‘I had been holding on so tightly for so long, white-knuckling this alone my whole life’
within a few days or weeks and can be tolerated by most people. Dr Pieter Cilliers, a psychiatrist in Cape Town, says the best thing a patient struggling with side e ects or a lack of improvement can do is ‘complain, complain and complain’ to their doctor to ensure a re-evaluation and a possible switch to a di erent medication or dosage.
Interior designer and yoga teacher Lisa Welter, 38, started taking antidepressants when she was 16 ‘in an e ort to not want to kill myself ’. She says some of the medications came with side e ects, including tremors and a rapid heartbeat, but she has eventually found one that makes her feel ‘able to get out of bed’ in the morning. She says she once skipped her medication for four days and ‘crashed into a deep hole’ of depression.
Johannesburg psychiatrist Rykie Liebenberg says it’s important to be consistent when taking antidepressants. ‘They are a long term treatment for a serious illness. They should not be taken on a whim.’
The question is, then, how does a patient know when he or she is ready to stop taking antidepressants? My psychiatrist asks why I would want to stop something that is clearly working; I tell him it is the desire to see what I am like in my pure state, unin uenced by chemicals.
The Wall Street Journal reports that patients who’ve had one episode of depression have a 50% chance of having a second, and those with two episodes have an 80% chance of another. Last year, the Journal of Clinical Psychiatry published a review of 15 clinical trials which reported that taking antidepressants until a doctor recommends stopping could cut the risk of relapse in half.
For treatment duration, the consensus is one year of treatment for a rst episode of depression lasting under six months. If a rst episode lasts between six months and a year, Pieter recommends two years of treatment. However, if the patient has experienced symptoms of depression for over a year, the medication should be taken on an ongoing basis until the doctor decides it can be stopped.
Antoinette says most patients who start taking antidepressants feel better within six to eight weeks – when many are tempted to stop their medications. Pieter points out that the brain only starts to recover after long-term treatment.
‘A patient should discuss with their doctor when the best time to come o their antidepressants will be. This depends on the length of treatment, the number and severity of their previous episodes, the current stressors in their lives and their ability to use other coping strategies to help in emotional times,’ Antoinette says.
After a few more episodes of depression and anxiety, a new GP recognised there was a pattern to Grace’s episodes and recommended she see a psychiatrist. After a barrage of tests, Grace was diagnosed with type II bipolar disorder and is now on a mood stabiliser and an antidepressant. ‘I wish I’d got the bipolar diagnosis sooner,’ she says. ‘It was such an extreme relief. I had been holding on so tightly for so long, white-knuckling this alone my whole life, and then I had someone tell me it was all right and help me loosen my grip.’
While antidepressants often yield positive results, experts recommend combining them with talk therapy. ‘I compare the medication to a plaster, which can be used to help the symptoms quickly while you work through the underlying issues in talk therapy,’ says Antoinette. ‘Medication cannot solve relationship problems or x underlying personality characteristics and patterns that can lead to a recurrence of depression or anxiety if not addressed by some form of therapy.’
Author and mental health activist Andrew Solomon agrees, writing in his book The Noonday Demon: An Atlas of Depression: ‘… it is terribly dangerous to put talking therapy on the back burner. Therapy allows a person to make sense of the new self he has acquired on medication, and to accept the loss of self that occurred during a breakdown. You need to be reborn after a severe episode, and you need to learn the behaviours that may protect against a relapse.’
As for the wine, I’ve discovered that generous quantities mixed with my medication leave me feeling anxious and depressed the following day, and as sweaty as a Bulls rugby player in summer. I try to stick to the shot-glass principle nowadays. When living life on antidepressants, sacri ces need to be made, but I’m grateful I can now revel in the good times when, eight years ago, taking a bath seemed overwhelming.