the snail shell

Some things I learned about antidepressants generally and Effexor particularly

Last year I went on an antidepressant. This year I’ve come off it. I’ve done this before, but I learned new things this time. Here are some of them.

background and facts

Prior experience: Prozac (fluoxetine) 20mg 2014-2019. This year:

they’re supposed to noticeably do something

SSRIs/SNRIs do something! They’re supposed to be noticeable! If they’re not noticeable, don’t bother!

I took Prozac for 5 years despite it basically doing nothing for me. If I squinted and ignored the placebo effect, I’d say, I don’t know, maybe it took me from a 3/10 to 4/10. Lexapro and Wellbutrin had the same effect. Nobody wants to promise you the moon, so I figured, well, it’s probably low-level working, maybe this is the best you can get.

But luckily, I kept trying. Effexor did something! It almost did too much; the first couple days I felt jittery, like I’d had too much coffee. But man, then it gave me a boost of like 3 points, from 3/10 to 6/10. Enough energy that I could get through each day. A little blunting - I felt a little like a robot - but better than ragedespairing.

“spin the wheel” is state of the art

I joke about the “wheel of antidepressants.” Spin the wheel, try whichever one it lands on. This is the best we’ve got.1 I guess Lexapro/escitalopram is a common first choice because it doesn’t tend to have bad side effects. Wellbutrin goes in another direction (it works on dopamine and norepinephrine instead of serotonin) so that’s why it’s often tried next. Prozac has a longer half-life than Lexapro. Effexor is an SNRI (norepinephrine and serotonin, not just serotonin) so that might be different too. But then, I know people for whom Lexapro doesn’t work but Zoloft/sertraline does, and they’re both “just SSRIs”. So who knows.

natural remedies might work instead of SSRIs or they might not

If you talk to hippie California types, they’ll say “you’re considering SSRIs? why not microdose mushrooms, or take kanna instead?” Well I… have a close friend who tried those, and they didn’t work. By all means give them a shot, but as with the previous point, who knows.

getting off is difficult!

Nobody told me this before I started, but Effexor is among the more difficult antidepressants to taper off of! Took me a while, anyway. I kinda wish I’d known that beforehand!

why are you snickering? oh yeah, well… that’s true too. not terribly, but noticeably :-/

you can split the pills

My psychiatrist said “well, when you’re at 37.5mg, that’s the smallest pill they make, so the next step is just to stop taking them.” That was hard for me. But the pills are little capsules, you can just open them and subdivide them with a milligram scale and some pill capsules. You can make 18mg or 9mg pills. I wish she had told me that too.

I eventually did 37mg for a couple weeks, then 18mg for a couple weeks, 9mg for a couple weeks, then 0. Going to 37 and 18 was effortless, going to 9 was kinda hard, going to 0 was kinda hard. A new feeling was “brain zaps” - not actually that bad but a little weird!

your psychiatrist might not share your goals

I wanted to get on an antidepressant for a period of months, to get me through the hardest time of baby raising. (My reasons aren’t the kind of thing I want to blog about, ask me sometime. But they’re not the dumb macho “I want to do it myself.") My goal doesn’t have to be your goal, and you should probably stay open to all possibilities regardless of your goal.

My psychiatrist didn’t see things that way; she saw no reason for me to get off. In fact, she wanted me to try a higher dose to see if it helped more. It is good to remember that your psychiatrist is looking at your case through a proverbial keyhole; you inhabit this brain 720 hours a month, they see you for maybe 0.5.

Your psychiatrist also probably doesn’t want you experimenting at all (e.g. reducing your dose before talking with them). So… not saying you should, but if you do, maybe don’t tell them; just present yourself as a very good rule follower.

(Hopefully it goes without saying to tread with care, though. Like, make sure you have other people checking on you who can tell if you’re going off the rails one way or another; you can’t always tell from the inside.)

this might mess up your life insurance

I was trying to apply for life insurance in the middle of this, and got denied. Weird; I have basically no other health concerns. Snooping around r/lifeinsurance, some people suggested that multiple prescriptions for depression meds might raise red flags. So, I don’t know, feeling ok is more important than life insurance, but just FYI.

  1. as a fan of luck-based medicine, I don’t actually mind this. but it would be nice if we could pinpoint “this one will work for you!” ↩︎


there’s a kind of low level logic behind your will to live, right

if everything feels good, you can achieve your goals, your needs are met, then it’s easy to feel motivated and optimistic and well adjusted. if you feel hopeless or stuck, it’s not. I think most people would agree with this.

one place my mind then goes is: “yeah but - look at Gaza, or Myanmar, or South Sudan, or the Great Pacific Garbage Patch, or global warming, or factory farms. there’s ~infinite suffering out there. how can we be happy in this world? how can all that possibly be worth it?”

this is actually not about Gaza or Myanmar, it’s about me

if I’m being honest, this is a dodge for “I feel bad right now and I want my pain to be legitimate so I’ll talk about the Whole World instead.” The real feeling is: “I feel negative infinity awful sometimes, how is this worth it?” It is embarrassing to say that because basically everything in my life is somewhere between “ok” and “amazing”. But let’s right now assume that my pain is legitimate, because otherwise we’re not gonna get anywhere. “I feel negative infinity awful sometimes, how can this all be worth it?”

infinity minus infinity

“negative infinity” here is my mind playing tricks on me. It’s my mind being overwhelmed and refusing to play. And I recognize it all the time now too:

and I guess if that was it, these people would be right. if life is just the occasional ice cream cone (+100) or pretty flower (+50) or Chernobyl (-infinity), it’d be pretty clear that this place is a kind of crap hellscape and not worth living

t-shirt that says “what kind of world is this? it’s kind of crap!

but… there are positive infinities too. why is it so hard to find them? here’s some:

(those may sound vapid, but “there’s a war in some country” or “this guy cut me off in traffic” are pretty vapid too)

Seems pretty obvious that if I believed in the positive infinities as strongly as the negative ones, I’d do fine. “I cannot reason about these huge things, brain shutdown, ehh might as well say the positives win.”

why the asymmetry

the next move here seems to be “focus on the positive things, do metta meditation, keep a fuckin' gratitude journal, until you deeply believe that the love of your wife and kid are way more positive infinity than your temporary lack of sleep is.”

so, yeah. I’ll do that. in some form.

but why is it so hard? why do I have to climb uphill to believe the positive infinities, while believing the negatives is effortless? it’s not like I do hate-meditation or hate-journaling every day.

Some hypotheses:

  1. The News; I’m not doing hate-meditation but our information landscape will do it for you! hate/fear/anger get clicks!
  2. my brain is honed to “find a problem, fix it.” some of that might be engineer brain! some of it is a tactic to avoid getting overwhelmed.
  3. maybe all our brains (2024 USA humans) are honed to “find a problem, fix it.” I remember decades of classes of Finishing Assignments and very few Playing Around or Enjoying The Moment
  4. maybe all our brains (humans) are honed to “find a problem, fix it.” this is why “get out of your head”/“touch grass” is such standard advice. being a mammal feels good. being a human feels… well, it’s evolutionarily advantageous, but it feels less good.

3 and 4 seem like a stretch because most humans and even most 2024 USA humans are not depressed.

How Much Does Media Affect You

Epistemic status: just brainstorming, no conclusions even

Here are some things I believe:

Anyway, interesting ACX post about how, maybe when you’re sad, listening to sad music doesn’t actually help and you should just get yourself to listen to happy music. Experimental History continued speculation about set points. … Sounds like, if I may continue speculating, it’s not about the action you take, it’s about where your set point is. So like, if you want some adrenaline, you watch a scary movie, fine. You want more adrenaline, you watch a gruesome serial killer movie, you go “glad I’m not in their shoes”, your body regulates itself. The problem is if your set point for “amount of gruesome serial killers you want to watch” is too high?

But man, I don’t know; how does that explain Social Media and The News3? People have a need to get angry, The News offers them this? What happened before say 1900? Did people just get mad in public more?

Back to the core question: how much does media affect you? Maybe we can look at it in layers; imagine we’re all a cognitive, emotional, and archetypal layer (among others, I guess). Media can definitely throw your cognitive layer way off; read stories of crime every day and you think it’s everywhere. Media can sort of affect your emotional layer; certainly short term, at least. If you have to go console a friend at a funeral, maybe don’t watch Saving Private Ryan first (or Looney Tunes, for that matter). But it’s not likely to affect your long-term emotional set points. And media can’t really, hopefully, affect your really deep-seated stuff, your basic person-ness. (just walk away from the screen, like close your eyes)

  1. ok I gotta admit, I actually kinda liked Saw. I think it gets a bad rap; most of the movie is about trying to find the killer, and the weird dilemma of: “what if he almost kills someone, but they’re grateful for it?” It’s not mostly about the killer doing gruesome things to his victims! (though there is that.) It sounds like some of the other films are much more pure torture-porn than Saw. But I gotta use it as the example here because it was kinda the biggest name in the whole 2000s torture-porn wave. ↩︎

  2. Though maybe that was a wave that came and went? wp describes how it was mostly 2000s-early 2010s - though CW: even reading wikipedia descriptions of these films is pretty troubling ↩︎

  3. the band was never the same after Huey Lewis left ↩︎