All right — I am married to a man I love and I dearly love my profession. So how could a “boy she has it all” woman like me possibly get depressed?
Mine didn’t look exactly like the criteria laid out in the DSM-IV. I mean, I am not going to sit around for two weeks feeling this way just so I can meet criteria. But other than the two-week bit — I was depressed. I did not want to do much of anything except cry. I could not believe the negative thoughts creeping into my consciousness and I was having a hell of a time pushing them out. I felt sleepy, listless, the whole nine yards.
I did not prescribe myself an antidepressant. I do not think that anybody really believes at this point that a congenital lack of antidepressant has made anybody depressed — ever. Read more on Things to Consider Before Reaching for Antidepressants…
California is known as “The Golden State” and some have called it “The Land of Milk and Honey.”
The Beverly Hillbillies noted that it was the home of “Swimming pools – Movie stars.”
That should be encouraging for people like my 27 year old, freckled, red-headed patient. After all, he had a pool cleaning business. But he was nervous — really nervous.
He did not have full-blown panic attacks, though he certainly fit the criteria for generalized anxiety attacks. Sometimes he did get a “heart in the throat” kind of feeling; something which some people would have called a “truncated anxiety attack.” But he had a lot of them and they really didn’t cramp his style very much.
He did not sleep very well, confessed that concentration was poor, and had great difficulty trying to find any interest in collegiate academics. As a result, his grades suffered considerably. And while I could potentially chalk this up to him falling into a category of males who may be better equipped for trade school than an actual 4-year college (based on patience; not necessarily intelligence), I didn’t believe this to be his case at all.
This guy was anxious. Read more on Stuck On The Treatment Treadmill…
“There’s no such thing as a free lunch” – but there are plenty of free samples when you go to your doctor’s office for a prescription.
Be wary of free samples.
What? Am I asking you to look a gift pill in the mouth? Drugs are expensive, even the co-pay for drugs can be expensive. What’s wrong with getting a freebie?
First, the drug companies that make them do not give them out forever. Usually, they give out samples on a newer drug as part of a launch – kinda like a “grand opening” at a store. The prices are really great that first week and it gets you trained to go to that store.
Another reason drug companies discontinue free samples is that, very often, the insurance companies or government programs may not have them on the “formulary” (the list of available drugs) right away. As soon as the relevant insurance (mediCal in California) starts paying for them, you can say “Bye-bye” to free samples. Read more on Free Samples Might Carry Heavy Cost — Health…
Number 5 in the USA Today catalog of medical changes in the past 25 years is (imagine a drum roll playing – and CYMBAL CRASH!) — antidepressants are the most popular drugs. Read more on Antidepressants Are Popular — And Dangerous…
The first known account of this plant, known by Latin (Carolus Linnaeus) nomenclature “Sceletum tortuosum allegedly dates back to Jan van Riebeeck, Dutch founder of South Africa. He appears, also, to have seen the first recorded comet that passed through that distant place, so we know he was educated enough to be a scientific dilettante at the very least. He has earned, rightfully, a lovely place in the history of South Africa. I am not knocking such status, mind you. I think few people would be clever or concerned enough to be scientific even at dilettante level in our day and age — thinking of even the cleverest of politicians. I am somewhat more concerned about what the South Africans seem to be excited about. Read more on African Drug Being Developed For Antidepressant…
I could not believe it when the patient asked me about ketamine. I had just seen an episode of “House, MD” on one of those cable super-stations the night before and it dealt with this weird drug. I told my husband about my experiences with it during my surgical career. Then, the next day, this patient brought up the same rare drug. When I looked at him closer, it became believable. He was old enough — in his sixties — that in the swinging sixties he had surely been one of those “knowledgeable” druggies who pride themselves on knowing all about everything that could give one a buzz.
This type of person is a sort of lay-pharmacologist — someone who knows not only how each drug made someone feel, but sometimes even about class of drug and mechanism of action. Of course, this type of expert would seldom know terribly much about what the FDA thought or felt about these drugs. “I heard it works pretty well and faster than anything on depression,” he said, “and I am kind of depressed and the standard antidepressants, the crap like Prozac and Zoloft aren’t worth taking and don’t do anything. But they say that stuff works fast on depression.”
Yes, he knew his stuff so well that he may even have read some kind of FDA reports or something. Still, ketamine is not the kind of thing you can dish out in a county clinic in Noplace, California. If you want something exotic, try a university psychiatry or pharmacology department, or call or email the National Institutes of Health. I could offer the standard stuff, but not ketamine. Not me, not there.
“I wants me some of them-there antidepressant pills.”
He was a 47 year old good old boy of the sort I had treated in Oklahoma and other rural parts west –a real cowboy. He had herded animals and done the rodeo and all of that.
No, he had never seen a psychiatrist before, ever. He had been out crying on the front porch, and it was a next door neighbor who had somehow convinced him that there were medications and he did not have to tell his whole life story to get pills. Well, maybe that would work with a general practitioner, but he was not only disappointed but also angry that it was plainly NOT going to work with me. Figuring he had been had, he broke down and told me the story. I could understand at once why he had been reluctant to get into this, for we went through half a box of Kleenex while he gave me a plot that was worthy of a tear-jerky country song. Read more on A Cowboy’s Lesson — Antidepressants Won’t Work Well With Alcohol…
People may look at the complex before they look at the obvious — which is a faster answer and closer to the truth. I happened to be talking and I found three more yesterday. Women. Young, intelligent, and attractive women, who did not have and did not want boyfriends. All three were part of the mental health treatment establishment.
The first time I discovered one of those was some years ago, a few cities ago, and she was a very clever and very talented psychiatric nurse. She loved her profession, and took good care of people. She loved nature and animals and plants. I believe her to have been quite attractive. She had been turning down dates because she would rather go to her gardening clubs or whatever.
She had also said, without tears or depression, that she expected she would always be alone, would move into the home for old nurses when she was old enough, and die there. She had been on Prozac for about three years. There were a few problems with this. First, nobody had ever talked to her about getting OFF Prozac. They said she might as well stay on it, since life was that good.
Actually, I have looked at data for depressed folks of varying ages. Sure, there is a risk of side effects, but nobody seems to care. I cannot remember, off the top of my head, seeing data about the recurrence of depression that suggested anybody needed to stay on antidepressants permanently.
Certainly, nobody under, say, 55 or so. And she was plenty under. I mean, there are things you can do to lessen the chance of recurrent depression — psychotherapy, even reading books. And there is the whole question of getting someone off SSRIs. I have had patients who claim it is impossible. I’ve had people come to me because the withdrawal effects were horrendous. Yet I have taken people off easily and (reasonably) quickly with natural substance regimens. It’s not impossible – you just have to know how.
That eliminates many of my colleagues. Or perhaps they keep their patients on prescription drugs to insure their return and a steady cash-flow. Naw – doctors wouldn’t do THAT!
There is another problem. There are drug side effects we know little about or may find hard to measure. I remember from my days doing clinical trials that at one time, shortly before I left the business, someone adopted a “uniform” side effect reporting system. The trouble with that was trying to fill in the blanks for the questions on the form when the patient is saying things that do not fit in the blanks.
Every one of these mental health professional women had been put on Prozac when it came out, because of the safety and efficacy. I remember, collecting data, one of the first people I gave Prozac to during clinical trials before that drug was on the market. She told me that she “felt like a zombie” and that she missed having the full amplitude of emotional expression. She missed crying at the movies, something she had genuinely enjoyed. Said she had a feeling of euphoria afterwards — a feeling of euphoria she really enjoyed. Try fitting that one on a uniform side-effects reporting system.
The three women I met yesterday are unlikely to get off their Prozac. They stood in wide-eyed disbelief of my assertions. Of course, they had just met me and know little about who I really am. Besides, people seem to have trouble taking advice for which they aren’t paying. I just reminded them as I remind patients that taking any medication is a choice, and reporting what is going on to a doctor is always a good idea.
If any of these intelligent and well-insured women had gone to a therapist, they could have ended up with some kind of verbally analytic procedure, which obviously would not help. Or maybe they would be referred for some hormone supplementation, which has biologic risks of its own. Big ones, like — cancer.
Worse yet, I’ve met two psychiatrists in my 30 years of practice who gave everybody electric shock treatment. Everybody! The first person in whom I suspected a real lack of sex interest had changed her life — the psychiatric nurse — did finally get off her Prozac. If she had any recurrent depression problems, I do not know about them.
She had a date within two weeks, and last I heard, was dating many interesting men, looking for a best boyfriend.
I am convinced that we are looking at a Prozac side effect that the system has made it impossible to measure. We probably have at least a little of the same side effect with similar drugs in the same class – such as Paxil and Zoloft. Maybe others, too.
The psychiatric nurse easily agreed her general quality of life had been diminished while she was on Prozac. She was too undepressed to notice. When she got off the drug, she suddenly noticed.
Getting a drug past the FDA takes some studies on how it gets into the body and the like. Nobody ever seems very worried about getting off a psychiatric drug. That’s been the focus of my private practice for at least the past five or six years.
For the individual, the effect is pretty evident even though I only have one clear cut example. What about the species? Is this just one of several steps driving humans to …. extinction? People change as time passes. What affected you in the past may have gone away – as many illnesses seem to do.
Spending your lifetime on a drug when you no longer need it is tragic. Or having your quality of life changed because of the way a drug reacts in your body – instead of seeking alternatives to control your problems.
I think it is worthwhile for anybody on a psychotropic drug to ask how their life has changed since they have been on a prescription medicine. We researchers have been limited to collecting information on side effects that the FDA and/or drug companies “let” us.
So don’t look toward the government or the drug companies for help.
We can’t pick our diagnoses like we pick what outfit we are going to wear.
I remember an encounter where the psych symptoms had political overtones, although I’ve handled plenty of other cases that had the same resistance to being diagnosed.
“I’m scared of this bipolar thing,” he said. “Everyone I know who has it is really sick — like crazy — and I’m not sure I want to take medication for it.” Read more on Great Manics of History…