I have been living with depression since a teenager and after so many years, I recently finally started receiving psychotherapy (CBT). While I’m already seeing some modest changes in my thinking patterns, my therapist noted that in the last few weeks the severity of the condition is worsening and it might be a good time to talk with my primary care provider about antidepressants as a combination therapy.
This got a reaction out of me, specifically that I don’t like the idea of chemically altering my mental state and losing access to what “I really feel” (as I perceive it).
I know that the logic behind this sentiment is not very solid, but we can’t reason ourselves out of our feelings that easily. For me this is also challenging because I don’t take any recreational substances that affect my mental state, so I can’t tell to myself that it’s like e.g. smoking weed only more targeted and supervised.
I’m curious if this sentiment is familiar to anyone else, and how you dealt with it (whether you decided for or against medication).
What makes you feel that your current state is what you “really feel”? Who decides that? I tend to feel the opposite way; that my currently depressed, anxious self isn’t the “real” me, and that any treatment I seek- whether through therapy or medication- is just a course-correction so that I can move closer to reality. Maybe it would help to reframe it that way? When you challenge your thought patterns and work on developing healthier ones, you are making changes but you aren’t changing who you are, nor are you denying reality. Medication is just another tool/aid in the same way that therapy is.
It might be helpful to talk to your therapist about why you’re worried about losing access to your current feelings. How are they serving you right now?
Maybe you’ll find it comforting to consider that antidepressants generally aren’t that powerful and aren’t likely to change your mental state to the point I think you’re worried about. Anecdotally, I’ve been on a variety of antidepressants; some made me feel worse physically, some made me feel worse mentally, some had absolutely no effect, and some have made me feel better or more functional but in subtle ways. I’m currently on medication that isn’t the cure I’d hoped it’d be, but has enough of a positive effect that it’s worthwhile for me. Not saying that medication is for everyone, but I hope hearing others’ experiences helps you make the right decision for yourself!
What makes you feel that your current state is what you “really feel”? Who decides that?
That may be the most crucial question my therapist should ask me. The answer that’s top of mind is “this is all I ever was since I can remember, so it has to be real even if it’s bad”. I can tell how shaky the logic is but it’s convincing to me.
Thanks, you provided me with some great questions and I’ll discuss those with my therapist.
Personally, I sought help because I didn’t want to feel those things/that way, and I couldn’t achieve that goal entirely through force of will. For what it’s worth: I still feel all of those things, but those feelings are nowhere near as intense. They no longer control me and prevent me from feeling anything else.
Plus as another commenter said, having been on and off meds that worked and didn’t work, I am absolutely still me. I’m just a more emotionally composed and in better control of myself and my feelings me.
I also didn’t get there immediately on the first medications my doctor prescribed. They’re there to work with you to find what works, so don’t be afraid to tell them if something doesn’t.
It may be worth talking to your therapist about the fact that you may have internalized these feelings as being a core part of your identity, something that you’re afraid to lose. I promise there’s more to the things that make you who you are.
It may be worth talking to your therapist about the fact that you may have internalized these feelings as being a core part of your identity, something that you’re afraid to lose. I promise there’s more to the things that make you who you are.
Yeah, I think you are hitting an important point and he also tried to poke at it when I told him how I feel about the suggestion.
One aspect of it is definitely that I’ve been depressed since I had a personality. At some level, I think I believed that this could never change (and that’s why I was so amazed when some of the CBT exercises started having the exact effects the theory said they would). Thinking of a potential me without all of the maladaptive patterns I developed since I was a kid is about as stressful to me as meeting a stranger.
Part of it is also that I don’t understand the chemical mechanism behind the various antidepressants though, so I’ll definitely need to talk with medical doctors about it.
First, I just don’t have very good experience with drugs in general. As a kid I waa being stuffed with useless pills against allergy and whatnot that just kept making things worse, and my problems basically stopped when I rejected them as a teen.
Second as a result of the above and other similar things, I had to learn to be very aware of how my body and mind function, what I can do and when and how. Considering drugs have known mechanics how they achieve the effects, it’s often not too hard to predict how they’ll affect you.
It’s not 100% reliable tho… Lots of people report better results than they expected. It’s probably worth a shot, if you ask me.
Btw would you consider crossposting to [email protected] too? You might get more varied opinions and get people to think. (Disclosure: it’s “my” community.)
I personally dislike antidepressants intensely. But the alternative is far worse. Antidepressants dull all sensation. It takes a lot to make me laugh. It takes me even longer to want or be ready for sex. All I feel is a great and vast emptiness. But that’s better than being actively suicidal as I’ve been there as well.
If you continue to make strides through CBT, then I’d consider psych medications unnecessary. They should be a last resort because of the unpleasant side effects.
I didn’t give a shit about real any more. I wanted more comfortable and did not cate at all whether my new state would be “real”.
I was an eager user of recreational drugs, and I never saw any of my drug experiences as “not real”. Doing psychedelics and uppers and muscle relaxants and all sorts of “research chemicals” gave me a view of my own consciousness as a little tiny sliver of reality modulated by neurotransmitters.
So for example the crazy world of interconnection and possibility that I saw during a trip was just part of reality that I normally wasn’t able to see. And the dark hell that I’d find myself in when coming down from MDMA was just another aspect of reality that I only saw in a certain brain state.
So a better way to put it is that I didn’t really think of there being a reality that I could see while “sober”. I just saw “sober” as a particular state point on the map of states of consciousness.
If I was going to take a drug that got me “high” by making me on average happier and more effective, I was fine with that. I didn’t want to run to win medals I wanted to run to explore the world. Give me steroids, robot legs, rocket skates, I don’t care if it’s my own “accomplishment” or not I just want the mobility.
Now I see it slightly differently. I still believe “sobriety” is but point in a vast landscape of equally legitimate/valid states of consciousness. But I also understand that what antidepressants do isn’t just get you “high” like any other paychoactive drug. They don’t change your mental state directly like that. Instead they alter neurogenesis patterns, and these grow certain parts of your brain, and the expansion of processing power in certain parts of your brain alleviates the depression. The extra capacity tends to lower the threat level perceived by your brain and it enables exploratory, spontaneous engagement with life and that’s the end of your depression.
They like to say “it takes a couple weeks to build up in your blood”.
Naw. MDMA and all other psychoactive oral drugs take a quite uniform 30 - 90 minutes to “build up in your blood”.
What takes two weeks is the effects of neurogenesis — the growth and differentiation of neurons — to have a discernible effect in mood. It’s physical brain changes that take two weeks, not blood concentrations of various orally ingested drugs.
I was an eager user of recreational drugs, and I never saw any of my drug experiences as “not real”.
I definitely think that some of my hesitations have to do with not having any experience of using chemicals that affect the mood before, so I don’t have a mental model that I can re-use for antidepressants. I definitely drink caffeine though, so it’s probably valid to say that I have constructed a fiction of me never having done anything like this, but it’s a convincing fiction.
I think of it like a sci for scenario where Earth is destroyed. There’s a new planet and some people might be thinking “but it’s not the same”, but I say it’s better than death.
Without the antidepressants, my emotional world was a charred landscape of pain and misery. No place for a life, even if it is more “natural”.
There’s nothing natural about a helicopter airlifting you out of the water, but the loss of natural is made up for by no longer drowning in a roiling sea.
Just try it for a month. If you decide there’s something too valuable missing with the loss of your “natural” state of mind, you can go back.
