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  • Q&A with Australian Health Practitioners

    Are depression medications addictive?

    Related Topics
    Depression Mental Health
    I have been prescribed anti depression medication and, being a first timer, I am nervous about taking it. There seems to be many and varied experiences from this particular medication (Pristiq) and I am nervous about this. I am also nervous about coming off of this medication. I don't want to be dependant on medication for the rest of my life and I hear too often that this can become a cycle. I am also getting professional support from a psychologist and hoping that this will ultimately get me better (with a lot of work). I see the medication as a short term solution until ‘therapy’ really kicks in. Am I naive to think this? I am open to do whatever I need but being medicated from here on in is not what I would like to happen ultimately. Is there much of a comedown from AD medication and how is this managed. I realise everyone is different so response is expected to be generally speaking.
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    Grant Dempsey

    Counsellor

    With a passion to see people move forward and break free from the barriers holding them back, Grant is a highly experienced counsellor with over … View Profile

    I'm not a GP so I won't answer specifically re the medication but I will tell you what I've seen with some of my clients.

    You are depressed for a reason and the medication won't solve that, it will however enable you to cope with your activities of daily living and put you in a better space to attack the cause of your depression with the help of a counsellor or psychologist. Unfortunately what I've seen happen is;

    • people see a Psychologist/Counsellor because they are struggling,
    • they see their GP and get prescribed medication,
    • with the medication they feel better so they stop seeing their Psychologist.
    • Inevitably things get worse and they go back to their GP and up the dosage.
    Once you are in this cycle getting off the meds becomes much harder. Therefore my suggestion is keep seeing your Psychologist, even if you are feeling better. Only stop when
    • you can identify the cause of your depression,
    • can clearly recognise the signs when it is coming on,
    • have strategies and support in place to overcome the depression, and
    • have utilised those strategies on several occasions and proven they work. 
    I have had clients attend weekly for 4 weeks, then fortnightly, then monthly, then 3 monthly, 6 monthly and so on. In my opinion there are usually some deep underlying emotional issues linked to depression and you need good cognitive strategies to fight the initial battles and get back on you feet but you need to deal with those emotional issues to win the war otherwise you never really free yourself from it.

    Keep seeing your Psyc and good luck.

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    Dr Simon Easterbrook-Smith

    Health Professional

    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    Writing as a non-clinical health professional, Pristiq is very similar in its pharmacological mode of action to the anti-depressant (Efexor) that I am on – they are both serotonin-norepinephrine reuptake inhibitors.
     
    The advice from my psychiatrist is that if we ever decide that I should come off it, that should be a very slow process. Rapid discontinuation can have very unpleasant side-effects, as “anonymous” has described above.
     
    If you and your mental health care team decide that that you should discontinue Pristiq, it is something to be done slowly with very close supervision (my psychiatrist told me that if we decide that I should discontinue Efexor, it would be best if I spent some time as a voluntary patient in a private psychiatric hospital so I can be carefully watched).

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    Dr Simon Easterbrook-Smith

    Health Professional

    My research interests include immunology and the mechanisms of amyloid formation. The latter has implications for people who are dealing with Alzheimer's Disease, Parkinson's Disease … View Profile

    Anonymous, I think that you have made some good points.

    My take on them, based on conversations with my psychiatrist and clinical psychologist, my reading and thinking as well as experience gained through being an administrator of a world-wide forum which supports people who live with mental illness, is that how helpful medication may be for people with Major Depressive Disorder and/or Generalised Anxiety Disorder depends on how severe the illness is.

    For people who are assessed in the mild-moderate range, often non-pharmaceutical therapy (for example, Cognitive Behavioural Therapy or Acceptance and Commitment Therapy (which a clinical psychologist can provide)) is often sufficient. For others (like me) who have been assessed at the severe end of the range psych meds are often indicated.

    I agree with you that everybody responds differently to anti-depressants. Matching the “right” one to the “right” person is an art, not a science. Also, anti-depressants usually take time (months) to kick in fully. On the mental health forum that I administer this is called, with typical black humour, “being on the medi-go-round”.

    One-line summary: for those reading this topic - if an anti-depressant is not helping after a month or so, go back to your prescribing doctor and discuss the option of one with different pharmacology with him/her.

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    Anonymous

    Thanks Dr. Easterbrook-Smith. I not sure how exactly it was put to me, but basically if someone hits rock bottom 3 times, my psychiatrist says they'll likely need medication and therapy for life. He figures I hit that point decades ago. I'd gotten pretty good at hiding the symptoms. It had become second nature to just suck it up and keep moving forward. When my physical health became an issue, it was the final straw for me. The medication doesn't solve my problems, but it makes a big difference in how I'm able to cope with them. My father was a perfectionist and it rubbed off on me. I felt tremendous guilt for every bad decision I've ever made. Mostly my therapy has been to assure me that I did have legitimate problems, I'm not crazy for feeling the way I do, and I can learn to change my perspective. The hardest lesson is learning to forgive myself, not that I've done anything so terrible, just normal human mistakes. It was a 3 year process to find the right psychiatrist and medication once I realised that I needed help, but well worth it in the long run. I wouldn't be here today without both. Hopefully this person finds what works much quicker than I did and it's only needed in the short term.

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