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The question was submitted Thursday, 28 January 2010

Subject: What do anti-Ds actually do?

Hi. I know it's seems a funny question. But I've noticed since going off my old medication (Pristiq) for a few days (to try another one for anxiety also - Cymbalta), it has really affected my mood. Very much. I had a panic attack yesterday, worse than usual, and I feel quite angry at times. I feel like the Anti-D have been masking what I've been really feeling. And where anxiety and panic are concerned, avoidance behaviours aren't helpful.

So I guess I'm wondering if medication is helpful for me. Maybe just a CHANGE would be better. I'm sure it's a question for my Dr. But do Anti-D medications mask real emotions?

I have had a big life change in the past few months, which would be stressful for anyone. Not sure if it's been a big PANIC and I ran away from my life to escape... either way, my life is very difficult at the moment. Need to make new friends, eventually find new work... and it scares me to death. That is what I have to face.

Will Anti-Ds be helpful to me? I want to just be myself, but I find that they make me feel like I'm someone else. I guess I don't know who I am anymore anyway. So much overwhelming mess.

P.S. I am also taking 1 Oxazepam at night.

Thanks for your help.

Answer from DepNet

This is a great question as it addresses some common points of misunderstanding regarding antidepressants.

Firstly antidepressants do not reduce “normal depression” sometimes called “reactive depression”.

They do not reduce depression due to “faulty” thinking (i.e. habitual pessimistic or gloomy thinking).

They do help (often very well) with a particular type of mood change that is primarily caused by chemistry changes in the brain. This type of mood change has certain characteristics which identify it as likely to respond to antidepressants. One of the first tasks for a doctor is to try to assess if someone complaining of depression has the type of depression that might respond to antidepressants or if some other type of therapy might be more helpful.

Sometimes when people complain that antidepressants “mask real emotions” they are experiencing sedation as a side effect and the sedation “reduces” the awareness of emotions. This is an unwanted side effect and not how the drugs work.

Next point: It sounds like you experienced some anxiety (panic) and mood instability a few days after ceasing an antidepressant. This may well have been a “discontinuation effect”. Some people get these especially if they rapidly reduce or cease the dose. You should always discuss problems of this type with your doctor as a matter of urgency rather than assume it is the “underlying problem” re-emerging.

Next….Everything I said about different types of depression (and their treatment) also applies to anxiety. I note you talk about anxiety and panic much more than depression. You also mention the “big life change in the past few months, which would be stressful for anyone” and “my life is very difficult at the moment. Need to make new friends, eventually find new work... and it scares me to death”. These sound like major stressors and you are probably experiencing what people once called “reactive anxiety”. If so this type of anxiety often responds poorly to antidepressants (unless you get the sedative side effects referred to above).

Will antidepressants be helpful to you? I’m afraid that I can’t tell you but a psychiatrist should be able to do a comprehensive assessment of your usual coping skills, your stressors, your other risk factors as well as your responses (or lack of them) to date and give you an outline of your options. I strongly suggest you see someone.

The answer was published on DepNet Wednesday, 3 February 2010