Going from One Antidepressant to Another

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One Antidepressant leads to another. I went to my general doctor. When I went to see him I told him I wasn’t feeling well. I’m tired all the time. I’m not productive as I used to be. And he talked to me for about 10 or 15 minutes and asked me some questions. He asked me some questions like: How did I handle problems like if my teenage son stayed out too late? Or if my daughter got bad grades or things like that. At that point he looked at me and said, “Well, Sharon, it sounds to me like you’re suffering from a case of depression, and it is a biological problem. It’s not your fault. Depression is something that’s easily handled. There are all kinds of antidepressants out there and they just kinda take the edge off a little bit.

I remember that, “Take the edge off a little bit.” [LAUGHING] And he was my doctor and he’s been my doctor for a very long time. Well, we can handle that problem. We can handle any problems you got for feeling bad. We’ve got antidepressants. They’re very mild. They don’t cause any negative effects, so take one of these a day and they’ll just take the edge off a little bit.

I said, well, okay. I’ll try it.

So, I got my first prescription filled. I found the effects the first medication had on me. The first three months I was on the medication, was that there was really no change at all. I was expecting a change, but the doctor had told me that, “When you take this antidepressant medication it may not be the one that works with your chemical imbalance.”

Of course because I had a chemical imbalance—I did not know I had a chemical imbalance. There was not a test to say here is the chemical imbalance. I was told, “You have a chemical imbalance. That’s what causes depression.”

I said, hh really. Okay. So, I took my first prescription drug.

And the doctor told me specifically,” If this one doesn’t work, it just means it doesn’t work with the actual chemical makeup of your system, but we’ve got one that will.”

I remember that. I remember thinking, alright. We can fix this problem. I don’t like feeling overwhelmed anymore. These antidepressants are supposed to make me feel normal. Normal, yes, he did say, “These will make you act and feel more normal.”

I said, normal. Normal is good. Okay, I’ll do normal. So, I took my first pill. And after the first month, because the doctor said to take it for one month, and see how you feel and come back and see me. So, I went back to the doctor and said this is not working.

He said, “No worries. We’ll give you something different.” The first time, he upped the dosage. We went through about six months of upping the dosage on the one medication to see if it could work, to see what level I needed. None of that was effective and none of it worked and I was getting a little frustrated because supposedly this antidepressant pill was gonna help me, this antidepressant medication was supposed to help me cope and deal with life and my problems and not feel overwhelmed. Not feel stressed out, and the antidepressant didn’t work.

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So I went back and I said, well, doctor the only problem I have is now I have a problem falling asleep at night. He said, “Well, that’s not a problem.” He gave me something [another pill] to take right before bedtime to help me sleep at night and to change the antidepressant I took in the mornings for the day. This was a cycle, a span of time, that lasted about a year and a half with my general doctor, until he finally said, “Well, Sharon, I really don’t think we’ve found the one that works for you. We’ve gone through 3 or 4 of them [antidepressants].

And oh, every time I go in there would be, “Just to let you know, we have a new [pharmaceutical] rep. come by with a new medication and this antidepressant will work for you because this one handles a greater number of people. So, this antidepressant is the one that will handle the situation.”

And I’d say, okay, and I’d go get my prescription pill and none of them worked. What I found was that not only was I just as stressed out, just overwhelmed, but I felt sluggish. My mind was slow. I couldn’t think straight. And it was a slow progression. It was very slow. It was something that was not obvious or I would have snapped to it immediately and said, whoa, there is a problem here. But it was a very, very, very slow reduction of mental capacity, and reduction of effectiveness over time.

When I went back, about a year and a half since I first took antidepressants, the doctor said, “Now, I’ve done all that I can do. I think we need to get you to a professional. But there’s no problem with that, you go, you talk to him.”

I kept asking, I do remember asking him this, over and over again: If it’s a chemical imbalance [that’s causing my depression], isn’t there a test? Give me a test. Is there a test you can do for my blood or my head to let you know what the chemical imbalance is? Because I really don’t want to go through all these antidepressant meds.

He said, “That’s something farther down. Don’t worry about that. Just try this antidepressant. Let’s try this one. I think this one will work for you.”

I kept doing what he said. After all, he was the doctor and I took the antidepressant he recommended. Then he refereed me to a psychiatrist. I went to the psychiatrist at that point. I met with the psychiatrist for the first time for about 15 minutes and the psychiatrist said, “We can help you. It’s not a problem. We can help you. Because we’ll just find the right medication that will take care of this chemical imbalance that you have.”

I said, there’s the chemical imbalance! That’s exactly what my doctor told me! There’s a chemical imbalance. Is there a test? Will you give me a test to say what chemicals are out of whack are so we can fix them. We want to fix this because I have a lot of work to do. And she said, “Well, the test they have out are not really effective in zeroing in on the exact chemical that is problematic.”

And I said, okay, well, there’s not a test?

“Well, yes, there is a test!”

Well, give it to me.

“Well, that’s not what we do. What we do is we put you on this medication and we will find the one that will be specific for your problem, for your chemical imbalance. Oh and by the way, don’t worry. If it takes more than one prescription, more than one medication, to handle your problem, it’s normal to end up having to take 3 or 4 different medications because together they work hand in hand to make you normal. To make you think better, think more clearly.”

Think more clearly? I do want to think clearly because by this time I’ve been on antidepressant meds for a year and a half and I was fuzzy that I was having difficulty coping. I was having real difficulty in life. So, yes, I took the medication and that started a timeframe of about 10 years of prescription meds. From start to finish [from seeing the doctor to the psychiatrist], it was 12.5 years.

Hi, my name is Sharon Johnson and I’m 45 years old. I’m 2.5 years clean from psychiatric drugs.

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Treating And Beating Anxiety And Depression: With Orthomolecular Medicine: A Guide For Patients.

Chemical imbalance

Chemical imbalance is a term used, particularly but not exclusively in medicine, to describe a situation where different chemical substances required for correct functioning of a system are not present in the required or correct proportions.

Chemical imbalance is sometimes used as a lay explanation of mental illness or mental disorders. The term is used in consumer literature and websites for psychoactive drugs (e.g., [1]), and in advertising in the United States after the deregulation of pharmaceutical advertising. It is not used in scientific literature as it does not reflect current knowledge. A criticism of the use of this lay explanation is that explaining mental illness in terms of 'chemical imbalance' implicates a chemical solution. For example, reduced levels of the neurotransmitter dopamine in Parkinson's disease are treated with L-DOPA to increase dopamine production and relieve symptoms. By analogy, it then appears that the appropriate treatment for an imbalance in neurotransmitter levels in mental illness is a chemical that fixes this balance. However, unlike Parkinson's disease, chemical insufficiencies have never been identified in patients diagnosed with mental disorders, and other treatments are available for mental illness, and medication is often most effective when supplemented with other treatments.

'Chemical imbalances'

Changes in levels of neurotransmitters and other neural level phenomena are hypothesised to be the underlying psychopathology for certain mental illnesses, notably clinical depression and schizophrenia.

Clinical depression

In 1965, Joseph Schildkraut hypothesized that depression was associated with low levels of norepinephrine in the brain, and later researchers thought serotonin might be the culprit.[2] Initially, relatively simple changes in the level of these neurotransmitters were thought to be found in individuals with depression. However, advanced findings began to fine tune the more simple explanations. For example, certain drugs used to treat depression were found to change the levels of neurotransmitters for several days, but then return to normal, well before any effect was observed on the depressive episode. Such findings implicate more complex mechanisms, such as changes in neurotransmitter production, transmission, re-uptake, and neural sensitivity. With respect to causality, a number of environmental factors have been suggested.

Psychiatric Drug:

Psychiatric medication is a licenced psychoactive drug taken to exert an effect on the mental state and used to treat mental illness. These medications are usually made of synthetic chemical compounds, although some are naturally occurring.

Types

There are four main groups of psychotropic medication. These are the anxiolytic/hypnotics, the antipsychotics, the mood stabilisers and the antidepressants. Additionally, there are various other miscellaneous types of medications, such as those used in the treatment of substance misuse and dementia.

Antipsychotics

Antipsychotics are drugs that are used in the treatment of various symptoms of psychosis, such as those caused by Psychotic Disorders or Schizophrenia. Antipsychotics are also sometimes used as mood stabilizers, most frequently to help manage such disorders as Bipolar disorder, even if no symptoms of psychosis are present. Antipsychotics may also be referred to as neuroleptic drugs and some antipsychotics are branded as major tranquilizers.

There are two categories of Antipsychotics, typical antipsychotics and atypical antipsychotics, and due to the nature of the drugs the majority of them require a verifiable prescription from a licensed physician.

Common Antipsychotics[1]:

* Chlorpromazine HCl (Thorazine®), Typical antipsychotic
* Thioridazine HCl (Mellaril®), Typical antipsychotic
* Haloperidol (Haldol®), Typical antipsychotic
* Perphenazine (Trilafon®), Typical antipsychotic
* Thiothixene (Navane®), Typical antipsychotic
* Trifluoperazine HCl (Stelazine®), Typical antipsychotic
* Risperidone (Belivon®, Rispen®, Risperdal®), Atypical antipsychotic
* Quetiapine (Seroquel®), Atypical antipsychotic

Antidepressants

Antidepressants are drugs used in the treatment of clinical depression, and are often used in combination with other drugs such as antipsychotics or stimulants, depending on the condition of the patient. Most antidepressants will restrain the metabolism of serotonin and/or norepinephrine. Such drugs are called Selective Serotonin Reuptake Inhibitors (SSRI), and they actively attempt to prevent the aforementioned neurotransmitters from dropping to the levels at which depression is experienced. SSRIs will often take 3-5 weeks to have a noticeable effect, due to the inability of the brain to process the flood of serotonin and it reacts by downregulating the sensitivity of the autoreceptors, which can take up to 5 weeks. Currently, Bi-functional SSRIs are being researched, which will occupy the autoreceptors, bypassing the 'throttling' of serotonin. Another type of antidepressant is a Monoamine oxidase inhibitor, which are thought to block the actions of MAO, an enzyme which assists in the breakdown of serotonin and norepinephrine. MAOI's are typically only used in the event that a tricyclic antidepressant or SSRI fails to prevent or exacerbates depression.

Common Antidepressants[2][3]:

* Fluoxetine (Prozac®), SSRI
* Bupropion HCl (Wellbutrin®), NDRI[1]
* Sertraline (Zoloft®), SSRI
* Phenelzine (Nardil®), MAO Inhibitor
* Isocarboxazid (Marplan®), MAO Inhibitor

Mood stabilizers

In 1949, the Australian John Cade discovered that lithium salts could control mania, reducing the frequency and severity of manic episodes. This introduced the now popular drug Lithium carbonate to the mainstream public, as well as being the first mood stabilizer to be approved by the Food & Drug Administration. Many antipsychotics are used as mood stabilizers, although typically the first resort would be a standard mood stabilizer such as Lithium carbonate. Many mood stabilizers, with the exception of Lithium, are anticonvulsants.

Common Mood Stabilizers[4]:

* Lithium Carbonate (Carbolith®), Regular Mood stabilizer
* Carbamazepine (Tegretol®), Anticonvulsant Mood stabilizer
* Valproic acid (Valproate), Anticonvulsant Mood stabilizer
* Valproate semisodium (Depakote®), Anticonvulsant Mood stabilizer

Stimulants

Stimulants are some of the most widely prescribed drugs today. A stimulant is any drug that stimulates the central nervous system. Adderall®, a collection of Amphetamine salts, is one of the most prescribed pharmaceuticals in the treatment of ADHD. Typically prescribed to treat adolescents with Attention Deficit Hyperactivity Disorder and an increasingly amount of adults, it is very common as a treatment. Patients respond differently to each drug. Most frequently used are timed-release mediums but if such a method doesn't work there are many options to try. Stimulants have the potential to be addictive and patients with a history of drug abuse are typically monitored closely or even barred from the usage and given an alternative. Discontinuing treatment without tapering the dosage is not advisable.

Common Stimulants[5]:

* Caffeine, Typical Stimulant found in many edibles worldwide
* Methylphenidate (Ritalin), (Concerta), (Daytrana) atypical stimulant
* Dexmethylphenidate (Focalin) D-isomer of Methylphenidate stimulant
* Dextroamphetamine (Dexedrine), (Dextrostat), (Vyvanse) D-Amphetamine-based stimulant
* Dextroamphetamine & Levoamphetamine (Adderall), D,l-Amphetamine salt mix stimulant
* Methamphetamine {Desoxyn), D-methamphetamine-based stimulant

Anxiolytics & Hypnotics

Barbiturates were first used as hypnotics and as anxiolytics, but as time went on, safer benzodiazepines (Lowell Randall and Leo Sternbach, 1957) were developed in the 1960s and 1970s. Eventually they led to billions of doses being consumed annually, but as prescriptions were increasing, even more was the abuse of them.

Common Anxiolytics & Hypnotics:

* Diazepam (Valium®), Benzodiazepine derivative
* Nitrazepam (Mogadon®), Benzodiazepine derivative
* Zolpidem (Ambien®, Stilnox®), an Imidazopyridine
* Chlordiazepoxide (Librium®), Benzodiazepine derivative

Administration and research

Prescription psychiatric medications, like any prescription medication, usually require a prescription from a physician before it can be obtained. Some U.S. states and territories have introduced so-called RxP legislation granting prescriptive privilege to clinical psychologists that have undergone additional training[2].

Doctors who research psychiatric medications are psychopharmacologists, specialists in the field of psychopharmacology.

Side effects

Psychiatric medications sometimes have adverse side effects that may reduce patients' drug compliance. Some of these side effects can be further treated by using other drugs such as anticholinergic (antimuscarinic) medications.

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