Hello everyone, I currently stand at a cross-roads with revisiting this pathway again. For context I'm a second year medical student, who cannot reconcile the potential positive benefits of anti-depressants with my past experience, but being forced to consider them as I am approaching clinical years and current circumstance. Needless to say this is causing a massive internal conflict.
I've taken three anti-depressants before - a SSRI, atypical antidepressant and a SNRI. The atypical one worked although made the anxiety worse, the SNRI did largely nothing, however the SSRI left me well with, let's say there's a reason why black box warning labels exist. Naturally, I discontinued this, and 6 years later, am feeling very good, although riddled with severe anxiety on a near daily basis (due to other factors). Therapy has also been to little effect - as arrogant as that sounds, a lot of the advice offered was already considered.
Recently my GP after my 1241241th visit for anxiety decided to raise the question of trying an anti-depressant again. Naturally, I was very hesitant but relented after she followed the same thought process as I did, knowing that entering clinical years would make my already severe anxiety worse. Naturally, I don't have a counter-argument to that as I realize that's in my future and would probably necessitate this. She put me on Mirtazapine (Remeron), and a month later, I'm looking at that box in front of me and still can't bring myself to take it.
The crux of the issue alongside everything is a very uncomfortable truth - that no-one knows how antidepressants work exactly and how would this leave me feeling afterwards. Then there is the fact that medicine is an evolving science (no issue there) - things we advocate in the current moment could eventually end up being downright harmful in the end and how the existing theories of anti-depressants are largely incomplete. Then there is my experience weighing on this, wondering what does it say when a tablet the size of a 5c coin can do that to you and the fact that I'll likely be on them for the rest of my life, something I don't want to do. That idea combination together is largely why I'm very very hesitant to open that Pandoras box again.
I tried staying objective. So far I looked up the pharmacology, pharmacokinetics, compared it to the profile of the SSRI and the SNRI I tried, talked to a therapist, even went for a genetic panel (which told me all SSRI's are practically off limits to me due to how I metabolize them). All of it seems promising, and the research/ science seems positive. The side-effects of Remeron are also acceptable - increased sleepiness, and weight gain is a positive with my current circumstances and it doesn't follow the same receptor binding as the other SSRI's which caused this. Despite all this, I'm still not brave enough to try it and still being forced to consider them.
My next appointment with my GP is in a month for another issue, and the way the wind is blowing, probably will label me as non-compliant which is a no bueno - I'd rather avoid that entirely. So my question is what do I do? It's not that I don't want the anxiety to go away or to feel normal when I enter clinical years or even survive until I get there (no I'm fine). I'm hoping for an answer, perspective, thought or an insight that I haven't thought of yet to help me overcome this block. Thank you in advance.