Antidepressants and climbing

I understand there is substantial scientific debate about whether antidepressants are effective at all in their primary purpose, e.g. this article

I suggest you try running a lot.

Timothy.Klein wrote: Modern SSRIs have a pretty low side effect profile, particularly if you find one that fits your body (see above statement).

On some people, and some modern anti-depressants are even modern SSRI's, many more are biphasic. So we have some overlap in our discussions, but they are apparently different discussions. I'm beginning to wonder how much you actually know.
Regardless, in any shoes, I'd be more careful about dispensing such overly broad advice. You didn't even see a diagnosis for the dude. ...a dude who is counting weed as an antidepressant. (!!! RED LIGHT !!!)
Sidebar: (And the OP may be trolling - i actually hope so, as being a troll sucks less than being depressed, just like faking suicide sucks less than succeeding at it. But I'm treating/discussing this as a serious thing.)
But I digress... Man oh man, that's a broad brush you paint with - and when that happens, the details look poor from any elevation below 10k feet.

Skitch- see a doctor. The comorbid conditions frequently associated with anhedonia can be pretty serious ones, but luckily, many have a strong physiological basis and if they are the cause, might present an effective fix.

PS:

skitch: Get thee to a professional. We on Mountain Project would love to help, and we have lots of ideas, some with lots of merit. But we're climbers, not mental health professionals.

That said, my two cents: (but, I've been seriously chronically depressed, and medication helped get me back, so I think my advice is worth at least a nickel; seriously, if you've never been there, you don't understand):

Your post on anhedonia shows that this is not a transient funk, it is ongoing. And this: "Does telling yourself 'you aint got shit to live for' help anyone else climb harder?" is deeply disturbing. No, being suicidaly reckless does not make you a better climber. You're not psychologically healthy. Get healthy, and climbing will give you a chance to reaffirm that. Climbing is awesome, and I want to spend the next 60 years doing it.

Seriously, talk to a professional. If you've got a good relationship with your GP, start there. He/she can prescribe an SSRI, which is where a psychiatrist would start anyway. They say up to 4 weeks before you respond (or don't), but likely you'll know in a week or two. I was lucky, the first drug (Citalopram, an SSRI) worked well for me. About 50% respond to the first drug; of those who don't, about 50% respond to the second. And likely you'll be able to keep it between you and your GP. (This is acknowledging that many of us are not comfortable around mental health issues, and still tend to treat them as personal failings; even me, knowing it from the inside, I want to minimize how much I identify as someone who is mental health insufficient, and see myself as someone with a chronic health(generic) condition that needs to be managed.)

If you feel like your GP is not up to speed on mental health, or the drugs aren't treating you right, or your condition is complicated due to co-conditions, then figure out how to see a psychiatrist. There are very smart people who spend 40 hours a week seeing complicated cases, navigating the gray zones of mental health.

Speaking of which: a key diagnostic is whether you're monopolar depressed or bipolar. Back to stating my lack of expertise, I don't know much about bipolar, except that the drugs are not the same, and often unhelpful if you're misdiagnosed.

All that said, I'm going to endorse some of the prescriptions here, especially for regular heart-rate-raising sunshine-exposing exercise. Can you commute by bicycle?

"Do antidepressants help you fit into "normal" society?"
Sadly, at least from my experience, no. Sounds like you've got (like me) anxiety issues in spades. I wish I had better answers. God, I wish I had better answers.

Feel free to pm me.

kevin

Skitch-

Not too much experience with it but talk first drugs later. Maybe try CU Colorado Springs mental health department. Get them to recommend a few names if you're not close with your GP, or don't have any other recommendations.

All the best,

A

Lucy in the Sky with Dragon cams...always sets me straight when the give-a-shitter is getting run down...SERIOUSLY. I wonder what kind of research has been done regarding its affects on those suffering from anhedonia? It has a way of making EVERYTHING and NOTHING engaging.

Mr Clean wrote:Lucy in the Sky with Dragon cams...always sets me straight when the give-a-shitter is getting run down...SERIOUSLY. I wonder what kind of research has been done regarding its affects on those suffering from anhedonia? It has a way of making EVERYTHING and NOTHING engaging.

Quite a bit of research with depression or cognitive issues, actually and quite a bit more has been done with pizza toppings. And research shows it can be pretty effective in certain situations.
Google is your friend if you want to know more. Grob, Groff, Danforth, etc - names you might want to add to searches. Erowid.com is a great place to start.

But I'm not aware of much specifically dealing with anhedonia. Perhaps because one must beware that psychotropics can have some pretty negative consequences for people with underlying mental health issues, most particularly schizo-effective disorders, which are commonly co-morbid with anhedonia. So I imagine that specific reasearch is more or less contraindicated due to heath liabilities. I have no idea what the liability would be for triggering florid schizophrenia in a pseudo-stable person might be... but I imagine the board would probably not approve. Most such modern studies are done as end-of-life studies.

If the anhedonia diagnosis is valid, then there is an increased risk there.

In other words, seeing a doc would be a better idea... than experimentation on one's own. A bad trip isn't "I think I can fly." A Bad trip is "This will never end otherwise, and I think I understand now what i have to do." Bad trips suck for some folks.

I done babysitted too many people in po' shape to think that flying solo is OK when they are starting in a bad place. Totally "two thumbs down" without help.

I think drugs are bad.

Hope you have insurance and plan to forever, most of those drugs are "take em for the rest of your life and up the dosage until you are a zombie" kinda drugs... If you go that route you'll end up on mood stabilizers, some meth based antidepressant, an every night you'll take a horse sized sleeping pill to get to bed... ride that roller coaster everyday over and over. Your life should be fulfilling and exciting... I'd start with a change, not a pill.

Rohan de Launey wrote:Hope you have insurance and plan to forever, most of those drugs are "take em for the rest of your life and up the dosage until you are a zombie" kinda drugs... If you go that route you'll end up on mood stabilizers, some meth based antidepressant, an every night you'll take a horse sized sleeping pill to get to bed... ride that roller coaster everyday over and over. Your life should be fulfilling and exciting... I'd start with a change, not a pill.

Wow... just WOW.
Uh - there's the flip side of that overly broad brush.
And what do you mean by "meth based antidepressant" ???

I'm quite surprised it took this long, Tony, and this is why I'm quite intentionally painting with that "broad brush." There are a lot of irrational, silly, dangerous views of psych meds out there. And those that hold said views love to tell people that need help that "drugs are bad, mmkay." Or much worse.

Going climbing now but I guess it's settled then, three studies and a couple of straw men questions have decisively proven that "drugs are bandaids".

Nothing could possibly go wrong, lol.

Drugs are recommended first and shoved down people's throats because pharmaceutical companies make a lot of money.

The question was about drugs. It's tilting at windmills to say anyone is pushing drugs.

Remember this is a real person. When one spouts their paranoid nonsense about pharmaceutical company conspiracies or zombie drugs in a thread like this, you are quite possibly scaring someone away from ALL help. Depression can kill people.

Even simple things like "I think drugs are bad" are profoundly unhelpful.

Use common decency, and go on your anti-drug tirade somewhere else.

Good luck feeling better, skitch. Cognitive behavioral therapy is the long term tool. But medication is absolutely a contender for helping short term, especially if the depression is bad. And antidepressants will have minimal to no impact on your climbing.

dmb wrote:. However, one of the studies I just linked shows that mindfulness CBT is just as effective. Why recommend drugs first (which can have drastic side effects), when there are alternatives that are similarly effective?

You do understand the difference between "equally effective" and "as "equally likely to be effective," right? That they are not interchangabe for most people? That it depends on the individual, and that any given individual may well respond to one substantially and not the other at all?
Emo people - I am betting on CBT and placebo.
Bipolars and TBI people - I am betting on chemical intervention first.
Schizo-effective disorders - Most certainly go for the chemical trials first.
Part of the Placebo effect in most trials likely has much to do with the attention given in the trial, not just the placebo. If you read the 'wellness' studies for people put on a healthcare program, you will see that a majority of the self-reported feeling of increased wellness occurs prior to any medical situation or attention is sought, and that objective and data-oriented measures show no change Vs a control - the people simply "feel better."
Remember - depression is self-reported.
Lots to say here, but it seems that I could make every other post just correcting broad and frequently misplaced generalizations. I am sure the OP gets the point:
See a doc, ask about alternatives, be your own advocate if you can - if you can't take your wife or a loved one who is not in a funk and can advocate for you.
Track your feelings and progress. If something is not working within 30 days, try something else. There is a theraputic lag associated with most anti-depressants, almost all with the exception of Ketamine(*1).
Ask loved ones to help you evaluate that too. I have family members with MDD and they loose the color in their voice and don't even hold their heads up to talk or make eye contact when they get bad. And they can't see the difference as soon as we can when they start making eye contact, gesticulating, and use vocal tones again... but we notice.
Serotonin is one thing people keep talking about, but they seem unaware then, that disorders associated with NE and DA can cause depression too - not just Serotonin. Considering that it is a rather 'minor' neurotransmitters, that's saying something. (*2) And dysfunctions associated with the NE and DA systems in the brain are associated with the second most heritable class of psychiatric conditions (yes, genetic) known. Even those are not the big lifters.

And lastly, Am I the only one who has thought to ask about recreationa drug use here? Esp. since the person declaring himself to have a MMD listed dope as an anti-depressant? Any red flags there for anyone but me? One of the most treatment-resistive people I have known with a MDD absolutely refuses to stop her daily use of dope and regular use of whatever else comes up, and she isn't getting better, no matter the approach. Shocking, right?

(*1) - still in trials/experimental and not totally understood why this one works. Perhaps Lester's 2012 proposed "inside out" mechanism for the escort of receptors from the cell body interior deserves more active review?

(*2) People never seem to talk about it, but Catecholamines and Glutimate do more heavy lifting. GABA, cAMP, and a host of neuromodulators are to be considered as well...

Complex stuff man. see a doc. And it's OK to be a skeptic, MOST ESPECIALLY of what people offer you on the net.

dmb wrote: CBT has been shown to be effective for all of these.

But not necessarily "more effective" or "as effective." Why are we having these parallel discussions? My above comment distinguishes a difference between "as effective" and "as likely to be effective." Misusing these terms is indiscreet if giving associated advice...

We agree on a lot of parallel stuff - and maybe I'm being picky about distinctions, but as someone who has had to call people in for consensus on 5150 (AKA Legal 2000 AKA Legal mental health hold) the devil is in the details.

So I wonder... What do you mean when you say that CBT is effective for Emo people? Do they cut their hair so they can see out of both eyes? I've got to think that would help with those crushing headaches that are causing their depression. That was more where I was headed with the statement. I was making a joke. I've dealt somewhat extensively with both real cases and attention-seeking cases and I'm not so fond of the drama-oriented depressed crowd. When there are people out there with real problems, the mental Munchhausen syndrome types are really clouding issues and sucking up resources that are needed in other places, so I guess my gallows humor follows that.

To the drama kings/queens...
"So see you when your 40, lost and all alone
being comforted by strangers you'll never need to know
not sad because you lost me
but sad because you thought it was cool to be sad
You think misery will make you stand apart from the crowd
well if you had walked past me today I wouldn't have picked you out
I wouldn't have picked you out"

My 2 cents worth (as a climber that was prescribed antidepressants once upon a time):

If you take them make sure you trust the prescribing psychiatrist or doctor as a person, not just because of their title. If they don't insist on monitoring your response to the drug, don't trust them!

Individuals vary hugely in their response to antidepressants, and it's impossible to predict. Some people get the little boost they need and some people get a big boost that leads to erratic behavior. If you turn out to be one of the latter, by definition you aren't going to be able to seek the help you need to stop taking the drug, because you are going to think you are totally fine!

For a climber feeling way too good can lead to uninhibited risk taking
on the rock! If the drug takes away your fear, you are a whole lot less safe. Fear is good.

The Keith Richards line from the Rolling Stones song "I wasn't looking too good but I was feeling real well" comes to mind.

Kudos to Samet in the article referenced earlier in this thread for opening up about his experience.

Although trite sounding (but certainly not meant that way), after all my travails with depression (and they have been many), the best solution I have found is "The best cure for depression is happiness". Maybe it doesn't work for everyone, but neither do antidepressants.

I don't know you so don't take this the wrong way. I could be barking up the wrong tree.

If you're drinking alcohol or doing any illegal drugs including Cannabis... STOP! Any of those things could make you feel the way you do. Cannabis has helped with depression but it's not for everybody. Stop for a month and you could feel much better.

I'm sorry if I'm wrong but I know firsthand how much better you can feel when you don't have a habit to feed. I hope you feel better soon. Depression is a fucked up place to be.

I would try every avenue available to you before seeking out a prescription. Here's what worked/works for me:

-regular exercise (not just climbing. I'm talking running/jogging, cycling, hiking: cardio stuff (though there are studies that show that extreme, strained cardio akin to triathlon type training is bad for the heart, so careful not to push it. After all, the goal is to feel good, right?))

-diet (definitely no processed/canned/boxed/fast foods, cut back on the gmos along with dairy, soda, sugar in general, and sodium)

-supplements (keep up with it, take them regularly: I swear by spirulina, ginseng, & ginko biloba. Also a good, general multi-vitamin is essential, and a B complex is great for overall energy.)

-stretch (just... stretch. Be it yoga, pilates, chinese meridian style, post-climb/run type stretching, whatever. Just do it. Regularly.)

You've probably tried some, if not all of that stuff already, and if you gave it a decent shot for a while and were consistent, and it still didn't help; I'd seek out a good, professional therapist.

If you do go the pill route, please be cautious, do your research, and choose your doctor/therapist wisely BEFORE you get on the meds. A lot of folks on this thread are offering up some great advice, but take it all with a grain of salt. Even with the professionals' opinions. The truth is, no one really knows the answer, because everything is different from person to person when it comes to this type of thing.

Good luck!

Jon Zucco wrote:I would try every avenue available to you before seeking out a prescription. Here's what worked/works for me: -regular exercise (not just climbing. I'm talking running/jogging, cycling, hiking: cardio stuff (though there are studies that show that extreme, strained cardio akin to triathlon type training is bad for the heart, so careful not to push it. After all, the goal is to feel good, right?)) -diet (definitely no processed/canned/boxed/fast foods, cut back on the gmos along with dairy, soda, sugar in general, and sodium) -supplements (keep up with it, take them regularly: I swear by spirulina, ginseng, & ginko biloba. Also a good, general multi-vitamin is essential, and a B complex is great for overall energy.) -stretch (just... stretch. Be it yoga, pilates, chinese meridian style, post-climb/run type stretching, whatever. Just do it. Regularly.) You've probably tried some, if not all of that stuff already, and if you gave it a decent shot for a while and were consistent, and it still didn't help; I'd seek out a good, professional therapist. If you do go the pill route, please be cautious, do your research, and choose your doctor/therapist wisely BEFORE you get on the meds. A lot of folks on this thread are offering up some great advice, but take it all with a grain of salt. Even with the professionals' opinions. The truth is, no one really knows the answer, because everything is different from person to person when it comes to this type of thing. Good luck!

+1 ^^^