# What to expect with anti-depressants after two episodes of depression?



## Into The Light (Nov 25, 2007)

i am just wondering what happens to most people once they've been through a major depressive episode at least twice when it comes to medication. is it unrealistic to think i could at some point come off my medication and live without it?

i know my gp told me that after a second episode that people usually are on an anti-depressant for an indeterminate amount of time.

i would like to think that at some point i could live a medication-free life but maybe the reality is that i am going to need it through various periods of my life? or maybe even for good?

will depression probably always be something i am going to have to deal with forever? i know the statistics of likelihood of becoming depressed again, and they are considerably high. i believe it's something like 50-60% after a first episode, 70% after a second, and 90% after a third.

i kind of wish i had a crystal ball when it comes to this piece of my life. i want to know what is realistic and then accept and adjust to that.

the other really weird thing seems to be that i sort of have depression tied into my self-identity. it's been that way for a while now. when it's not bad and i'm managing fairly ok it feels almost like a friend and i kind of want it to be around in the background. but when it gets real and interferes with my day to day then it's no longer a friend. i guess i am feeling conflicted since it feels like part of who i am but at the same time i know how destructive it can be.


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## ladylore (Nov 25, 2007)

ladybug said:


> the other really weird thing seems to be that i sort of have depression tied into my self-identity. it's been that way for a while now. when it's not bad and i'm managing fairly ok it feels almost like a friend and i kind of want it to be around in the background. but when it gets real and interferes with my day to day then it's no longer a friend. i guess i am feeling conflicted since it feels like part of who i am but at the same time i know how destructive it can be.



I can't answer the medical part of depression - I have been fighting it for most of my life with a number of severe episodes. What I have understood that alot of it is connected to past history and once I got to that and how it effects me now-then some of it went away.

Its also an automatic fall back position at times, as those paths through the brain are well worn. I have to fight and retrain myself to really think and believe differently - changing beliefs systems is hard but it can be done.

As for the old friend part - I have had to ask myself what scares me about success and optimum health. The answers that came to me were a bit surprising.

But LB - this all takes time and no one is happy all the time, people go through ups and downs - what we might consider depression may only be an off day -

My therapist actually kicked my butt this past week - she told me it was time that I got back on the horse as my last upset was over a month ago. I agreed - time to get back into the game and get involved with life one more time.

Anyhow LB :friends::hug:


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## HA (Nov 25, 2007)

LadyBug,

I'm just curious why someone would want to come off their medication after having a second episode of depression. There are the stats as you said about the risk being about 70% and then 90% with the third episode. 

I think the risk factors would increase with psychosocial factors such as losing a job, death/illness in the family and other adverse life events. Perimenopause and menopause would also be a factor.

I'm curious why someone would want to come off medication because I recall not wanting to take a medication because I did not want to be "sick/weak" or "abnormal" and if I did not need to take a medication then that would mean I was "normal" or not sick.

After the second time I needed medication I was never so glad to feel better and be able to function. I never want to feel like that again and I don't know if I will ever want to take the risk of stopping medication. 

The other reason I did not want to take medication was the hassle of taking it everyday. It was just another thing added to my daily "to do list " that I did not need added to. Now it is no different then eating breakfast...it's just an important part of my daily routine.

So....why would you not want to take your antidepressant?


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## David Baxter PhD (Nov 25, 2007)

ladybug said:


> i am just wondering what happens to most people once they've been through a major depressive episode at least twice when it comes to medication. is it unrealistic to think i could at some point come off my medication and live without it?
> 
> i know my gp told me that after a second episode that people usually are on an anti-depressant for an indeterminate amount of time.
> 
> i would like to think that at some point i could live a medication-free life but maybe the reality is that i am going to need it through various periods of my life? or maybe even for good?





HeartArt said:


> I'm just curious why someone would want to come off their medication after having a second episode of depression. There are the stats as you said about the risk being about 70% and then 90% with the third episode.



There are several factors to consider, I think. First, no it is not unreasonable to think that at some point you may be able to discontinue your antidepressant medication - most people are able to do so at some point.

One of the factors is whether or not the individual is active in addressing some of the factors that triggered the depressive episode, especially the cognitive self-talk factors and the life issues/events factor. If treatment is limited to taking medication, I would think a typical experience is that as soon as the medication is no longer there you'll find yourself right back in the frying pan again.

Additional factors include the severity of the depression and how long you remain on medication the first time before discontinuing it. I don't have hard statistical data for this but based on my professional experience I generally tell clients that they should try to remain on the medication for a minimum of a year - and 18 months or 2 years is better. It doesn't take nearly that long in most cases to start feeling better but it takes that long to rebuild sufficient resilience and coping skills to avert a relapse. There is some data to support this, actually: People who do remain on SSRIs for 2 years are significantly less likely to have a subsequent major depressive epiosde within the next 2 years than those who only took the SSRI for a year or less. All this, of course, assumes that one is also addressing the psychological factors in therapy as well as taking the medication.

As well, one needs to consider whether some of the factors triggering the first major depressive episode may be more "biological" than psychological. For example, people with chronic low level depression (dysthymia) who progress to a major depressive episode are probably more vulnerable to relapse than those without dysthymia. Similarly, those who are vulnerable to seasonal affective disorder may also be more vulnerable to relapse. Some of the latter clients are able to reduce the medication to a very low almost sub-maintenance level during the summer and then increase it again in the fall (assuming it's the winter version of SAD).

And finally, whether or when to discontinue your medication is also dependent on how adept you are at recognizing the early signs of relapse and your willingness to go back on at least a low maintenance dose of the medication and/or take other effective measures when those early signs appear.


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## Into The Light (Nov 25, 2007)

> I have had to ask myself what scares me about success and optimum health. The answers that came to me were a bit surprising.


that is an interesting perspective and something i'll have to think about. did you have many reasons or just one or two?



> So....why would you not want to take your antidepressant?


i'm fine with taking it as long as i need, but i don't want to take it if it is no longer necessary. i know i need it at the moment so i am taking it right now. i do worry a bit about possible long term unknown side-effects, such as medication-caused diabetes or things like that.

there's another vague reason for not wanting to be on it but i can't put my finger on it. i think maybe if the answer had been that i need it for life, that i then would be condemned to always being sick underneath. it's kind of hard to explain. maybe it does have to do with wanting to be normal and not wanting to need anything.


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## ladylore (Nov 25, 2007)

> that is an interesting perspective and something i'll have to think about. did you have many reasons or just one or two?



The main answer to that one was 'what if I can't keep up the success and relapse again? Basically, once I am "well" (whatever that means  ) I have felt and still feel at times, that I have to keep it going at a certain level or I will let myself and everyone else down." Therefore if I am sick I don't have to expect perfection and neither does anyone else.

There is definitely some faulty beliefs within that one - but that is the truth of the matter - for me. 



> there's another vague reason for not wanting to be on it but i can't put my finger on it. i think maybe if the answer had been that i need it for life, that i then would be condemned to always being sick underneath. it's kind of hard to explain. maybe it does have to do with wanting to be normal and not wanting to need anything.



I know someone has mentioned this before at some point. You may want to consider this like having diabetes and the anti-depressents are your insulin. No one is going to tell you to ever stop taking your insulin - as that would be extremely hazardous to your health. If you need anti-depressents - you need them.  :2cents:


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## Into The Light (Nov 26, 2007)

thanks ladylore for sharing what your fear of becoming well is all about. i know one reason i have but it's hard to share.



ladylore said:


> I know someone has mentioned this before at some point. You may want to consider this like having diabetes and the anti-depressents are your insulin. No one is going to tell you to ever stop taking your insulin - as that would be extremely hazardous to your health. If you need anti-depressents - you need them.  :2cents:


i totally agree with this viewpoint in terms of being ill: depression is a disease and it requires medication to keep it under control. however, the difference between diabetes and depression in my eyes is that diabetes, once you have it, is permanent. i do not believe depression is permanent, therefore medication need not be permanent.

i am all for medication when you are in need of it, and i know i am in need of it right now. on good days i am quite sure i'll be able to hit a point where i won't need it, on bad days i believe i'll be depressed forever and therefore on medication forever. i guess this confuses me because my view can change rather radically.

david's response was helpful too, as i think his post reflects a fairly objective view, and this is what i was looking for, an answer to what is realistic, and what i can expect.


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