Antidepressants: Are we getting better?

*Please note that all references to the terms “male” and “female” are intended to reflect the current gender/sex measurements in data research, which is undoubtedly trans-exclusionary.

If you take any category of psychiatric medication (yes, Lexapro and Xanax count!), you may want to dedicate 3-4 minutes to read this to the end. Antidepressants/anti-anxiety medications (aka anxiolytics) do their job and they do it well. The question is what’s the “job” we’re asking them to do? 1) Address debilitating symptoms in an acute capacity? Yes! 2) Mitigate symptoms on a chronic/long-term usage basis? Nope! ⠀

One in every 10 Americans takes an antidepressant (these are pre-COVID numbers, (that number drastically increases in forthcoming research due to the stressors COVID brought to us all). Of that population, 25% take them for 10 years or longer. This was never the intention of this class of drugs and ZERO studies even examine the usage effects over a similar duration of time. Brand new 2020 research out of Harvard indicates that less than one-third of those individuals taking a single antidepressant (as opposed to multiple prescriptions) have seen a mental health professional in the past year.

What’s a prescribing provider to do when their patient still has symptoms and the standard psychopharmacological treatment of an SSRI or SNRI is no longer working (read: Tardive Dysphoria)? The new protocol is to add an antipsychotic to the medication regimen.

Re-read that sentence.

Antipsychotic medications that are being used to augment treatment for anxiety, depression, and mood-related diagnoses include Abilify (aka Aripiprazole), Seroquel (aka Quetiapine), Symbyax (aka Olanzapine/Fluoxetine), Risperidone (aka Risperdal), etc.

So, now we have (lots of) people on primary medications for extended periods which have plateaued and are no longer effective, secondary medications in the antipsychotic family, and tertiary medications to manage the devastating list of side effects caused by the aforementioned antipsychotics (e.g., increased risk for diabetes, tardive dyskinesia, obesity, akathisia, etc.).

HOUSTON, WE HAVE A FUCKING PROBLEM.

Credit: mytherapistsays

I encounter every possible presentation of depression and anxiety in my private practice. I have seen clients who experienced life-changing benefits from the addition of psychiatric medication. I have seen clients who have been put on a sub-therapeutic dose of medication experience a debilitating paradoxical reaction that took almost a year to psychologically and physiologically recover from. However, what I have seen the most, are clients who have been overprescribed or under-monitored and at some point, begin the process of assessing whether they still “need” the medication that was prescribed to them a decade ago when they were going through a divorce.

Have you tried telling a prescribing doctor that you are ready to come off of a psychiatric medication? It’s…. interesting and usually involves defending your ability to be oriented to reality and not “decompensating” or “symptomatic”, but just a human who is ready to try life sans medication.

It is HARD to find a progressive and integrative psychiatrist who will prescribe to address acute distress impacting daily living and who also has the plan to deprescribe when the scaries have passed and you have built a toolbox of coping skills (therapy, breathwork, diet, and sleep changes) to manage...wait for it…FEELINGS.

Because feelings aren’t pathological unless they are disrupting your ability to live your life or resulting in behaviors that are dangerous to yourself or others. Feelings are BIG. They’re big and they can be awful and uncomfortable and make you cry oceans of tears and scream at the heavens - but feelings are part of life.

We medicate symptoms. We support feelings. Find clinicians who can parse out the difference between the two.