Post by Amtram on Apr 10, 2014 11:39:52 GMT -5
I have had Major Depressive Disorder for more than 15 years now. I'd always been a little depressed, but it reached a point where I could not function without medications back in the late 90s. I was doing pretty well on 60mg of Cymbalta and 30mg of Adderall XR, but then I had brain surgery. The way I look at it, what's happening to my brain right now is akin to what happens to your foot after it's fallen asleep and you take the pressure off. Just not as painful, physically, and much more prolonged. The pain part is the depression kicking in, big-time, and just as it takes a while for circulation to return to your foot, my brain is constantly changing as the "circulation" returns and synapses rearrange themselves.
What this has meant to me is that a lot of symptoms of depression and anxiety that were manageable with medications back while my brain was being smooshed are now much more intense, and medications are either not working or exacerbating them. My old regimen made me so anxious that I was physically impaired, so we've been trying new stuff for about 9 months - and I'm on antidepressant number three, soon to be changed out because it isn't working, either.
What I've learned over all this time from my own experience, other people's experiences, and obsessively perusing the research, is that it really is of utmost importance that you get your depression under control first, because it's key to your coping ability and to determining what medications to add to handle other symptoms.
Finding the right antidepressant is tricky and time-consuming. Each one targets neurotransmitters differently, even if they're inhibiting the reuptake of specific neurotransmitters. Only a couple work only on serotonin; most have intended or auxiliary effects on norepinephrine and/or dopamine, and the balance of effect is different in each one. Some are targeted in such a way that they work on a specific type of receptor - there are several for each chemical. All SSRIs are not created equal, and you can't just change them and expect the same results.
Further, you won't know whether or not the medication is right for you until several weeks after you start taking it. There are some that will start making a difference after only a couple of weeks, but most don't reach stability for 6-8 weeks. If you go for two months only to find that the medication isn't right for you, then you need to take another period of several weeks to decrease the dose (because discontinuing these meds has to be done slowly to lessen the unpleasant side effects of withdrawing) and then give the next med another couple of months to kick in.
Stimulant medications for ADHD, OTOH, start working immediately. You can discontinue them immediately if they have adverse effects. In addition, there are some patterns behind what stimulant might work for you based on your response to the antidepressants, and which stimulants tend to complement which antidepressants, so the decision of which stimulant to prescribe involves much less guesswork if an effective antidepressant has already been found. In fact, if you're already using a stimulant and then add an antidepressant, they might negatively affect one another. For example, your stimulant might start making you anxious if you add a particular antidepressant, or it might stop working on improving your focus. And you might not realize it until several weeks have passed.
So you fix the problem that has the most complex and nuanced pharmaceutical treatment first.
The other nice thing about getting your depression under control is that it automatically lowers your anxiety and makes it a little easier to emotionally cope with your ADHD symptoms. Some lucky souls will even find that fixing the depression removes the need to medically handle the ADHD.
And I can tell you right now from where I am with my depression and where I've been when meds are working - the difference in your quality of life on the appropriate antidepressant is so significant that you should never give up until you find it.
What this has meant to me is that a lot of symptoms of depression and anxiety that were manageable with medications back while my brain was being smooshed are now much more intense, and medications are either not working or exacerbating them. My old regimen made me so anxious that I was physically impaired, so we've been trying new stuff for about 9 months - and I'm on antidepressant number three, soon to be changed out because it isn't working, either.
What I've learned over all this time from my own experience, other people's experiences, and obsessively perusing the research, is that it really is of utmost importance that you get your depression under control first, because it's key to your coping ability and to determining what medications to add to handle other symptoms.
Finding the right antidepressant is tricky and time-consuming. Each one targets neurotransmitters differently, even if they're inhibiting the reuptake of specific neurotransmitters. Only a couple work only on serotonin; most have intended or auxiliary effects on norepinephrine and/or dopamine, and the balance of effect is different in each one. Some are targeted in such a way that they work on a specific type of receptor - there are several for each chemical. All SSRIs are not created equal, and you can't just change them and expect the same results.
Further, you won't know whether or not the medication is right for you until several weeks after you start taking it. There are some that will start making a difference after only a couple of weeks, but most don't reach stability for 6-8 weeks. If you go for two months only to find that the medication isn't right for you, then you need to take another period of several weeks to decrease the dose (because discontinuing these meds has to be done slowly to lessen the unpleasant side effects of withdrawing) and then give the next med another couple of months to kick in.
Stimulant medications for ADHD, OTOH, start working immediately. You can discontinue them immediately if they have adverse effects. In addition, there are some patterns behind what stimulant might work for you based on your response to the antidepressants, and which stimulants tend to complement which antidepressants, so the decision of which stimulant to prescribe involves much less guesswork if an effective antidepressant has already been found. In fact, if you're already using a stimulant and then add an antidepressant, they might negatively affect one another. For example, your stimulant might start making you anxious if you add a particular antidepressant, or it might stop working on improving your focus. And you might not realize it until several weeks have passed.
So you fix the problem that has the most complex and nuanced pharmaceutical treatment first.
The other nice thing about getting your depression under control is that it automatically lowers your anxiety and makes it a little easier to emotionally cope with your ADHD symptoms. Some lucky souls will even find that fixing the depression removes the need to medically handle the ADHD.
And I can tell you right now from where I am with my depression and where I've been when meds are working - the difference in your quality of life on the appropriate antidepressant is so significant that you should never give up until you find it.