Tag Archives: depression

Straight talk about antidepressants

19 Apr

Women with PCOS have a higher rate of depression than the rest of the population. (And, according to the National Institute of Mental Health, 6.7% of adults suffer depression in a given year–that’s a huge proportion!) I have talked about how to identify depression and how to manage it, but I haven’t talked about antidepressants specifically.

Most people who suffer depression over a long period of time will consider antidepressants, even though some people still feel uncomfortable about taking these kinds of drugs. They can help a lot. But it’s important to know what you’re getting; there can be side effects and withdrawal problems, too.

Personally, I’ve tried a number of different antidepressants. Some were awful for me; some worked well. I’m not going to discuss which ones might be best for you, beyond a couple of general statements, because one of the biggest challenges for doctors who treat depression is that every sufferer responds to these drugs differently.

I am discussing newer types of antidepressants–SSRIs, NDRIs, and SNRIs–because these are the drugs of choice today. There are some others, but chances are that your doctor will consider these first. Most of the drugs you hear about (Prozac, Zoloft, Paxil, Effexor, Wellbutrin, Lexapro, etc.) fall into these categories. Tricyclic antidepressants and MAOIs are not used very often because of the higher likelihood of serious or dangerous side effects.

1. These drugs are life-saving and medically useful. If you are resisting trying them, even though you’re miserable, because you think you should be able to “just snap out of it,” or because you think that antidepressants are for wimps, rethink it. At least consider it. There are good reasons that some people may not want to take them, but this particular reason is silly.

2. Be aware that the first one you try may not help you. Finding the right medication for you takes trial and error. Work with your doctor and be prepared for the possibility that it will take time.

3. In a related vein, don’t expect these medications to help overnight. It can take up to six or even eight weeks to feel better, in some cases. (Some people do see a lot of improvement very quickly. It varies.)

4. Take them conscientiously. These are not drugs that you want to take “when you need them” or forget to take. A missed dose now and then is not a crisis, but they really do work best–and have the fewest side effects–when you take them every day, exactly as directed.

5. Antidepressants can also be extremely helpful for anxiety problems or make anxiety worse. Again, it varies. Be aware that if you suffer anxiety as well, you may have to adjust your medication based on that.

6. Tell your doctor about ANYTHING else that you take–other prescription drugs, over-the-counter drugs, supplements.

Some common side effects of antidepressants include:
* drowsiness
* dry mouth
* nervousness, anxiety
* insomnia or hypersomnia (that is, too much or too little sleeping)
* decreased or increased appetite
* weight gain (this is long-term–not immediate–but it’s a big problem for some women and something to remember if you already struggle with your weight because of PCOS symptoms)
* sexual dysfunction, including anorgasmia (aka the inability to have an orgasm)

In some cases, if you can ride it out for a week or two, the side effects will go away. In other cases, not. In particular, weight gain and sexual dysfunction tend to be the ones that cause long-term problems. If the side effects are untenable, don’t give up. A different drug might be better for you. Wellbutrin might be something to ask about; for most people, it actually produces a small increase in libido, and it doesn’t contribute to weight gain (indeed, some people find it easier to control their weight or lose weight while they’re taking Wellbutrin). Some people also take Wellbutrin with their other antidepressant to help ameliorate the side effects.

When you stop taking an antidepressant, you can suffer symptoms. (People sometimes call these “withdrawals” but the technical term is “discontinuation”–that’s because these drugs are not addictive in the sense that animals–or people–given free access to them are not driven to take them. They do, however, cause symptoms when you stop taking them.)

These symptoms can be very, very unpleasant, although not everyone experiences them. The most notorious antidepressant for causing these symptoms is Effexor (and I can attest that it can be extremely unpleasant indeed to stop taking it!), but any of them can cause these problems:
* depression
* irritability or agitation
* aggressiveness
* dizziness
* sensory disturbances (e.g., paresthesias such as electric shock sensations–a lot of sufferers call these “brain zaps,” and all I can say is, if you experience them, you’ll recognize the description)
* anxiety
* confusion
* headache
* lethargy
* nausea
* vertigo
* bizarre and vivid dreams
* seizures (rare)

Some of the specifics here depend on your specific drug. The half-life of your medication (that is, how long it stays in your body) affects the severity and duration of the symptoms. If you are on a med that has a short half-life, you may see these more quickly and they may be worse. (Effexor, which has a very short half-life, can produce these symptoms even if you miss a dose.) It is a good idea to cut your dose down gradually, as your doctor directs. Some doctors also prescribe Prozac, which has a long half-life, while you are discontinuing your other medication. Sometimes taking a short course of Prozac can make the symptoms less severe.

Antidepressants may be very useful to you. While the big lists of scary side effects can be intimidating, these drugs have changed the lives of a lot of depression sufferers. The most important thing is that you have a good care provider: one who listens to you, will help you tweak your regimen, and has a lot of experience dealing with antidepressants. I recommend, if you can, that you visit a psychiatrist. They do nothing but psychiatric medication management (mostly–a few of them also provide therapy), and they’re very good at it. If you can find a doctor who knows a lot about these drugs, it will make the process a lot easier and you might see some excellent results.

1. If you are pregnant, breastfeeding, or planning to get pregnant, be sure to discuss this with your doctor. There is considerable evidence that the advantage of treating depression in a pregnant or nursing mother may outweigh the risks, but it should be an educated decision–and there are some drugs that are much better-tested in pregnancy than others.

2. If your medication tells you not to drink alcohol, don’t. Talk to your doctor if you want more information. I have a glass of wine often even though I take Wellbutrin, but I would not drink more than one drink while I’m taking it. It’s very important because alcohol can affect you more when you’re on an antidepressant, which means both that you may end up more intoxicated than you had planned or expected, and that any side effects of your medication may get worse. Plus, in a more general sense, alcohol is a depressant, which is not what you want if you suffer from depression!

3. Sometimes, an antidepressant that works well for you might stop working. This just happens occasionally. For example, I found that after my pregnancy, when I went back to my old antidepressant, it no longer worked well for me. That can happen even if you don’t stop taking it or have an obvious physical change such as pregnancy and birth. If it happens to you, don’t panic–talk to your doctor, and try something else.


depression, revisited

25 Sep

Autumn is here (officially, as of Wednesday), and with it, for some of us, its unwelcome pal–seasonal affective disorder, or SAD. For some sufferers, the spring and summer are fine and the fall and winter are plagued by depression; for others, depression is a year-round struggle that intensifies as the days shorten.

As you start thinking about preparing for the holidays and planning your Halloween costume, if you are prone to autumn and winter depression, you might want to think about preparing for that, too. Things you can do right now to improve your mood all year:

* Exercise. I’ve said it before, and I’ll say it again: exercise is the #1 most effective antidepressant I’ve ever heard of or experienced. It works for almost everyone, almost every time. The reason it’s not the first-line treatment is that it’s hard! And when you’re depressed, it’s much harder than usual. I know, firsthand, how hard it is to get into an exercise routine and how easy it is to slip back out of it. So let this serve as your reminder to get out there and take a walk, hit the gym, do some yoga or push-ups or whatever. (I’ll even try to join you–my dissertation has taken over my exercise regime and I am ready to recommit!)

* Get your sunshine and vitamin D. Yes, I said “and”–although I’m no doctor and I’m not going to tell YOU what to do, I am taking vitamin D supplements as well as trying to get out in the sunshine every day even if I only have ten minutes. One bonus for the fair-skinned among us: as winter approaches, it’s harder to get sunburned because the angle of the light changes.

* Be vigilant about tracking your mood. Be prepared for a slide by keeping yourself aware of your own mood. It is distressingly easy not to even realize that depression is affecting you, until it’s really bad. If you keep a journal, jot down how you felt each day; if not, consider doing a daily “check-in” to ask yourself how you’re doing. No one else is going to care about you as much as you do (except maybe your spouse), so you need to keep track of your own mood status.

* Enjoy the things that are great about fall. Even though I find it difficult when the days get shorter and the sunlight gets scarce, there are some definite high points about the autumn. Crisp air, beautiful trees, Honeycrisp apples–appreciate them while they’re here!

seven steps to help you deal with anxiety

29 Jun

If you have anxiety, there are many options open to you to improve your life! Here are my recommendations for the first things you might try.

1) Make sure it’s anxiety.
See your doctor to rule out the possibility that your symptoms are caused by something else. Some of the manifestations of anxiety are very similar to other health problems, and a physical is a good idea. Take a list of your symptoms to the appointment, and tell the doctor that you think it may be an anxiety problem but that you’d like some help differentiating between that and some other health problem.

2) Write down your experiences.
If you and your doctor think that anxiety is the problem, the next thing I recommend is a bit complicated, but worth it: keep a journal for a week that records your symptoms with the date, time, and any comments you have. Use the journal to record, as well, the following things: how much sleep did you get? How much exercise? What did you eat and drink? Did you have any major stressful events?

3) Look for patterns.
Once you have a week’s worth of observations to examine, sit down with your journal and look for patterns. Are you very tense on days when you haven’t gotten enough sleep? Do you have a panic attack before every big work meeting? These correlations can help you find the best treatments for you.

4) Evaluate your lifestyle. Things that can reduce anxiety include getting enough sleep (easier said than done for many of us); getting plenty of exercise (also great for fighting depression); cutting out caffeine; and reducing your intake of sugar and other simple carbs. You will have to decide which of these changes you are willing and able to make. It is not always feasible to overhaul everything in your lifestyle, especially all at once. But making a few changes (such as switching to decaf coffee or iced tea, adding a walk to your lunchtime routine, or doing a bit of gardening every night for exercise and relaxation) can help, too. It isn’t all or nothing.

5) Learn a few simple relaxation techniques
. Deep breathing can help, and it’s easy to learn. Anxieties.com has excellent information about this, so I won’t try to reinvent the wheel by listing them here–but deep breathing, muscle relaxation, and other techniques can help a lot, even if it doesn’t seem likely to you right now. Give it a try and see if it helps you!

6) Counseling can also be useful. Depending on what your brain is saying to you when you’re feeling anxious, learning different kinds of self-talk can help a lot. Cognitive-behavioral therapy, or CBT, is great for this. You also might find that counseling can help you resolve whatever issue is causing you the stress in the first place (a problematic relationship, a bad work situation…whatever it is that’s leading you to feel so anxious, if you suspect that your anxiety is situational).

7) Finally, medication can help. There are two basic ways of medicating anxiety. Some people do both.

The first is the use of antidepressant medication, which often also has an anti-anxiety effect. You may have to try several before you find one that works for you, and because it takes a while to see results, this period can be frustrating. Popular choices for medicating anxiety include Zoloft, Lexapro, and Paxil; some other antidepressants, such as Wellbutrin, are less likely to help with anxiety. That said, Wellbutrin is what I take and it does help me a lot, so patients vary in this respect!

The second class of medications for this problem is the benzodiazepines. (Some of the newer drugs in this group are not actually benzos; however, I’m not quite sure what else to call them.) These include Xanax, Klonopin, Valium. There are definite up sides to using these drugs: they have measurable, quick, and reliable effects on anxiety. Most people who take them will see a reduction in anxiety. These effects take only a half an hour to an hour to appear. There are also some down sides, though–notably the fact that they can be habit-forming and that they can be too sedating, leading to excessive sleepiness, uncoordination, and inability to focus. (Some people take them at night to help initiate sleep, which cuts back on the sleepiness problem, but may exacerbate the addiction problem.)

Benzodiazepines can also be dangerous when combined with alcohol or other prescription drugs (including painkillers and sleeping pills). Be sure that your doctor knows everything else that you are taking, and avoid alcohol when you’re using them (or at least limit it to minimal amounts).

Many studies have shown that benzos lose their effectiveness when used routinely.

The bottom line on anti-anxiety medications is that antidepressants are safer; these can be excellent choices. It takes some time for these medications to work, though. In my opinion, there are some situations where benzodiazepines are very useful: to have on hand for major stressful events that exacerbate your anxiety disorder; to use when needed until your antidepressants start to kick in; or to help augment your antidepressants during a panic attack if you have occasional panic attacks. I do not think that taking them daily is a good idea–if nothing else, they will lose effectiveness over time, and then you won’t have that in your toolkit in case you have a major anxiety-causing event.

some notes about birth control pills as PCOS treatment

2 Jun

One of the first lines of treatment for PCOS for women who are NOT trying to get pregnant [and for a few who are] is usually hormonal contraceptives. This has the superficial result of regulating your period, though it doesn’t actually improve your cycle in a meaningful way; you have an artificially-induced period, called a “withdrawal bleed,” when you switch to the week of placebo or iron pills in your pack. [In this post, I am discussing “birth control pills”–but this info applies also to the NuvaRing and the birth control patch.]

There are benefits to this for some women:

1) Obviously, it is more convenient to have a regular period instead of the erratic cycles or spotting that some PCOS ladies get.

2) Birth control pills can also improve bone density if you are otherwise not having cycles [estrogen is important for bone density, and most birth control pills provide it].

3) They also reduce testosterone, which can, in some cases, reduce other symptoms of PCOS–hirsutism [that would be the unwanted hair] and acne. If this is important to you, you might ask your doctor about Yaz, which also contains drospirinone, a drug that can help with those problems.

4) Some women find that hormonal birth control reduces PMS.

5) Having a period can decrease your risk of endometrial problems, including endometriosis, which can be painful and may reduce fertility.

6) Birth control pills can also increase fertility–yes, INCREASE. They are sometimes used as part of a program for treating infertility, as especially the first month after you stop using them, you may experience increased fertility. If your doctor recommends this line of treatment, there is probably more benefit to using them than there is reason to avoid them.

That said, there are also some compelling reasons to avoid hormonal birth control as a first-line treatment for PCOS. They carry risks: not just the standard “increased risk of stroke and blood clots” and less-serious side effects such as nausea or headache, which you always hear about and will see on the monograph that accompanies your prescription, but also the possibility of weight gain, which can make PCOS worse.

In addition–and this is my completely non-medical opinion–using hormonal contraceptives falsely regulates your cycle, which means that it masks one of the most significant measures of your health. At least for me, my menstrual cycle is a sort of litmus test for how well my lifestyle is working to control PCOS. When I eat well and exercise, my cycle is quite regular. If I don’t–well, my body will remind me, through irregular cycles, that it needs better care. This is a valuable way that my body reflects the success or failure of management, and I don’t want to obscure it. It would be a bit like taking ibuprofen every day because you have been prone to headaches: you wouldn’t know whether the headache was still there if you took it every time your dose was up! I would rather commit to treatments that are really treating my insulin resistance problem.

Finally–and let me emphasize that this is only my experience and that many women have excellent experiences with birth control pills–I no longer use hormonal contraceptives because they contribute a great deal to the depression that I have always suffered. Depression and anxiety are common adjuncts to PCOS. If you suffer either of these disorders, it’s important that you track your response to ANY drug you take, including contraceptives, to see whether they contribute to your problem. For me, it’s not worth it.

One final note about hormonal contraceptives AS contraceptives: I had a great experience with NuvaRing and used it for years, and I felt good while I was using it; however, I also got pregnant while I was using it. My doctor at the time said that women with PCOS often seem to have failures of hormonal contraceptives; in retrospect, I believe this to be true because many women with PCOS are overweight, and women over about 150-175 pounds in weight have decreased rates of effectiveness with hormonal birth control. Food for thought, eh?

depression, part 2: seeking treatment

16 May

PCOS is associated with elevated risk for depression, anxiety, and possibly other psychiatric disorders as well. Maybe it’s hormonal; maybe it’s just the situational result of some of the issues that accompany PCOS, such as infertility and body image problems. Either way, the correlation is real!

So, how do you know if you are depressed? You may not feel “sad,” which is what sometimes springs to mind when you hear the word “depression.” Instead, you may:
* feel aimless or empty
* overeat or lose your appetite
* sleep too much or too little; suffer insomnia
* feel like everything takes too much effort
* stop enjoying things that used to bring you pleasure [a condition called “anhedonia”]
* be crabby or have mood swings
* lose patience easily
* cry frequently
* feel angry often

All of these can be symptoms of depression. Whether they indicate depression or just the normal vicissitudes of life is a matter of degree. Ask yourself whether these things interfere with your life or relationships. If yes, it’s worth seeing a therapist or doctor.

It’s easy to say this, but it’s often hard to do for a number of reasons. Does any of the following things sound like YOUR excuse?

1. “I’m too busy.” If you’re really suffering depression, the time you spend will be more than made up by the time you stop wasting when you feel better. You don’t have time? Then why do you waste so much time on the internet reading my blog? [I’m kidding, but only sort of: most of us waste so much time that an hour a week is like a drop in the bucket.]

2. “I can’t afford it.” This, unfortunately, is often true for many people–at least, as long as therapy is not a priority for them. If you have health insurance, check and see: you may find that therapy is partially or totally covered, especially now that there are laws in place in some states to require parity of coverage between mental and physical health. You might only have to pay a co-pay, as for a doctor’s visit. If you are uninsured or if your insurance doesn’t cover it, call around: there are many therapists and clinics that provide care with prices that are on a sliding scale depending on your income. If you are religious, check with your church or place of worship–many of them provide free or inexpensive counseling.

If all else fails, you can always talk to your primary care doctor. Sometimes a psychiatrist is covered even if a therapist is not, and if you are interested in trying medication, your primary care doc can prescribe that. It is best [in my opinion] to see a specialist, because antidepressants are such tricky drugs to get right, but it’s by no means required.

The bottom line: therapy does cost money. The amount varies, depending on your situation, but it does cost money. But if you ask yourself, what else would I buy with this money, and your answer is “something I can live without,” then you can afford it. And you should.

3. “I feel stupid talking about my problems.” First of all, your problems are not stupid, and your doctor is not going to think that they are. But beyond that, you don’t have to go into a therapist’s office and describe your childhood traumas [unless that is relevant for you]. Those stereotypes about therapy are not what most counseling is immediately or primarily about. Rather, a counselor can help you figure out how to change your approach to a challenging life situation, rewrite the scripts that your brain runs daily without you thinking about them, or reshape your relationship with food, alcohol, or other destructive elements in your life.

4. “I don’t need it.” Do you not need it? Or do you not want to do the work required? Be honest with yourself.

5. “I don’t know where to find a counselor.” This can also be challenging, but it’s definitely doable! If you are working with insurance, you can get a list of the counselors in your area who take your plan, and then narrow down by availability. If you have more than one choice, ask if you can meet once for a consultation and see whether that therapist has a good vibe for you. If you’re uninsured, you have more choices, and you can call around and ask a few questions of the practice to get a feel for which one you want to try. For many PCOS ladies, food is a central problem, and it’s not a bad idea to look for a therapist with some experience with eating disorders.

The big issue is that you do SOMEthing. There is no right first step toward treating depression, aside from no step at all. It is a lifelong journey. I have only recently come to terms with the fact that I will probably never be cured, per se; I am just managing and living with this disease, and I hope that I will get better at it over time.

There will be more on living with this and managing it in a future post, as well as information about anxiety.

depression: part 1

7 Jan

PCOS is often associated with depression. But the fact that we are predisposed to depression for biological reasons does NOT mean that we are doomed to it! It doesn’t even always mean that PCOS sufferers need antidepressants, although I do take them. Today, I want to talk about a good first step toward controlling depression, for almost everybody: exercise.

Obviously, exercise is good for us on a number of levels. Its health benefits are undisputed. But even if you only exercise a little, it can help a lot with depression. You don’t have to be out there sweating up a storm to see this benefit (although you will feel even better if you do!).  Even a walk every morning–no matter whether it’s “brisk,” as all of the health magazines seem to specify, or not–will help. My theory on this is that it’s partly the physical activity; partly the sunshine, if you walk outside; and partly just the feeling of doing something good for yourself.  In my own life, because I have a job and two small children and a dissertation to write, a walk or run in the morning is a great source of solitude and a lovely opportunity to take a break from worrying about other people.

I know that, if you are suffering from depression, this sounds unrealistic. It is also really, really hard to do. And I am the last person to argue that it is enough to make you all better. But it’s a great start, and it’s free and good for you in other ways, too. Here are a few tips to help you get started and stick with it.

* If you can, enlist someone to support you and help you. My husband has prodded me out the door any of a number of mornings just by rolling over and mumbling, “Was that alarm for you? Oh, you’re going running, right?”–which is to say, by reinforcing the expectation that I will, indeed, get up and do it. Even if it’s early, and cold, and I don’t like either of those things.

* Log it. Seeing what you’ve accomplished over a month or two is motivating!

* If you’re an early-morning exerciser, get any gear you need ready the night before. I am terrible at this, but it’s such a nice bonus when I wake up and I have a running-ready outfit waiting for me and my iPod charged. I also try to remind myself that if I want to, I can take a lovely hot shower when I get home–a nice reward on those cold mornings.

* Don’t have a nice neighborhood for running/walking in? Neither do I. I live on a busy street with no sidewalks. So I have scoped out my area and I have a park and a scenic cemetery, each within a 5-minute drive. Driving to walk seems counterintuitive, but if it gets you somewhere nice, it’s worth it. I also run on the track at my university some mornings. Less interesting and less attractive, but easy on the joints. Examine your options–there are probably several choices of walking routes near you.

* Be proud of yourself. Even if you’re just taking a casual amble three times a week, that’s time you’re spending to make yourself better in all kinds of ways! Savor those moments and carve out the time you need to create them.

* Finally–last but not least–if this is out of reach for you because of depression, GET TREATMENT. I will have more to say about this in further posts, but it can’t be said often enough: depression is a disease and it CAN be treated. It’s not always easy, because different things work for different people, but most of us can find effective treatments and get relief.