Antidepressant Expectation Overreach

One day last week, all five clients I worked with were taking antidepressants. I asked all five if they believed they were benefiting from them; four of the five told me they couldn’t tell.

antidepressant_pillI am increasingly convinced that most antidepressant users start these drugs with a sort of blind faith, attributing power to them to change their circumstances for the better – a power the drugs just do not have. Nor are they getting the straight scoop on what to expect and what the medications are capable of, short or long-term, either. Also, the issue of withdrawing from them, well…, I suppose that too is for another day.

People contemplating the use of an antidepressant or have already started should have a clear expectation of what they want from the drug, and should re-align their expectations if they’ve fallen prey to what I refer to as “antidepressant expectation overreach.”

Here’s the way it goes all too often. Individual sees TV ad for antidepressant or knows of a family member, friend or colleague taking one. Individual decides he/she could benefit from one too.  Individual approaches PCP with a hodgepodge of undefined symptoms, and due to time constraints, gets only tidbits of information about the drug, but emerges with a prescription nevertheless. Individual attests to mood improvement, feels brighter and more motivated but is gaining some weight and experiencing sexual dysfunction. Individual becomes disheartened by this and disappointment sets in. In another scenario, individual perceives improvement, manages or tolerates the weight gain and sexual issues, but concludes they’ve plateaued on the drug. In either instance, individual becomes disillusioned and wants to stop the drug. (Some don’t, of course, and continue the perpetual cycle of dosage increases and augmentation in pursuit of mood improvement). But stopping isn’t so easy; it’s replete with uncomfortable and often formidable withdrawal symptoms. So individual is trapped between a rock (side effects, drug poop-out) and a hard place (the challenge of withdrawal) and continues the medication in spite of no measurable benefits.

The number of occasions I’ve encountered either one or both of the above scenarios is in the hundreds. So for an antidepressant user I recommend this: Clearly understand that an antidepressant will not, in and of itself, change any behavior. The drug can however provide a motivational lift and a measure of mood improvement upon which the user can build. So use the drug as a jumpstart to get going. Then, if or when the drug’s positive benefits after adequate dosing seem to have leveled off, consider this the point to start discontinuing.

Do this for two reasons.

  1. The medication has little, if anything left to offer.
  2. The withdrawal process can begin sooner, rather than later.
Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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