Antidepressants, Part 2: Your experiences and follow-up questions

A few weeks ago, we answered your questions about antidepressants — specifically, what we know (and don’t know) about how they work, how effective they can be, and what it means to take them long-term.

We asked you to tell us about your experiences with depression and antidepressants, and we received so many diverse and honest accounts.

I reached out to several of you to get your consent to share your stories with the larger Group Therapy community. I’m going to share parts of those messages in this newsletter.

I also followed up with Dr. Awais Aftab, a psychiatrist at Case Western Reserve University, who was kind enough to answer your additional questions. We spoke with Aftab during a live Twitter Spaces event on the complex and personal decision to take antidepressants. If you missed it, you can listen to it here.

Your follow-up questions

Joanne, 69, of Coatesville, Pa. wanted to know whether antidepressants contribute to dementia or memory loss. Joanne wrote that she took Amitriptyline, an antidepressant and nerve pain medication, for 26 years because of severe nerve damage caused by a tumor removal. But she stopped taking it recently because she read that this particular kind of antidepressant, called anticholinergics, has been linked to higher risk of dementia.

This is what Aftab had to say: “Research that has examined the use of antidepressant medications and the risk of memory disorders has found conflicting results. Pooled results of such studies show that there may possibly be a small increase in the risk of memory disorders with use of antidepressants, but caution is needed in interpreting the results since depression by itself is associated with an increased risk of dementia and memory impairments, and many existing studies cannot adequately control for the effects of depression.

“That said, different antidepressant medications have different side effect profiles. Amitriptyline is recognized as having strong ‘anticholinergic’ effects with a negative impact on memory and cognition (it blocks the activity of the cholinergic system in the brain, similar to the anti-allergic drug Benadryl, and the cholinergic system plays an important role in cognition). Because of these cognitive adverse effects, the use of amitriptyline in older people is generally not recommended. Fortunately, there are other antidepressants available that do not have prominent anticholinergic effects and are safe for use in older people.”

Matt, a 25-year-old living in Florida, wrote to tell us that he’s never taken antidepressants, as he believes that they may do more harm than good. (The experts I spoke with acknowledged that this may be true for some people, depending on their side effects, but this certainly isn’t the case for everyone who takes them.)

“By all counts, my biggest childhood traumas — losing my mother at age 7 and a house fire at 13 — should’ve landed me in a psychologist’s office,” Matt said in his email. “Luck, environment, maybe genes, and more luck saved me. I wish this was the case for more people, especially children whose brains develop at such truly awesome rates. How could SSRIs and other antidepressants not cause significant changes in the brain in the long term when taken by children? Don’t doctors extol the ability of antidepressants to change the brain’s chemistry?”

In response to Matt’s question, Aftab said: “Antidepressants produce a variety of effects on brain chemistry and physiology while a person is taking them, and it is hypothesized that effects such as increased neurogenesis (the production of new neurons in the brain) and neuroplasticity (the ability of neural networks in the brain to change through growth and reorganization) may be responsible in part for the therapeutic benefits of antidepressants.

“With long-term use, however, antidepressants can cause physiological adaptation and dependence. That is, the brain systems can get used to the presence of antidepressant effects, and this may produce effects such as withdrawal, which can be protracted for some people. For reasons not clearly understood, antidepressants can also rarely cause long-lasting sexual side effects in some people, which arise or persist even after they have stopped taking antidepressants. In patients with stroke, long-lasting differences in neurological recovery may be seen, with individuals treated with antidepressants showing better outcomes even years later. Aside from these or other rare situations, long-term brain changes that alter the development of children or persist long after the discontinuation of antidepressants have not been demonstrated. Just because a medication produces brain changes in the short-term doesn’t mean that there will also be long-term effects. While there are still many unknowns, the practical experience of antidepressant use in children and teens over the past several decades, when they are prescribed appropriately, has been reassuring.”

We also heard from Denise, a 70-year-old in West Hollywood who has tried seven different antidepressants. “Every single one of them put me to sleep,” she wrote. “They said to take in the morning, and I would go to sleep and I couldn’t function.”

“I am desperately looking for help, and every clinical trial seems to be only up to age 65,” Denise went on. “I was wondering why that would be.”

Aftab said: “There is a lot of variation in how different people respond to medications. One reason for this, among others, is that different people metabolize (‘break down’) drugs at different speeds. Some individuals metabolize drugs very fast and may experience few effects, while others may metabolize drugs very slowly, causing build-up of medication in the body and producing high levels of adverse effects. There is genetic testing available that looks at the activity of enzymes that metabolize psychiatric medications. For people who’ve had tolerability issues with multiple antidepressant medications, such testing may be a reasonable next step (insurance coverage for such testing is inconsistent) and you can discuss this with your medical provider. Other reasons for tolerability problems may include variations in the sensitivity of the nervous system to medications.

“Elderly individuals are at higher risk of experiencing adverse effects of medications, both because they tend to metabolize medications more slowly and because their nervous system is more sensitive to the medications. Many clinical trials exclude elderly individuals to avoid dealing with the tolerability risks, and that means that there can be considerable uncertainty regarding how the medication affects the elderly. Although there are comparatively fewer trials of antidepressants with elderly subjects, and we do need more high-quality trials, there are enough such trials that we have a fair idea of the efficacy and safety of antidepressants in the elderly.”

Your experiences

Here are just a few of the many messages we received from readers about their experiences with depression and antidepressants.

The benefits of medicine and therapy

“Prozac helped me 25 years ago. I had become depressed, and it was about as bad as it could be. Not wanting to continue living, but not exactly wanting to die either, I began looking for a therapist. I lucked out and found Christine, a wise and compassionate MSW who practiced cognitive therapy.

“I ended up on Prozac. I was highly motivated not to die because of my son. I placed my trust in Christine and her ability to lead me back to life. And I committed myself 100% to getting myself away from the edge of that abyss, full of horror and hopelessness, even if it took the rest of my life to do it.

“It all worked. Here I am. I’ll never know for certain the exact role the Prozac played in my recovery. I’m certain that it was important. It changed the way I interacted with the world…

“I’m thankful for Prozac. It truly saved my life. But so did the cognitive therapy. I know people whose doctor prescribed Prozac, but they never bothered to get some sort of therapy. All they did was take the Prozac, and the only thing Prozac ever gave them was the Prozac headache.

‘Recovery from depression takes work. You don’t just take a few pills and expect to find yourself back in your happy place. Drugs and therapy work hand-in-hand.

“Apropos of nothing, I don’t know what caused me to become clinically depressed. You may as well ask which came first, the chicken or the egg. What happens first, an unrelenting run of incredibly bad luck that finally knocks you down, keeps you down, and derails your brain; or is there an idiopathic event that throws off your brain chemistry and then you yourself go off the track?

“I don’t know. I’m just thankful that I made it through. I hope I’m a better person because of it.”

— Karen, 71, West Warwick, R.I.

A new experience with medicine

“I started taking antidepressants about a year ago! I had been seeing a therapist for 5 or 6 years and never talked about it. It was my general physician that suggested I look into it. I went in for my annual physical, and he had me fill out a questionnaire about my mental health and related behaviors.

“He suggested I consider Lexapro. I was taken aback! What?! This is the easy way out. No way. Anything in life that’s worth it is hard work. I mentioned that to my therapist, and he said, ‘oh, I think you should consider it.’ It pissed me off because I felt like he’d been holding back a tool to help me in my journey.

“One year into 10mg of Lexapro, it’s been great. I have more confidence at work. It’s given me a willingness to try new things. I started playing golf recently, and I’ve made friends with other guys that way. Overall, it’s helped me live in a way where things may turn out well?

“The side effects are that I’ll usually want a nap at lunch and I’m always hungry.”

— Eric, 39, Los Angeles

More support for the withdrawal process

“As someone who has been on one antidepressant or another for the last 30 years, more attention needs to be given to the toxic withdrawal process of these meds. I’m a woman who is nearing 60 and have received little to no support from Kaiser in this process. Combine that with the loss of hormones post-menopausal and you get trouble.

“If medical providers and big pharma continue to rely on medications as the first line of defense for depression and anxiety, they need to provide equal support to those who want to get off the hamster wheel of these pharmaceuticals.”

— Leah, 59, San Diego

Another approach

“Nothing was mentioned about changing one’s diet, journaling, or increasing B12 and calcium/magnesium/Vitamin D in that we get less sun in the fall/winter seasons. I have been on antidepressants, had therapy, and finally, after years of up and down cycles, found myself in a better place by eliminating dairy and decreasing sugar, etc. I also am exercising more and checking my tendency to ‘recast my present moment experience by applying what has been my experience in the past.’

“For example, I live in the Pacific NW but am a native Southern Californian. I used to have horrific episodes of Seasonal Affective Disorder and it was while living in Seattle that I got off alcohol and on Paxil. After 3 months, I got off Paxil and have stayed off alcohol. I started working on my thinking and how I feel about myself and who I am at this point in time. When I started to go into a funk when the rain became a reality, a week or so ago, I said to myself, you don’t have to do this. I may add a little more caffeine for a few days to get the mental energy bump and put some sugar in coffee or tea to not feel deprived, but I make it short term.”

— D. Livingston, 71, Portland, Ore.

Balancing risk and benefit

“I have had two significant depressive episodes, both treated with therapy ( group and later individual), and later I was prescribed Wellbutrin, which I took for some years then weaned off. But after a couple of years, I found I just didn’t have the motivation to get much done, so I restarted. A number of years later I was diagnosed with ADHD ( via neuroscientist testing) and voila — I think I understand why Wellbutrin works for me. I had a small dose of Ritalin added and that seems to work, though with some additional family stress I plan to re-enter therapy. I am comfortable planning to stay on Wellbutrin forever …

“I know that the stimulants I take raise my cardiac risk, but it is worth it to be able to enjoy the journey, the work, the challenges.”

— Rebecca, 71

Your stories so profoundly illustrate how varied responses to antidepressants — and other ways of dealing with depression, like diet and psychotherapy — can be. And they’re a reminder that treatment isn’t a one-size-fits-all endeavor. Thank you so much for sharing them.

A note before I sign off: As we move into winter and the holiday season, we’d like to ask whether there are any related topics you’d like us to explore, whether it be about family dynamics, holiday gatherings, the seasonal changes, or the new year (or anything else on your mind). I’m learning so much week to week and look forward to what’s next.

Until next week,

Laura

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email GroupTherapy@latimes.com gets right to our team. As always, find us on Instagram at @latimesforyourmind, where we’ll continue this conversation.

See previous editions here. To view this newsletter in your browser, click here.

More perspectives on today’s topic & other resources

Many who try to quit antidepressants say they can’t because of withdrawal symptoms they were never warned about. But the medical profession has no good answer for people struggling to stop taking the drugs — no scientifically backed guidelines, no means to determine who’s at the highest risk, and no way to tailor appropriate strategies to individuals, according to this New York Times piece.

“Chopped” champion Brooke Siem shares her story of antidepressant withdrawal after 15 years of using the drugs in this episode of PsychCentral’s “Inside Mental Health” podcast.

Diet is such an important component of mental health that it has inspired an entire field of medicine called nutritional psychiatry. Several recent research analyses support that there is a link between what we eat and our risk of depression.

Other interesting stuff

The therapist will see you now — on a hike or a surfboard. An increasing number of psychotherapy programs blend talk therapy with physical activities to help people process. Across the country, you can find everything from dog walking therapy to horticulture therapy to improv therapy, according to Times writer Julia Carmel.

A family member’s suicide made this writer reexamine her own mental health. “I realized how much mental health-related stigma in the Black community was hurting people’s ability to get help,” writes Gabrielle Chenault in this piece for BuzzFeed.

Renowned psychotherapist Esther Perel leads a therapy session between a husband and wife whose family has been torn apart by the war in Ukraine in this podcast episode of Ten Percent Happier.