I’ve been dealing with depression (and anxiety) for well over 5 years now. I’ve tried so many different medications and treatments with no apparent success. Inevitably, in the course of the treatment, the doctor will ask if I’m starting to feel better to see if it’s worth continuing the treatment, up the dose, or swap to something else. And… I never know what to say. If it’s not going to get dramatically better all of a sudden, I don’t really know how to recognize any incremental progress if it’s happening at all and without being able to do that, I might be passing on treatments that could have helped if I gave it more time.
So if you’ve been in this situation, how did you recognize progress? To the extent that you can put it into words, what did it feel like to slowly get better as you were treated?
It’s like boiling a frog in water or weight change over time. You don’t notice it until one day it hits you. It like, faded away but you didn’t notice because you’re so used to it. So you relish it and enjoy it until it inevitably comes back. It’s like a roller coaster but slow and shitty. Gotta have the rain to appreciate the sunshine as they say.
When I first started lexapro I would find myself just having a good time. I’d be sitting somewhere and realize “Huh, I feel… okay.”
Not happy or excited or interested, just… okay.
And then I would think “Wait, do other people feel like this all the time?”
It feels like the floor is lifted, honestly. The low isn’t as low, and there’s maybe some more energy to do basic tasks. That’s the level of incremental progress I look for. It takes forever, and is super frustrating, but patience over a couple months is key, and always remember the side effects come first. Look for some kind of incremental change at least 4-6 weeks later. Don’t be afraid to advocate for yourself either — if your provider (hopefully a psychiatrist and not a PCP) isn’t listening to your concerns, find one who will. Best wishes to you, and I hope something clicks soon.
Felt like I churned up FoV from 60 to 130 and fps from 15 to 240. I did some drastic changes though, so it wasn’t exactly gradual. Unless you count a year being gradual. A lot of it wasn’t the result of my own merits though, but rather being surrounded by good people. The rest was happenstance.
When I was an arrogant asshole teenager I had made up my mind that I was too smart for counseling to help me and I needed antidepressants to fix the issue. I received both and just told the counselor things he wanted to hear me say until I could be on my own. I make no claim that the meds do not have real, meaningful benefits to many people, but in my case I feel like they were marketed to me.
I am still on bupropion, but I strongly suspect the difficulty in stopping it is withdrawal symptoms. I decided many years ago that I’ll have a serious discussion with psychiatry about going off it once I have some sort of stability in my life, but thinking that might come anytime soon was pretty naïve.
Counseling was what really helped me, once I matured enough to be open to the idea. In particular, the benefit came from just being forced to articulate my thoughts and argue vehemently against whatever piece of advice I am given and then accept that it actually is good advice a couple days later once it has finally sunk in. This is still how therapy works for me, I have not matured one iota.
To answer your question, what recovery feels like is walking out of a therapy session and realizing that the past few months you’ve mostly been spending these sessions shooting the shit and unloading random thoughts and emotions that are not explicitly sad. In my opinion it is worth continuing to go (although maybe with reduced frequency) because depression can return just as silently, and having regular sessions helps maintain stability.
Do people recover? Asking for a friend.
It’s a very slow progress. Like you don’t really notice your shoes wear in and then wear them down. It is weird enjoying things that you’d be too jaded to even consider enjoying before. But it takes time to register that you are actually enjoying something, I had not much context for that.
It’s not instantaneous, like its often portrayed in film (Theoden de-aging in LOTR f.i.) You need to re-learn a lot of things, like someone in a severe accident learning to walk again. Only it’s in your brain. First you need to realize you are not in constant stress anymore and threatened by everything in life all at once.
And then you need to slowly learn to relax all those mental muscles that were all balled up in paroxismic spasms for far too long.
And after a long time of trusting this new norm without getting betrayed by life or significant others you gain the mental state in which you discover that you are enyoing simple things. Those at first only slightly penetrate your walled garden as you are too careful to allow deep feelings to sway you (as deep feelings have betrayed you before). But step by step you are amazed by tiny, almost insighnificant things that bring joy to your soul.
Thats’s where I am at. I am both overjoyed at feeling things and so sorry for my former self for being in that locked-in state. But I am grateful for the experience and proud of the fact I persevered and not given in to suicidal thoughts. I am really happy at my current state of being even though every once in a while, like a craving for cigarettes I gave up a couple of years ago, I am drawn into a short burst of ‘appèl du vide (call of the void)’ where I imagine things unraveling again.
It’s not an easy road and I certainly needed the support of others. But the most important currency is trust. Trusting yourself, trusting your friends/significant others. And most likely you will never see as much support as someone in rehabilitation over drunkenly crashing their car into a tree, as the wounds are not visible. But it is worth it at some point you will realize how big of a handicap depression actually is and it’s such a free feeling not to be tied down by it anymore.
I’ve been diagnosed with depression twice now and I’ve been on Sertraline/Zoloft both times, smallest 50mg/day dose.for about 6 months each time. Towards the end of it I had clear signs that I got better.
Main two observations:
- I no longer got angry or frustrated. This was especially noticeable when I was looking after a 1 year old and then 3 year old on the second time. Specifically when the little one screamed irrationally.
- Good days Vs bad days. Before starting the meds I think I had no good days for 3 months or so. Even when I did fun things or family days out. I wasn’t able to enjoy the good parts of life. After meds for a few weeks. I started to have good days, and then more and more of them. I still don’t have all good days but there are definitely more than when I had no meds
Anyways it was a slow and gradual progress for me and never that obvious in the moment, but upon reflection over the last few weeks it was usually visible.
Hope you manage to get better!
Short answer to your precise question, for while you’re transitioning to a new treatment:
What triggers for you a strong, negative emotion, every time you’re exposed to it? I knew I was recovering when they stopped hitting the same way. In my case, I was extremely sensitive to my friendships and was ultra-tuned towards any suggestion they were growing distant from me. A late reply to a text (bad), or two friends hanging out without me (devastating) really hurt. I knew something was up once those stopped bothering me so much.
Longer ‘answer’ detailing my whole experience:
Since I was a young child I was always unhappy, worried, etc. Suicidal ideation started in my early teens. In my late 20s, at the start of the pandemic when I was unemployed, living alone, and friends I had made in grad school were all ditching town to quarantine with their families, I was in an emotional crisis and I had real doubts I’d survive. I sought out treatment again (attempts years earlier failed for BS non-medical reasons, not worth getting into). I was initially prescribed with bupropion, which while it tends to be a good first choice for many people, in my case it enhanced my negative emotions. That was very, very bad. I was quickly switched to venlafaxine (FYI while it has terrible side-effects when getting onto it they usually resolve after a couple of months).
Anyway, after a few months of being on it / some dose increases every few weeks from the initial low dose, I started to feel better. I stopped craving the endorphins I’d feel from the extreme emotions of suicidal ideation, and I stopped overreacting to negative events / perceived slights from friends (say friends A & B played golf together and didn’t invite me, even though they know I hate golf and maybe just wanted their own 1:1 hang). This is sounding like “he stopped feeling anything”, but once the stress & anxiety & rehashing of the bad parts of my childhood disappeared, there was finally room for me to become the person I had always wanted to be (goofy, care-free, smiling, relaxed). The depression & anxiety didn’t fade into numbness, it got replaced with happiness. I can honestly say I feel happy a majority of the time and I’m one of the happiest people I know; I recognize bad events but they just don’t affect my baseline all that much. It’s like - if depression is always feeling bad, and while good events momentarily help they don’t last, then I have “anti-depression”. This whole process probably took about a year.
With the supervision of my doctor I am in the process of getting off venlafaxine. There’s nothing wrong with staying on it forever if need be, but some of the newer theories of how these drugs work suggest that your brain grows new neural circuitry as it adapts to the drug, and it’s the new circuitry that actually helps. If that’s true, then once the new circuitry is grown the drug isn’t actually needed anymore. We’ve been slowly decreasing my dose, monitoring my mood, and so far I’m still feeling great. I’m now on the lowest dose, and if things continue as they have then I won’t need a refill in 2 months.
Every time I share my experience I want to clarify a few things:
- For those who may get onto venlafaxine - it’s terrible side effects should fade over time. I almost quit taking it at first but I’m glad I continued.
- Some medications work for some people and not for others, while others work for them but not for the first group. Probably depression & anxiety are just symptoms of different afflictions. We can see the common symptoms but we don’t know which affliction causes it, but each affliction needs its own treatment. As a result the best you can do is keep trying treatments until you find one that works for your affliction; there are so many out there that there’s probably one for you.
- Related to the above, but therapy may help. It wasn’t super effective for me but it didn’t hurt either, but depending on the underlying cause you may have better luck with it.
- I’m going off venlafaxine because whatever underlying cause of my symptoms appears to have been permanently cured. That won’t be true for everyone - some diseases require ongoing medication to treat. Don’t go off your medication without your doctor’s supervision & approval; you’ll need your mood monitored to ensure it doesn’t worsen and some of these medications should never be abruptly stopped.
- One of my biggest regrets was not pushing harder earlier in my life for treatment. While my baseline is happy, I do get pissed thinking about how much I unnecessarily suffered and that I didn’t get to enjoy most of my 20s. If a reader (yes, you) are chronically unhappy and unsure whether to get treatment, just go for it.
Manic heh
It’s a slow process. Look at the contrast between how you are currently feeling versus how you were at your lowest and realize the progress that you’ve made.
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Before I was diagnosed, I tried the Zoloft my brother wasn’t taking, and that kinda put me in a numb cloud. I dealt with things better but it smashed down the good stuff too much so I gave up on that.
Tried a girlfriend’s free sample pack of something that wasn’t working for her, and that worked pretty well. Just leveled me out. It was harder for me to get frustrated and angry, and I just had a better baseline feeling. That was fairly early internet, so we had no clue what the pills were, so when they were gone, they were gone.
I don’t know how much any of that would have helped because I was still around my family, which was the prime source of my depression.
About 9 years ago, I hit a low point in life and decided to deal with this in an appropriate manner after realizing I’ve had depression for about 20+ years. Doc gave me Lexapro and said it would take 2 weeks or so to kick in.
I swear the next day I felt like a new person. The doctor said it doesn’t work that way, but I felt what I felt. Maybe I was just bone dry on serotonin and just a little bit was a shock to the system, who knows.
It didn’t make anything better, I want to be very clear on that. Before the pills, my insides were like a sponge. Anything that happened to me would soak in and get held onto. Bad stuff from my past, my own self esteem issues, any perceived slight someone gave me, whatever, it was all soak into my head and stay there until I blew up or panic attacked, etc.
What happened with medicine is now like I had an emotional raincoat. Most of that stuff would still hit me, but it would run off instead of soak in. The intrusive thoughts were there, my stressors were still there. But I could deal with them as they came up. I wasn’t still trying to get out from under a pile of them every time another hit me.
I could still get sad or depressed for no reason, but it felt like something I could handle instead of that being the only thing I could be. And that got better with time.
This year, I’ve been having problems again so I’m going to need to check in soon to discuss if I need to change something. I’ve been feeling slightly depression more often, I’m low on energy, and I’m losing interest in a lot of things I enjoy. There’s no real new stressors I’m aware of, so I’m not sure what’s going on.
I feel I’ve had a luckier time than many with medication, but even so, it isn’t a silver bullet, it’s still a chronic condition. Working meds just get you to the same starting line as “normal people” for you to deal with your day. You’re still running the same obstacle course every day, but you’re not starting way behind. Hope that was some help.