Monday, May 21, 2007


...I am posting this from a computer in the lounge of the Honda dealership, and all the Blogger buttons are in Chinese. Go figger.

The car saga continues, and continues to intersect with the therapy saga. (Sorry, I'm not up to hunting down html for internal links in Chinese, but the post about switching therapists and car problems is in my archives under Depression. I'll try adding the link later.)(Okay, it's later now, and here it is.)

On Friday, I was going to have my last therapy session with my ineffective therapist. What I haven't said about Ineffective Therapist is that almost the first thing she did when we started last Fall was offer me medication, while also acknowledging that I'm not the type to want to use it. I didn't want to use it, and the idea of going on antidepressants still scares me and, honestly, makes me burst into tears if I think too hard about it. But Ineffective Therapist, now that I think about it, didn't have a lot else in her bag of tricks. She put me on other ingestables instead--vitamins and minerals and Bach flower remedies. The supplements probably helped some, but it wasn't enough.

Here's what happened Friday: the car wouldn't start. I had cut it rather close because I had to open the store on Friday, and I hadn't gotten Z. to day care before store-opening time, so by the time I called Ineffective Therapist to cancel it was very close to the time of my appointment. And she asked if I wanted to reschedule. Which I didn't. I stopped therapy with her over the phone instead, explaining I was going back to Dr. L. She took it okay, not great but okay, and ended the conversation by saying that if I wanted to start medication she would be happy to help.

After that phone call, I called daycare to say no Z., because I figured there was no guarantee I'd be done with car stuff in time to pick her up. Then Z. and I had adventures with tow trucks and extremely nice co-op shoppers--the tow truck couldn't accommodate a car seat even though I told the dispatcher I was travelling with a toddler, and Extremely Nice Co-op Shopper saw me while she was loading her groceries into her car and offered to follow the truck. Good Samaritans just stop me in my grumpy tracks--and I gotta pay it forward next chance I get.

We were in the dealership a good long time, and it wiped Z. out and she was sick all weekend with low appetite and spiking fevers, but she seems okay this morning, except for waking up at 6:00. That was because I needed to get the car here early enough for a loaner. And why am I back here after spending most of the day on Friday? They replaced the battery, but didn't have time to check out the whine. And so here I am, waiting for that loaner so I can get to my first full session with Dr. L.

What I think about antidepressants is that they seem like an easy solution to a hard problem, and I'm not sure that they don't do more papering over than actually solving anything. I don't like the idea of feeling worse while they kick in. I don't like the idea of side effects so severe that many people can't tolerate them. I don't like the fact that they're only slightly more effective than placebo, and help only half or less of those who use them. I don't want the effect on libido--really, really, I don't think my marriage could take that. I don't like facing a withdrawal process getting off of them. And I don't like the idea of something chemical affecting my mood, though if the rest weren't there I think I'd be more willing to risk it. But I'm not, not yet.


niobe said...

I'm on antidepressants, but luckily haven't had any of unpleasant side effects that many people do.

But part of the reason that I find ADs so useful is that I'm not very good at talk therapy. Since you have a therapist you work well with, maybe ADs are something that you aren't going to need.

Magpie said...

Sex and exercise are anti-depressants. So, I think, is gardening. But sometimes, the pills become necessary. And that's not a bad thing. Different ones have different side effects, and a good psychiatrist should be able to work through those with you, so as to mitigate the worst ones (the worst ones for you, that is).

Good luck.

S. said...

Yes! That's sort of what I'm getting at in easy solution/hard problem. I know that gardening these past few weeks has helped me. Gardening and exercise do have a profound effect on serotonin levels, but they take more time than popping a pill. You have make space in your life to fit them in. It's also more fun, which has to be part of the therapy.

Sex, well, my mother is reading so we won't go into that exactly, but I meant what I said about the libido-inhibiting effect of Prozac.

I also need to be able to tell the story of Z.'s birth without crying. And talk therapy seems like a very good place to figure that out. (Commenting post-Dr. L., where I told the story and cried the whole time, and I'm going back tomorrow to finish. Phew.)

Niobe, I know tons of people who swear by them, so I know that they can be transformative, even life-saving, and I hope I don't sound judgmental about not wanting to take them. I could see myself changing my mind down the road, if going back to Dr. L. doesn't help. But I hope it will.

I'm glad you aren't suffering side effects--some of them sound so very, very unpleasant.

jo(e) said...

Good for you for leaving the ineffective therapist!

wolfa said...

I say this as a non anti-depressant user (but I've tried a lot of them): you have something chemical affecting your brain already. Whether or not it was initially a chemical problem, the two feed into each other. And ADs are not supposed to be the solution, just a way to get you to a place where you can find a way out.

I had every side effect except the libido one. However, ability to use said libido when the smell of anything (soap, say, or toothpaste) makes you throw up? Or when you're sleeping 20 hours a day, but want to be sleeping 22? Frankly, depression has always been more copable than side effects for me. Other issue is that I cannot remember to take a pill every day.

I hope Dr. L is more helpful than Dr. Ineffective.

Lo said...

You mention Prozac, which is an older SSRI...most of the newer ones have a much less clunky side effect profile. (and of course it's all about your individual body's reaction) The newer SSRIs target increasingly specific parts of the brain, hence fewer side effects. Also if you have them on one, sometimes you won't have any problems on another.

I have never had any side effects from my various SSRIs except, briefly, weight loss. (alas, that was many years ago)

in my opinion (and I believe many others more qualified than myself) drugs are no replacement for fact, drugs without therapy can be dangerous. However, as wolfa points out,there are already chemicals in your brain, so sometimes, part of the solution is chemical. But, I have no idea whether this is the case for you. And I don't think there's any exact way to find out (that's where the diabetic/insulin metaphor falls apart); so it's just something people can try. Or not.

also I think a lot of the scary crap you mention, like withdrawal symptoms, is limited to Effexor, which is a different chemical makeup than Prozac and its progeny. (I have also been on and off SSRIs and never experienced withdrawal symptoms).

Long comment. Stopping now.

Lo said...

I must add that Co has informed me that in fact, in autopsy doctors can identify if people had serotonin deficiencies. Not so helpful to us now, however.

S. said...

Lo and Wolfa, you both know more about this than I do. I mentioned Prozac mostly to name something--I haven't comparison-shopped SSRI's because, as I said in the post, thinking about them too hard makes me burst into tears. So researching them seems premature.

I do know that brain chemicals are powerful--I've been pregnant, everyone! I melted down weekly, at least! Not to mention the whole unmedicated-labor-endorphin-haze thing--but I have never really enjoyed the effects of drugs in my system. I don't even drink coffee, and my alcohol consumption is minuscule. I think I'm right to feel well shot of someone who begins and ends her relationship with me by urging me to take drugs.

What I want is to get my own, internal biochemical feedback loops working in my advantage. Thinking about natural serotonin enhancers is useful--gardening, talk therapy, and the like. I even suspect that I was keeping Z. home so often this winter because she simply cheers me up. Which is not exactly good parenting.

Co said...

Lo overstated the autopsy thing. There is a large-scale study being done where the brains of suicides are being compared to control brains. (I took a neuroscience class a year ago and as the child of someone who commit suicide--my dad--the topic interests me a great deal.) From what I read a year ago, the study had found that the brains of suicides typically had many more serotonin receptors than the control brains. That doesn't prove that the people who commit suicide (whose brains are being used) had a serotonin deficiency. But it suggests that their brains were trying to suck the most out of the serotonin that they did have (by adding more receptors). Which sort of implies they might have had a deficiency but doesn't prove it. Essentially, SSRIs are thought to work similarly...not by increasing the number of receptors, but by inhibiting the reuptake of serotonin back into the neuron and letting it stay longer in the synapse. That, too, is thought to be allowing the brain to make the most out of the serotonin it has and may help in stabilizing mood. Of course, the reality is, no one knows for sure how SSRIs work. Anyway, it's interesting to me that the brains of suicides may have been trying to mimic, to some degree, what an SSRI does in an attempt to stabilize mood. It might mean that an SSRI could have saved some of those people's lives. Anyway, I just thought that was academically interesting and I mentioned it to Lo. It has no relevance to your post really since you're not talking about people for whom ADs are life-saving,

Right now it seems that you are taking some other positive steps toward feeling better. You're moving from an ineffective to a good therapist. You're trying to find other ways to boost your moods. I think it's probably a good idea to see how the therapy itself goes and to maybe get the advice of the therapist you trust about whether or not meds might be best for you, if you are still pondering taking them a while from now. I agree that you shouldn't listen to the ineffective therapist who wasn't able to help you and who just wanted to shove meds down your throat. Good luck. I'm glad you "broke up" with the ineffective therapist.

E. said...

Others have already commented on ADs. I'd like to say a few words about the car. That sucks! The whole thing isn't just annoying; it's also part of the scare with A.'s accident. The accident makes one feel unsafe. Now this new car acting up compounds that feeling because it, too, is not dependable. Which is scary. The difficult thing about depression is that it takes so much energy to do things. Feeling unsafe, and trying to do stuff anyway despite that feeling, increases the emotional energy drain.

You haven't talked about this in terms of safety, so maybe that's my projection. If so, my apologies; I don't mean to put words in your mouth. I am just so sorry that you have to deal with this car thing right now on top of everything else. Dealing with depression is enough on its own without Car Trouble and Scary Accident to boot. And saying goodbye to Ineffective Therapist is not an easy task under the best of circumstances. It takes courage.

Love and hugs to you....

S. said...

Co, could the extra receptors have themselves been part of the problem? If you have a lot of receptors, would you crave more serotonin? (This is a real question.)

We've never really talked about your father's death, but I hope you know how sorry I am. I remembered your reaction to hearing the military planes after September 11, and when we lived in Madison and heard military planes on exercise all the time, I like to think of them as your father's buddies keeping us safe. It was a good antidote to my knee-jerk antimilitarism.

E., you're right and I think that this whole aspect of the car stuff deserved its own post.