. 2. eacommerce 07:49 PM 2/16/12

   I have a very important personal message to anyone with depression: although meditation and other techniques are well documented as anti-depressant and well-being enhancers, there is a particular Tibetan Monk who suffered personally of anxiety and panic attacks as a boy and wrote how he finally could overcome these ample suffering through simple work meditation. His web page is www.tergar.org and the book I am talking about is “The Joy of Living”, by Yongey Mingyur Rinpoche.
   I sincerely hope it will help you as helped so many, good luck in your battle, I am sure you will succeed.
   

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3. 3. Conde 10:43 AM 3/1/12

   I would like to ask if they have tried amphetamines for treatment of depression. These are fast acting and in low dose they make one feel better about themselves and also help with thought processes. These are normally used for ADD.

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4. 4. clouston 08:11 AM 3/8/12

   I was prescribed Dexedrine in 1991. I played a lot of online solitaire. Very fast. My mood may have improved slightly, but my functionality/productivity did not. Also, it was difficult finding a pharmacy that would fill the scripts.
   I've tried plenty of supervised treatments. I once had 9 pretty good months...

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5. 5. cannabossa 01:36 PM 3/8/12

   What about cannabis sativa aka marijuana (the sativa dominant strains in particular) for relieving depression? The resinous flowers of these strains of plant are very fast acting and the dose can be titrated to different individuals needs, less being more in my experience. It can be eaten with more lasting relief. Why uncontrollable laughter is considered by some to be an unpleasant side effect is beyond me, isnt laughter the best medicine?

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6. 6. harderm in reply to Conde 08:38 PM 3/12/12

   I believe amphetamines were tried in very early attempts at treating depression, and of course they are a form of self-medication. They have a few problems however. First, unlike ketamine the positive effects of each dose only last for a few hours. After that, the stimulation is replaced by a depression that can be worse than before. That's believed to be the result of their mechanism of action. They cause certain neurons to dump their dopamine content into synaptic spaces. Afterward, the action of the dopamine is absent because the pre-synaptic neurons no longer contain any dopamine to secrete. The behavioral result is depression. Furthermore, I think it's now well-documented that large doses of amphetamines cause nerve damage. Next, amphetamines are extremely addictive and share its destructive behaviors with the other addictive drugs. Finally, if a patient is even slightly bipolar, which is the case for many who present with depressive symptoms, stimulants can precipitate destructively manic episodes. Conclusion: Speed is probably the worst treatment for depression, excepting maybe alcohol.

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7. 7. harderm in reply to clouston 08:46 PM 3/12/12

   Were you prescribed Dex for depression, or ADD? I'd be very surprised if the former were true. In the USA, at least, amphetamines are not approved by the FDA for depression, but may be used for AD(H)D. How much trouble (depression, craving, weight gain) did you have when you quit using them?

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8. 8. harderm 08:51 PM 3/12/12

   I've had no luck treating my depression with meditation. Perhaps my ADD blocks the one essential of meditation - a relaxed, focused mind. If anything, I feel a bit depressed after meditation. Deep massage therapy based on Asian principles has helped enormously, as have running and other cardiovascular workouts. It seems that I need bodily involvement to relieve my depression.

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