Ssri poop out anxiety

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'My Antidepressant Stopped Working': Do's and Don'ts

If you feel that your antidepressant no longer helps with your depression symptoms, there are a few steps you can take to remedy it.

Sometimes, medications don’t offer the relief they once did. Maybe your body has changed, or your needs are different than they used to be.

Although rare, it’s possible that your antidepressant stops working for you. Working with a healthcare professional can help you develop a new plan that takes your current physical health and life experiences into account.

It’s important, though, that you don’t discontinue or change your antidepressant before discussing the pros and cons with your healthcare team. This could prevent withdrawal symptoms and other unpredictable reactions from stopping your meds.

Although frustrating and upsetting at the moment, there are many ways to get back on track if your antidepressant stopped working.

The effects of your antidepressant can change at some point. This includes feeling it doesn’t work like it used to.

For most people, though, antidepressants continue to be effective for the duration of treatment.

It’s possible to experience “antidepressant poop-out,” more formally known as antidepressant tachyphylaxis. That’s when an antidepressant that once improved your symptoms doesn’t work as well anymore, or at all.

This can be managed by a healthcare professional, though. It’s important that you don’t stop taking the medication.

Drug tolerance refers to the body becoming used to a certain dose, which in turn may lead you to no longer feel its effects. This is a rare occurrence with prescription medications, though.

Researchers aren’t sure why some antidepressants stop working for some people. It may not have to do with the medication itself but rather a new environment or circumstances in your life.

Possible factors that may result in antidepressant tachyphylaxis include:

• Other prescription medications. Prescription meds for any condition may interact with some antidepressants. If you’re taking a new medication, it may make your antidepressant less effective.
• Substance use. Drinking alcohol or using nonprescription drugs can impact your mood, even if you’re taking your prescription as directed. Substance and alcohol use can make it harder for the antidepressant to work.
• Pregnancy. Your body goes through many changes during pregnancy. Some of them may change the effectiveness of your medication. Taking antidepressants when pregnant is safe, but you may require a change in your dose or prescription brand.
• New stress. Life changes. You may be going through events at home or work that are causing you distress or challenging you in some way. This may mean your healthcare professional may need to revisit your dose or type of medication you need.

Should I take a break from my antidepressant?

No. It’s not recommended to stop taking antidepressants “cold turkey.”

The cause of your antidepressant poop-out may not be drug tolerance. A “tolerance break” won’t necessarily make your medication work better. It can actually cause you more distress or withdrawal symptoms.

It’s highly advisable that you don’t abruptly stop taking antidepressants, even if you believe they’re no longer helping you.

Instead, and in case you need to stop taking the medication, talking with your healthcare professional may help. They can guide you through a slow tapering process or any adjustments you may need.

There are many ways you can approach your antidepressant not working. These are some suggested steps:

Step 1: Keep taking your medication

Medications to treat depression depend on a delicate balance. If that balance isn’t working for you right now, there are ways to go back to it.

Stopping your medication all of a sudden may create other symptoms that make your experience even more challenging.

It’s a good idea to keep taking your antidepressants even if you feel they’re no longer working for you.

Step 2: Talk with a mental health professional

A mental health professional can help assess your current experience. They can offer advice, support, and strategies on how to feel better again.

They may suggest some lab work. They likely want to gather information about your current life situation too.

Depending on what they determine is the cause of your antidepressant not working, your mental health professional might recommend a change of dose or type of medication. They could also refer you to other health professionals for additional support if you’re having a hard time.

Step 3: Develop a new plan to support your health

Once you discuss your symptoms and your medication with a healthcare professional, they will help you develop a new plan.

A 2019 review of studies on tachyphylaxis in major depressive disorder uncovered some possible strategies to make meds work again, including:

• changing your antidepressant dose
• switching class of antidepressant medications
• medication augmenting or combining
• psychotherapy
• lifestyle changes and self-care strategies

Step 4: Practice self-care

Whether your antidepressant is or isn’t working, self-care is important when living with depression.

Here are some options that may help:

• eating a nutrient-dense diet and limiting sugar consumption
• engaging in light or moderate exercise, like walking or yoga
• working on your support network and reaching out for help
• practicing meditation and mindfulness exercises every day
• rearranging school or work commitments to decrease levels of stress
• spending time in nature
• journaling

You may not be able to do all of these every day. But even small steps can help ease your symptoms as you continue to manage depression.

Sometimes antidepressants stop working, or you may feel they don’t work as they used to.

Even if you no longer feel their effects, it’s highly advisable that you continue to take your medication and talk with a healthcare professional.

Stopping antidepressants abruptly can bring on withdrawal symptoms and intensify your depression.

You can work with a healthcare professional on new management strategies. This may include changing your dose or medication, or starting talk therapy if you haven’t.

Adjusting your antidepressant medication so it starts working again can be done. Managing depression may be a long-term process, but it’s possible to do it effectively.

causes, symptoms, diagnosis, treatment, therapy and drugs

Anastasia Somova

worries a lot

Author profile

I suffered from increased anxiety since childhood, and at the age of 22 a psychiatrist diagnosed me with generalized anxiety disorder.

I am now 24 years old and have had severe anxiety since I was 15. I was treated for vascular dystonia, headaches, sleep problems, low blood pressure.

In the eleventh grade, at the peak of preparation for the Unified State Examination, I fainted at school and ended up in the hospital - in the children's neurological department. There, too, no one suspected a psychiatric diagnosis and problems with mental health. But they prescribed a whole list of non-working drugs - nootropics and the like. At that moment, I myself did not know anything about mental disorders.

Explain how I got the correct diagnosis and how I live with Generalized Anxiety Disorder.

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

What is Generalized Anxiety Disorder

The International Classification of Diseases has an entire section on anxiety and fear-related disorders.

Generalized Anxiety Disorder in Adults - Uptodate

Generalized Anxiety Disorder in Adults: Management - Uptodate

Generalized Anxiety Disorder is the most common of these. In addition, this disease is generally one of the most common mental disorders.

Why Generalized Anxiety Disorder develops is not yet known. Perhaps this is due to a disruption in the production of a number of neurotransmitters, that is, connections due to which brain neurons communicate with each other, or to a change in metabolism in some parts of the brain. There is also a link between increased anxiety and a large number of traumatic situations, especially in childhood.

Generalized Anxiety Disorder - NHS

Generalized anxiety disorder can begin at any age. For no reason, a strong anxiety appears that prevents a person from living and working normally. Anxiety attacks can be accompanied by bodily manifestations: a feeling of lack of air, a strong heartbeat, numbness of the limbs, and others.

The disease does not pass without a trace, not only for the psyche. According to some data, increased anxiety increases the risk of coronary heart disease and hypertension, and also increases the risk of death from cardiovascular diseases in general.

I believe that my disorder began to manifest itself in childhood. I grew up with a constant feeling of anxiety, which became stronger with age. My father is a very specific person. He could at one point just stop talking to me and mom. I collected my things and "moved" to another room - the apartment was big enough. I don’t know why I, a small child, fell under this “torture by silence”. Colliding in the corridor or at the front door, we did not say hello.

I also had constant headaches from the age of six. I was examined, but the reasons were not found. Neurologists prescribed glycine, physiotherapy and pain relief according to the situation.

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Now, after going through therapy and many hours of soul-searching, I understand that almost every interaction with my father went through anxiety.

For example, with a good family income, you had to beg for clothes, choosing the time when he was in a good mood. Trips - no matter to the country or abroad - have always been nervous and stressful.

I wasn't taught to recognize emotions, so I didn't know it was anxiety. I felt it as a restless state in which everyone lives in one way or another - that's how it seemed to me then.

Headaches, by the way, disappeared with the start of taking antidepressants. The psychiatrist said that most likely they were one of the symptoms of the disorder.

Symptoms of generalized anxiety disorder

Kirill Sychev

psychiatrist, psychotherapist

The main difference between generalized anxiety disorder and other disorders is that anxiety in it is not limited to specific situations. That is, anxiety lasts for a long time - a month or more, for at least two weeks, and does not depend on what the person does.

The main signs of pathological anxiety are intense, constant, almost uncontrollable, and appear without clear causes. A person with an anxiety disorder usually feels fear, distress, and impending danger most of the time.

Anxiety becomes a constant companion: a person wakes up in anxiety, worries all day for a million different reasons and without, falls asleep for a long time and sleeps badly because of anxiety. At the same time, he cannot cope with this feeling on his own.

Life before diagnosis

Anxiety did not recede during adolescence, and then it only got worse. After school, I entered St. Petersburg State University, where I really wanted to go. However, as a result, I was expelled at the end of the third year - I did not even pass the session to get an incomplete higher education.

Six months before that, there was a period of constant unreasonable anxiety, absolute impotence, inability to sleep and unwillingness to get out of bed. Most of the time I didn't go to university. The people around attributed everything to laziness, but in fact, sometimes I physically could not force myself to get out of bed and go to study. In fact, I did everything to be expelled: I didn’t have the strength to reach the administration and refuse to study myself. And the alarm would not even allow me to enter the faculty building.

It was not customary in my environment to talk about problems with mental health. Perhaps if I had come across a person, video or text with recommendations to go to a psychiatrist with my symptoms, I would not have been expelled and life would have turned out differently.

After leaving the university for two years, I lived in a state of anxiety. I had a constant headache, ten painkillers were enough for a week. I went to a neurologist - he prescribed muscle relaxants and nootropics, and advised melatonin for sleep problems.

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My body has never been relaxed. Every little muscle was tense every second. Massage trips always took place with the requests of the master to relax. I didn’t sleep well, I could wake up at night and lie awake for several hours.

Anxiety arose even because of everyday trifles and was incommensurable with the problem. For example, dirty dishes in the sink in the morning, which the boyfriend had to wash, became the cause of terrible anxiety for the whole day. Even fixing the problem - washing dishes - did not change the state.

I think it comes from childhood - my father constantly scolded me for what I thought was a mess. It seemed to me that the dirty dishes in the sink meant that I was useless, you couldn’t love me, you had to leave me as soon as possible. In those moments, I did not recognize such thoughts as strange and illogical.

There was a similar situation with spending money: I bought something expensive, spent the money, so you can’t love me, you have to leave me alone. At the same time, my boyfriend and I have been together for a long time and have never quarreled over expenses that fit into the budget.

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In general, I had a clear set of anxiety triggers. These are dirty dishes and the floor, spending money on something relatively expensive, buying coffee to go, talking with your father. And if before the trigger, anxiety was background, then after it began to grow to the size of an entire planet.

At this time, popular science books came into my life. In the summer I bought a book by Daria Varlamova and Anton Zainiev “Go crazy! A Guide to Mental Disorders for a Big City Resident. One of the chapters is devoted to anxiety disorders - and it was about me, and so precisely that it became scary. At the same time, I learned about the Beck test for determining the level of anxiety, passed it and got almost the maximum score.

Beck's Anxiety Scale in Russian

However, I still didn't think about the urgent need for a psychiatrist. To go to the doctor, I had to make an effort and admit that I have a problem. I didn’t want to do this - I was afraid to be unnecessary and unloved again. After all, you cannot love a person with mental problems. My logic, of course, was wonderful.

First visit to a psychotherapist and diagnosis

One day I went to the market where I bought Uzbek tomatoes for 800 R per kilo. They were insanely delicious, fit into the budget, that is, the purchase should not have caused me discomfort. However, anxiety didn't think so. She covered me as soon as I left the market building.

The anxiety was so strong that I did not remember either the way to the house or how I spent the evening. I was shaking, at home I locked myself in the toilet and sobbed sobbing. I was suffocating, I was terribly out of breath. The night did not sleep, every second I thought about the price of tomatoes. One obsessive phrase was spinning in my head: "Tomatoes cost 800 R per kilogram. "

/psychotherapy-search/

How to choose a psychotherapist

In the morning I began to google a psychotherapist. At that moment, I did not know about psychiatry according to compulsory medical insurance, as well as about the division of doctors into psychiatrists, psychotherapists and psychologists.

Can a psychologist work with anxiety disorders

Anna Shilova

psychologist

For a psychologist, the first meeting with a client is a diagnostic one. On it, we find out whether it is necessary to connect a psychiatrist. I ask questions about the quality of sleep, the level of libido, eating habits and appetite, chronic and current diseases, fatigue, somatic manifestations of anxiety, if any.

When I complain about anxiety, regardless of the data that I collected during the first meeting, after it I send a diagnostic questionnaire - it allows you to determine the likelihood of a diagnosis.

As a psychologist, I have no right to make diagnoses - this is beyond my competence. This part of the work is done by a psychiatrist. If, according to the results of the questionnaire and the collection of information, there are symptoms of a disorder, I send the person for a psychiatric consultation. I do this even with the slightest suspicion, because only a doctor can comment on whether it is necessary to connect medication to psychotherapy.

I chose my first psychotherapist based on reviews and the ability to see me on the same day. The appointment then cost 3500 R. At the clinic, I was met by a pleasant doctor, led to the office, where he asked me to tell me what was bothering me. I told him about the tomatoes, the inability to sleep well, and my relationship with my father.

3500 Р

cost one appointment with a private psychotherapist

Before the appointment, I made a checklist for myself, where I wrote down the main causes of anxiety. It helped me a lot - due to the large flow of emotions at the reception, it was difficult to focus on my thoughts. The psychotherapist asked me questions, led me to reasoning, as a result, he diagnosed me with generalized anxiety disorder, and prescribed treatment.

Diagnosis of generalized anxiety disorder

Kirill Sychev

psychiatrist, psychotherapist

For a doctor to make a diagnosis, a person must have the following manifestations:

The American DSM-5 Diagnostic Manual also emphasizes that a person must have at least three of the following symptoms: feeling “on edge”, easy fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbance.

Treatment of generalized anxiety disorder

Anxiety disorder is treated with psychotherapy, particularly cognitive behavioral therapy, and medications, most commonly antidepressants. Psychotherapy can sometimes be used as the main method of treatment - it depends on the severity of anxiety and the patient's capabilities, since not everyone can regularly visit a psychotherapist.

Pharmacotherapy for Generalized Anxiety Disorder in Adults - Uptodate

Generalized Anxiety Disorder in Adults: Cognitive Behavioral Therapy and Other Therapies - Uptodate

My doctor recommended antidepressants at my first consultation. He told about their work and how to properly start a reception.

I really liked the metaphor about crutches and broken legs. Crutches are antidepressants. They will not help the leg grow together, but they will make life easier and make it possible to walk while the leg in the cast grows together. Gypsum, on the other hand, is therapy and its own work. You can walk on crutches for a long time without a cast, but nothing good will come of it.

With a psychotherapist, we also went through therapy. Then I didn’t know about different methods and schools of psychotherapy, so I can’t say exactly what technique he used. Most likely, it was one of the variations of cognitive behavioral therapy.

I was prescribed an antidepressant from the group of selective serotonin reuptake inhibitors, or SSRIs. Simply put, these drugs increase the concentration of serotonin in the brain, which improves mood and relieves anxiety. However, in the first weeks of taking such medications, they can cause the opposite side effect - increased anxiety. Therefore, in addition, I was prescribed a tranquilizer. He also helped to sleep well.

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When I first handed the prescription to the pharmacist, I felt like I was buying something forbidden and scary. In the countries of the former CIS, antidepressants, it seems to me, do not have a good reputation, but in fact there is nothing wrong with such pills, let alone prohibited.

Tranquilizer relieves symptoms almost immediately. For a long time I lived with the feeling that someone stepped on my chest and I couldn’t breathe normally. The feeling of relaxation and calmness that I got after the first use of the medicines is hard to forget. It's like taking off uncomfortable shoes after a hard day's work or unzipping your jeans after a heavy meal - only ten times better.

Taking an antidepressant was easy enough for me. A month later, I again went to a psychotherapist and received a prescription for six months. In addition, I was also prescribed one of the neuroleptics for sleep. It took about 900 R per month for pills. We also discussed the issues that worried me again, they mainly concerned behavior patterns.

900 R

on average I spent monthly on pills

Summer and early autumn after the first dose were among the best for me in several years. I lived the life of an ordinary person, I had enough strength to work, go to the gym, take long walks. If earlier I started shaking at the sight of a dirty plate in the sink in the morning, now it worried me much less.

How generalized anxiety disorder is treated

Kirill Sychev

psychiatrist, psychotherapist

Treatment of generalized anxiety disorder usually begins with cognitive behavioral therapy, if the person agrees to it and is ready to do it. If it does not help or this option is not suitable for a person, we use pharmacological treatment.

Antidepressants, selective serotonin reuptake inhibitors and selective serotonin and norepinephrine reuptake inhibitors, i.e. SSRIs and SSRIs, are usually prescribed first.

Antidepressants are well-researched and effective drugs. This is the same adequate treatment for mental disorders as insulin for a person with diabetes or a painkiller for a fracture. They restore the correct functioning of the brain and thinking, give the patient the necessary resource to fight the disease.

Antidepressants are not addictive. From a medical point of view, addiction is a craving for use, accompanied by a constant increase in the dose of the substance taken. When taking antidepressants, there is no such craving. The patient does not need to constantly increase the dose. However, at the stage of selecting the drug, the doctor can increase it.

There are concepts of the minimum and maximum therapeutic dose - the first is not always enough, but it is never raised above the maximum. And then the patient drinks the medicine in the required amount until the end of the course.

In the treatment of depression and anxiety disorders, antidepressants should be taken for at least a year from the moment the condition noticeably improved. So the risk of relapse is lower.

The first unsuccessful attempt to get to the doctor under OMI

In the autumn, a few months after the start of treatment, I decided to go to the psychotherapist again. The anxiety went away, but the dream began to go astray, there were questions that I would like to solve in therapy: I still transferred the patterns from the relationship with my father to the relationship with my boyfriend. At that moment, the price of seeing a paid psychotherapist increased to 5,000 R. I could not afford it and for the first time decided on CHI therapy.

At that time, a list with numbers of free psychological help roamed the Internet. There was also a number of a free psychotherapist in St. Petersburg, where I lived. Everything turned out to be not so simple: at first, I called the reception desk of one of the PNDs for about an hour, and they told me to call another phone number. By the second number they gave me another number. As a result, after a couple of hours, I got through and made an appointment. They asked me for my name and age, gave me the address and name of the doctor.

/psychotherapy/

How psychotherapy works

The office was in one of the clinics in my neighborhood. I arrived for the session at nine in the morning. At the registry, which was separate for a psychotherapist, they took my address of residence, passport number, compulsory medical insurance and SNILS, then I went to the doctor.

The first question the therapist asked me was if I was working. At that moment, I had problems with this, I honestly answered that I didn’t, and my boyfriend helps me with money. Here he began to scold me. He said that I had no right to apply for help under compulsory medical insurance, that I had to go to a paid doctor, that I was a parasitic and all that. And also that I can’t come to him, because this is an office not in my place of residence. After that, I didn’t want to open up to the person, I shrunk in my chair and almost cried. But I needed to extend the prescription - this is the only thing that kept me from escaping.

After somehow telling what I was taking and what my diagnosis was, I asked for a prescription. He shook his head and began to tell me that I needed to leave Russia and there was nothing for me to do here. Then he recommended taking Phenibut, a drug that is available by prescription, but does not have proven effectiveness.

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I left the office in shock. Fortunately, this did not affect my psyche - from the very beginning I managed to build an armor between me and this pseudo-psychotherapist. By the way, in the end he wrote out the prescriptions I needed. However, the experience was unsuccessful, so until the next year I was afraid to even think about psychotherapy.

Treatment by a psychiatrist at the district dispensary according to compulsory medical insurance

In winter, I went into remission - this means that I felt like a healthy person for a long time on the therapeutic dosage of the medicine. Then I decided to reduce the dosage. A paid psychotherapist told me about the correct exit from treatment in one of the first sessions, so it seemed to me that I understood how to do it.

Back then, I was actively sitting on a mental health forum where people share their stories of illness and treatment. You can also consult a psychiatrist there. Such a consultation will not replace treatment and face-to-face sessions, but it can help in situations where you need an answer to a small question, but you don’t want to pay 5000 R for a session.

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I asked a question on the forum about the abolition of pills and received general recommendations. The dosage of the antidepressant was reduced very slowly, reaching 1/8 tablet. It was hard, because out of ignorance I did not take anything to alleviate the symptoms.

Of course, stopping antidepressants on my own was a big mistake. When taking any medication, you do not need self-activity and advice from the Internet. I decided to stop taking the pills too early - I had to take antidepressants for at least a year from the improvement in my condition, best under the supervision of a doctor.

Why you can’t stop drugs or change the dosage yourself

Kirill Sychev

psychiatrist, psychotherapist

You can’t stop psychiatric drugs on your own, because there is a high probability that side effects or a withdrawal syndrome will occur.

It is best to be in touch with your doctor during dose changes or withdrawals. So you can choose the right withdrawal tactics, add other drugs for this period that will remove side effects, change the rate of withdrawal, taking into account the reaction of the body.

In the spring of 2020, the COVID-19 pandemic struck, and I again developed severe anxiety. The social and medical problems associated with the coronavirus bypassed me, there were no objective reasons to worry. And I was worried.

And it happened all of a sudden. I could do yoga and in the middle of the practice lie on the floor with a rapid heartbeat due to sudden unreasonable anxiety or suddenly cry. It feels like a sudden wave: it covers your head, you can’t run away from it anywhere.

About two months have passed since the end of taking the pills. I tried to cope with anxiety non-drug - meditation, dynamic relaxation according to Jacobson, freewriting about experiences. It did not help. The prices for therapy at that moment rose again, and I needed, if not psychotherapy, then definitely crutches in the form of pills.

/shizofreniya/

How much does it cost to support a relative with a mental disorder? To do this, I found the address of the district PND in the issuance of a search engine, called the registry office and found out what was needed for admission. Everything turned out to be simple:

1. You need to come to the PND, apply to the reception. There, give your passport, policy and SNILS, give the actual address of residence. At the reception, they will issue a card and call the office number.
2. People go to the office in a queue. Each section has its own psychiatrist. You cannot sign up for a specific time, as it happens in a regular clinic. It is better to come early, then you will get there faster. Arriving 15-20 minutes before the doctor started the appointment, on average I was third or fourth in line.

At the appointment, the psychiatrist asked what was bothering me. I told my story, he offered me several antidepressants to choose from, talking about the pros and cons of each. He also prescribed a tranquilizer to remove the primary side effects.

The antidepressant was from the same group as the first time, but different. The packaging cost me 800 R, in total I bought two of them. I was told to come back in three or four weeks. This is necessary to understand whether the medicine suits me or not, whether the dosage needs to be adjusted. The diagnosis remained the same - generalized anxiety disorder.

A month later I came back to PND. At that moment, another doctor saw me, because my district police officer fell ill. During my visit to the dispensary, I talked with four different psychiatrists - and I had no problems with any of them. No one humiliated me, everyone spoke politely and professionally, they really tried to help.

The pills did not help me this time, so the psychiatrist suggested trying to be treated in a hospital. With a residence permit in St. Petersburg, I could be hospitalized in a neurosis clinic. However, there was no registration, so they could only offer me a day hospital at the hospital named after. Kashchenko.

You can get to the hospital only by direction from the PND. The doctor appoints a day, issues a referral with which you need to come to the hospital. They make a card there, and then send it to the primary appointment with the doctor.

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Treatment in a hospital according to compulsory medical insurance

In total, I was treated in a day hospital twice. I don't have a single negative memory associated with it, I liked this place, I liked the people there.

Treatment is quite simple. After an initial conversation with a psychiatrist, medications are selected. You also need to consult with a clinical psychologist, make a cardiogram, if necessary, visit other doctors - for example, a cardiologist or endocrinologist. This can be done either in the hospital itself, or in the clinic in the direction.

Clinical psychologist gives tests for attentiveness and memory. Together with him, we also filled out several questionnaires - for the level of anxiety and the presence of depression.

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There is a psychotherapist in the hospital, and a psychiatrist also makes appointments with him. Usually these are one-hour sessions once or twice a week. You can also go to a theater or art studio, to bibliotherapy, dance therapy, adaptive yoga. All this is free.

Studio teachers really want to help patients. People in the hospital are different, with different diseases, different states of mind, but it was very comfortable to work with everyone.

I went to psychotherapy twice a week, every other day I went to the psychiatrist. I wanted to go to yoga several times, but it was early in the morning, I woke up every time.

The way psychotherapy sessions go depends on the methodology that the therapist uses. I wanted to do cognitive behavioral therapy, one of the techniques supported by evidence-based medicine. This was not the case at the hospital, but my doctor offered to help me find a good private therapist working in this direction if I wanted to.

Tablets prescribed by a doctor were distributed by nurses in a special room. You need to go to the hospital often - at first every day, then every other day, at the end at least twice a week. The drugs are given in the amount they are needed for the time while the patient is not in the hospital. The nurses are sympathetic and sweet, they call everyone by diminutive names, they remember them in just a couple of days.

In the hospital they provide food, you can have breakfast and lunch. The food is ordinary hospital food, but I liked it: I love simple food, especially all sorts of stews.

/bye-depression/

“It was like a strict regime sanatorium”: how much I spent on treating depression

During the pandemic, consultations with psychotherapists were moved to Skype, and visits to a psychiatrist were once or twice a week, sometimes more, depending on the state.

Due to frequent visits, any changes in the condition are easily monitored and the dosage of drugs is quickly adjusted. For example, once I was unsuccessfully prescribed a drug. The next day, I told about it at the meeting - and it was canceled for me.

Treatment in the hospital continues until a stable condition is reached. For example, in my case it was the disappearance of constant anxiety for at least a few weeks.

Both times I left the hospital myself because I got tired of visiting it so often. But before that, the doctors selected a treatment for me, and it worked. I had to try several schemes. As a result, we came to my very first medicine, only at a dosage 2.5 times higher. I still take it.

My experience only describes a particular hospital. The system of psychiatry in Russia is imperfect, it is difficult, but possible, to find a competent doctor for CHI. The biggest problem in this situation is not to run into a specialist who will only make things worse. However, incompetent specialists are also found in the commercial system.

How I currently live with Generalized Anxiety Disorder

I am still undergoing compulsory medical insurance. It will soon be a year since I follow the latest version of the therapeutic regimen. Once every three or four months I go to a paid psychologist, a consultation costs 3500 R, but now I don’t need regular therapy.

Increased anxiety is still in my life, but it does not immobilize me, does not deprive me of freedom. I still have problems sleeping, and the crowd is filled with terrible anxiety and lack of air. Mostly somatic manifestations remained: muscle tension in trigger situations, a feeling of lack of air and headaches if I am very nervous.

On the other hand, I learned a lot during the treatment period: talk about problems, look for solutions, work with anxiety, and even relax. Both psychotherapy and antidepressants helped me with this.

/psychotherapy-pros-cons/

Pros and cons: is it worth spending money on a psychotherapist

I spend 28,250 R per year on the treatment of anxiety disorder

Psychotherapist appointment

Cost

From 3500 R per visit

Total for the year

14 000 R

Antidepressants - in a pack of 100 tablets, I have enough for 40 days

Cost

1200 r per pack

Total for the year

Neuroleptic - neuroleptic - In a pack of 60 tablets, I have enough for 120 days

Cost

1100 R per pack

Total for the year

3300 R

What helps me to work with anxiety

I will talk about books, applications and other things that are helped me before and help me now, but do not replace therapy and taking pills:

1. Mental health diary application. It is built on the principles of cognitive behavioral therapy. Helps to recognize automatic thoughts and rationalize them, makes it possible to become more conscious. The application has a diary of automatic thoughts, where you can write daily what worries you. My favorite feature is the destruction of negativity, try it.
2. Robert Leahy, "Freedom from Anxiety". A must have book for all anxious people. The author is a doctor of psychology, adheres to the methods of cognitive therapy. You can read in order, or you can only read the chapters of interest. It will not replace therapy, but it will help to understand where the anxiety manifestations come from, teach you how to work with the disorder.
3. Forum "Mental Balance". As in any other forum, the audience there is different, so the information needs to be filtered. However, it was there that they supported me when I was very ill. Here you can also consult with psychiatrists, read useful articles and case histories of other people.
4. TED Talks about psychological first aid and emotional hygiene.
5. Lindsey K. Gibson, Adult Children of Emotionally Immature Parents. One of my favorite books that helped me understand and let go of my relationship with my father. The book has interactive tasks to help work through the questions.
6. Muscle relaxation according to Jacobson. I like a particular video, but there are many options on the Internet.
7. Application for meditation Insight Timer and meditation by Valery Veryaskin. I tried a thousand and one meditations, but only Valery's audio helps me relax and fall asleep in the evening. My favorite is The Practice of Relaxation.

Remember

1. If you feel that anxiety interferes with your life, you should go to a psychiatrist. For self-examination, you can take the Beck test.
2. It is better to ask for help - to the doctor, relatives, friends, people on the forum. Anxious thoughts are much easier to deal with if you speak them out.
3. Taking antidepressants, antipsychotics and tranquilizers as prescribed by a doctor is normal and not a shame.
4. You should definitely share your problems with those with whom you live. For people who are unfamiliar with mental disorders, many of the actions of anxious people will seem strange. In the most difficult moments, I slept for days, simply because anxiety takes a lot of strength. From the outside, it looks incomprehensible, and therefore it is worth talking about the problem.
5. Anxiety is treated, after a while it will be possible to return to normal life.

Did you also have an illness that affected your lifestyle or attitude? Share your story.

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What you should know about antidepressants

Ekaterina Kushnir

treats anxiety disorder

I have generalized anxiety disorder.

For a long time I coped without pills and other help, but one day I got tired of constant anxiety and began to interfere with my normal life. As a result, I turned to a private psychiatrist.

The doctor prescribed an antidepressant from the SSRI group - these are selective serotonin reuptake inhibitors. Such drugs are the first thing prescribed in the treatment of depression and a number of other conditions, including my disease.

The doctor immediately warned me about some peculiarities associated with taking the drug. Some of them I then felt on myself. I think everyone who plans to be treated with antidepressants should know about them.

At the same time, it should be taken into account that most of the negative effects of therapy are temporary and not dangerous, and if they do not go away, one medicine can be replaced with another. Antidepressants help many people with mental disorders and other illnesses get rid of their symptoms and return to a full life, so you definitely should not be afraid of them. The main thing is to take such drugs when they are really needed: as prescribed by a competent doctor and under his control.

See a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

Fact No. 1

Antidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation - the so-called causeless motor agitation, the inability to sit still. It's not dangerous, but rather unpleasant. This condition is sometimes referred to as initial anxiety, that is, the anxiety of starting therapy. Up to 65% of people face it.

Antidepressant-induced anxiety syndrome - a systematic review in the British Journal of Psychiatry

There is also evidence that some classes of antidepressants, including SSRIs, may increase suicidal ideation in depression in young people aged 18 to 24 years. These data are not very reliable, and in older people, the risk of suicide no longer increases and even decreases.

Without treatment, depression is more likely to lead to suicidal thoughts, and in case of anxiety, you just need to prepare for such an effect, then it will be easier to survive the attacks.

The doctor told me that in the first two or three weeks there may be an increase in anxiety, but I did not take it too seriously.

Everything was fine for the first week. After about seven days, I became nervous and irritable. And then I woke up at night and after a while I felt an incomprehensible fear. My heartbeat increased, my head was spinning, my throat was constricted. Because of this, I felt a real panic - I spent the rest of the night fighting terrible thoughts, in the morning I got up completely broken.

/list/antidepressant-myths/

8 myths about antidepressants

I have never had such panic attacks before medication - my anxiety was background, general. I got scared and wrote to the doctor, who reassured me and said that it was not dangerous and would pass soon.

After that, I already expected these panic attacks, immediately tried to relax, calm down, remember that this was just a temporary effect of the drugs. And they ended faster, and then they completely disappeared.

Fact No. 2

Increase the dose of antidepressants gradually to reduce side effects. They usually start with the minimum, and then bring it up to the working one. For example, for SSRIs with the active ingredient "sertraline", the working dose is from 100 mg per day. I started taking such a drug with 25 mg, and then gradually, in several steps, under the supervision of a doctor, raised the dose to 100 mg.

SSRI dosage - NHS

What doses of antidepressants will be optimal - an article in The Lancet

The process of reaching a working dose can take from two weeks to a month or more. It depends on the drug and its tolerance. I turned out to be sensitive to the medicine, it was hard for me to survive every increase in dosage: anxiety increased again, there were other side effects that then stopped. However, this is not the case for everyone, sometimes the process goes faster.

The full therapeutic effect, that is, the disappearance or a strong improvement in the symptoms of the disease, occurs some time after reaching the working dosage. As a rule, this is a week or two, although some positive changes may be earlier. For some people, this process stretches for a longer period: 6-12 weeks. Minimum initial doses of drugs usually do not work.

It is better to prepare for the fact that the symptoms of the disease will not disappear in the first weeks of treatment. And remember - this does not always mean that the drug needs to be changed, sometimes you just need to wait or further increase the dosage under the supervision of a doctor.

Fact No. 3

Another way to mitigate the side effects of antidepressants is to prescribe an additional drug along with them: for example, from the group of tranquilizers. Such drugs may have their own side effects, they should not be taken for a long time. Unlike antidepressants, some of them can be addictive. They are usually appointed for a month, but this period may be shorter or longer.

Antidepressants together with benzodiazepines work better for depression - BMJ magazine

My doctor prescribed a rather mild drug for me. However, he did not suit me. At first, it caused increased drowsiness: during the period of increased anxiety, it went away for a while, but then returned - even with half a pill I turned off and could sleep all day. And if I drank at night, I woke up with difficulty in the morning. The psychiatrist prescribed another medicine, but I could not buy it: the drug was not available in any pharmacy nearby.

As a result, I simply endured all the side effects of therapy - they were unpleasant, but tolerable. When discussing with the doctor, she called this option acceptable if the side effects of the second medicine only worsen the situation.

Fact No. 4

Modern antidepressants, including SSRIs, are mild and have almost no side effects. Older drugs - tricyclic antidepressants and monoamine oxidase inhibitors - cause more side effects. Doctors usually use them when milder first-line drugs don't work or when they can't be prescribed.

Side effects of antidepressants - the National Health Service of the UK

Side effects of various antidepressants - Uptodate

Side effects of antidepressants and their impact on the treatment of a large depressive disorder - the journal NATURE

STRICTIC STRICTIC OF REDITION

. effects of antidepressants - advice from the Mayo Clinic staff

Choosing an SSRI drug does not guarantee the absence of side effects - many people tolerate treatment easily, but sometimes a change in drug may be necessary.

The first couple of weeks of taking there is a risk that the state of health will be so-so - it's worth thinking about. It may be worth scheduling the start of therapy on vacation.

I work remotely, and it was easier for me: the first pill was taken on Saturday, I slept through the weekend. Then she continued to work, but refused any additional loads: housework, part-time jobs, training and everything else.

It was hard work: I wanted to sleep, then I began to worry and get distracted. I also had diarrhea, nausea, headaches, tremors, i.e. hand trembling, hot flashes, sweating, palpitations. At night, panic attacks began, in the morning I had difficulty getting up because I was in pain and dizzy.

There are mixed data on how common the side effects of antidepressants are. If we summarize them, then the numbers look something like this:

• nausea - about 25% feel it;
• diarrhea - it happens in 15% of people, and 5% will, on the contrary, have constipation;
• sweating and a feeling of heat occur in about 20% of people;
• sexual dysfunction, decreased libido may occur in 80% of cases;
• insomnia - in 11% of cases;
• headache and dizziness - in about 10-11% of cases;
• weight gain - not all drugs give this effect. Some, on the contrary, can reduce weight. On my medicine, I lost 2 kilograms in the first month, despite the fact that I quit training due to poor health. True, then they returned back.

It can be seen that most side effects occur in less than half of the cases. In addition, in most cases they pass in the first weeks and are not dangerous.

Side effects not listed above are very rare. I was "lucky", and I faced one such - a decrease in visual acuity. Once in the morning I noticed that I see worse without glasses. A little later, I realized that something was wrong with the glasses.

I wrote to the doctor, she replied that this happens, as a rule, is not dangerous and passes, but it is better to visit an ophthalmologist. I went to the ophthalmologist, everything was fine with my eyes, there was nothing terrible, but my vision really worsened - it was not a subjective feeling. On the right eye, it was -0.5 diopters, it became -0.75, and on the left eye it was -1.5, and it became -3.5.

I was offered to try changing the drug, but I decided to wait. Vision was then restored. I have not yet gone to the doctor to have it measured, but according to subjective feelings, it is at the same level as before: I am comfortable again in my glasses.

Side effects should not be tolerated - if something greatly worries, scares or interferes with life, it is better to tell the doctor right away. The psychiatrist will be able to determine whether the side effect of the drug is dangerous and whether it is worth continuing to take it. There are several antidepressants of the SSRI group, in addition, there are groups of drugs with a slightly different mechanism of action. As a rule, doctors manage to find a medicine that gives a good effect without side effects.

If there is no danger, the doctor can adjust the dose or increase it more gradually - this often helps to cope with unpleasant effects.

Fact No. 5

Antidepressants are not drugs that you can stop drinking as soon as you get better. They are taken for a long time: usually from several months, less often several years.

Anxiety Therapy - UpToDate

For example, for generalized anxiety disorder, the duration of treatment is at least a year. Moreover, the date is not counted from the very beginning, but from the moment when a lasting effect appeared from the pills. In fact, they will have to be drunk for about 1.5 years - it depends on how long it takes to reach the working dosage of the medicine.

The cost of a package of the most famous antidepressant "Zoloft" is about 700 R, enough for about a month. That is, a course of therapy will cost about 10,000 R - maybe more or less, depending on which drug is selected.

Psychotherapy review - UpToDate

The cost of an appointment with a good psychiatrist in Moscow is 3000-5000 R. At first, you will need to visit him about once every 1-1.5 months, then less often.

You can apply to the psycho-neurological dispensary at the place of residence under compulsory medical insurance - it's free. At the same time, they will not put you on psychiatric registration: it was canceled in 1993. People with disorders that do not threaten their lives or those around them are on consultative and diagnostic care. If you stop going to the doctor, he will not find out what happened: a person seeks help at will.

Psychotherapy, usually cognitive-behavioral, is also commonly prescribed to enhance and sustain the effects of antidepressants. In many cases, it improves the effectiveness of drugs, including depression and generalized anxiety disorder. An appointment with a psychotherapist in Moscow costs an average of 5000 R. For treatment, you will need about 10 sessions or more.

/psychotherapy/

How psychotherapy works

Fact No. 6

Antidepressants are not addictive. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as electric current discharges while moving or turning the head, headaches, dizziness, insomnia. Many people experience symptoms similar to the flu or an intestinal virus: low fever, diarrhea, general malaise, chills. Often there is anxiety, there are intrusive images.

Withdrawal symptoms after taking serotonin reuptake inhibitors - Journal of Clinical Psychiatry

How difficult it is to stop taking antidepressants - American Psychological Association

Stopping antidepressants in adults - UpToDate

treatment, they should be canceled only under the supervision of a doctor.

Antidepressant withdrawal occurs as gradually as the start of treatment. The dosage is slowly reduced, usually at this time again a cover-up drug is prescribed to alleviate side effects. As a rule, this is the same medicine that was at the beginning of the intake.

Withdrawal is usually harmless and resolves within the first weeks of stopping the drug. Sometimes even within a few days - it still depends on which medicine was prescribed. If severely disturbing symptoms appear during the withdrawal period, you should consult a doctor.

Fact No. 7

It is far from always possible to immediately find the right antidepressant - sometimes the side effects do not go away and you need to take a new one.

Changing antidepressants in adults - UpToDate

Serotonin syndrome - MSD

Most often, it is started again with a small dosage, this delays the process of obtaining the effect of treatment. The new drug may also have side effects - the same or different. We will have to wait again until they pass.

You won't be able to change the drug on your own, since all antidepressants are sold only by prescription - and that's good. Switching from one drug to another can be dangerous if you do not know the characteristics of different groups of drugs.

For example, taking SSRIs is possible only some time after the withdrawal of antidepressants from the group of monoamine oxidase inhibitors - due to the risk of developing serotonin syndrome. This is a potentially fatal condition, accompanied by a change in mental state, high fever, increased muscle tone and other symptoms.

If the drug is changed correctly, there will be no dangerous negative effects, so consultation with a doctor is required.

/psychotherapy-search/

How to choose a psychotherapist

Fact No. 8

Preparations may be original or generic. Originals are medicines first released by some pharmaceutical company that have passed all clinical trials and checks. Generics are drugs with the same active ingredient from another pharmaceutical company, that is, copied from the original drug.

Theoretically, the action of generics should not differ from the action of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials.

Due to my anxiety, I did not read anything in detail about specific drugs before I bought my first antidepressant in a pharmacy so as not to be scared and not think about taking it. I also didn’t think to ask the doctor about this question.

/list/covid-depression/

Psychoneurological complications after covid: memory problems and depression

As a result, I first bought a generic because it was in stock. Then it turned out that, after all, according to the experience of my psychiatrist, the original drug often gives fewer side effects and is better tolerated. As a result, I changed the generic to the original drug - and, indeed, the side effects softened.

In my subjective opinion, which is supported by some data, in the case of antidepressants and other psychotropic drugs, you should always choose the original medicine. Moreover, the cost of originals and generics is not always very different.

Originals and generics of some SSRIs

CERTRINLINE

Original

Zoloft

Original cost of the original

about 700 r, tablets 100 mg

generics

"Serenata", "Cerelift"

The cost of generies

Escitalopram

Original

Cipralex

Original cost

3000 r, tablets 10 mg

generics

“Checkra”, “Elice”

Cost of generics

500-1300 r, tablets 10 mg

Flioxetin

Original

Prosak

Cost Kal original

About 350 R, tablets 20 mg

Generics

Profluzak, Fluoxetine

Cost of generics

100—200 R, tablets 20 mg

Fact No. 9

Drinking alcohol while taking antidepressants may exacerbate unpleasant side effects. Also, alcohol is a depressant, that is, it has the opposite effect, and its intake can adversely affect the results of treatment.

Why you shouldn't mix antidepressants and alcohol - Mayo Clinic

Alcohol is strictly forbidden to drink with some groups of antidepressants, for example, tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in pressure. MAO inhibitors in general require a special diet - it is unlikely that a doctor will prescribe such drugs as the first antidepressants, but if necessary, he will issue a list of what is allowed and prohibited.

With other antidepressants, moderate use may not be dangerous and may even pass without consequences, but doctors still recommend abstaining so as not to increase side effects and improve treatment outcome.

The main thing is not to temporarily stop taking the drug in order to drink. This can lead to the development of a withdrawal syndrome.

/trevoga/

How I Treated Generalized Anxiety Disorder under CHI

Fact No. 10

It is important to tell your doctor what medications you are taking and what chronic illnesses you have. For example, SSRIs may not be suitable for epilepsy and bleeding disorders, and tricyclic antidepressants are usually not prescribed for those who have recently had a heart attack, suffer from glaucoma, or porphyria.

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