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13 Myths and 13 Truths About Today’s Antidepressants

13 Myths and 13 Truths About Today’s Antidepressants

You can thank tuberculosis for the 29 antidepressants we now have on the market.

No, that’s not an urban myth, that’s actually true.

Sixty years ago, a drug called iproniazid was being used to treat tuberculosis.  But when the doctors discovered their previously discouraged TB patients dancing in the hospital hallways one evening, researchers began studying its possible impact on depression.

It turned out to be effective in treating depression in many people.  Unfortunately, doctors learned the hard way that iproniazid came with a notable danger: if while taking the drug the person drank wine, ate cheese, or consumed any other food that had the amino acid tyramine in it, the person could experience a drastic spike in blood pressure that in some cases resulted in sudden death.

And so the search was on for a drug that could treat depression without running the risk of killing the patient.

Since then, controversy about the use and effectiveness of these drugs has grown about as immense as their popularity, and the conversation around antidepressants has created two distinct camps: one declaring that antidepressants are life-saving and the other insisting they are somewhere between worthless and down right dangerous.

With emotions running high, it’s not surprising that a slew of myths from both sides have crept into social media, making the discussion even more confusing.

In the interest of science and truth, below are 13 of the more popular myths with fact-based commentary that comes from the scientific community and my thirty-plus years as a psychiatric nurse.

MYTH #1: Antidepressants are the best and fastest way to treat depression.

TRUTH: The chances that antidepressants are the “best” treatment for depression are only about 30% statistically.

Research has shown that of those who are clinically depressed, about 30% of them respond best to a consistent exercise routine.  Another 30% respond best to cognitive-behavioral therapy.  Only 30% respond best to antidepressant therapy.

But for that 30%, antidepressants can be a godsend.

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As to their speed, well, antidepressants are anything but fast.  Most antidepressants will take at least 1-2 weeks before their effects can be felt by the patient.  Sometimes, it’s as much as a month.  And for the full effects to be known, doctors ask you to wait 6 weeks.

Once they’ve kicked in, the dose may still need to be adjusted.  Since the best rule of thumb for prescribing antidepressants is “Start low, go slow,” your doctor will likely start you on the smallest dose available and then, if necessary, titrate the dose up after she’s seen how you’re responding… which will take more time.

Not exactly a “quick fix.”

MYTH #2: Antidepressants are basically serotonin supplements.

TRUTH: Antidepressants are not supplements. They are highly complex drugs that require careful monitoring by an experienced doctor.

Scientists have not yet found a way of capturing or manufacturing the brain hormones called neurotransmitters (like serotonin, norepinephrine, dopamine) themselves, the way we’ve been able to manufacture insulin (for diabetes) or thyroxine (for hypothyroidism).

They have, however, found a way of making parts of the brain more sensitive to the neurotransmitters that are necessary for strong mental health, effectively increasing the levels that way.

But again, the increase in sensitivity takes time, which is why it takes 2-6 weeks before you really know how the medication is working for any given individual.

MYTH #3: Antidepressants will change your personality

TRUTH: The short answer to this is, No. They will not make you gregarious if you have always been shy or analytical if you have always been intuitive. Your core self will remain entirely intact.

But there’s a much bigger conversation going on about this that’s worth touching on.

Peter Breggin, the brilliant psychiatrist who wrote Talking Back to Prozac and Toxic Psychiatry pondered this philosophical point: when someone is born with a pessimistic view of themselves and the world–a sort of human Eeyore–is that their core personality? Or were they born with a chemical imbalance that is actually hiding their core personality?  

The answers to these questions are worth exploring.  But I’m a bit more of a pragmatist.  So my questions are more like this: Is the person in emotional pain because of a psychological inability to reach their dreams and aspirations?   And if so, does that person want to change? If the individual is suffering and wants to increase their ability to do something, I’m in favor of trying to help, as safely and with as much integrity as possible.

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MYTH #4: They are addictive

TRUTH: The chemicals that make up antidepressants have no addictive qualities.  According to the American Society of Addiction Medicine, one of the key components to addiction is the inability to control one’s behavior. Antidepressants have no such effect on the brain.

In fact, many of my patients on antidepressants report feeling that they have more control over their behavior and lives, not less.  They no longer feel imprisoned by the crushing fatigue and brain fog. They feel able to socialize again and be more productive.

It is true, however, that your body may get used to the drug being there (which would be considered more of a physical dependence, not addiction), and that a decrease in dosage may cause you some side effects of withdrawal. So it’s vital that when the time comes for you to stop taking an antidepressant that your doctor taper the dosage down slowly, sometimes over a period of weeks.  Stopping abruptly could cause some unpleasant, but temporary, symptoms, such as nausea, diarrhea, headache, lethargy, and other flu-like symptoms.

MYTH #5: Once you start taking them, you have to take them the rest of your life

TRUTH:  People who have suffered numerous bouts of depression, and who have also found relief from antidepressants, are usually urged to stay on medication indefinitely.  So yes, some people choose to take antidepressants for decades.

But the vast majority of people are on them for only a few months after they’ve achieved remission.

Why is the length of time so important?  Because studies have shown that continuing on antidepressants for several months after most of the symptoms are gone decreases the chance of a relapse later on.  Stopping the medication too soon could cause a return of the depressive symptoms.  And each occurrence of depression makes effective treatment just that much more difficult to achieve.

The more depressive episodes you’ve experienced, the longer you should stay on antidepressants. How long that is, is up to you and your physician.  So try not to cut corners by going off the medication too soon.

MYTH #6: They ruin your sex life

TRUTH:  Many of these medications effect sexual function in some people, especially at the beginning of therapy.  Sometimes it’s nothing more than they cause the sensations in the genitalia to be less intense at the beginning of therapy.  But in some cases, antidepressants can cause erectile dysfunction and make it difficult to experience orgasm, even after being on them for a while.

Fortunately, the percentage of people who experience this side effect is fairly low.  And if you are not currently active sexually, these side effects may be of little concern to you.

If you are sexually active, and you do have side effects that decrease your ability to participate or enjoy sexual contact, it’s important to be direct with your doctor about this.  Solving the problem may be as simple as switching medications.

MYTH #7: They make you gain weight

TRUTH:  Some antidepressants cause a change in appetite in some people.  For instance, while nortriptyline (Elavil) and fluoxetine (Prozac) might increase it, bupropion (also known as Wellbutrin) often decreases it. Since one of the side of effects of moderate to severe cases of major depression is weight loss, this might not be a bad thing.  But as a rule, antidepressants don’t themselves pack on the weight.

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However, if you are already overweight or have a medical condition that would worsen with weight gain (such as diabetes, orthopedic problems or cardiac disease), my recommendation is always the same:  before you try an antidepressant, get into some kind of exercise program.  Get a personal trainer, swim at the Y, ride your bike, or take an exercise class, and see if you’re among the 30% whose depression can be alleviated through exercise.

Regular moderate exercise increases oxygenation to the brain, releases feel-good hormones, improves self-esteem, and helps us connect more with the outside world, all of which contribute to a better mood.  By all means, try this for a month and see if it doesn’t brighten your mood considerably!

MYTH #8: They make you feel numb

TRUTH:  Usually the opposite is true.  Sinking into clinical depression can be so painful, emotions may shut down all together, leaving the person feeling emotionally numb.  When the depression begins to lift (through whatever treatment), people often comment that they feel alive again, that they are experiencing color again, instead of everything looking and feeling grey.

It is true that in some people, antidepressants even out some of the highs and lows, and that evening-out can feel strange, perhaps even dull or numb, to someone used to the emotional roller coaster.

MYTH #9: Antidepressants work on all kinds of depression.

TRUTH:  Not even close.  For instance, depression that is caused by bipolar disorder (previously known as Manic-Depression) must be treated with an entirely different class of medication (such as mood stabilizers or antipsychotics) than those that are used to treat major depression.  Antidepressants can actually trigger psychotic episodes in those with bipolar disorder.

Depression due to a loss of some kind, such as divorce, death of a family member, loss of job, etc. is usually best treated with support groups or individual talk therapy, such as Human Needs Counseling or Cognitive Behavioral Therapy.  If after supportive counseling the person still feels stuck in their emotional quicksand, a short course of antidepressant therapy can help get them unstuck and moving forward in their healing.

MYTH #10: Antidepressants are like antibiotics–they cure what’s wrong

TRUTH:  Depression is nothing like an infection, and antidepressants bear no resemblance to antibiotics.  This particular myth probably stems from our society’s penchant for taking something vs. doing something to resolve pretty much any discomfort.  Backaches are addressed with muscle relaxants instead of strengthening exercise and stretching.  Headaches are addressed with vasoconstrictors and anti-inflammatories instead of meditation and a non-allergenic diet.  We’ll throw medications at anything troubling, if we think they have a chance of making it quietly go away.

Depression is much more complex than most people realize.  There is a long list of stressors that can cause depression, and in most cases, it’s not one but several that are involved.  Maybe it starts out as feeling unattractive after a break up, but picks up steam when the person also has lost self-esteem because the relationship had been abusive.  And maybe, because of the abuse, the person now has terrible anxiety about trusting people and no longer believes in their own lovablility.  And all of that together causes so much pain, the person tries everything they can think of to relieve the pain… including behaviors that are actually far more destructive than they ever are helpful.

In my 30+ years of working with depressed and traumatized people, this complex storyline is the norm, not the exception.  Medication alone might be a good place to start, but it’s not going be enough to get this person safely to the other side of this crisis.  The person also needs education and coaching to have a good chance at fully recovering.

MYTH #11: Once you feel better, you can go off the medication

TRUTH:  Most doctors recommend staying on antidepressants for at least 6 months, to allow the brain to adapt to the higher level of sensitivity.  And as stated earlier, discontinuing antidepressants too soon can set you up for a recurrence of the symptoms.

Once you and your doctor have settled on the right antidepressant for you, and your symptoms have resolved, the general consensus is that patients should stay on an antidepressant for at least a year. That way, your brain has the chance of adapting and sort of “locking in” the changes, decreasing the chances of remission. If this is your first depressive episode, stopping treatment sooner than 6 months may increase your risk of your symptoms returning.  If it’s your second or third, most doctors recommend at least a full year.

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MYTH #12: The side effects are worse than the depression

TRUTH:  As someone who has herself suffered bouts of severe depression, I’d have to say that nothing is worse than depression.

But more to the point, it is true that antidepressants may cause uncomfortable side effects in some people.

For instance, in some cases antidepressants can briefly cause or intensify thoughts of suicide.  Antidepressants across the board often cause dreams to become quite vivid, sometimes even a bit “wild.”  I always found it more entertaining than disturbing, but it’s different for everyone.

Tricyclics (TCAs) side effects tend to be along the lines of dry mouth, dry nose, dry skin, blurred vision, urinary hesitancy, weight gain, drowsiness, and/or constipation.  Selective Serotonin Reuptake Inhibitors (SSRIs) sometimes cause agitation, anxiety, irritability, jitteriness, confusion, headache, reduced sexual desire or ability to perform, insomnia, change in weight, diarrhea and/or nausea.

But it is also true that many people have few, or no, side effects while on them.  There’s no way to know ahead of time whether you might experience side effects or not, and if so, what exactly those might be.

MYTH #13: They’re all about the same.  So if one doesn’t work, none of them will.

TRUTH:  There are 29 separate antidepressant formulas on the market that fall into one of 7 different drug classes:

  • Aminoketones
  • Monoamine oxidase inhibitor
  • Norepinephrine and dopamine reuptake inhibitor
  • Serotonin and norepinephrine reuptake inhibitor
  • Selective serotonin reuptake inhibitor
  • Tricyclic antidepressant
  • Tetracyclic antidepressant

Each drug class works differently in the brain, and even drugs within the same drug class have chemical differences. For instance, citalopram (Celexa) and escitalopram (Lexapro) are both SSRIs and chemically very similar.  And yet, people react very differently to each of them.  Many patients have told me that they’ve tried both and found that one of them gives them great relief while the other hardly affected them at all.

There’s no way to predict how each individual’s brain will match up with any given antidepressant.

Featured photo credit: miszaqq via 123rf.com

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Last Updated on August 20, 2019

How to Control Your Thoughts and Be the Master of Your Mind

How to Control Your Thoughts and Be the Master of Your Mind

Your mind is the most powerful tool you have for the creation of good in your life, but if not used correctly, can also be the most destructive force in your life.

Your mind, more specifically, your thoughts, affect your perception and therefore, your interpretation of reality. (And here’s Why Your Perception Is Your Reality.)

I have heard that the average person thinks around 70,000 thoughts a day. That’s a lot, especially if they are unproductive, self-abusive and just a general waste of energy.

You can let your thoughts run amok, but why would you? It is your mind, your thoughts; isn’t it time to take your power back? Isn’t it time to take control?

Choose to be the person who is actively, consciously thinking your thoughts. Become the master of your mind.

When you change your thoughts, you will change your feelings as well, and you will also eliminate the triggers that set off those feelings. Both of these outcomes provide you with a greater level of peace in your mind.

I currently have few thoughts that are not of my own choosing or a response from my reprogramming. I am the master of my mind, so now my mind is quite peaceful. Yours can be too!

Who Is Thinking My Thoughts?

Before you can become the master of your mind, you must recognize that you are currently at the mercy of several unwanted “squatters” living in your mind, and they are in charge of your thoughts. If you want to be the boss of them, you must know who they are and what their motivation is, and then you can take charge and evict them.

Here are four of the “squatters” in your head that create the most unhealthy and unproductive thoughts:

1. The Inner Critic

This is your constant abuser who is often a conglomeration of:

  • Other people’s words; many times your parents.
  • Thoughts you have created based on your own or other peoples expectations.
  • Comparing yourself to other people, including those in the media.
  • The things you told yourself as a result of painful experiences such as betrayal and rejection. Your interpretation creates your self-doubt and self-blame, which are most likely undeserved in cases of rejection and betrayal.

The Inner Critic is motivated by pain, low self-esteem, lack of self-acceptance and lack of self-love.

Why else would this person abuse you? And since this person is actually you– why else would you abuse yourself? Why would you let anyone treat you this badly?

2. The Worrier

This person lives in the future; in the world of “what ifs.”

The Worrier is motivated by fear which is often irrational and with no basis for it. Occasionally, this person is motivated by fear that what happened in the past will happen again.

3. The Reactor or Trouble-Maker

This is the one that triggers anger, frustration and pain. These triggers stem from unhealed wounds of the past. Any experience that is even closely related to a past wound will set him off.

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This person can be set off by words or feelings, and can even be set off by sounds and smells.

The Reactor has no real motivation and has poor impulse control and is run by past programming that no longer serves you, if it ever did.

4. The Sleep Depriver

This can be a combination of any number of different squatters including the inner planner, the rehasher, and the ruminator, along with the inner critic and the worrier.

The Sleep Depriver’s motivation can be:

  • As a reaction to silence, which he fights against
  • Taking care of the business you neglected during the day
  • Self-doubt, low self-esteem, insecurity and generalized anxiety
  • As listed above for the inner critic and worrier

How can you control these squatters?

How to Master Your Mind

You are the thinker and the observer of your thoughts. You must pay attention to your thoughts so you can identify “who” is running the show; this will determine which technique you will want to use.

Begin each day with the intention of paying attention to your thoughts and catching yourself when you are thinking undesirable thoughts.

There are two ways to control your thoughts:

  • Technique A – Interrupt and replace them
  • Technique B – Eliminate them altogether

This second option is what is known as peace of mind!

The technique of interrupting and replacing is a means of reprogramming your subconscious mind. Eventually, the replacement thoughts will become the “go to” thoughts in the applicable situations.

Use Technique A with the Inner Critic and Worrier; and Technique B with the Reactor and Sleep Depriver.

For the Inner Critic

When you catch yourself thinking something negative about yourself (calling yourself names, disrespecting yourself, or berating yourself), interrupt it.

You can yell (in your mind), “Stop! No!” or, “Enough! I’m in control now.” Then, whatever your negative thought was about yourself, replace it with an opposite or counter thought or an affirmation that begins with “I am.”

For example, if your thought is, “I’m such a loser,” you can replace it with, “I am a Divine Creation of the Universal Spirit. I am a perfect spiritual being learning to master the human experience. I am a being of energy, light, and matter. I am magnificent, brilliant, and beautiful. I love and approve of myself just as I am.”

You can also have a dialogue with yourself with the intention of discrediting the ‘voice’ that created the thought, if you know whose voice it is:

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“Just because so-and-so said I was a loser doesn’t make it true. It was his or her opinion, not a statement of fact. Or maybe they were joking and I took it seriously because I’m insecure.”

If you recognize that you have recurring self-critical thoughts, you can write out or pre-plan your counter thoughts or affirmation so you can be ready. This is the first squatter you should evict, forcefully, if necessary:

  • They rile up the Worrier.
  • The names you call yourself become triggers when called those names by others, so he also maintains the presence of the Reactor.
  • They are often present when you try to fall asleep so he perpetuates the Sleep Depriver.
  • They are a bully and is verbally and emotionally abusive.
  • They are the destroyer of self-esteem. They convince you that you’re not worthy. They’re a liar! In the interest of your self-worth, get them out!

Eliminate your worst critic and you will also diminish the presence of the other three squatters.

Replace them with your new best friends who support, encourage, and enhance your life. This is a presence you want in your mind.

For the Worrier

Prolonged anxiety is mentally, emotionally and physically unhealthy. It can have long-term health implications.

Fear initiates the fight or flight response, creates worry in the mind and creates anxiety in the body.

You should be able to recognize a “worry thought” immediately by how you feel. The physiological signs that the fight or flight response of fear has kicked in are:

  • Increased heart rate, blood pressure, or surge of adrenaline
  • Shallow breathing or breathlessness
  • Muscles tense

Use the above stated method to interrupt any thought of worry and then replace it. But this time you will replace your thoughts of worry with thoughts of gratitude for the outcome you wish for.

If you believe in a higher power, this is the time to engage with it. Here is an example:

Instead of worrying about my loved ones traveling in bad weather, I say the following (I call it a prayer):

“Thank you great spirit for watching over _______. Thank you for watching over his/her car and keeping it safe, road-worthy, and free of maintenance issues without warning. Thank you for surrounding him/her with only safe, conscientious, and alert drivers. And thank you for keeping him/her safe, conscientious, and alert.”

Smile when you think about it or say it aloud, and phrase it in the present tense; both of these will help you feel it and possibly even start to believe it.

If you can visualize what you are praying for, the visualization will enhance the feeling so you will increase the impact in your vibrational field.

Now take a calming breath, slowly in through your nose, and slowly out through the mouth. Take as many as you like!

Replacing fearful thoughts with gratitude will decrease reactionary behavior, taking the steam out of the Reactor.

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For example:

If your child gets lost in the mall, the typical parental reaction that follows the fearful thoughts when finding them is to yell at them.

“I told you never to leave my sight.” This reaction just adds to the child’s fear level from being lost in the first place. Plus, it also teaches them that mom and/or dad will get mad when he or she makes a mistake, which may make them lie to you or not tell you things in the future.

Change those fearful thoughts when they happen:

“Thank You (your choice of Higher Power) for watching over my child and keeping him safe. Thank you for helping me find him soon.”

Then, when you see your child after this thought process, your only reaction will be gratitude, and that seems like a better alternative for all people involved.

For the Trouble-Maker, Reactor or Over-Reactor

Permanently eliminating this squatter will take a bit more attention and reflection after the fact to identify and heal the causes of the triggers; but until then, you can prevent the Reactor from getting out of control by initiating conscious breathing as soon as you recognize his presence.

The Reactor’s thoughts or feelings activate the fight or flight response just like with the Worrier. The physiological signs of his presence will be the same. With a little attention, you should be able to tell the difference between anxiety, anger, frustration, or pain:

  • Increased heart rate and blood pressure; surge of adrenaline
  • Shallow breathing or breathlessness
  • Muscles tension

I’m sure you’ve heard the suggestion to count to ten when you get angry—well, you can make those ten seconds much more productive if you are breathing consciously during that time.

Conscious breathing is as simple as it sounds; just be conscious of your breathing. Pay attention to the air going in and coming out.

Breathe in through your nose:

  • Feel the air entering your nostrils.
  • Feel your lungs filling and expanding.
  • Focus on your belly rising.

Breathe out through your nose:

  • Feel your lungs emptying.
  • Focus on your belly falling.
  • Feel the air exiting your nostrils.

Do this for as long as you like. Leave the situation if you want. This gives the adrenaline time to normalize.

Now you can address the situation with a calmer, more rational perspective and avoid damaging behavior.

One of the troubles this squatter causes is that it adds to the sleep depriver’s issues. By evicting, or at least controlling the Reactor, you will decrease reactionary behavior, which will decrease the need for the rehashing and ruminating that may keep you from falling asleep.

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Master your mind and stop the Reactor from bringing stress to you and your relationships!

For the Sleep Depriver

(They’re made up of the Inner Planner, the Rehasher and the Ruminator, along with the Inner Critic and the Worrier.)

I was plagued with a very common problem: not being able to turn off my mind at bedtime. This inability prevented me from falling asleep and thus, getting a restful and restorative night’s sleep.

Here’s how I mastered my mind and evicted the Sleep Depriver and all his cronies.

  1. I started by focusing on my breathing—paying attention to the rise and fall of my belly—but that didn’t keep the thoughts out for long. (Actually, I now start with checking my at-rest mouth position to keep me from clenching.)
  2. Then I came up with replacement strategy that eliminated uncontrolled thinking—imagining the word in while breathing in and thinking the word out when breathing out. I would (and do) elongate the word to match the length of my breath.

When I catch myself thinking, I shift back to in, out. With this technique, I am still thinking, sort of, but the wheels are no longer spinning out of control. I am in control of my mind and I choose quiet.

From the first time I tried this method I started to yawn after only a few cycles and am usually asleep within ten minutes.

For really difficult nights, I add an increase of attention by holding my eyes in a looking-up position (Closed, of course!). Sometimes I try to look toward my third eye but that really hurts my eyes.

If you have trouble falling asleep because you can’t shut off your mind, I strongly recommend you try this technique. I still use it every night. You can start sleeping better tonight!

You can also use this technique any time you want to:

  • Fall back to sleep if you wake up too soon.
  • Shut down your thinking.
  • Calm your feelings.
  • Simply focus on the present moment. 

The Bottom Line

Your mind is a tool, and like any other tool, it can be used for constructive purposes or for destructive purposes.

You can allow your mind to be occupied by unwanted, undesirable and destructive tenants, or you can choose desirable tenants like peace, gratitude, compassion, love, and joy.

Your mind can become your best friend, your biggest supporter, and someone you can count on to be there and encourage you. The choice is yours!

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Featured photo credit: Priscilla Du Preez via unsplash.com

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