My first psychotropic medication was, as nearly as I can remember, imipramine (Tofranil). At the time I was only diagnosed with unipolar depression, so it seemed like a good choice. Imipramine is what is called a “tricyclic” antidepressant because of its chemical structure. Many people complained of the side effects.
Tricyclics were about all the medical community had to offer until 1987, when Prozac hit the market, followed by its cousins Zoloft and Paxil. All of these were classified as SSRI drugs, ones that selectively acted on the neurochemical serotonin in the brain, rather than a wide variety of brain chemicals as the tricyclics had.
Since then we have listened to Prozac, talked back to Prozac, and been referred to as a Prozac Nation. Prozac has been hailed as a miracle drug, damned as a gateway to violence or suicide, and prescribed in phenomenal amounts.
And Prozac has helped me. After about six weeks on it, when the drug started to kick in, I was on a sailing trip. One of the crew said I was the passenger most at peace with myself that he knew. It was a revelation to me and a new way of thinking of myself.
Prozac changed my life – possibly saved it. And then, not so much. I moved on to other medications.
“Major Study Finds Antidepressants Work, But May Have Limitations,” by Brigit Katz, published on The Smithsonian.com, validates my perception.
Her article states, “A meta-analysis [or study of studies] of existing trials suggests that the drugs are mostly effective on a short-term basis for patients suffering from acute depression.” Katz’s article also cites articles in the New York Times and The Lancet that report similar findings.
The Lancet study “analyzed 522 double-blind studies that included 116,477 patients and 21 commonly prescribed antidepressants. The results of the study showed that all 21 of the antidepressants were more effective than placebos in reducing depressive symptoms during the first eight weeks of treatment.”
“The new analysis suggests, however, that the efficacy of the drugs may be limited,” Katz reports. “For one thing, the benefits applied in the short term, and only to patients who are suffering from acute major depression.” [emphasis added]
The Smithsonian.com article and the studies conclude that “while the new study suggests that antidepressants are more effective than a placebo, at least in some cases, media reports claiming [as an article in Newsweek did] that the research shows ‘antidepressants do work, and many more people should take them’ are not entirely accurate.”
(This hearkens back to a pet peeve of mine: that headline writers (who are almost never the authors of the articles) do a poor job of summarizing articles in favor of more definitive or appealing descriptions of the text. https://wp.me/p4e9Hv-Br)
At any rate, the meta-analysis bears out my experience. Although I was bipolar 2, my disorder first manifested as major depression. I got relief from Prozac, results that later diminished. Since my proper diagnosis I have found more relief from a combination of an SSRI, an anticonvulsant medication often used for bipolar disorder, and an atypical antipsychotic also useful for bipolar as well as schizophrenia. Even though I do not have seizures or schizophrenia, these medications work for me and have not worn off for several years now.
So, what’s the takeaway from all this? I think it is that, if your medication for bipolar or depression seems to be “wearing off,” your perception may indeed be valid. But that’s no reason to give up on psychotropics altogether. People and their disorders differ in ways we just don’t know. You can ask your doctor to try a different medication or combination of medications that may work better for you.
The benefits of medication for psychiatric disorders do not simply go away just because the effect of one does.