Depression and meds: staying in the zone

I’m sure you’ve seen a highway speed sign like the one above. What does it mean? Don’t operate your vehicle above or below the zone deemed safe. This idea of a controlled high limit and a controlled low limit is how I think of most common medications prescribed for depression: selective serotonin reuptake inhibitors (SSRIs).

Since my diagnosis nearly 20 years ago, I’ve been prescribed several SSRIs. You might have heard the names: Celexa, Lexapro, Prozac, Paxil, and others. How do they work? Per the Mayo Clinic:

SSRIs treat depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain nerve cells (neurons).

SSRIs block the reabsorption (reuptake) of serotonin into neurons. This makes more serotonin available to improve transmission of messages between neurons.  SSRIs are called selective because they mainly affect serotonin, not other neurotransmitters

Ok, but for the layman (me), what does that mean? I really don’t know, after 2 decades on them. Some of my practitioners have told me that no one really understands how they work. I don’t have the background to know whether that’s correct. I do know that I’ve had to try several different types of SSRI before finding one that worked for me.

What I do know, or at least think I’ve come to understand, is that my depression meds act like the sign above. They set limits on my mood: at the low end, keeping depressive symptoms above a certain level. At the high end, unfortunately, they can also keep my enjoyment of some things below a certain level.

The benefits outweigh the drawbacks, generally speaking. I’d rather sacrifice some modicum of pleasure than bottom out in a depressive episode.

But here’s the thing. The meds alone aren’t enough for me. As I mentioned in an earlier post, medication is only one of the legs in a three-legged stool. Exercise and cognitive coping skills complete the trio.

Under what have become normal circumstances for me, medication can keep me in the target max/min zone. However, there are times when a depressive episode is particularly acute, and meds alone can’t handle it. Let’s explore this.

First, a note for the pedants: what follows is a terrible chart. The axis aren’t labeled, there’s no legend, etc.

Imagine that this is a mood-tracker. The line represents some arbitrary way of measuring my mood over time. My mood lifts and falls and is represented by the black line. The green band represents the min/max limits permitted by medication. Except for the dip which has its lowest point in red, it’s pretty good.

But what happened to get me to the red point? Some kind of decline in mood, also known as a depressive episode. Happily it seems to have been temporary (we don’t know here without time labels), but they aren’t always short-lived episodes. Most importantly, the meds weren’t able to keep me in the target band.

In the tracker as depicted, most of the time, I’m in the green, and that’s hunky-dory. Overall in my life, I’m in the green most of the time, and the meds are worth the other sacrifices (everything but difficulty nursing, you may recall). The challenges come when I drop below the mood equivalent of the legal minimum speed limit.

This is why the other legs in the stool (so many mixed metaphors) are super important. When the meds alone aren’t enough, that’s when I need to be exercising and applying coping strategies. Both of which I’ll devote space to later in this blog.