Antidepressants and Medical Uncertainty

I’ve occasionally talked about how great my experience with antidepressants was. First one (2015) worked great and reduced my trigeminal neuralgia to boot. But it wasn’t enough so I started a second one (2017), which was also great and also helped my trigeminal neuralgia with no other side effects. I knew this experience wasn’t universal, but I would occasionally share it so people would have data on the best case scenario.

Welp.

I tried lowering both meds last summer, but each time my neuralgia got worse so I resumed my regular dose. Then in January USPS delivered my pills two weeks late, and I was forced to go off them (luckily I saw this coming as was able to taper with my remaining pills, so it wasn’t cold turkey). Like over the summer my neuralgia got worse, as did my anxiety, but the depression definitely did not come back.

A bunch of stuff happened here. First I was fine, then I was sleeping an awful lot, then I was sleeping quite a bit less (and felt fine about it). Every time I felt bad I would wonder “is this a transient reaction to an external stimulus, a sign of returning depression, or both?” When I had my checkup with my psychiatrist and mentioned that I no longer needed a daily nap, she immediately said “Oh that’s [medication 2]”.

I’ve talked to multiple doctors about my previously quite extreme sleep needs, including her. They all tried a bunch of complicated stuff, and they all had access to my list of medications, but no one ever said “hey, it might be this medication you’re on, let’s try adjusting that”. It’s possible the medication was the right choice for a period of time even when it was eating two hours of of my day, it’s possible it wasn’t eating two hours of my day and it’s a coincidence things have improved. But when my doctor is so sure it was the problem now and nobody even mentioned it before, something has gone deeply wrong somewhere.

There was a time this would have really freaked me out and possibly triggered a panic attack, but TBH it’s about what I expect from medicine at this point. So the point of this post is mainly to be an accurate data point for people assessing antidepressants for themselves, because God knows the medical community isn’t going to give them to you.

I still think medications were mostly a success for me. I really needed them when I started them, I might really need them again in the future and would consider taking them even with the risk of nap. But I would pay a lot for a doctor who even raised this possibility.

PS. Given what I do for a living, “why didn’t you research this yourself?” is a reasonable question. The answer is:
1. I was not in a good place to do this when I started them
2. The fatigue did not kick in immediately- I was actually hypomanic for a bit, and the mandatory naps kicked in at least a year later
3. I did in fact know that fatigue was a possible side effect of the medication, but I was taking it off label at a drastically lower dosage than is typically prescribed (<1/20th), so it didn’t seem very applicable. I don’t think better scientific studies are the solution here, humans are too variable. What’s needed is a system that is responsive to individual feedback, including doing experiments to get that feedback.

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