Pride Effects

Posted by fxckfeelings on February 11, 2013

For people who suffer from mental (or almost any serious) illness, finding the right course of treatment is a lot like dating; the goal is to find a match that’s steady, provides what you need (even if it provides some minor things you don’t), and gets along with/doesn’t burden your family. The risk of side effects—not side effects themselves, but their risk—is like the risk of wasting time with jerks, unavoidable for almost every treatment, and weighing those risks against the need for treatment and its benefits is what makes medical decision-making tough. Since you probably wouldn’t go for an arranged marriage (or even a matchmaker on Bravo), you shouldn’t assume your doctor is responsible for finding a safe, no-side-effect treatment while you sit back and wait. Nerve yourself to do the research, face the risks involved and then give yourself credit for the required courage, no matter how many medicinal Mr. Wrongs you face along the way.
–Dr. Lastname

I’m glad my wife was finally helped by her third antidepressant, because she’s now a lot less grumpy with me and the kids and she no longer seems touchy and unhappy all the time. The trouble now is that she’s less interested in sex that she was before, if that’s possible, and it leaves me feeling frustrated and ignored. It’s sad, because we used to have great sex and it always brought us together, and now we’re under greater stress than ever and she acts like sex is just more work. I don’t want to sound like her wanting to have sex is more important than her not being depressed, but I can’t pretend her total lack of interest isn’t hard to deal with. Surely there’s a better solution to her depression, so my goal is to help her find it.

I wish I could tell you that the treatments for depression are surefire and reliable, but they aren’t. This is due partly to the mysterious nature of the brain, but also because no doctor worth his or her salt will tell you that any treatment is 100% effective, 100% of the time. Even Athlete’s Foot can be tricky (and also decrease libido, at least for one’s spouse).

That said, finding the medication and/or therapy to relieve depression is especially tricky, so it’s important to remember that whenever you hear the words “this treatment has proven effective,” what they mean is “better, on average, than nothing.” So, unfortunately, there may be no treatment better than the one your wife is now taking, even though it’s the worst for her sex drive.

The ultra-hit-or-miss nature of treating depression also means that patients and their families must often make tough decisions about whether or not to try another treatment, possibly losing the benefit of current treatment and risking new side-effects, i.e., her decreased libido is tough, but if she rolls the dice again and comes up with a sleep-disorder, the only sex she’ll have energy for is in her dreams.

On the other hand, the most important treatment for depression is knowing that her—and your—negative thoughts about life, self, and relationships have nothing to do with who you are, what you’ve done or failed to do, or your love for one another and everything to do with depression. This reminder is a treatment you have to perform on yourself and one another every day if it’s to be effective, and it requires recalling that your relationship is every bit as important and loving as the day you were married, even if the illness of depression has made her withdrawn, critical, and hard to live with.

Part of not taking her depression personally is offering to see her psychiatrist with her, as you would with any other medical condition, and helping her weigh the pros and cons of various treatments. Remember, seeing a psychiatrist with your wife doesn’t mean you’re getting shrunk, either as an individual or as a couple, but ignoring negative feelings just by coming with and helping her make good decisions at a time when her brain is not working at its best. It’s an act of friendship and therapy, with you doing the therapy.

It’s possible, of course, that another medication may help her without causing sexual side effects. Several antidepressants are unlikely to cause sexual side effects—e.g., bupropion, mirtazapine, venlafaxine—but each has the same rate of treatment failure as the rest, approximately 33%, and carries a risk of new side effects.

In any case, don’t give up hope on sex forever. If she’s back to her old self in other ways, your wife may want to give you sexual pleasure whether or not she can have an orgasm. To find out, however, you have to take away the stigma of sexual dysfunction by letting her know that it’s the relationship that matters and that you don’t take her physical unresponsiveness personally. On the contrary, she should know that you have greater respect and appreciation for her wish to make you happy when it doesn’t give her sexual pleasure.

You can also legitimately hope that depression will pass, medication will not always be necessary, and better medications will come along. In the meantime, the measure of a partnership is not how hot your sex life is, but how well you stand by one another and stay friends when it’s not. The only thing trickier than treating a complicated illness is doing so while staying married.

STATEMENT:
“When my wife isn’t interested in sex, it feels like she isn’t interested in me or my needs and doesn’t really want to be with me, but I know sexual frustration tends to feel like personal rejection even when it isn’t. I’ll keep on remembering that our relationship has not lost its value, regardless of the negative feelings caused by depression and now by sexual dysfunction, and try to find ways to stay in touch with that value and bring it to life.”

My girlfriend tells me I need an antidepressant because she says I always seem irritable and unhappy and I sometimes scare her and our friends. I’ve also gotten some negative feedback at work about my abrasiveness, and I sometimes get so down it’s hard to go to work, period. From what I’ve read, however, it seems that some people have bad reactions to depression, like getting suicidal or gaining weight, and I just don’t feel they’re safe. I also listen to the warnings on the TV ads that talk about getting diabetes. I may not be happy, but my goal is not to be pressured into taking unsafe medication that will make me worse.

Doctors sometimes miss the good old days when people had faith in us and our recommendations, even when we were clearly wrong. Our patients often seem to want to return to those bad old days by looking for treatments that are “safe” and “effective.” Well, welcome to the modern age of percentages and uncertainty.

While the negative side of knowing that nothing is safe is never being sure how things are going to turn out, the positive side is making better-informed decisions about your health care, being the ultimate decider of your own treatment, and never, ever being a victim.

So let me tell you what I first tell my patients about antidepressants; they can kill you, but so can aspirin, and in both cases, it’s very, very, very rare. They can trigger mania, which can look very amusing but isn’t that much fun if you’re talking irritable nonsense to a TSA agent who doesn’t know mental illness from a Bin Laden manifesto. One of these medications, bupropion, can cause seizures, but seldom in its usual dose, while others can have weird interactions with migraine meds. All of these dangerous side effects are rare and manageable enough, however, so that we consider antidepressants safe, as medications go.

I could keep going down the list of other possible side effects, but I don’t think it helps, because while many antidepressants can cause weight gain, it’s not usual and no one has ever gone to bed and woken up ten pounds heavier. In other words, you can stop the medication right away if you feel your weight getting out of control, so there’s no point in scaring yourself about things that will probably not happen and can be easily managed if they do. After all, these medications can trigger suicidal depression, but I’ve never known anyone who died from it and didn’t just stop the antidepressant and ask me what the fuck I was thinking prescribing that crap since they feel so much better now they’re off of it.

The next worst thing about antidepressants is that they require three or four weeks of taking them every day, faithfully and regularly, before you know whether they’ll work and there’s a big, 33% chance that each time you try, that particular medication won’t work. So not only do these drugs require patience and dedication, they also force you to possibly throw in the towel several times before you find a treatment that works. It’s a lot of work, standing firm until it’s time to step down, but if you’re willing to put in that work and research, and not be a passive spectator of your own illness, you’ll make the right decision.

So turn your fear and worry into good risk management. Don’t ask whether a medication is safe, but how great the risks are and what can be done about them. It’s like the decision to drive a car, which is dangerous but worth the risk if you have reasonable skills (and don’t drive in Boston). Use your doctor to help you analyze the risk and weigh it against your need for medication, which is a topic on which you’re the ultimate expert.

In other words, ask yourself what’s the risk of not getting treatment, in terms of losing your marriage, job, etc. The process is more painful than finding a doctor, or medication, that you can have faith in, but it will make you a strong person, a good decision-maker, and an active participant in finding answers and improving your health.

STATEMENT:
“I hate the idea of having to take medication, particularly when other people tell me it’s necessary, but I know how to make my own decisions after taking their suggestions and my fears into account. Just because I’m nervous doesn’t mean I’m not a brave, objective decision-maker.”