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Most cases of depression are not single isolated episodes but part of a recurring pattern. Sometimes even the intervals between episodes are characterized by mildly depressed mood, mild anhedonia etc., the so-called dysthymia.

I point out the relapsing and remitting behaviour of mood disorders because it shines a light on other ways of managing it. The effect size of SSRI’s is not all that large to be honest. But characterizing the risk of adverse effects as terrorizing is probably over-pessimistic and unwarranted. That said, I’ve taken meds - tricyclics, traditional SSRI’s, atypicals and I can’t say that any were terribly effective. Working with a skilled and trusted therapist has been practically life-saving though. It took a long time to find the right person. Before my current therapist I saw someone for 2-3 sessions and she seemed like she had never even had any experience in clinical interviewing let alone any insight into the sort of existential troubles that I was facing. I am an MD but I try to keep that out of the fray because it can skew the therapeutic relationship in odd ways. I don’t know. Just was “off.” But current therapist is awesome.

I also have two checklists that I review weekly. The first is titled “What’s going on?” It just lists some of my early warning signs. If those start pointing in the wrong direction I look at the second list which is about 60 things I know that have helped me in the past. Exercise or just being outdoors is near the top.

The expectation/anticipation of adverse medication effects is known to increase the risk thereof. The nocebo effect. If you are that agitated about the risk my advice is to work really hard on finding a compatible therapist.

I don’t think you can brute force your way out of depression but you yourself and especially with a therapist can begin to identify patterns of thought and behaviour that can keep you stuck. It’s just a nudge.



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