anti-depressants

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I enjoy having friends, like just about everyone does. But that’s not why I’m in this business. When a patient needs help, I will do my best for them every single time.  And if a few colleagues get bruised egos along the way, so be it.

She was a 53-year-old woman, but I don’t think she even would have liked to hear me to refer to her as a woman.  We’re talking about someone who was short and stout and wore the kind of cap one would expect to see on a newsboy during World War I.  She wore a very male looking zipper jacket, and told me she had the name of the other woman to whom she had dedicated her life tattooed on the back of her neck.

Regardless of all this, her face was red and she was crying. She told me she was chronically suicidal and never thought about anything else.  Despite being medicated, her depression seemed to have gotten worse. Read more on What is there to Treat?…

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I accidentally watched Dr. Drew Pinsky’s “Life Changers” and it put me in a state of utter stupefaction.

That was fortunate, as I found myself unable to destroy the television.  Doubly fortunate, in that this was a hotel-room TV and the bill would have been padded for replacing the set.

Okay, so I was in a hotel flipping channels during the day.  I do this once in a while to see what is being communicated to the TV-watching public, especially about health.

Dr. Oz has a show.  His guest was Rachel Ray showing how to fix things you might screw up in the kitchen.  Common sense fixes with repartee.  I did not see this as a health problem and I did not make it to the end of the show. Read more on Dr. Drew Pinsky’s “Life Changers”…

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He was in his fifties and he wanted the same medications he had, except for one thing. He just could not manage to have sex with his live-in girlfriend.  He never had.  I was filling in at a clinic where I knew this was the only time I would see him.

There are a couple of strategies with prescription medications that sometimes work.  A partial agonish to reverse a receptor; adding another antidepressant.  I reluctantly told him about them, since a complex mental illness was being otherwise quite well managed. I mean, this man’s diagnosis was “schizo- affective disorder.”  He had been really psychotic, hearing bad things and thinking they were real and running naked in the streets.  As much as I think an interest in sex is healthy and part of normal living, I certainly did not want to risk having all of these horrible things happen to him again. Luckily, he told me the last thing in the world he wanted to think about was another drug.  Even a little bit of another drug.

There are herbal solutions that actually work.  I was thinking about some oriental herbs, which I certainly did not think were that expensive.  But he assured me he had no disposable income at all. Maybe true, maybe not, but I always wonder at least a little bit when people tell me that they want something very badly, but then do not seem to find any money for it.  I mean, he was a heavy smoker (over a pack a day) and I was certain insurance did not pay for that.  I tried to approach this subject, and he became so angry at me I would have dived under the desk for protection if it had been physically possible. Read more on Men Just Want To Talk About Sex…

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As far as I know, every antidepressant has the same “black box” warning on its package insert, as reported by a reputable academic psychiatrist in a reputable journal a while ago.

Incidentally, he has, in this editorial type piece, effectively logged most of the “attacks” recently made upon psychotropics.  He advises the readers, presumably other psychiatrists or at least physicians of some sort, to do “nothing.”  This is the common way of academics, to wait and gather data.  It is not a common way of doctors, at least ethical or idealistic ones, who still scramble at any chance to save people.

black-box warning

For now let’s look at the warnings about antidepressants that have merited the special FDA attention. Except that it is in a “black box”  (has a black border like a funeral announcement) and there may be a couple of things added on relative to an individual brand, this is the disclaimer: WARNING: SUICIDALITY AND ANTIDEPRESSANT DRUGS Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of Major Depressive Disorder (MDD) and other psychiatric disorders.

Anyone considering the use of (Brand Name) or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Read more on Black Box Warnings — Read Carefully!…

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