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what do you do when your depressed and can't take meds?


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#1 melpomene

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Posted 07 May 2010 - 12:55 PM

i can't take meds. i just can't. i've tried a few but my liver can't handle anything. i have a hard time keeping therapy appointments.... i swear something always gets thrown in my face and i have to cancel but when i do get to go i spend the 45 minutes giving the "update". on top of it my co-pay is $40 so that's $160 a month IF i can make all the appts..... and once a week isn't NEARLY enough and in NO WAY affordable. of course, therapy can take years anyway..... IF you find the right person.

i feel stuck. suffocating between a rock and a hard place.


#2 melpomene

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Posted 07 May 2010 - 12:58 PM

and i CAN spell... i DO know the difference between you're and your. i just don't always type it right.

#3 SashaSue

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Posted 07 May 2010 - 01:59 PM

Well, if you decide you're stuck, you certainly will be. That's up to you though.

What do you mean when you say your liver can't take meds? Are you getting bloodwork done with each med trial and the liver stuff is coming back weird?

There are meds, lithium for instance, which are not metabolized by the liver. That might be something to consider.

How long therapy takes can be highly variable, depending largely on what kind of therapy it is. CBT tends to be faster, and more goal oriented, than, say, a psychodynamic approach.
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#4 melpomene

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Posted 07 May 2010 - 02:16 PM

one time of liver bloodwork coming back bad is enough for me. i have family history and can't take the chance of this one being bad, then that one being bad, then "poof" i'm dead. i can't take the chance. not to mention a $4000 deductible.

i thought lithium was mostly just for BPD? which is a possibility.... but it's hard to say at this point since i think i'm hitting perimenopause (at 40) which is aggrivating everything. but who wouldn't be having mood swings with all the crap in my life and no skills to really cope?

#5 rowen

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Posted 07 May 2010 - 03:16 PM

Lithium can be used for depression.

Have you looked in to Wellness Recovery Action Planning? Not a cure, but it's helpful.
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#6 SashaSue

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Posted 07 May 2010 - 04:27 PM

OK, so, if I'm understanding correctly, you got bad bloodwork back while you were taking one specific med, and then decided your liver couldn't handle any meds? Is that right?

If so, do you see how that, plus your long list of reasons not to bother with therapy, could create the impression some part of you is actively choosing to stay stuck right where you are, rather than taking the chance that the unmapped territory of greater stability might be a better place?

Change is scary. When you're used to being depressed, as awful as it is, the prospect of not being depressed anymore can be terrifying, in a way. But if you don't do the scary stuff, you end up not really doing much at all.
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#7 sorrel

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Posted 07 May 2010 - 05:59 PM

You have a family history of what? It seems like you have a pretty poor grasp of the connection between various liver ailments and the use of meds. Uh, no offense.

Anyway, therapy may benefit you more (I am extrapolating from things you've said.) Do you live near a medical school/teaching hospital? I got free therapy at a med school-affiliated clinic for several years.




#8 Stickler

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Posted 07 May 2010 - 08:49 PM

Hmm...I didn't realize that SSRI's, which is what they usually give people for depression first off, messed with the liver.
Would think you might need a lower dose b/c processing issues.

Lithium is dirt cheap...but you have to get blood tests done.

I would suggest that you look for a depressives workbook-one based on cognitive therapy, or cognitive-behavioral therapy, or DBT...all of those ought to help with the cognitive distortion aspect. Do this as an adjunct to therapy, so you get more bang for the buck.
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#9 null0trooper

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Posted 08 May 2010 - 12:10 PM

i can't take meds. i just can't. i've tried a few but my liver can't handle anything.


Can't take them, or won't take them? "one time of liver bloodwork coming back bad" being enough for you sounds more like an excuse for avoidance. One set of routine test results looked at once after taking a series of unspecified psych meds of some sort doesn't mean much - and doesn't sound like you're seriously worried about the condition of your liver.

Over time, bloodwork and copays are expensive. Untreated depression IS a lot more expensive, even without wasting $40 a month for a "catching up" therapy session on the days you can't find an excuse to cancel in advance.


Hmm...I didn't realize that SSRI's, which is what they usually give people for depression first off, messed with the liver. Would think you might need a lower dose b/c processing issues.


SSRIs by themselves aren't well-known for damaging the liver - sertraline has a low incidence of reported liver damage, even though it is metabolized by the liver. Being a "slow metabolizer" or having liver disease can mean that some SSRIs would be difficult to manage, even at a reduced dose, but not ALL SSRIs, and certainly not all psych medications.

TCAs would be problematic, because some can elevate liver enzymes without damaging the liver, and not many (any?) can be taken once liver disease progresses to moderate/severe damage. Liver damage is possible, so a doctor might not want to prescribe them to a high-risk patient who won't come in for regular bloodwork.

You'd probably want to skip the hydrazine MAOIs (including Marplan and Nardil) because they can cause liver damage. However, the non-hydrazine MAOIs, Parnate and selegiline (as Eldepryl or Emsam) are not associated with liver problems.

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#10 LilacOutsideMyWindow

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Posted 09 May 2010 - 10:18 AM

First, I ditto the advice above, and there is sound info up there about meds.

You sound like me in the throws of depression last year. I couldn't afford anything, and even if I could, none of it was going to help. That was the depression talking. It wasn't real. A friend described depression like a living entity, like a parasite - it needs you to keep it going, so it feeds you thoughts that are false, but that keep the depression going strong. A lot of them end up sounding like excuses when viewed from the outside, but I remember just how very real and true they were for me (if only everyone could have seen into my head - I was a hopeless case in there, I was).

I am not a hopeless case now. It is hard to afford the therapy sessions, and my cc debt is growing, but my health right now is more important than my credit score (sucks to have to borrow $ to get healthy, but I'll do what I have to). It sucks trialing meds, and it's scary getting bad blood work results. Way back in January, I had been Abilify just 1 month and my fasting blood sugar was 107. I have a family history of diabetes (type I, but still scared me). I thought, breifly, about calling it quits with meds, especially AAPs. Then I got manic. I added first Zyprexa prn, then later Seroquel. Both AAPs, both even more likely to raise my blood sugar. I'll admit I freaked out. It was scary. Then I had my blood drawn last month, aftering being off Zyprexa and Seroquel but on a higher dose of Abilify....and it was 97. I had done what my depression had told me was impossible. I had done for myself something I was sure I couldn't do.

I know the liver is different, and diet alone will not stop or change liver enzyme testing results, but different meds have different effects on the liver. Some have no effect at all. And in any case, you need sequencial tests to see how things are changing over time - getting better/worse/staying the same.

What you are saying right now sounds so much like me I just had to chime in. And I'll say again - it's the depression talking. You do have options. You do.
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#11 isis

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Posted 09 May 2010 - 11:04 AM

there are so many varieties of drugs all metabolized and excreted through different organs that having liver issues (even if you do) is not a reason to not take meds at all.

i'd risk another med even if it *might* cause liver damage because being depressed sucks and is statistically probably more likely to kill you anyway.
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#12 Catnapper

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Posted 09 May 2010 - 12:37 PM

i'd risk another med even if it *might* cause liver damage because being depressed sucks and is statistically probably more likely to kill you anyway.


I think this is the main issue - depression can be a fatal disease and the chance of dying from it is a lot more likely than med-induced liver damage.

What does your pdoc say regarding your liver and meds (or your GP, for that matter)? As others have mentioned, there are a lot of meds available that have little to no effect on your liver.

All the MI meds are a trade-off between possible side effects and relief of symptoms. But it's not just MI meds, that's true of all meds for all types of disease. If you had diabetes or high cholesterol or high blood pressure or MS would you deny yourself the benefits of meds, even though there may be side effects?

I think your depression is in charge right now and if you would allow yourself to try some meds for a few months and get out of the pit, you might feel well enough that therapy would be more helpful and you would just feel a lot better in general.

I have spent years of my life crawling along the bottom of the abyss in the dark, and I am willing to potentially do long-term harm to my body via meds not to go back to the abyss.

I hope you get some relief soon.

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#13 Guest_Jamie_*

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Posted 23 November 2010 - 07:23 PM

i can't take meds. i just can't. i've tried a few but my liver can't handle anything. i have a hard time keeping therapy appointments.... i swear something always gets thrown in my face and i have to cancel but when i do get to go i spend the 45 minutes giving the "update". on top of it my co-pay is $40 so that's $160 a month IF i can make all the appts..... and once a week isn't NEARLY enough and in NO WAY affordable. of course, therapy can take years anyway..... IF you find the right person.

i feel stuck. suffocating between a rock and a hard place.

Wow, I found someone like me. I can't take any meds either. I tried some but they've all caused reactions. When I was prescribed Lithium and Zoloft, I took it for 2 days, then went into acute liver failure. My liver tends to not like meds. I'm scared now to even try anything. You can't live without your liver. I guess counselling would be a good option if you can't take meds.

#14 Guest_Jamie_*

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Posted 23 November 2010 - 07:33 PM


i can't take meds. i just can't. i've tried a few but my liver can't handle anything. i have a hard time keeping therapy appointments.... i swear something always gets thrown in my face and i have to cancel but when i do get to go i spend the 45 minutes giving the "update". on top of it my co-pay is $40 so that's $160 a month IF i can make all the appts..... and once a week isn't NEARLY enough and in NO WAY affordable. of course, therapy can take years anyway..... IF you find the right person.

i feel stuck. suffocating between a rock and a hard place.

Wow, I found someone like me. I can't take any meds either. I tried some but they've all caused reactions. When I was prescribed Lithium and Zoloft, I took it for 2 days, then went into acute liver failure. My liver tends to not like meds. I'm scared now to even try anything. You can't live without your liver. I guess counselling would be a good option if you can't take meds.



#15 Guest_DreamNaut_*

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Posted 28 November 2010 - 12:43 AM

try sleep deprivation (4hrs of sleep a night). It may not be long term, but sure as hell provides me with at least 16 hrs of relief.

#16 colinmichaels

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Posted 29 November 2010 - 08:14 AM

try sleep deprivation (4hrs of sleep a night). It may not be long term, but sure as hell provides me with at least 16 hrs of relief.


yeah right! the SSrI's tend to reduce REM sleep. Sleep deprivation studies show a clear relationship with depression relief-but the price is pretty steep. One method that I have found helpful is sleep restriction-allow yourself a limited amount of time in bed-say 6 hours and force yourself up. This limits long periods of REM sleep which can leave a person more depressed while at the same time increasing deeper sleep which is far more restorative anyways. Languishing in bed-feels really good-but generally makes me more depressed once I get up. Just the process of changing routine and doing almost anything I also find helpful-placebo effect perhaps but who cares if it helps! Therapy with a professional of some kind is of course your best non-med option.
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#17 Not me

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Posted 29 November 2010 - 08:38 PM


try sleep deprivation (4hrs of sleep a night). It may not be long term, but sure as hell provides me with at least 16 hrs of relief.


yeah right! the SSrI's tend to reduce REM sleep. Sleep deprivation studies show a clear relationship with depression relief-but the price is pretty steep. One method that I have found helpful is sleep restriction-allow yourself a limited amount of time in bed-say 6 hours and force yourself up. This limits long periods of REM sleep which can leave a person more depressed while at the same time increasing deeper sleep which is far more restorative anyways. Languishing in bed-feels really good-but generally makes me more depressed once I get up. Just the process of changing routine and doing almost anything I also find helpful-placebo effect perhaps but who cares if it helps! Therapy with a professional of some kind is of course your best non-med option.


Do you have any sources showing the reduction in REM sleep? Its just the only AD's that I can remember doing it are tricyclics.

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#18 colinmichaels

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Posted 30 November 2010 - 05:28 PM

Do you have any sources showing the reduction in REM sleep? Its just the only AD's that I can remember doing it are tricyclics.
[/quote]

Antidepressants and sleep: a review
JM Holshoe - Perspectives in Psychiatric Care, 2009 - Wiley Online Library
... et al., 2001). The SSRIs, with the possible exclusion of escitalopram, have a profoundly
negative effect on sleep. The SSRIs decrease REM sleep, decrease sleep efficiency
and continuity, and increase awakenings.

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