Short answer to your precise question, for while you’re transitioning to a new treatment:

What triggers for you a strong, negative emotion, every time you’re exposed to it? I knew I was recovering when they stopped hitting the same way. In my case, I was extremely sensitive to my friendships and was ultra-tuned towards any suggestion they were growing distant from me. A late reply to a text (bad), or two friends hanging out without me (devastating) really hurt. I knew something was up once those stopped bothering me so much.

Longer ‘answer’ detailing my whole experience:

Since I was a young child I was always unhappy, worried, etc. Suicidal ideation started in my early teens. In my late 20s, at the start of the pandemic when I was unemployed, living alone, and friends I had made in grad school were all ditching town to quarantine with their families, I was in an emotional crisis and I had real doubts I’d survive. I sought out treatment again (attempts years earlier failed for BS non-medical reasons, not worth getting into). I was initially prescribed with bupropion, which while it tends to be a good first choice for many people, in my case it enhanced my negative emotions. That was very, very bad. I was quickly switched to venlafaxine (FYI while it has terrible side-effects when getting onto it they usually resolve after a couple of months).

Anyway, after a few months of being on it / some dose increases every few weeks from the initial low dose, I started to feel better. I stopped craving the endorphins I’d feel from the extreme emotions of suicidal ideation, and I stopped overreacting to negative events / perceived slights from friends (say friends A & B played golf together and didn’t invite me, even though they know I hate golf and maybe just wanted their own 1:1 hang). This is sounding like “he stopped feeling anything”, but once the stress & anxiety & rehashing of the bad parts of my childhood disappeared, there was finally room for me to become the person I had always wanted to be (goofy, care-free, smiling, relaxed). The depression & anxiety didn’t fade into numbness, it got replaced with happiness. I can honestly say I feel happy a majority of the time and I’m one of the happiest people I know; I recognize bad events but they just don’t affect my baseline all that much. It’s like - if depression is always feeling bad, and while good events momentarily help they don’t last, then I have “anti-depression”. This whole process probably took about a year.

With the supervision of my doctor I am in the process of getting off venlafaxine. There’s nothing wrong with staying on it forever if need be, but some of the newer theories of how these drugs work suggest that your brain grows new neural circuitry as it adapts to the drug, and it’s the new circuitry that actually helps. If that’s true, then once the new circuitry is grown the drug isn’t actually needed anymore. We’ve been slowly decreasing my dose, monitoring my mood, and so far I’m still feeling great. I’m now on the lowest dose, and if things continue as they have then I won’t need a refill in 2 months.

Every time I share my experience I want to clarify a few things:

• For those who may get onto venlafaxine - it’s terrible side effects should fade over time. I almost quit taking it at first but I’m glad I continued.
• Some medications work for some people and not for others, while others work for them but not for the first group. Probably depression & anxiety are just symptoms of different afflictions. We can see the common symptoms but we don’t know which affliction causes it, but each affliction needs its own treatment. As a result the best you can do is keep trying treatments until you find one that works for your affliction; there are so many out there that there’s probably one for you.
• Related to the above, but therapy may help. It wasn’t super effective for me but it didn’t hurt either, but depending on the underlying cause you may have better luck with it.
• I’m going off venlafaxine because whatever underlying cause of my symptoms appears to have been permanently cured. That won’t be true for everyone - some diseases require ongoing medication to treat. Don’t go off your medication without your doctor’s supervision & approval; you’ll need your mood monitored to ensure it doesn’t worsen and some of these medications should never be abruptly stopped.
• One of my biggest regrets was not pushing harder earlier in my life for treatment. While my baseline is happy, I do get pissed thinking about how much I unnecessarily suffered and that I didn’t get to enjoy most of my 20s. If a reader (yes, you) are chronically unhappy and unsure whether to get treatment, just go for it.