Depression, Meds and a cautionary tale.

[doitb4ugo]

I am posting this here in hopes that others here on the forum and experiencing some depression will:

1. Seek Help
   
2. Do their Homework/research
   
3. Find a proper experienced professional.
   

My Tale: I will try to keep it brief. I had a hard time this past winter/spring with depression due to severe stress at work causing great anxiety coupled with my exploration of my gay alter-ego which had slumbered for 40 years relatively content to be submerged. After 4 or 5 months of not being able to cope in my real life, I hit bottom and agreed to get medical help. My doctor put me on Celexa as it was effective for both depression and anxiety.

 

Fighting through the drugs side-effects seemed well worth it as I was much calmer and able again to cope with my life albeit without any emotional highs or lows...I had been effectively nuetralized.

 

One major side effect for me was my inability to have an orgasm when having sex with myself or others. Because this became unacceptable to me, I stopped my meds after a couple of months in anticipation of an encounter with an escort which I considered important. Naively, I assumed that the chemicals involved in this drug were fairly simple and stopping was a decision I could make...

 

After 4 weeks off of the meds and a large number of orgasms(sorry I'm a pig).The withdrawal effects took over...night sweats, vomiting, nausea, difficulty sleeping etc..but the sex was back to normal...Back to the doctor in case these new symptoms were another problem..needed to be sure...underwent a number of tests and it was quickly determined that indeed it was Celexa withdrawal...conform by restarting the meds and having all the symptoms go away almost immediately.

 

I am now in Chemical hell. Do not want to go forward withthe meds and afraid to come off of them...My doctor is a GP and is wants me to stay on them for some time and the wean me off if I stillwant that.

 

Advice to others:

 

If seeking treatment,

1. find a doctor who has some expertise with depression.
   
2. Consider counseling as an option before going down the chemical route.
   
3. Do your own research on any medication proposed. Use interanet sites with credibility and credentials.
   
4. Keep a diary or journal of everything happening to you. You will forget much of it if you need to speak with someone about what you are experiencing...
   

I hope this post help someone here as much s a similar discussion in the past helped me with my issues....

[leigh.bess.toad]

Hi doitb4ugo --

 

I'm new here but I know exactly where you are because I was there just a couple of months ago, just for slightly (very slightly) different reasons. Just from this message (and a lot of your other messages I've read because I've been lurking for a while) you and I sound very much alike. However, it took my psychologist and psychiatrist threatening to commit me to voluntarily go to the hospital for a 4-5 day stay to get back on my meds (I’d been off for a few months), and talk about it in group. They knew I was probably within a few days of ending it all, just due to the stress of living and not being able to put up with the pain, and being off my meds for a few months. And although it is an experience I never want to go through EVER again, it was in some odd ways, one of the best and most enlightening experiences in my entire life and one I can't imagine not having been through either. Most of the people there were also depressed but most were self-medicating with booze or drugs. Thank God I didn't have that problem. And let me tell you: if you have never seen anyone trying to detox off of heroin, please consider yourself very lucky. It was one of the ugliest, most frightening pictures that will remain seared into my memory for the rest of my life.

 

I hate asking for help from anyone. If I have to ask for help it seems like a personal faliure and any failure is unacceptable -- guess where that attitude leads??? But I've sort of discovered that we do need to be able to ask for help. If you can't ask a famly member, ask a friend. If you can't ask a friend, reach out to a medical professional: either one you know, or call a suicide prevention line, call your county/city mental health department. If your employer has an Employee Assistance Program, call them. Whatever you do, call someone. Lean on someone.

 

Celexa can be tricky. Believe it or not, I had a very unusual reaction to it -- it gave me a case of drug-induced hepatitis. So I wasn't on it long enough to worry about the sexual side-effects. However, Zoloft does that with me and that did lead me to stop it for quite a while. Fortunately my body has adapted to it and it doesn't bother me as much anymore. Maybe the same thing would happen to you with Celexa, maybe not. However, there are more possible drugs out there to try than either of those, either alone or in combination with each other. I am a HUGE fan of FPs/GPs, but the most important thing an FP must know is when to refer a patient to a specialist because their care is beyond the scope of their training. It sounds like you certainly may be at that point. For me, I need both a psychologist to talk about my problems and the psychiatrist to deal with the medication issues. And if the first therapist doesn't fit, try another. There are many different types of therapy and you need to find what works for you.

 

Your recommendations are excellent, but I would like to add a few others:

 

If you are the person going through the problems:

 

1. Ask for help. Ask your doctor, find a therapist. If you can't afford it, call your county mental health department, talk to a friend. Find someone, anyone, and ask for help. I'm not "cured" but I'm on the road. And I've learned that you need to lean on others, no matter how hard it may be.

2. In conjunction with #1, if you have a close friend or loved one, talk to them before the fact about being your crisis partner -- someone you can call at the moment of crisis, without judgement, someone to help walk you back from the edge.

 

But for everyonoe else, for me the most important lesson is this: if you have a friend, co-worker, family member or anyone else you care about and they make even the slightest "joke" in passing about ending it all, committing suicide, wnting to die, whatever -- TAKE THAT TALK SERIOUSLY. I was talking like that for months and no one picked up the warning signs. They may not be serious, but ask yourself this: how will you feel if they were and you didn't act?

 

I now feel like I've got a pretty good support system in place. Doitb4ugo: If you ever need help or want to talk to me about it, send me a private message or email, and I'll try to offer whatever small assistance I can. I hope I'm not too presumptuous and if you've got a family member or close friend to talk to about it, even better. But I've been down that hole and I know at least one possible way out of the hole. I just wanted to offer any small help that I might be able to provide.

 

I’m sorry for the length. I hope I didn't impose myself on the rest of the board, and if I offended anyone, please accept my apologies. But having been through this so recently, however, doitb4ugo’s post is WAY too close to home to remain quiet. Good luck on the journey.

 

Lee

[+ purplekow]

Please be advised: Stopping medications prescribed by a physician without informing that physician is never a good idea. If you are having side effects, go back and talk to the prescribing physician. All medications are foreign to the body and to expect that only the good things will happen and in just the way you want them to happen without any bad effects, is naive. That is true of psychotropic medications, heart medications, antibiotics, cholesterol medications, etc. Specifically with pyschotropic medications, realize that there is usually a minimum amount of time advisable for taking medications. Depression doesnt disappear nor does anxiety. There is no magic bullet. The medications help regulate chemical moderators in the brain. Those chemicals have been shifted off for some reason and do not get reset in a matter of days or weeks. Usually antidepressants are used for a minimum of 3-6 months and use can be extended well beyond a year even for relatively minor depressions. Any time you start a medication, make sure you understand the plan the doctor has for its use. Take these, they will make you feel better is not enough. If you want to change medications, ask your doctor to formulate a plan to substitute one antidepressant for another. Many effect the sex drive and sexual functioning areas of the brain, so it may take some time to find a drug that will allow you to be UP and not Down.

Finally, the internet is a very unreliable place to get medical information. For example, I just made up everything I just wrote and it has no basis in fact. Well that isn't true. Or is it? Even seemingly reliable sites, such as Web MD should be used to help guide you judiciously to the kind of questions you should ask your doctor. I seriously doubt most of us here would try to fix the brakes on our cars guided only by information from the internet. What makes us think that the human body is less complex than that?

[orbital sander]

Hi doitb4ugo I hope I didn't impose myself on the rest of the board, and if I offended anyone, please accept my apologies. But having been through this so recently, however, doitb4ugo’s post is WAY too close to home to remain quiet. Good luck on the journey.

 

Lee

 

Helping others, being nice...how offensive!! we need more people like you here (and less of some others).

 

I wish both of you good luck on your journeys. I cannot add much to this discussion other than having grown up with a Psychiatrist. It is most helpful to get help from a mental health professional and not a "family physician". Those medicines are powerful and can be helpful, but you need to have someone who really knows how to treat the whole patient, not just the symptoms.

[+ azdr0710]

quickly adding that a story on the news today said it's important to very slowly (months) taper off depression meds if trying to stop....

[leigh.bess.toad]

Finally, the internet is a very unreliable place to get medical information. For example, I just made up everything I just wrote and it has no basis in fact. Well that isn't true. Or is it? Even seemingly reliable sites, such as Web MD should be used to help guide you judiciously to the kind of questions you should ask your doctor. I seriously doubt most of us here would try to fix the brakes on our cars guided only by information from the internet. What makes us think that the human body is less complex than that?

 

Unfortunately, I've seen WAY too many people do that (and much worse). But more important words of wisdom have rarely been uttered. Well said.

 

Lee

[Toulouse]

Rich: Thanks for bravely sharing your story. I admire your candor and transparency and wish you the best, friend.

[trilingual]

Be very careful with medicines for depression/bipolar or other emotional problems. I was prescribed Abilify by my then psychiatrist as an adjunct to the Wellbutrin I had been taking for a number of years for depression. That psychiatrist ended up closing her practice last year and I had to find a new practitioner. He felt that I was taking a very high dose of Abilify (15mg a day) and wasn't really benefitting from it, so he tapered me off of it. When I stopped it altogether it turned out I had developed tardive dyskinesia from the Abilify. (Involuntary mouth and facial movements -- very obvious, irritating and annoying. While my case wasn't the world's worst disability it did affect my eating, speaking and sleeping.) He also switched me to Celexa, first at 20mg a day and then 40mg. Even at 20mg, the Celexa snapped me out of the profound depression I was experiencing. At 40mg it was causing dizziness upon standing up, and one night before last Xmas I actually fainted just as I reached the top of a flight of stairs. Fortunately I wasn't hurt. But I insisted on reducing the dose back to 20mg, which I gather is low, but it works for me and I haven't experienced any more dizziness.

 

Meanwhile I had to find a neurologist specializing in movement disorders to try to get the tardive dyskinesia (TD) under control. He was reluctant to try his top choice of medications as our first attempt, because it can cause depression in patients, and after my recent deep depression I wasn't ready to go back there, either. Unfortunately, the other drugs had very unpleasant side effects (mainly extremely dry mouth) and I had to stop them and try other things. That included Seroquel, another drug similar to Abilify, and it did have an effect although I was up to a very high dose of it without eliminating the TD symptoms entirely. I had to taper off of that one, too -- it had some other undesirable effects, anyway. We finally ended up trying my neurologist's first choice (tetrabenazine) and it has worked pretty well. The TD symptoms are greatly reduced, although not entirely gone, and fortunately I've had no real adverse side effects from it, especially not depression. But it took a lot of experimentation and close monitoring by my neurologist and psychologist while I went through this medications odyssey. And yes, with many of these drugs you run the risk of withdrawal symptoms if you don't taper off the medication gradually.

 

As for the sexual side effects, many of the anti-depressants do that. Wellbutrin is one that usually doesn't have that effect, and I was on it for years before it finally started affecting my sex drive. But it eventually did, and the Celexa also seems to have the same effect as the original poster described. It's annoying, but I can live with it. It's either that or going back to the depression, which I definitely don't want to experience again!

 

This is just one man's story. Different meds work differently in different people. Prescribing for these problems is as much an art as a science. You need to find practitioners who specialize in psycho/neuropharmacology and are willing to work and experiment and follow you carefully until you find a med or combination of meds that works for you. It's a pain in the butt, but it's worth it when you find the right meds and your symptoms improve. Good luck!

[MsGuy]

Doit, the good news is that you're encountering this problem relatively late in life. That means the stress component of your depression likely plays a larger role than the genetic. Odds are very good that your symptoms will gradually fade out later this year or early next year; odds are fair that you won't have another disabling level recurrence down the road.

 

The bad news is that while you're in the middle of an episode, the good news doesn't mean squat.

 

Advice:

 

1) Consider consulting a specialist. Your physician should have made a point of warning you about the possible consequences of suddenly terminating Celexa. Not saying that he's a bad doctor, just that few GPs have the experience or knowledge base to adequately manage depression.

 

There's a slew of drugs on offer for depression/anxiety. Your physician needs to be familiar with all of them. Everyone responds (or doesn't) to each one in his own way. Side effects vary both by drug and by individual. Getting the dosage right can make a world of difference (& it can vary over time).

 

You probably want to be on the minimum dosage necessary to relieve symptoms. This is largely a matter of trial and error. Both you and your physician need to be alert to subtle changes that signal you're doing better (or worse). This is one area where your suggestion to keep a daily journal can be invaluable.

 

2) You are right in your preference for counseling. Peer reviewed studies are all over the place on this, but there's a fair amount of evidence that you're much better off if you confine the med option to getting through an episode that's severe enough to seriously interfer with your life.

 

3) Pay attention to the stress relief tricks that they will probably introduce you to in counseling. Give them all a fair trial, even the ones that seem silly. You'll never know what works for you and what doesn't unless you give them a fair trial.

 

4) Eliminate as many chronic sources of stress from your life as you reasonably can. Some things you can dump, some you can't. In my experience, for guys our age, simply being gay, esp. closeted, can be a significant source of stress. Don't allow avoidable stressors to accumulate.

 

Stress is additive. Your brain doesn't know or care what occasions the stress. It just know how much total stress it's experiencing. If you can find ways to chop off several small recurring stressors, that can help nearly as much as ditching one medium one. That has the advantage of allowing you to make small positive steps at a time that anything larger may seem too difficult. Later, several mediums can equal one major.

 

5) As far as you can, focus on getting though of this episode. If possible, try not to make life altering decisions until you're back up and fully functioning. The first job is to get through this.

 

6) Once you're in the clear, give some serious consideration to permanently pruning a strong stressor or two from your life. You've mentioned several here and likely there are others. Take your time before you act, talk things over with friends, seek reliable advice, but keep in mind you don't want to wake up some morning two or three years down the road and find yourself in the same hole again. This is the part that took me nearly 30 years to figure out.

----

Your advice above to those seeking treatment is spot on. You've obviously given your situation a lot of thought. Take that as an indicator that you're already starting to improve.

----

I'm no mental heath professional nor am I a MD, so take what I've said here with a large dose of salt. But my whole genetically cursed family starts getting episodes of depression beginning in their late teens/early twenties, so I have had considerable experience dealing with depression. The main thing is to keep in mind you will get through this and, with a bit of effort and luck, will be able to avoid/minimize it in the future. Just remember to keep a eye peeled for stressors creeping up on you.

 

I wish you the best, Doit. Please feel free to PM any time you want to talk.

[Lookin]

What a great group of guys, and what good advice!

 

Not much to add here, except maybe under the heading 'How to Taper Off'.

 

Twice in my life, I was on Prozac, both times for what my shrink called 'situational depression'. I was taking three of those little capsules a day. When it came time to quit, the first time I quit cold turkey. Not a good idea.

 

The second time, I dropped one pill a week until I was off. So, 21 pills the first week, 20 pills the second week, and so on. After twenty weeks, I was down to a single pill for that final week. Talk about gradual. But it worked.

 

Don't know how these other meds are dosed, but a pill cutter may be needed to drop the dose gradually, or maybe there are lower strengths of pills that you can phase in. Your doctor can help you plan the best way to come off gradually. Very gradually.

[+ Charlie]

There is much good advice here. The only thing I would add is that each person's experience with any drug is different; in fact, one person can have a different experience each time one starts a treatment with the same medication. No doctor, specialist or not, can be absolutely certain how YOU will react to a medication that he has prescribed to others, so don't hesitate to contact the doctor if your own reaction is different from what you were told to expect. I think many of us don't like to "bother" the doctor, or are afraid of being perceived as a pest, but even if that is the feeling you get from the doctor or his staff, ignore it--or get another doctor.

[whipped guy]

One more thought...

 

Yes, there is lots of great advice here. Still, there is one thing that I feel compelled to emphasize and it was indeed mentioned above but only in passing. That concerns dry mouth. Virtually all the drugs used to treat depression produce dry mouth as a significant side effect. I have heard of too many situations whereby a person’s teeth and gums have been quite adversely affected by such medications. Actually there are many other drugs used to treat a variety of maladies, not to mention certain medical conditions, that cause dry mouth as well. In all such cases it is advisable to contact your dentist so that the appropriate preventative measures can be taken. It is amazing how many physicians neglect to inform their patients of such adverse side effects… and such affects can be quite devastating resulting in the loss of teeth in a very short time frame.

 

Google the term “xerostomia” (dry mouth) and get appropriately informed if you are experiencing such side effects… and get to your dentist as soon as possible…

[leigh.bess.toad]

Hey Whipped Guy -- I haven't had those side effect with any of the myriad of psychotropic meds I've tried before I got to my current ones that are working, but I don't doubt that they could have that effect. If Celexa could give me hepatitis, I don't doubt anything. These are powerful drugs and not to be taken lightly (or stopped being taken). The only extension to your wise recommendation would be to apply it not only to these meds but to everything. If you are taking a med and it just doesn't feel right, tell your doctor immediately. Listen to your body. It may be nothing, but it may be something. Most drugs have an extenisve lilst of possible side effects. The chances of the rarest of these side effects are so small that most doctors don't know about them and will have to research them. Make sure they do. Besides the hepatitis (which was like 75th on the list of possible adverse reactions) I've had a few other reactions that were that far down the list. Most weren't severe, but you need to tell your doctor. There are very few diseases that can be treated with only one medication. If one med is causing a problem, switching to another may work without any side effects. But if you don't say anything, you'll never know.

 

Lee

[gp0560]

Another source of info

 

Here's a site that I use to get basic info about specific psychotropic drugs. The articles also trigger specific questions to ask my prescribing health care person. May you be as fortunate as I have been to find a "shrinklet" (not an MD, sort of a PA, but trained specifically in brain chemistry). My guy is very relaxed about considering my ideas about trying different meds and combinations of meds. He is also very good at explaining how specific drugs work and why or why not certain combinations would be worth a try.

 

http://www.crazymeds.us/

 

BTW, do any of you health professionals out there have any comment to make about the effectiveness of this site?

[+ g56whiz]

1) Consider consulting a specialist. Your physician should have made a point of warning you about the possible consequences of suddenly terminating Celexa. Not saying that he's a bad doctor, just that few GPs have the experience or knowledge base to adequately manage depression.

 

All of MsGuy's advice is great but this first is crucial. These psychotropic drugs are complex and their side effects can be significant and vary greatly from individual to individual. I'm of a layman's opinion that they should not be prescribed by anyone but a psychiatrist with knowledge of the various regimens.

 

All of these drugs are metabolized in the liver. One day I was confronted by colleagues who's considered opinion was that I looked like hell and should see a doctor ASAP. I looked really looked in a mirror and was shocked by the yellow visage staring back at me. A week of tests later (and my demand that the MD and psychiatrist confer) it was determined that the many drugs (I was on six or more) had eaten my liver: I had non-viral hepatitis. I was ordered to stop all meds immediately. By the time I got the diagnosis to my traveling partner half a continent away (we were told to expect liver cancer) I was incoherent. Eight hours (and $1,500) later he was at my side getting me through the detox the docs had forgotten to tell me about.

 

Six years later and I've managed to stay off the meds. Knowledge is the key. I commend to you "Noonday Demon, An Atlas of Depression" by Andrew Solomon. It won a National Book Award several years ago. And Solomon is openly gay so he writes knowingly from our perspective. The more you know about depression the more sensitive you are to its onset and the quicker you seek relief. Knowing yourself is also important. That's were therapy can help. In my case, as part of a spiritual quest, I had to write a spiritual biography. Once I opened the floodgates, memories both sad and sweet came rushing back. Twenty pages in I realized that I was actually engaged in DIY psychoanalysis. It worked! Yes I still suffer from a profound mood disorder: I cry at the end of each evening news, Oprah, anything on Lifetime Channel etc. but that's a small inconvenience compared to what happened to my liver. This year I've encountered two life threatening illnesses and lost four friends to cancer since May 1 (including my oldest and also my closest friends) and other than an occasional quick case of the weepies, I've been fine. Some claim exercise is better than paxil for depression: others say that's not proven. For one of my illnesses I've had to drop 50 pounds. I can tell you that the compliments of friends and acceptance by those eye candy at the gym do a lot for one's self esteem which certainly helps stave off depression.

[dfw2sfo]

Anti depressants

 

As many warnings as there are here both my brother and my partner have expressed significant reservation in starting anti-depressants even when they have saved my life. I have no doubt whatsoever that I would be dead if not for these medicines. My mind functions so differently if I am not on them. The one warning I would give is that even though it can take some time to build the presence of the medicine in the blood stream, it takes me only one or two days of missing a dose to suffer consequences. Get help.

[leigh.bess.toad]

All of MsGuy's advice is great but this first is crucial. These psychotropic drugs are complex and their side effects can be significant and vary greatly from individual to individual. I'm of a layman's opinion that they should not be prescribed by anyone but a psychiatrist with knowledge of the various regimens.

 

This year I've encountered two life threatening illnesses and lost four friends to cancer since May 1 (including my oldest and also my closest friends) and other than an occasional quick case of the weepies, I've been fine. Some claim exercise is better than paxil for depression: others say that's not proven. For one of my illnesses I've had to drop 50 pounds. I can tell you that the compliments of friends and acceptance by those eye candy at the gym do a lot for one's self esteem which certainly helps stave off depression.

 

Hey g56whiz -- great contribution. I certainly hope you're doing ok with your illness, and I'm very sorry for your losses. It sounds like I wasn't the only person who ever developed hepatitis from these drugs. I'd never heard of that happening to anyone else. Maybe we can start a club with T-shirts and everything. As far as your opinion that the drugs shouldn't be prescribed by anyone other than a psychiatrist, I would agree unless the case is very mild and can be treated on only 1 medication. Once it needs multiple meds or the case is more than a minor case of "the blues" it needs to be monitored by a psychiatrist -- beyond a shadow of a doubt.

 

And for me, although exercise won't replace the meds, it sure helps the mood. Just being here and seeing some of the pictures of the escorts on RM, RB and M4RN certainly inspires me to exercise. For although many of the escorts I've come to respect have commented (very sincerely, I believe) here that the physical shape of the client doesn't make any difference to them, as the client it makes a difference to me. I'm old, I'm follically and verticallly challenged and I'm overweight. I've only got a chance to fix 1 of those 4 (trust me, the national debt couldn’t pay for my follicle challenge). I'm down 40 pounds (25 to go) and there is an extra bounce in my step when I walk out of the gym. If I can look better at 55 than 35 that would mean the world to me. I'm not nuts, I know I'll never resemble any of these great looking men I drool over (well I am nuts, but that's another discussion), but if I can look good for someone of my age that will certainly help my depression considerably. I just want to be able to list HWP on an CL ad.

 

And looking at the eye candy at the gym ain’t bad either (in fact, it's not so much eye candy as it is eye desert tray -- tonight there was one guy I just wanted to throw down on the floor and explore his anatomy intensively). <Sigh>..

 

Again, hope your health is doing well. Best wishes and stay strong.

 

Lee

[best hotel]

Wellbutrin has worked well for me.....it creates minimal sexual and weight gain side effects.....the time release version helps minimize the indigestion side effect.......hope you are feeling better soon