Medications for Depression/Anxiety/Stress & other mental health problems.

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Lemur
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Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Lemur »

Hey guys,

What is the ERE strategy (or opinion*) on utilizing medications for depression, anxiety, or just stress? Some over-the-counter stuff can be fairly cheap and perhaps even worth budgeting for if they're needed. While I feel stress can be mitigated with lifestyle changes, depression and anxiety are a bit tougher to deal with. There are both genetic and environmental factors to deal with. I would like to preface this post with the fact that I am not a brain scientist, psychologist, or anything like that, but I am in the honeymoon stages of research lately into what triggers these mental states in the brain (neurotransmitters like dopamine, serotonin, etc. are terms I'm seeing a lot) and what can cause these mental states.

I'm particularly interested in situational anxiety, public speaking anxiety, etc...I'm generally a happy person most of the time (no depression) and stress is a non-issue because I've worked myself into a good balance between family/work/school/saving/etc. What spurred my sudden response is I get particularly anxious/stressed at work in meetings, presentations, and especially conference calls. Up until now, I always just accepted that this is the way I was and to just "deal with it" when it comes. This has been I life-long problem for me and I would like to start looking for long-term approach to these problems and dealing with them...

Two nights ago I laid in my bed the entire night because I had to lead a conference call at work with 20 people on it. I literally got no sleep...luckily I take a bus to work and don't have to drive! Before I got to work, I felt like I was running out of breath and, very unlike my usual self, I blew some money on GABA, 5-htp, Fish Oil, and Vitamin D at a GNC right before work. I took these together about 3 hours before the meeting time. I got through the meeting decently...not even sure if the drugs worked and I very well could have place-bo'd myself into thinking I was good now. They certainly had some type of effect because normally I am nearly choking, trembling, sweating, but I didn't get that this time (but I did get my usual sudden mutism that happens in meeting when I'm asked to speak).

Anyhow, what are your guys thoughts? Does anyone take things for mental health? In the interest of not 'wasting my money' (sunk cost fallacy?) I'm taking the single dose of GABA every morning with 5-HTP until I run out. Also looking into L-theanine for anxiety.
Last edited by Lemur on Thu Jul 19, 2018 9:46 am, edited 1 time in total.

Gilberto de Piento
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Gilberto de Piento »

It sounds like this is very much related to public speaking. Could you get some training so you get habituated to it? Something like Toastmasters?

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Mister Imperceptible
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Mister Imperceptible »

I’m no expert but I would be extremely leery of substances and trying to hack your brain chemistry.

Life is suffering. You cannot medicate the suffering away, without doing worse damage.

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Lemur
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Lemur »

Gilberto de Piento wrote:
Thu Jul 19, 2018 9:12 am
It sounds like this is very much related to public speaking. Could you get some training so you get habituated to it? Something like Toastmasters?
I'm looking into this actually. I'm noticing a pattern lately from reading some books of this being a good recommendation. I used to be bothered from just making a phone call (no longer have a problem) and conducting small meetings between 3-5 people (no longer a problem either). Both came through practice. Perhaps large groups of 20+ people can be the same? My younger brother studies psychology and a research student and he believes a good method is to find a way to induce the anxiety at home to learn coping strategies without real-world consequences. Blowing a meeting at toastmasters sounds perfect when you're around a supportive environment....
Mister Imperceptible wrote:
Thu Jul 19, 2018 9:15 am
I’m no expert but I would be extremely leery of substances and trying to hack your brain chemistry.

Life is suffering. You cannot medicate the suffering away, without doing worse damage.
While I agree life is suffering and we can only grow from when we suffer and then preserve, I partially disagree with the statement "you cannot medicate the suffering away, without doing worse damage." Sometimes a combination of therapy, CBT, and medications is what people need to get through whatever they're dealing with. We live once...why suffer needlessly when science has made it possible to make things better? I'd imagine with CBT & practice, one could wean off the meds/supps but perhaps not if some problems are truly genetic.

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Mister Imperceptible
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Mister Imperceptible »

I’m not going so far to say you can cure cancer with prayers to the Almighty, I’m just saying be very careful not to habituate yourself. I’ve lost a lot of childhood schoolmates to opioid addiction. Even if what you take is not so severe, you could end up being a hollowed out version of yourself.

I’m no expert. Be careful. Take what any doctor says with a grain of salt. Many of them are well-paid to dole out poison.

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Lemur
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Lemur »

Oh for certain! I have zero plans to go beyond some over-the-counter stuff you can find at a GNC or Vitamin Shoppe or even Walmart and just to take the edge off (I wouldn't want to completely rid myself of anxiety; in fact, a little anxiety can actually be a good thing)

If my job ever took me to a point where I considered drugs harder then some harmless vitamins, I'd just find a new profession.

suomalainen
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by suomalainen »

Lemur wrote:
Thu Jul 19, 2018 9:22 am
Sometimes a combination of therapy, CBT, and medications is what people need to get through whatever they're dealing with.
Based on your description and your success with phone calls and small meetings, CBT sounds like the perfect treatment option. Habituate to the trigger, work to deliberately calm your physiological reaction and the fear to the trigger lessens. Doing toastmasters seems like an easy way to do a self-CBT course.

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Mister Imperceptible
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Mister Imperceptible »

Anxiety is often an indication that something is wrong and needs to be corrected. I say this as an anxious person.

Other things people use to take the edge off: alcohol is available over the counter and marijuana if not available over the counter in your state can easily be had from a sketchy guy calling himself “Deezy.” Neither the liquor store nor Deezy have done much to help me in the long run.

As long as you are aware.

ZAFCorrection
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by ZAFCorrection »

One point I would make is over-the-counter doesn't mean it can't mess you up, just that the FDA hasn't bothered regulating it. Melatonin and other sleeping aids are pretty good examples of things that can cause negative effects if taken at too high of a dosage or if taken for too long (primarily dependency). Go slow and systematic if you are trying stuff out.

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Lemur
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Lemur »

Mister Imperceptible wrote:
Thu Jul 19, 2018 9:50 am
Anxiety is often an indication that something is wrong and needs to be corrected. I say this as an anxious person.

Other things people use to take the edge off: alcohol is available over the counter and marijuana if not available over the counter in your state can easily be had from a sketchy guy calling himself “Deezy.” Neither the liquor store nor Deezy have done much to help me in the long run.

As long as you are aware.
I'm quite aware.

While I would never purchase anything from a guy calling himself Deezy, I did utilize alcohol about 6-7 years ago to get through most social situations. I'm grateful this was a short stint and I never sunk into that one!

EdithKeeler
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by EdithKeeler »

I took Effexor for a while. I don't recommend. It actually did a much better job on my anxiety than on my depression, but I couldn't deal with the side effects, and weaned myself off when my doc wanted to keep UPPING my dose.

I think some people need medications for some things. I would say medication is not really warranted for situational anxiety and stuff, unless it's super, super, super interfering with significant aspects of your life.

I used to be very anxious in work situations, public speaking, stuff like that. It was painful, but lots of practice took care of it, along with a lot of self-talk. "OK, you're freaked. What's the absolute WORST thing that could happen? They don't like your presentation--oh well. You forget what you're talking about--that's what notes are for. You'll fart and they'll hear it--embarrassing, but pretty much everyone has a fart story..." and so on.

I personally hate Toastmasters, but it's good for getting practice in a non-threatening environment.

Diet and exercise help. Salmon and veggies are good for brain chemistry, and exercise releases serotonin, endorphins and dopamine. Sex is good--get lots of oxytocin flowing.

I think chemically fucking with your brain is scary, whether it's over the counter, street or prescription drugs.

Jason

Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Jason »

I cycled through pretty much all the SSRI's dealing with depression but specifically OCD. They work at masking the symptoms but ultimately do not remove the causation. I am now working with a psychologist who can't prescribe medication and treatment is much more beneficial addressing things from a cognitive angle.

They can't moderate the doses to such an extent that you can ease into them without even noticing you are on them.

I experienced side affects of increased appetite which led to weight gain and drowsiness. So it was a kind of trade off - no more obsessive thoughts in exchange for becoming fat and lazy.

Riggerjack
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Riggerjack »

Go over to slate star codex. He talks about brain chemistry and drugs, and studies, and the "right way" to use them. A Rational, who also works in the field, it's been very interesting.

My own experience is that we need effective ways to deal with stress, and few people develop effective stress management techniques their own. Medication can help with the symptoms, but not the cause. And relieving the symptoms often lowers the incentive to find and fix the causes.

So I am all for the meds, as part of a larger strategy, and against meds as an effective treatment, if that makes sense.

Good luck.

oldbeyond
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by oldbeyond »

I can’t speak for severe cases of anxiety and/or depression, but for the moderate intensities I have experienced and do experience, there seems to be a lot one can do to to manage the symptoms and even and least partially cure the illnesses. With medication I’m concerned about:

1. Side effects, be they altered personality or liver damage. Especially if you do large doses of a lot of substances at once. Even if they’re “natural”. Dosage/concentration can make a poison. So I’m for the precautionary principle.

2. Positive effects waning over time, leaving you were you started, perhaps with 1.

It is my feeling that more specific mental ailments are more easily treated. And you have apparently conquered several challenges within this exact subfield of “work communication”.

That said, I am dependent on safety behaviors(coffee, music, internet, pats on the back, checking personal stats etc) to cope so I’m not perfect by any means.

thrifty++
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by thrifty++ »

Yes your anxiety and stress seems well connected to public speaking. This is very normal.

I used to experience anxiety like you but having spoken to massive crowds so frequently it no longer makes me anxious. Like almost zero anxiety Probably far less than the majority of people. Exposure often seems to destroy or minimise these phobias.

Maybe you need to live through the pain like I did to get through it.

But toastmasters is an excellent recommendation that I see has already been made.

I went to toastmasters and loved it. It definitely significantly impacted my confidence and I found my group quite fun. It is a supportive environment. It gives you positive experiences to reflect on in your mind while you are dealing with work related speaking and that was invaluable in my experience.

Clarice
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Clarice »

Lemur wrote:
Thu Jul 19, 2018 8:34 am
Hey guys,

They certainly had some type of effect because normally I am nearly choking, trembling, sweating, but I didn't get that this time (but I did get my usual sudden mutism that happens in meeting when I'm asked to speak).

Anyhow, what are your guys thoughts? Does anyone take things for mental health? In the interest of not 'wasting my money' (sunk cost fallacy?) I'm taking the single dose of GABA every morning with 5-HTP until I run out. Also looking into L-theanine for anxiety.

Hello Lemur,

I feel compelled to give you some motherly advice. PLEASE DON'T. Real drugs for these conditions have some HORRIBLE additional effects, besides the ones that are advertised. Supplements are usually poorly researched. Just because you swallow them doesn't mean that the content gets absorbed in your blood. Read about bio-availability. They also have additional not desired effects.
You say that you are anxious and suck at public speaking. LIVE WITH IT. I've read your post. What you've described is nothing special, a normal variant. Your best bet is to learn to live with the beast. You are not planning a career as a public speaker, aren't you? Eat well. Sleep as well as you can with a small child. Get some sun. Don't let any industry to parasitize o your weaknesses. Just accept them. Otherwise, you are very likely to end up with more problem than you've started with.
Read The Myth of Mental Illness by Thomas S Szasz, MD.
Best of Luck!

Riggerjack
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by Riggerjack »

As a general idea of what can be found at SSC, here's a quote, taken at the end of a long post about linkjng lead and depression:
There are thirty-plus plausible causes of depression that nobody knows enough about to be sure they’re real, estimate their magnitude, or begin to treat. If you look at any one of them too closely, you will come to the conclusion that every psychiatrist in the country is a quack who’s ignoring the evidence right in front of their eyes and willfully blind to the role of [lead/zinc/toxoplasmosis/inflammation/gut microbiome/etc] in order to keep getting the sweet pharma company cash for prescribing Lexapro. It’s not that we don’t know about these things. It’s that we don’t have an action plan. We don’t have a good feel for when to do the tests, what numbers on the tests mean we should do something, what that thing should be, and whether it should work. So we punt the question to the researchers, who already have a backlog of ten million other things they need to be working on.

This isn’t a great state of affairs. But I only know three ways doctors can deal with it, and none of them are very good.

The first is the one I learned at age 3 from my father teaching me to read out of evidence-based-medicine textbooks. You insist that nothing can be admitted into the medical canon unless it has some guideline-making-body’s stamp of approval, which the guideline-making-body will not give until a bunch of randomized controlled trials have validated every step of the model and shown that the proposed solutions definitely work on a large scale with every demographic of patient. Until then we will keep doing the things that have met that bar – which is basically giving people Lexapro and telling them to diet and exercise. This path assures you a long and prosperous career as a respected member of the medical establishment.

The second is to become Dr. Oz. You fall in love with anything that has an even slightly plausible mechanism and at least one n = 15 study saying it works. I’m not talking about literal homeopathy here. I’m talking about things where if you ask a biologist whether it works, they just sort of shrug and say “well, it should“, and there’s a bunch of respectable research into it. But this is a really low bar, and if it’s the only one you hold yourself to, then you’re going to be the guy telling your patients they need heavy metal tests and vitamin levels and SPECT brain scans and screens for twenty latent infections just because they came in saying they’re tired all the time. This path assures you a lucrative daytime TV show and a side gig selling supplements with your picture on them.

The third is to be a generally respectable doctor with one Big Idea. Like “why aren’t we testing everybody for lead?” or “why don’t we care more about the gut microbiome?”. These people are often really good at what they do, really passionate, and mostly within the mainstream. Sometimes they are impressive researcher-crusader-prophets, they get their Big Idea universally adopted, and then they become the next generation of medical orthodoxy. Other times they’re just annoying clinicians who love saying “I see you aren’t even testing for cortisol levels, clearly you have no interest in going beyond Textbook 101 Level” but can’t really explain why this is better than the twenty-nine other things you might consider doing. This path assures you a long bibliography of successful articles in The Journal Of Medical Hypotheses.

I love everybody in Group 3, they’re all great people. But the thing is, if I were to believe everybody in Group 3, then I would end up as Group 2 – and I don’t have enough time to star on a TV show, so screw that. I think that makes me Group 1 by default, which is good, because otherwise my family would disown me.

“Shouldn’t we be able to use rationality techniques to figure out which of the Group 3 people are right, and move faster than guideline-making bodies“? Well, that’s the dream. But take that route, and you notice you’re wading through ankle-deep skulls. I occasionally flirt with trying this – like every doctor, my practice has a few idiosyncrasies and places where it deviates from the exact textbook solutions. But I would be nervous putting too much trust in my own gut.

This is all context for how to think about questions like “should we test everybody for lead?” or “should we think more about lead?” or “is the psychiatric establishment incompetent for not testing lead more?” The prior on the psychiatric establishment being incompetent is never that low. But the prior on any given alternative being especially fruitful isn’t great either
That's not the post, it's just a taste. If you want a good overview, he provides it. If you want a list of 10 most depressing habits, well, try Google.

DutchGirl
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by DutchGirl »

I had a depression. I had to try two SSRIs to find the one that helped me without annoying side-effects. I guess that I was relatively lucky that the second one worked for me/my body. I used it for half a year and it helped me to be energetic and optimistic enough to visit a psychologist and to work on my issues at that time. Then I slowly stopped taking it and the effect of the therapy stayed.

So I think they can be really helpful to get people out of a state of total depression and into a state where they can actually start improving their situation (and their own view of situations).

As for Lemur, I'd indeed try exposure therapy and get as much experience talking in public as you can. I wouldn't do that while using alcohol or soft drugs, as they have a lot of side-effects that are well-known.

FruGal61
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by FruGal61 »

Hi Lemur,

I have heard it said that many people fear public speaking more than death. You are certainly not alone, this is a crippling fear for many, many people.

For situational anxiety, many people have success with a beta blocker medication called Inderal (generic name: propanolol) that is usually used for high blood pressure and for other heart conditions. Inderal has been used for years for people to combat public speaking or performance related anxiety and you take it only before your performance. This might be worth investigating while you are gaining your confidence at public speaking, as it is considered not addictive, and you only take it as needed. Like any drug, there are side effects to consider but with the proper dose, these can be lessened.

As a health care professional, in general I am not in favor of medications like the SSRI's (Prozac, Effexor, Celexa, etc) for depression or benzodiazepines (Valium, Ativan) for anxiety unless the person truly cannot function with them. Recent studies show that long term use is detrimental and many people have a difficult time getting off of these drugs. Medication as a way to work through life's problems is a band-aid solution and sometimes it is necessary to experience sadness, heartbreak, failure or embarrassment in order to grow, get stronger and learn coping mechanisms. Yet, sometimes a short period, e.g. 6 months, is indicated for situational depression related to a crisis or traumatic event.

I know many, many people who have been on an SSRI for years with no intention of ever coming off. These people have been told they have a "chemical imbalance" in their brain and they need the drugs to increase their serotonin levels. I think in many cases, using these drugs can become a crutch and as above, many studies report long term use can be dangerous.

I took Zoloft about 20 years ago for crying jags related to depression and a break up. it worked but I had trouble sleeping so was offered another drug for sleep (trazodone). After five or six months I got off of the Zoloft and never went back, and I rarely took the trazodone as I did not want to be taking two prescription drugs daily.

Today I still deal with depression but I work at keeping it at bay with self-directed CBT, exercise, taking Vitamin D, diet, being outside, spending time with my boyfriend's dog, and hanging out with non-judgmental, friendly, supportive people. Good luck!

ThisDinosaur
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Re: Medications for Depression/Anxiety/Stress & other mental health problems.

Post by ThisDinosaur »

The only thing I'd add to what's been said already is the stoic mindset of only concerning yourself with things you control.

When giving a speech, are you worried about what others think? How they react to you? You cant control that, so dont waste a thought on it.

Are you worried that they'll see your hands shaking, and hear your voice cracking? Will your heart race and you'll feel unpleasant? So what? Give the speech anyway.

You can perform *during* a panic attack. Once you've done so a couple of times, you'll realize they're no big deal. Just a physiological thing that happens. Teddy Roosevelt once gave a speech after being shot. You can give one during a panic attack.

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