AHunter3, I cannot believe that you seriously posted a link from Gary Null’s Natural Living Website. I went to his homepage, and he is a quack conspiracy nut who is selling bogus “natural living” products such as “magnetics” and silly herbal remedies. He buys into the “HIV doesn’t cause AIDs” nonsense. And I have neither the time nor the inclination to scour his website to see what other nonsense this guy’s into. He betrays his real agenda in this quote:
If Gary can convince you that doctors are trying to poison you, and that you must buy his “herbal remedies” instead, it’s more cash for Gary.
Gary is a modern-day snake oil salesman. Do yourself a favor and don’t give quacks your business.
My experience as a counsellor in the Australian context is that most peoples reluctance with taking AD’s is related to what it ‘means’ if they’re doing so, as described above. ie that it means they’re weak, taking the easy way out, etc etc, which ties into a general self blame issue in regards to experiencing it in the first place.
A lot of my work involves working on the beliefs involved in that, ie that its not really about having a ‘weak mind’ or being immature as such. If one doesnt view it as that, the meaning of taking AD’s changes quite a bit.
While theres the possibility that taking AD’s means you dont put in place preventive strategies, if anything Id say the reverse can occur - AD"s often give ‘breathing room’ for people to think things through a bit and make some longer term changes that reduce the chance of future reoccurrence. Similarly, ‘toughing it out’ can mean that people come up with other coping strategies that arent so great and increase the chance of reoccurrence, eg relying on marijuana or alcohol instead when they’re feeling down.
You can get it at both ends of the spectrum - the people who want to do it naturally, strength of mind etc etc - and you see them go through hell rather than consider even trying AD’s. At the other end you get people who think they’re the complete answer or as close as we can currently do and that counselling etc is just modern day voodoo.
Ive also seen an awful lot of people turn up to services who’ve never even been offered them. despite being at some pretty serious levels of depression. Diagnosis of mental health is in general still at a fairly patchy stage Id say.
Based on my own lit search, you can demonstrate a vague statistical correlation between MVP and panic attacks/anxiety disorder. However, there is no reason to think that the MVP itself–which is an abnormality in the cardiac anatomy, totally asymptomatic in all but a tiny minority of patients–has any causative effect on the autonomic system or any other neuropsychiatric system.
Also, whether or not a patient also has a mitral valve prolapse doesn’t do anything to change the management of the panic attacks–you would treat them exactly the same anyway. A good doctor never does a test if he’s not going to change something based on the result, so why order an $800 echocardiogram that won’t affect your management of the problem at all?
I will look up the AHA’s statement on this (as quoted by your cite) when their web site isn’t being wonky (and when my bandwidth isn’t being taken up downloading Iron Chef America episodes).
My mom’s a pscyh N.P., and her biggest problem with drugs is A) They’re too easy to get, and B) They’re too hard to get. Add to that the fact that clinicians don’t talk to one another, and sometimes she wonders if it isn’t the pharmacists who are doing all the heavy lifting in psychopharmacology.
She’s frustrated by GP’s being quick to prescribe, but she’s also frustrated by the fact that some of these people do need the drugs and never get to her. She’s of the oppinion, and I agree, that the reason a patient ought to be getting medicated for psychatric disorders by a specialist is because those people often either work in conjunction with a psychotherapist, or are ones themselves. Therapy by itself has few or no side-effects, and is of equal efficacy for most patients as drugs. However, for those patients who are refractory, the combination of drugs and therapy is almost often more effective than drugs alone.
But psychotherapy, even CBT, takes lots of time, and is expensive as hell. Drugs are pretty cheap in comparison, both for the patient, and the insurance companies. She thinks GPs feel pressured to prescribe psychotropics themselves over providing referrals, since they are rewarded financially for keeping specialists’ away from patients as much as possible. It’s bad for everybody.
If the first response to the average diagnosis of depression were always a short course of therapy plus some simple form-based diagnostics (how many psych patients are given short diagnostic tests on a regular basis to monitor progress, even by specialists?), nobody would suffer ill effects from psychiatric care, and “overdiagnosis” wouldn’t be such an issue. If the first response is to dole out pills, it’s the wrong approach. My mother sees patients who have been on an SSRI, prescribed by their GP, for two years or more, who report they never got any relief from depression the whole time. How can this happen? The system needs some reforming, there’s no question.
Neither can I. That’s what I get for googling in search of a reference to something I knew I’d find and going with the first example thereof.
Seriously though, SSRIs can and do cause iatrogenic psychological effects in some cases, with recent publicity on suicides via paradoxical effect being a notorious example.
Otara:
I would agree with that, although they aren’t for every depressed person.
Understood. But that’s not what I was getting at. Gregongie asked, “if anti-depressants are readily available for people that don’t truely need them, won’t they become more reliant on AD’s to overcome a depression, and less likely to grow and mature emotionally in order to solve their problems?” I’m not aware that SSRIs have caused people NOT to “grow and mature emotionally”. I was attempting to dispel the myth that there is some sort of emotional gain to be had from suffering; that if a depressed person takes medication, that they are somehow “cheating”, and depriving themselves of some process that is required to overcome the depression. In other words, SSRIs aren’t preventing any natural healing process from occurring. While iatrogenic effects need to be considered, that’s not really the same thing.
I started going to doctors in about 1989 or so because I was discovering (for lack of a better expression) “holes” in my memory. I felt fine, I was happy, life was good, it’s just that there were significant events I had lost all memories for. Like remembering that my 75-yr-old-father had come from Fla. to HI to visit, etc. Significant events.
GP referred me to Neuro, all checks out OK. Neuro refers me to Psych: “Oh, you have ‘dysthymia’ (low-grade depression). Here have some Prozac.”
It doesn’t do anything, so they say “Get another opinion.” At which point another health caretaker says, “Oh, they didn’t know. It’s depression and anxiety. Here, have some Paxcil and BuSpar!”
Within a few months, as serum levels built up, I got so wonky I was totally confused and disoriented 24/7, had to quit work and go on TDI. At some point I realized (they didn’t tell me) that what changed was they had put me on meds I didn’t need. I tapered my dose after reading PDR cautions. It took me a year to get back to baseline and get back to work.
Aye. Scroll upthread and you’ll see where I made much the same point, also in response to Gregongie.
Well, to make the cheap & easy point by using the extreme case, the folks who committed suicide aren’t exactly growing and maturing emotionally. So, yes, sometimes they flat out get in the way.
While I agree completely that antidepressants don’t coddle you and turn you into an “emotional weakling” or some such tommyrot – and that if they help you get through the immediacy of your rough times you’re more likely to get your life together than if you don’t make use of them – I’d also say that for some people, antidepressants do a sufficiently formidable job of fucking up their head that they are prevented from growing and maturing. But not because the antidepressants are making things too easy on them. Doctor J, are you saying you’d use the same protocol for mitral-valve induced behavioral and emotional disorders as for clinical depression? Or just that you’d use the same protocol as for panic disorders that weren’t thought to (necessarily) have anything to do with mitral valve probs?
I’m saying that patients who present with symptoms of anxiety, depression, or panic disorder are treated exactly the same whether the patient also has mitral valve prolapse or not.
There is no reason to think, at present, that such symptoms are “mitral valve-induced”; all we know right now is that people who have one appear to be slightly more likely than average to have the other, and from what I can tell, those data are less than rock-solid. It certainly isn’t enough to go surgically repairing a bunch of mitral valves–a very complicated surgery–hoping to relieve the emotional symptoms.
Having said that…I was under the impression that most of the symptoms of the mitral-valve phenomenon could be addressed by clonazepam or one of the similar diazepines (sp?), and that in most cases once the sufferer becomes aware that the experience (episode) is a manifestation of a physical ailment and will go away on its own in reasonably short order even without medication, they cope pretty well with it. They don’t need antidepressants and they usually don’t suffer ongoing mood and outlook-on-life problems.
OTOH, I’m personally aware of a couple of people who appear (unconfirmed) to have this syndrome, and both have tales of being diagnosed clinically depressed and bipolar (both, at different times); in both cases, treatments proposed for their alleged psychiatric conditions involved some unpleasantness, ranging from having to discourage a well-meaning shrink from doing an involuntary commitment to shelling out a rather intimidating amount of unhelpful and sometimes harmful Depakote, Effexor, Wellbutrin, lithium, Xanax, etc.
My understandings could be off-base, and lots of my information is 3rd-hand and comes from the patients who are also not doctors (although in one case she’s pretty damn knowledgeable for a layperson).
My understanding is that science has not yet found a way of determining if these suicides are the result of a rare reaction to the medication or are a result of the depression itself. I know that patients who begin taking certain anti-depressants are supposed to be closely watched for any sudden changes in behavior. Do you have a link to the latest info?
gregongie, we grow and mature from dealing with many kinds of experiences. For many, many people with clinical depression, anti-depressants allow us to return to being ourselves. Only then can we learn and grow. If I cannot concentrate, stay awake, remember what I was doing, stop crying, etc., then I am not going to be able to make the sound judgments needed for personal growth.
I think that anti-depressants are prescribed when often the problem is a bad case of the blues. But doctors can’t know that for sure. Since clinical depression is too often a terminal illness, physicians often err on the side of safety. I don’t blame them.
All of us have suffering enough in our lives without needless suffering.
Clinical depression is not a character flaw or a sign of personal weakness. It is not a matter of attitude or will power. Often there are physical causes. Sometimes medication is very helpful. Or you may benefit from counselling or a combination of the two.
Some doctors are very gifted and insightful. Others are not. They are neither demons nor angels. Finding the right therapist may take a little time.
Well then we should be on the same side here. So what’s the problem?
Hmmm…I rather wish you had resisted the temptation to make the “cheap & easy” point. I mean, that’s just silly. I’d wager that more suicides have been prevented by antidepressants than have been caused. It’s probably a good thing to watch for, but I don’t think it’s fair to deprive millions of people of relief from depression because a very small few have possibly been led to commit suicide by medication. Hell, I bet if you really dig, you could find some cases of people dying after taking aspirin. Should everyone stop using aspirin?
I whole-heartedly agree. But I was trying to make the distinction between those with what we define as clinical depression and those with a more temporary depression. IANAD, nor even a student of psychology, but from personal experience it seems that those with a more temporary depression are suffering from immediate causes. Like for example, I believe my mother was suffering from depression because she had just gotten divorced, and had spent many years in two different controlling and abusive marriages. In the case of myself, I first went to see the doctor during the last few months of a failing relationship, and once we finally broke up I was full-fledged depressed. But it’s a year later, and I’ve resolved things with the girl, and I’m rather okay now. Also, it’s been a few years for my mother, and she has found and will soon marry someone who truly makes her happy. Did we really need the anti-depressants? I honestly don’t know.
I’ve thought my position over, and I concede that you are quite right on this manner, too. The harm of possibly overprescribing anti-depressants is much less than the harm of not prescribing them for the people who truly need them. However, I do think the screening ought to be more rigorous. GP’s should only be able to refer patients to psychiatrists, rather than being able to prescribe anti-depressants themselves. I don’t know about other’s situations, but when this happened for me it was quite speedy.
Let me just say though, I did not mean to imply people who are clinically depressed are just “emotional weaklings”. Like I’ve said, many of the members of my family are clinically depressed, and that is the last thing I’d ever call them. What I meant was that sometimes depression is a natural reaction of the psyche. Other times, it’s obviously not.
Initially, to me it had seemed that anti-depressants for people who don’t really need them would be like treating the symptoms but not addressing the root problem. Something akin to “soma” in Brave New World. Perhaps this is where I misjudged the situation. Prozac and Zoloft aren’t “soma”. They aren’t meant to “make you happy”, but rather they are meant to balance out your mental state.
A question for you experts to help clarify these thoughts: Will someone who is not depressed, clinically or otherwise, feel any psychological effects if they are put on anti-depressants?
I’m not an expert, but like I said, I was on Zoloft for awhile, and my understanding from the reading I did and from talking to doctors is that the only effect it would have on a non-depressed person is the side-effects. There really isn’t any reason for a non-depressed person to take it; it’d probably just make you feel like crap. SSRIs definitely aren’t “happy pills”. All it ever did for me was to make me feel “normal”. And if you have been profoundly depressed, “normal” is a wonderful way to feel. But I’ll leave it to the experts to explain in more detail.
FWIW, I agree with you that anti-depressants ought to be prescribed by psychiatrists rather than family doctors.
Here is a really good link on the symptoms of depression:
Notice that not many people will have all of these symptoms, but only three or four of them. Also note that it is important to seek help if these symptoms last more than two weeks.
gregongie, I almost always mention that depression is not a weakness or a character flaw when the subject comes up. It is such a common misconception. I didn’t mean to imply that you had left the impression that you thought it was!
Sometimes a traumatic event like losing a loved one results in a normal grieving process and sometimes it can be a trigger for clinical depression. And the strange thing is that even though someone has had clinical depression before, she or he won’t always recognize that it has returned.
And sometimes people do get better on their own. But speaking for myself, my judgment becomes so impaired when I am depressed that I would never want to risk being left to pull myself out of it. Before prozac rescued me, depression made me much more vulnerable to impulsive suicidal behaviors.