Teach Me How To Feel
Abby Norman

Everyone’s experience of depression, and the background that contributes to it, is different, so I can’t truly say I understand how you feel. But I see a lot of similarities with my own experience, so I think I have some understanding of how you’re feeling.

I’m not a neuroscientist, or a doctor, or a psychologist, but I read and ponder obsessively about these things. So take what I’m going to say for whatever it’s worth. This is also a gross oversimplification of incredibly complex and not fully understood processes…

SSRIs like Zoloft are the first choice of medications for serious depression. They work by increasing the amount of serotonin in the brain. Serotonin is the neurotransmitter that gives us feelings of contentedness, like after a great meal or sex.

You may see dopamine referred to as doing this, but that’s based on old, flawed research. Dopamine is responsible for our motivation. It goes up when we’re pursuing good food or sex. Incidentally, it’s why cocaine pushes into overdrive, making people feel like they can rule the world.

There’s a negative feedback between these two neurotransmitters, so when one goes up, the other goes down. This is why SSRIs make you feel unmotivated, uninterested.

Then there’s norepinephrine, which controls overall energy levels. It’s also involved in negative feedback mechanisms with the other two.

Through years of trial and error, I’ve finally found a combination that works well for me: Pristiq, an SNRI (serotonin and norepinephrine), and Wellbutrin, an NDRI (norepinephrine and dopamine). This gives me a balance of contentedness, motivation and energy that lets me live a relatively normal life. Combined with CBT, I feel like I’m making progress on my depression for the first time in 40 years.

The concern with these is that if you’re in a serious depressive state when you start, the additional dopamine can actually give someone the motivation to go through with a suicide. So getting stabilized on an SSRI first can be a good idea, then switch gradually to these others.

The problem is that doctors are not taught these things, so you need to find a well-read psychiatrist who will do this for you. And of course, not everyone responds the same, so what worked for me may not work for others. But it may be worth a shot.