Comment by chasil

Comment by chasil 3 days ago

Every time I have a yearly physical, my GP will ask if I have feelings of depression.

I know this road leads to SSRIs at the very least, so I always reply in the negative.

The parent comment hints to me that this might be a mistake. I do not want to become accustomed to an antidepressant, so perhaps my course of action was correct.

I was measured low on Vitamin D, which I've hopefully corrected, and I haven't always eaten fish regularly. Perhaps I should pay more attention to that.

staticassertion 3 days ago

> I know this road leads to SSRIs at the very least, so I always reply in the negative.

Seems odd. Your doctor can't force you to take anything. If they say "do you want to try X?" just say "No". Not giving your doctor full medical context seems like a mistake - for example, maybe depression would be indicative of another issue, or maybe people who are depressed really shouldn't take a specific medication.

To each their own, and perhaps you have other reasons, but this seems like a less than ideal solution to a very trivial problem if the goal is just to not take an SSRI.

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grep_name 3 days ago

N=1, but last yearly physical my primary care doctor asked me if I ever had anxiety. I said yes, but that I wasn't really interested in treating it outside of lifestyle change. They asked if I wanted a prescription for prozac, without explaining anything about how to does it or titrate up or down or a time frame. I said I wasn't interested again, and that I particularly didn't want to take any medications that you can't just stop taking one day on a whim (a statement she didn't respond to).
She then proceeded to say "well I'll just write you the prescription anyway and you can do your research later and decide to fill it or not".
I was actually shocked by this interaction, and think about it often. She's a regular family doctor with the local hospital system, and this was just a regular checkup. I answered one question with a "yes, but it's manageable and I think I can handle it with lifestyle change" and then said no twice to medication and ended up with a prescription, which I ignored but don't appreciate having on my record, since it's a false indicator for future prescribing physicians.

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- vikingerik 3 days ago
  
  Likely the office was getting a kickback from the supplier for writing that prescription. This is shockingly common in the US. A straight cash payment is prohibited, but it's easy to work around that legally and provide equipment or "compensate" some other expense.
  
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- staticassertion 3 days ago
  
  Crazy. I hear such wild horror stories with doctors. I'd never return to a doctor like that, sorry you had that experience. Still, this feels like a case where the lesson is "get a new doctor" not "lie to one" but I understand that circumstances can make that a pain.
  
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freedomben 3 days ago

Agreed. A friend of mine is a primary care doctor, and it's remarkable how often people come in for depression and after examination and labs it turns out their depression is heavily influenced by other issues, especially low testosterone or hypothyroid. A lot more people have issues with these than most people realize. There have also been people he has seen who were reporting depression, often where nearly every anti-depressant had been tried, where getting treatment for ADHD massively improved their case and was life changing. As much as people like to hate on Adderall nowadays, for people with ADHD it is miraculous.
Getting treatment for "depression" doesn't always mean SSRIs etc. Sometimes it means treating the underlying condition(s) that are having downstream affects. I would suggest everyone gets their Testosterone levels checked among other common things.

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- kmos 3 days ago
  
  I am in that case, low testosterone and hashimoto (hypothyroid), ADHD and big Scolioses. Last weeks I am dealing with insomnias, and had to take pills to sleep and it seems my parasympathic system is in alert mode for years, stress, divorce, ex-kid and older kid, etc.. I stopped SSRI after 21 years for 5 months and its probably causing my insomnias, the brain was not used for missing serotonine and brain don't stop thinking, loop, alert mode.
  I am doing several blood analysis with a functional doctor and lyme may be around or was in the body, and so many other things. I was thinking I had lucky gut, but seems negative..
  I did get my Vit D up to 65 and I seems to be issues with ADH hormone since kid and probably that makes dehydration. It's a fucking nightmare..
  I may only see a testosterone replacement as a solution maybe..
  
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- pixl97 3 days ago
  
  >often where nearly every anti-depressant had been tried, where getting treatment for ADHD
  This is actually a somewhat difficult diagnosis to make, especially when diagnosing adult ADHD without the user documenting and bringing in a well defined log of their behavior (and possibly another person to point out things they don't know about themselves).
  >ADHD is a highly heterogeneous disorder with a significant comorbidity rate.
  Is thing that you read about in literature around it. And even more common than that is the comorbidity of all the above symptoms, that is ADHD and depression + more in autism.
  
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Fischgericht 3 days ago

You really should give some modern SSRI like Escitalopram a chance. It has made my life so much better, and that of a lot of friends, too. The two most common complaints I have heard are:

1.) It's killing my libido 2.) It's too strong

For 1.) - yes, this is a very very common side effect. And it's logical - you simply get "triggered" less. Applies for me, too.

And 2.) is the same that a lot of people fail to understand: Then try a lower dosage!

Unlike most anti-depressants, where you have to constantly increase the dose because your brain just generates more receptors to fight back, SSRIs hardly wear off.

Also, relax about the "become accustomed" part. Should your Serotonin levels be too low, then they are too low. Just think about it like you think about table salt. It would be just as unhealthy to try to "get off" salt.

All of this being said: There are tons of different kinds of root causes for depression. A good rule of thumb is: Are you depressed because bad things happened to you? Then seek psychological therapy, and potentially combine this with medication in case it would be too painful to uncover the dark things. Are you depressed on a regular basis, but can not name any valid logical reason? Then your brain has a chemical problem, so stop treating it like this is an illness, but do what you would do if your car would turn on the "oil warning" lamp. You can not replace oil with therapy or willpower.

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drumdance 3 days ago

There are also SNRIs, which don't have the sexual side effects. I've done mostly SSRIs but in the last few years I've been on an SNRI called Pristiq and it's the best by far.

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somehnguy 3 days ago

YMMV for sure - I was on an SNRI (Cymbalta) for a few months as an attempt to eliminate nerve pain. It all but destroyed my ability to climax both during and for maybe 6 months after getting off of it.
The brain zaps were also hell if I was even like an hour later than usual to take it

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mrguyorama 3 days ago

Why do you think SNRIs wouldn't have sexual side effects? They still inhibit the reuptake of serotonin just like SSRIs. That's the part that causes (certain) sexual side effects.

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