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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 July 8, 2020

18 Benefits of Journaling That Will Change Your Life

18 Benefits of Journaling That Will Change Your Life

The act of writing in a journal often seems daunting or unnecessary to many people. Even authors who work on novels might shun the idea of daily diaries. What purpose does jotting down words on a regular basis do if not contributing to the next novel, play or song? I know from experience many benefits of journaling that I wish to share.

1. Understand Yourself Better

Though many people and even writers avoid keeping journals, I vow to do it more often. Not only do I desire to take up daily journaling but also I plan to do it with pen to paper.

Some of the benefits I’ve found from my more active days include finding myself in the sense of understanding what matters to me and what I want out of life. I’ve been incredibly fortunate to find a spouse who is my best friend and advocate in raising children. I attribute this and much more to what I learned about myself in keeping journals for years.

2. Keep Track of Small Changes

I’ll admit that I never got very far with my guitar lessons, but in writing in a journal, I have seen the ability to track small changes like those that come when you practice anything.

Those learning a musical instrument often fail to see the small improvements that come with regular practice. Writing won’t help you switch chords any faster, but it will help you to develop a better sense for language and grammar just by doing it.

3. Become Aware of What Matters

As you continue to write in a journal, following a stream-of-consciousness feel, you can look back on the topics that you chose to write about. Those issues and emotions that poured out of you will provide insight on to what matters most to you.

You may not even realize that you’re job is depressing you or that you want to spend more time with your kids until you look over your thoughts that you weren’t really thinking about.

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4. Boost Creativity

The idea that the brain and its neural activity across hemispheres encourages learning also shows up in increased creativity. Just like with learning an instrument, your increased activity will inspire your thoughts to connect and reconnect in different ways.

When I wrote in a journal, I often wrote poetry as well as just my thoughts as they came out. I started to hear poems more in my mind; so much so that I took to scrawling lines on napkins and finding metaphors in mundane activities.

You really are what you do, so writing helps grow more than being a writer. Writing boosts the way you communicate and structure language, which really is a creative process.

5. Represents Your Emotions in a Safe Environment

A journal is as private as it gets. You can lock it in a safe or tuck it under a pillow and no one will accidentally share it on social media or have an opportunity to “leave a comment.”

Write about your sorrow as much as your happiness and frustration and know that you don’t have to keep your emotions inside your body. You can put them on paper.

6. Process Life Experiences

When you take the time to look back over what you’ve written, be it a week or a year later, you will have the distance you need to more objectively interpret your raw feelings.

Everything from losing a job to losing a loved one can emerge in a new light for a fresh perspective. Figuring out how the benefits of journaling affect your perspective on life will create connection and increase creativity.

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7. Stress Relief

In combining the exercise inherent in fine motor coordination that comes from the act of writing with the emotional release of self expression, those who maintain a journal relieve stress.

Try it out. Go home and write about your day. Write about the traffic. Write about the coffee order the barista got wrong but you didn’t have time to change. See how you can physically purge some of that pent-up stress by putting it on paper.

8. Provide Direction

Though journaling is often conducted as an activity without much direction, it often provides direction.

One of the biggest benefits of journaling is that your chaotic thoughts merge to show a direction in which to head. Asking the right questions is the only way to achieve the best solutions, so look to your journal to find your way toward your next goal.

9. Solve Problems

Just as in practicing math problems, we all get better at finding hidden solutions through the act of processing.

Think of your next goal as X and solve your life problems by reading your journals as word problems. The benefit of journaling here is that you write, explore and process to recognize and then solve problems.

When life is too in-your-face, you have to step back to see reality. Living in the moment allows us to write in the moment and use that expression to solve problems.

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10. Find Relief From Fighting

Solving your problems only comes after time to process, recognize and strategize. Just as in the benefit of journaling where relief comes from the act of writing, relief from fighting comes when you decide to “sit this one out” and communicate one-way.

Fighting is only productive when the fighters care to communicate and find common ground. When the emotions are as high as the stress levels, writing will function as the best time out.

11. Find Meaning in Life

Journaling will show you why you are living, whether you are wallowing in things you wish to change or striving to make the changes. Your life will begin to take on new meaning and your own words will reveal the actions that got you where you are so that you can assess and pave a new path for your future.

12. Allow Yourself to Focus

Taking even a small amount of time out of every day will provide you with not only peace of mind but also increased focus. Taking a break to meditate in writing and journaling will sharpen your mental faculties.

13. Sharpen Your Spirituality

When we write, we allow all the energy and experiences to flow through us, which often provides further insight into our own spirituality. Even if your parents didn’t raise you to follow a specific religion, your thoughts will start to show you what you believe about the universe and your place in it.

14. Let the Past Go

I’ve mentioned a few examples where going back over your writing offers advice and direction, but the simply truth is that writing down our feelings can be the best way to let them go. We can choose to literally throw these pages away when they’re filled with negativity and hate.

15. Allow Freedom

Journaling is the perfect way to not only express yourself but to also experience the freedom of being who you are. Your books can stay private or you can publish them. Your freedom stems from your sense of self and your perception of your thoughts.

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16. Enhance Your Career

Again, the private act of pen-to-paper processing provides the benefits of journaling mentioned above, but you can also enhance your career when you take similar ideas and categorize, edit and publish them in an online blog.

Your thoughts will often be personal and express emotions, but another benefit of journaling is uncovering fresh ideas about your work.

17. Literally Explore Your Dreams

All the benefits I’ve mentioned explore ideas, thoughts and emotions, which is also what our dreams and nightmares do. Through writing down your dreams from the previous night, you can enhance your creativity as well as connect some of the metaphorical dots from the rest of your journal.

18. Catalog Your Life for Others

No one wants to think about dying, but we all die. Leaving a journal will act as a way to reconnect with family and friends left behind. The ideas you wish to keep personal while you process the life you’re living will serve to rekindle and inspire those who loved you through the process.

We consider our partners our life witnesses, but writing provides a tangible mark on the world.

Now that you’ve learned all the benefits of journaling, it’s time to start writing a journal:

Featured photo credit: Kelly Sikkema via unsplash.com

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