Sunday, November 09, 2008

Tell Your Doctor If You Experience Any Of The Following...










A reader writes in:


I might suggest that in some cases, the more outre side effects of SSRIs are not reported because the person taking the drug is afraid of being thought insane. I had unbelievable rage while I was taking Effexor, and never told anyone about it because I was afraid of not being believed, and also afraid that there was something else seriously wrong with me.

I am a highly intelligent and naturally moral person, and never hurt anyone despite my desire to do so, though I did put my fist through a wall at one point. But I had extremely disturbing violent impulses while on the drug, including a desire to maim or kill my beloved cats, and a strong desire to physically assault the woman I was dating at the time.
All of this vanished completely when I decided to voluntarily go off the drugs, which I had been told I would need for the rest of my life. As it happened, the psycho-emotional disorder I had was consistently missed by therapists and clinicians, and SSRI drugs were not an appropriate treatment.

This may or may not account for the peculiar side effects, but at any rate -- my thought is that possibly these things go unreported due to shame and fear on the part of the patient.


So we don't give medical advise here on Shrink Rap. I borrowed this comment, however, because I'm struck with how often patients withhold critical information. If a patient tells me that since we started a medication, he's had a new symptom, if that symptom is intolerable to him, or in any way worrisome, I don't sit there thinking they are crazy. I stop the medicine. If the side effect sounds like it's a little uncomfortable but the overall quality of someone's life is better with the medication, I simply restate the facts and my thoughts about whether the good outweighs the bad, I let the patient chime in with their thoughts (I'm not in their body), and I consider the circumstances before the medication was started as well as the response to the medicine. If someone was suicidally depressed and unable to function , then maybe it's worth tolerating a dry mouth in exchange for the ability to return to work and not be sad or suicidal?

It's not just medications-- it's anything major going on in someone's life. If something huge is going on in a patient's life, the doctor needs to know. "I'm more depressed lately," has one meaning in the context of a medication change and another meaning in the setting of a recent loss.

What psychiatrists can't do is know what someone is experiencing without being told. We don't have crystal balls, we don't have ESP, we aren't mind readers, we don't "know" what you're thinking, feeling, worrying about, distressed by, unless a patient tells us in fairly precise terms.

22 comments:

Anonymous said...

Agreed, doctors need the whole picture of what's going on in order to treat patients effectively. I think when doctors make this (and that they do not judge people based on symptoms) clear, then patients tend to be more forthcoming. I think people's fear of "being crazy" is much, much stronger than doctors realize, sometimes.

Anonymous said...

I was one a drug when I was younger and had tons of side bad side effects. I didn't think to connect it to the new drug I was taking. Because of my age doctors had told my parents of what side effects to look out for (or at least I hope they did) but not me. So I hid what was going on because I though I'd get in trouble because of it.

Even now that I read about what side effects I need to worry about from a drug it's tough knowing what to mention. Am I just noticing it because I read about it? Or is it actually related to the new drug?

David Rochester said...

Well --

Perhaps I ought to have provided a bit more information about the situation. I was on SSRIs about seven years ago, when the side effects of them were largely (if you will forgive my saying so)denied by the psychiatric profession.

The first side effect I was was increased suicidal ideation, while taking Zoloft. I reported this, and was told it couldn't possibly be related to the drug, and the solution was to double my dosage, which gave me a toxic physical reaction. I was also told that the bizarre sensation I had of being given continual high-voltage electrical shocks couldn't possibly be related to the medication; as I understand it, that is now commonly recognized as a side effect of SSRIs, and has been given the colorful nickname "brain zaps."

Since my experience was being denied by my care provider, I was not willing to talk about the rage as a side effect. Of course, in an ideal world, I would have changed providers, or told her anyway, or some combination of those two things.

However, I think that perhaps when discussing what clients should and shouldn't be doing as far as how they relate to psychiatric and medical providers, it's easy to forget that the client is in fact not fully functional, and that the seemingly simple task of appropriate self-disclosure, or appropriate self care (as in flipping the bird to the asshole who wouldn't listen to me, and going elsewhere) may be impossible for the client to handle.

I think I had some very bad luck, but I also think a lot of people have similarly bad luck with care providers. There are a lot of undereducated and uncaring doctors and psychiatric workers out there, and it is difficult for a psychologically and emotionally compromised patient to act in his own best interests.

Should I have reported that I was losing my mind and becoming a chainsaw-wielding nutcase? You betcha. Was there a valid reason why I didn't? Well, unfortunately, yes there was.

AA said...

You're one of the good ones, Dinah, which is why we read the blog, but not all psychiatrists are created equal.

The psychiatrist I was seeing on Ohio for so many years who put me on Effexor, Wellbutrin, and Lamictal, supposedly had a reputation for being great at managing medications, yet he didn't warn me about any side effects for any of those medications. It was only years and years later after I'd started seeing someone new that I realized that many things I was experiencing were indeed side effects and not just "who I was."

Novalis said...

I find it alarmist and distracting to mention more than two or three of the most common side effects when starting any given medication, but once a patient has a side effect (no matter how arcane) I feel he or she should be entrusted to identify it as such and to decide whether it outweighs any benefit.

Therapy Patient said...

I had a strange condition when I was taking several psych meds (among them were Abilify and Zyprexa) which after I went off the meds I finally realized must have somehow been a drug side-effect. What happened 10-15 times a day would be that I would "accidentally bite" my tongue HARD. There were other times I would start to choke on my tongue. I kept trying to "watch" my tongue coordination so that I would not bite it or choke on it and despite much tongue monitoring I would again bite it or again start to choke on it. This is the first time I have told ANYONE. Have you encountered that before? It did not go away right away when I went off the meds but gradually became less and less, and now my tongue behaves again. It was HORRIBLE, and scary. I still think it's a really weird side-effect.

Rach said...

I guess I'm also one of the lucky ones - as my shrink asks that I call in the effects of my meds whenever he adds on something new, or ups the dose of whatever I'm on - I leave a message on the voicemail at a predetermined interval - every 2 or 3 or 4 days, or more often if things are going hairy, and then he calls back... Which is great because I don't need to keep a list of all the things I'm experiencing or not, and I suppose it gives him a more complete clinical picture on his end between sessions...

I have to say, voicemail is such a valuable tool - especially in this type of situation, because I don't necessarily need to make an appointment - I can tell him what I'm experiencing, and he can judge whether it just needs a phone call to say "give it another few days and then we'll see" or whether it's an "OMG this is MAJOR" type of issue. I've been in both situations and in both the turnaround time's been very respectable.

As I've been writing on my own blog as well, having a chronic mental illness and being on medication doesn't mean that everytime something happens the meds have to be changed... often it's a matter of trying to understand life contextually and trying to figure out how to fix the life situations that might be upsetting the delicate balance that the meds are a part of.

AA said...

Novalis said...
I find it alarmist and distracting to mention more than two or three of the most common side effects when starting any given medication, but once a patient has a side effect (no matter how arcane) I feel he or she should be entrusted to identify it as such and to decide whether it outweighs any benefit.


It may indeed be distracting and alarmist to mention everything, but it strikes me as hypocritical to not be completely open and upfront with all the potential side effects and then expect the patient to be open and upfront with everything he or she is experiencing. Granted, it is in the patient's best interest to do so either way, but how can I really place trust the doctor if he's "hiding" (intentionally or not, for my benefit or not) things?

Doug Bremner (MD) said...

As a "blogging doctor" I am struck by how much anger there is out there about side effects of antidepressant medications, and how much psychiatrists are felt to be to blame for that. Perhaps there has been over-promotion of prescription medications. But there are side effects that we don't know about and only learn about with longer experience. We are not magicians or mind readers.

Anonymous said...

Therapy Patient, that sounds like it could have been a somewhat interesting case of tardive dyskinesia.

Anonymous said...

As a person who is tapering off of psych meds due to horrendous side effects, including a hearing loss, I feel extremely frustrated that some points are being missed.

As some posters have already mentioned, they did tell their psychiatrists about some side effects and were blown off. That was definitely my experience.

But this issue doesn't just pertain to psychiatry as there was a survey done that people who reported side effects of Statins were blown off even though they were listed as such.

That is where the anger is coming from Dr. Brenner. Instead of just shouting louder about the fact that you're not mind readers, why don't you all ask us why we are so angry? You might learn something.

Speaking of learning about side effects, Dr. Brenner, it has been my experience that if a doctor doesn't know about it, it isn't valid even if a patient finds it listed on a site like http://www.rxlist.com. Those patients gotta stop thinking they're experts.

Yes, I am being sarcastic. Insomnia as a withdrawal symptom will do that to you.

AA

Anonymous said...

Novalis,

Your comments come across as arrogant and condescending even though I am sure that wasn't your intention. Just because you're a psychiatric patient doesn't mean you're stupid and don't deserve full disclosure.

Sorry, as one who became suicidal on Prozac only to never be told by psychiatrists that is what happened, I am a little sensitive about that.

I know you don't have time to list every side effect known to Tom, Dick and Harry. But what about telling patients that if they start having strange feelings after starting the med, that they should contact you immediately. Stress that this is a rare occurrence but it it important they know so they don't go blaming themselves for their behavior and realize it may be the drug causing the problems.

AA

AA said...

So I'm curious who this other "AA" is that wrote the last two anonymous comments... It certainly ain't me.

Prynne said...

It's great that you listen to your patients about their side effects. It's been my experience that since I was officially diagnosed crazy, my experience of my life, body, and mind is generally ignored or chalked up to that documented craziness by shrinks and PCPs. And it's great fun, I assure you, to try to navigate doctors' offices and the emergency room with this handicap.

Some people fight when this happens to them. I shut up. It's too tiring to constantly defend my perceptions to "experts" who aren't going to listen to me regardless. Once a doctor has demonstrated unwillingness to hear or believe me, that's it. I may as well be quiet and do what I have to do. At least I won't get chucked into the psych ward for my trouble.

Anonymous said...

aa,

I have been posting for awhile on this blog as AA. Maybe I will change to something like AA11.

I am not the most creative person with screennames:)

Gianna said...

I had side-effects medicated as part of an "underlying problem" until I was on 7 drugs at two and three times the therapeutic doses and basically slurring my words, stumbling and drooling.

Once I properly educated myself I have now gotten off all the drugs save a tiny bit of Klonopin I'm still working on tapering off of...I am fine mentally, except for horrible physical symptoms from the withdrawal...

I am an example of why patients don't tell their doctors symptoms...some people actually intuitively know they are in the hands of someone who doesn't know what the hell they are doing...

I never needed to be on drugs but got one drug after another loaded on due to side effects that WERE NOT believed to be side effects. I was very young and didn't have a lot of confidence or trust in myself.

I wish I had had the sense to be like the commenter you highlighted. I would have saved myself a lot of pain. I now choose doctors who allow me to educate them. The doctor who prescribes for me now trusts me and my experience and allows me to get my care out of state by phone because basically virtually no one knows a thing about withdrawal which I am now facing because of the hack who put me on so many drugs.

My psychiatrist also teaches Western Psychiatry at a Chinese Medical School and he lets come into his class room and tell the truth about how much psychiatry is practiced and my experience of it because he believes me and knows a lot of his colleagues are incompetent and are not aware of alternatives which for him I've mostly brought into focus.

I'm not just a patient...I'm also a mental health social worker and saw what was done to me, done repeatedly to clients.

Therapy Patient said...

Thanks anonymous. I just read about tardive dyskinesia and that must be what it was. I also had trouble sitting still (such as in a movie theater) and had trouble keeping my left foot still, but I kept thinking I was imagining it. I also had periodic severe chest pains like I was having a heart attack. Those went away too, thank God. The really troubling side-effect of psych meds for me was that they impacted my short term memory, my long term memory, my ability to reason, my ability to create (problem solve and connect disparate pieces of information). I thought my brain was shot for good because my brain took so long to come back, but my experience since June as a student in the State Univ. teaching credential program, plus my experiences teaching have shown me my brain is sharp again. What a relief the impact was not permanent (at least the effects were minimal if present).

Anonymous said...

yeah, I have had several doctors tell me that there are no long term memory effects, that after you stop the drugs within a short time memory and cognitive functioning return. I still think they are wrong.

In general, if it isn't in the prescribing literature or already a known side effect, I think it's not worth mentioning because all the doctors can and do tell you is 'I hadn't heard of that' which, if you are already questioning your grip on reality is akin to 'it's all in your head.'

castorgirl said...
This comment has been removed by the author.
castorgirl said...

Speaking only from my experiences as a person with trust issues, it's very hard to be open with a psychiatrist. Once you get bitten a couple of times by people who shouldn't be in the profession, you tend to become wary of full disclosures. As an example of how I have been treated - one psychiatrist wrote for the entire appointment and when I turned up got the DBT specialist on the phone and said "the borderline actually turned up" and then went onto prescribe lithium to augment the SSRI that I was taking (unsuccessfully) to control suicidal ideation. She'd looked at me once and talked to me for less than 10 minutes before making this rather drastic recommendation.
Not only was her "bedside manner" appalling, but I don't have Borderline Personality Disorder.
At the same service I saw another psychiatrist who had a conversation with me rather than his note pad. He commended me for not taking the lithium and took me off the SSRI and said there was no drug that could help me - three years later he is still being proven correct in his statement.

Psychiatrists aren't mind readers. But psychiatric patients are people that deserve respect and to be treated as an individual with concerns and intelligence.

Drugs do have a place in psychiatry. But every individual is different and so will react differently to those medications. Please listen when a patient tells you something, and look for signs when they might NOT be saying anything.

Anonymous said...

Pharmacologically Enhancing Psychotropic Pharmaceuticals
In the 1930s, physicians approached the mental illness of depression a bit differently that we do today. While acknowledging a likely cause of depression in one of their patients is often due to some great misfortune, they seemed to focus on what is called a complex. A complex is disturbances of ideas and impulses that are the cause of consistent habitual patterns of thought, feelings, and behavior. An example of this state of mind of one who is depressed is one who experiences an exaggerated or obsessive concern or fear. And the etiology for this mental disorder was often undefined. People react differently to life stressors in their life, so depression cannot be empirically determined.

In the 1930s, psychotherapy such as cognitive therapy was recommended for treating the depressed patient, and not pharmacological therapy. Also considered for the depressed patient was positive lifestyle changes that would lessen the pain that the depression was causing them. Try and be grateful, they would tell their patient, as well as thankful and appreciative for whatever good may be in their life, and normally the depressed patient would eventually recover.

Times have changed since then.

Presently, serotonin-enhancing drugs are the therapeutic regimens for those who are suspect of having a depressed state, or perhaps the patient simply asks for these types of drugs due to their perception that they are depressed. Furthermore, and remarkably, various other mood disorders one may have can be treated with these drugs, typically called SSRIs.

What is remarkable is that the mood disorders which will be discussed later are subject to debate and have also been brought to the attention to so many others through disease awareness campaigns by the makers of these SSRI drugs. So mental flaws claimed to be relieved by SSRI drugs may not be the case at all.

With depression, the most severe cognitive and behavioral malfunctions are expressed in what is called a major depressive disorder, which is also called clinical depression or major depression. Symptoms of this type of depression, which is the most concerning to health care providers in particular due to its severity, include decreased or flat affect, decreased interest in activities once enjoyable, self perceptions of worthiness, guilt, regret, helplessness, and hopeless by the sufferer, to name a few of the diagnostic features that may be present with one who has such a major depressive disorder.
The disease has a vexing insistence on staying with the victim for a lengthy period of time- often continuing to progress symptomatically in severity and discomfort. This disease is very disabling, and cannot be lifted by one’s will, so all health care professionals likely agree that depression is a potentially serious condition with their patients. Suicidal ideation and attempts are associated with major depression.

These SSRI drugs mentioned earlier are known by some health care providers as third generation anti-depressants. Such drugs, drugs that affect the mind, are called psychotropic medications. SSRIs also include a few drugs in this class that include the addition of a norepinephrine uptake inhibitor added to the SSRI in one capsule, and these drugs are referred to as SNRI medications. The combination of two different drugs has made them the top class of prescriptions for psychological misalignment.
There are several available SSRIs presently, yet it is believed that only two SNRIs are available, which are Cymbalta and Effexor.

Some consider these classes of meds, the serotonin enhancers in these medications, have been considered the next generation mood enhancers- after the benzodiazepine hype decades ago, which was followed by what were called trycyclic drugs for depression for some time.

Furthermore, regarding SNRIs, adding the additional agent of norepinepherine is presumed to increase the effectiveness of SSRIs by some, yet not everyone claims relief from these types of drugs.
Some Definitions:

Serotonin is a neurotransmitter thought to be associated with mood. The hypothesis was first suggested in the mid 1960s that this neurotransmitter may play a role in moods and emotions in humans. Yet to this day, the serotonin correlation with such behavioral and mental conditions is only theoretical. In fact, the psychiatrist’s bible, which is known as the DSM, states that the definite etiology of depression remains a mystery and remains unknown with complete certainty. So a chemical imbalance in the brain is not proven to be the cause of mood disorders, it is only suspected as a result of limited scientific evidence. In fact, diagnosing mental diseases such as depression is based on subjective assessment only, as interpreted by the prescriber, so one could question the accuracy of such diagnoses.

Norepinepherine is a stress hormone, which many believe help those who have such mood disorders as depression. Basically, with the theory that by adding this hormone, the SSRI will be more efficacious for a patient prescribed such a med, as suggested earlier.

And the depressive state of a patient certainly can be aggravated by another mood disorder at the same time with some patients. Anxiety usually exists with one who has a major depressive disorder. An objective diagnosis of such a mental condition is rather impossible to assess objectively. Therefore any diagnosis made for a mental abnormality lacks complete accuracy and assurance.

Such illnesses can only be assessed conceptually, so the diagnosis or impression concluded by the patient’s health care provider is dependent on subjective criteria expressed by the suspected patient that is not mentally sound. At times, there have been screening programs that have been used for identifying depressed patients have proven to be largely ineffective.

A social patient history is uncertain and tricky as well, some have said, yet is obtained often from such patients. There is no objective diagnostic testing for any mental malfunction to validate as to whether or not such a disease is present. A health care provider has to assess as to whether certain non-verbal or vocalized features are present with a patient in order to conclude confidently that one may have in fact some degree or level of depression. To assess a suspected depressed patient is further complicated by the fact that the exact cause of major depression is unknown. Research says that there is a strong genetic component to this illness.

The diagnosis of depression as well as mood disorders that may exist within patients has increased quite a bit over the past few decades. Some have asked themselves, as well as others- actually how many people are really and actually depressed? What is believed is that if one determined to be cognitively impaired from a mental paradigm, then this may be in fact major depression. If this mental disorder is determined by a health care provider, it is possible that pharmacological therapy may be considered reasonable and necessary, as well as psychotherapy either suggested to be performed with or in place of medicinal therapy.

Studies show that both therapies working together may be of most benefit for the depressive patient, yet it is not a guaranteed protocol for treatment in this way.

It has been reported that around 10 percent of the U.S. population will at some point be affected by an episode of what may be a major depressive disorder. This is much greater in number than just a few decades ago. Perhaps media sources are to blame, by suggesting to their viewers that they may in fact be depressed. So the diagnosis and medicinal treatment have remarkably increased in a relatively short period of time in the United States. Of course, the expansion of those claimed and determined to be depressed does not sadden the makers of these drugs used to treat this mental disorder one bit, I’m sure.

Some have said that so many more people seek treatment now for what they believe is a major depressive disorder they are experiencing, when in fact it may be possibly intense sadness, perhaps, due to a loss of some sort in their lives. There is a difference, and health care providers should have the appropriate tools and knowledge to discriminate between the two states of mental conditions.

Sadness is not a medical problem. Symptoms associated with an unfavorable mental state need to be excessive and chronic to be considered to have in fact the medical problem of a major depressive disorder, as stated by others.

In Time magazine’s June 16th 2008 cover story, it was reported that the military personnel in the Iraq war are pounding down SSRIs often. Every time there is a new war, there is a new drug, it seems. Yet the story may illustrate the frequent usage of these types of medications in a variety of different areas for different reasons.

Some reasons may be valid and appropriate, yet others perhaps may not be reasonable for such medicinal therapy. However, as illustrated in this situation, they appear to be accepted as a treatment option without reservation.

In regards to those pharmaceutical companies who make and market such psychotropic drugs in the manner that their manufacturers do is largely unknown to others, such as with screenings performed essentially by front groups, and so forth. However, what is known is that the psychiatry specialty, as they often treats and manages depressed patients, is the one specialty that receives the most monetary funding that is paid to them by these certain pharmaceutical companies for ultimately what they hope will be continued and additional support of the psychotropic meds that they currently promote to these doctors.

Needless to say, the desire and the aspect of the pharmaceutical industry clearly is primarily concerned with encouraging as much use out of their products as possible- with both doctors and patients being the route of that increased use they desperately hope will occur.

Regardless, SSRIs and SRNIs are the preferred treatment methods if depression or other mood disorders that are suspected and determined by the health care providers who treat such patients. Yet these drugs discussed clearly are not the only treatments, medicinally or otherwise, for depression and other related and suspected mental disease states, moods, or disorders. Patients should be aware of this fact as well as caregivers. And they may not be aware of the options available to them.
For example, tens of millions of prescriptions are written by health care providers for these types of medications for their patients.

These drugs are not inexpensive, either, as it is not unusual for a patient to pay greater than one hundred dollars to have their prescription filled for only a month’s worth of these particular drugs.

Presently, there are about ten different SSRI/SRNI meds available, many of which are now generic, yet essentially, they appear to be similar in regards to their efficacy and adverse events. The newest one, a SNRI called Pristiq, was approved in 2008, and is believed to be launched as a treatment for menopause.
The first one of these SSRI meds was Prozac, which was available in 1988, and the drug was greatly praised for its ability to transform the lives of those who consumed this medication in the years that followed. Some termed Prozac, ‘the happy pill’.

In addition, as the years went by and more drugs in this class became available, Prozac was the one of preference for many doctors for children. A favorable book was published specifically regarding this medication soon after it became so popular with others.

Furthermore, these meds have received upon request of their makers to the FDA to have additional indications besides depression for these types of drugs they produce and market, and the indications they have received are for some really questionable conditions, such as social phobia and premenstrual syndrome.

Also included with indications that now exist with these types of medications are the quite devastating conditions of what may be mild anxiety and shyness, yet the makers of these drugs consider such patients as having chronic anxiety with severe anxiety disorder, which others have said is rather obsurd.

And it gets worse with the indications received for these types of drugs, which now include Obsessive-Compulsive Disorder, Panic Disorder, Agoraphobia, Post Traumatic Stress Disorder, Bulimia, and any form of stress disorders in general. I understand they are seeking indications for pain management as well with these SSRI or SRNI pharmaceuticals.

Likely, they will get the indication for their drugs to treat such creative cognitive states apparently others have in great numbers.

With some of these indications for these classes of drugs, I question as to whether or not they are actual and treatable disease states or medical problems. Yet with additional indications for particular drugs in these classes of medications, one can be assured that the market for these drugs will continue to grow- as more are prescribed to those patients who are progressively asking for them specifically for relief they anticipate they will receive from taking these drugs.

What such patients are not aware of is that studies have shown that this class of medications is only effective in roughly half of those who take them. And some of the indications granted to drugs in these classes of medications may be considered disease mongering tacitly performed by the makers and marketers of these drugs to again grow the market share for particular drugs of this type.

This is combined with drug companies who make these types of meds either forming or creating front groups in order to have more diagnosed with various medical problems that may not exist so their medication can be utilized more.

And as mentioned earlier, such pharmaceutical companies have been known to either create or support front groups to ultimately encourage who may be normal people to get evaluated for the diseases indicated with these medications. Of course, such tactics implemented by such pharmaceutical companies are deceptive, inappropriate, unreasonable, unnecessary, and potentially if not actually dangerous to others.

Perhaps of greater concern and danger with these particular psychotropic medications involve the adverse effects associated with these types of drugs, which include suicidal thoughts and actions, violence- including acts of homicide, and aggression- and this is only to name a few. Such events are devastating and have been demonstrated by those who have or are taking these types of drugs. It has been reported that the makers of such drugs are suspected to have known about these toxic and dangerous effects of their drugs and did not share them with the public in a timely and critical manner until forced to do so.
While most SSRIs and SNRIs are approved for use in adults only, prescribing these meds to children and adolescents has drawn the most attention and debate with others for understandable reasons, which have included those in the medical profession as well as citizen watchdog groups.

The reasons for this attention are due to the potential off-label use of these meds in this population of children, yet what may be most shocking is the fact that some of the makers of these meds did not release clinical study information about the risks of suicide as well as the other adverse events related to such populations, combined with the true decreased efficacy of SSRIs in general, which is believed to be only less than 10 percent more effective than a placebo.

Paxil caught the attention of the government regarding this issue of data suppression some time ago, this hiding of such important information- Elliot Spitzer specifically was the catalyst for this awareness, as I recall. Furthermore, that drug is in the spotlight once again years later. Some believe the drug maker knew about possible risk to the youth as early as 1991. Yet did not disclose such danger associated with their drug to the public or the FDA, and this was done with intent.

And there are very serious questions about the use of SSRIs in children and adolescents regarding the possible damaging effects of these meds on them as they get older- these children and teenagers who are prescribed these drugs. Others are asking if this is really necessary- and are these drugs doing more harm than good for their children.

For example, do the SSRIs correct or create brain states considered not within normal limits, which in effect would possibly cause harm rather than benefit a patient on such a drug? Are adolescents really depressed, or just experiencing what was once considered normal teenage angst? Do SSRIs have an effect on the brain development and their self identity of such young people? Do adolescents in particular become dangerous or bizarre due to SSRIs interfering with the myelination occurring within their still developing brains?

No one seems to know the correct answer to such questions, yet the danger associated with the use of SSRIs does in fact exist, as demonstrated by others. It is observed in some who take such drugs, but not all who take these drugs.

Yet health care providers possibly should be much more aware of these possibilities, possibly, along with the black box warning now on SSRI prescribing information for the youth that has existed since 1994. There are other medications health care providers could prescribe for such patients that have no less benefit for them then the serotonin drugs discussed.

Finally, if SSRIs or SNRIs are discontinued by a patient rapidly, abruptly, and without medical supervision, withdrawals experienced by many of these patients are believed to be quite brutal that follow soon after this drug is not taken anymore by a former patient. This in itself may be a catalyst for one to consider or attempt suicide, others have suggested. Many are aware and understand that discontinuing these SSRIs and SSNIs leaves the brain in a state of neurochemical instability for some great length of time as the neurons need to recalibrate after existing in a brain over-saturated with serotonin and neuron alteration.

This occurs to some degree with any psychotropic medication, yet the withdrawals can reach a state of danger for the victim in some classes of meds such as SSRIs and SNRIs, it is believed. And this seems to concern many, yet does not inhibit health care providers for continuing to select such therapy with these drugs for their patients.

SSRIs and SRNIs have been claimed by doctors as well as patients to be extremely beneficial for the patient’s well -being regarding their apparent mental issues that resolve in time. Yet overall, the factors associated with this class of medications may outweigh any perceived benefit for the patient taking such a drug that can harm themselves and others.
Before these medications mentioned were developed, doctors praised trycyclics, another class of anti-depressants mentioned earlier, in a similar manner since their advent in the 1950.

Considering the lack of efficacy that has been demonstrated objectively with these new serotonin specific psychotropics, along with the deadly adverse events with these SSRI and SSNI meds only recently brought to the attention of others, other pharmacological and non- pharmacological treatment options should probably be considered, but that is up to the discretion of the prescriber.

And the perception of the benefits derived by these types of drugs may be flawed, as there has been no decrease in incidences of suicide or remission of depression since these drugs have been available, many have concluded.

Yet antidepressants in general have been considered by others to create amotivational syndrome, which is a lack of interest in various activities, as well as creating a state of flat affect of users of antidepressants.

Furthermore, recent studies have suggested that the supplement, St. John’s Wart, has shown to be as effective as medicine for major depression. Deficiencies in vitamins B12 and Folate have been suggested as a cause for depression as well. One study showed that a small jog performed by a depressed patient offered similar if not greater relief than a SSRI drug.

It is my hope that such a prescriber rules out possible other etiologies for their patients’ mental conditions before they conclude that such a patient is suffering from true mental illness requiring the medications mentioned earlier, such as asking their patients about life stressors and other medications these patients have taken or are presently taking. Because at times, a doctor can in fact do harm without intent.

“I use to care, but now I take a pill for that.” ---

Author unknown*

Dan Abshear

Anonymous said...

Serotonin Enhancers

In the 1930s, physicians approached the mental illness of depression a bit differently that we do today. While acknowledging a likely cause of depression in one of their patients is often due to some great misfortune, they seemed to focus on what is called a complex.

A complex is disturbances of ideas and impulses that are the cause of consistent habitual patterns of thought, feelings, and behavior.

An example of this state of mind of one who is depressed is one who experiences an exaggerated or obsessive concern or fear. And the etiology for this mental disorder was often undefined. People react differently to life stressors in their life, so depression cannot be empirically determined.

Also in the 1930s, psychotherapy such as cognitive therapy was recommended for treating the depressed patient, and not pharmacological therapy. Also considered for the depressed patient was positive lifestyle changes that would lessen the pain that the depression was causing them.

Try and be grateful, they would tell their patient, as well as thankful and appreciative for whatever good may be in their life, and normally the depressed patient would eventually recover.

Times have changed since then.

Presently, serotonin-enhancing drugs are the therapeutic regimens for those who are suspect of having a depressed state or mood disorder. Patients believing they have such cognitive issues often ask for such medications. The drugs are known as SSRIs, or SRNIs.

What is remarkable is that the mood disorders which will be discussed later are subject to debate. Yet such disorders have been brought to the attention to so many others through disease awareness campaigns by the makers of these classes of drugs. So mental flaws claimed to be relieved by SSRI drugs may not be entirely accurate.

With depression, the most severe cognitive and behavioral malfunctions are expressed in what is called a major depressive disorder, which is also called clinical depression or major depression.

Symptoms of this type of depression, which is the most concerning to health care providers in particular due to its severity, include decreased or flat affect, decreased interest in activities once enjoyable, self perceptions of worthiness, guilt, regret, helplessness, and hopeless by the sufferer, to name a few of the diagnostic features that may be present with one who has such a major depressive disorder.
The disease has a vexing insistence on staying with the victim for a lengthy period of time- often continuing to progress symptomatically in severity and discomfort. This disease is very disabling, and cannot be lifted by one’s will, so all health care professionals likely agree that depression is a potentially serious condition with their patients. Suicidal ideation and attempts are associated with major depression.

These SSRI drugs mentioned earlier are known by some health care providers as third generation anti-depressants. Such drugs, drugs that affect the mind, are called psychotropic medications.

SSRIs also include a few drugs in this class that include the addition of a norepinephrine uptake inhibitor added to the SSRI in one capsule, and these drugs are referred to as SNRI medications. The combination of two different drugs has made them the top class of prescriptions for those suspected of psychological misalignment.

There are several available SSRIs presently, and a few SRNIs. Both classes of medications are prescribed for similar mental conditions.

Some consider these classes of meds, the serotonin enhancers in these medications, to be the next generation mood enhancers- after the benzodiazepine hype decades ago, which was followed by what were called trycyclic drugs for depression for some time as well, it is believed.

Furthermore, regarding SNRIs, adding the additional agent of norepinepherine is presumed to increase the effectiveness of SSRIs by some, yet not everyone claims relief from these types of drugs included in the SRNI class.

Some Definitions:

Serotonin is a neurotransmitter thought to be associated with mood. The hypothesis was first suggested in the mid 1960s that this neurotransmitter may play a role in moods and emotions in humans. Yet to this day, the serotonin correlation with such behavioral and mental conditions is only theoretical.

In fact, the psychiatrist’s bible, which is known as the DSM, states that the definite etiology of depression remains a mystery and remains unknown with complete certainty. So a chemical imbalance in the brain is not proven to be the cause of mood disorders, it is only suspected as a result of limited scientific evidence.

Diagnosing mental diseases such as depression is based on subjective assessment only, as interpreted by the prescriber, so one can examine the accuracy of such diagnoses.

Norepinepherine is a stress hormone, which many believe help those who have such mood disorders as depression. Basically, with the theory that by adding this hormone, the SSRI will be more efficacious for a patient prescribed such a med, as suggested earlier.

And the depressive state of a patient certainly can be aggravated by another mood disorder at the same time with some patients. Anxiety usually exists with one who has a major depressive disorder. An objective diagnosis of such a mental condition is rather impossible to assess objectively. Therefore any diagnosis made for a mental abnormality lacks complete accuracy and assurance.

So such speculated mental illnesses can only be assessed conceptually. As a result, the diagnosis or impression concluded by the patient’s health care provider is dependent on subjective criteria expressed by the suspected patient that is presumed to be not mentally sound.

At times, there have been screening programs that have been used for identifying depressed patients have proven to be largely ineffective.

A social patient history is uncertain and tricky as well, some have said, yet is obtained often from such patients. There is no objective diagnostic testing for any mental malfunction to validate as to whether or not such a disease is present- just the perception of the health care provider, and survey questions related to a particular mental disorder.

A health care provider has to assess as to whether certain non-verbal or vocalized features are present with a patient in order to conclude confidently that one may have in fact some degree or level of depression or any other mental disorder.

To assess a suspected depressed patient is further complicated by the fact that the exact cause of major depression is unknown. Research says that there is a strong genetic component to this illness, however.

The diagnosis of depression as well as mood disorders that may exist within patients has increased quite a bit over the past few decades. Some have asked themselves, as well as others- actually how many people are really and actually depressed, or affected by any other mental disorder?

What is believed is that if one determined to be cognitively impaired from a mental paradigm, then this may be in fact major depression. If this mental disorder is determined by a health care provider, it is possible that pharmacological therapy may be considered reasonable and necessary, as well as psychotherapy either suggested to be performed with or in place of medicinal therapy.

Studies show that both therapies working together may be of most benefit for the depressive patient, yet it is not a guaranteed protocol for treatment in this way.

It has been reported that around 10 percent of the U.S. population will at some point be affected by an episode of what may be a major depressive disorder. This is much greater in number than just a few decades ago.

Perhaps media sources are to blame to some degree for the progressive increase in diagnosing mental disorders by suggesting to the public that they may have such disorders. So the diagnosis and medicinal treatment have clearly increased in a relatively short period of time in the United States.

Of course, the expansion of those claimed and determined to be depressed does not sadden the makers of these drugs used to treat this mental disorder one bit, it is safe to say.

Some have said that so many more people seek treatment now for what they believe is a major depressive disorder they are experiencing, when in fact it may be possibly intense sadness, perhaps, due to a loss of some sort in their lives. There is a difference, and health care providers should have the appropriate tools and knowledge to discriminate between the two states of mental conditions.

Sadness is not a medical problem. Symptoms associated with an unfavorable mental state need to be excessive and chronic to be considered to have in fact the medical problem of a major depressive disorder, as stated by others.

In Time magazine’s June 16th 2008 cover story, it was reported that the military personnel in the Iraq war are pounding down SSRIs often. Every time there is a new war, there is a new drug, it seems. Yet the story may illustrate the frequent usage of these types of medications in a variety of different areas for different reasons.

Some reasons may be valid and appropriate, yet others perhaps may not be reasonable for such medicinal therapy. However, as illustrated in this situation, they appear to be accepted as a treatment option without reservation.

In regards to those pharmaceutical companies who make and market such psychotropic drugs in the manner that their manufacturers do is largely unknown to others, such as with screenings performed essentially by front groups, and so forth.

However, what is known is that the psychiatry specialty, as they often treats and manages depressed patients, is the one specialty that receives the most monetary funding that is paid to them by these certain pharmaceutical companies for ultimately what they hope will be continued and additional support of the psychotropic meds that they currently promote to these doctors.

Needless to say, the desire and the aspect of the pharmaceutical industry clearly is primarily concerned with encouraging as much use out of their products as possible- with both doctors and patients being the route of that increased use they desperately hope will occur.

Regardless, SSRIs and SRNIs are the preferred treatment methods if depression or other mood disorders that are suspected and determined by the health care providers who treat such patients. Yet these drugs discussed clearly are not the only treatments, medicinally or otherwise, for depression and other related and suspected mental disease states, moods, or disorders.

Patients should be aware of this fact as well as caregivers. And they may not be aware of the options available to them.

For example, tens of millions of prescriptions are written by health care providers for these types of medications for their patients.

These drugs are not inexpensive, either, as it is not unusual for a patient to pay greater than one hundred dollars to have their prescription filled for only a month’s worth of these particular drugs.

Presently, there are about ten different SSRI/SRNI meds available, many of which are now generic, yet essentially, they appear to be similar in regards to their efficacy and adverse events.

The newest one, a SNRI called Pristiq, was approved in 2008, and is believed to be launched as a treatment for menopause.

The first one of these SSRI meds was Prozac, which was available in 1988, and the drug was greatly praised for its ability to transform the lives of those who consumed this medication in the years that followed. Some termed Prozac, ‘the happy pill’.

In addition, as the years went by and more drugs in this class became available, Prozac was the one of preference for many doctors for children. A favorable book was published specifically regarding this medication soon after it became so popular with others.

Furthermore, these meds have received upon request of their makers to the FDA to have additional indications besides depression for these types of drugs they produce and market, and the indications they have received are for some really questionable conditions, such as social phobia and premenstrual syndrome.

Also included with indications that now exist with these types of medications are the quite devastating conditions of what may be mild anxiety and shyness, yet the makers of these drugs consider such patients as having chronic anxiety with severe anxiety disorder, which others have said is rather obsurd.

And it gets worse with the indications received for these types of drugs, which now include Obsessive-Compulsive Disorder, Panic Disorder, Agoraphobia, Post Traumatic Stress Disorder, Bulimia, and any form of stress disorders in general. I understand they are seeking indications for pain management as well with these SSRI or SRNI pharmaceuticals.

Likely, they will get the indication for their drugs to treat such creative cognitive states apparently others have in great numbers.

With some of these indications for these classes of drugs, I question as to whether or not they are actual and treatable disease states or medical problems. Yet with additional indications for particular drugs in these classes of medications, one can be assured that the market for these drugs will continue to grow- as more are prescribed to those patients who are progressively asking for them specifically for relief they anticipate they will receive from taking these drugs.

What such patients are not aware of is that studies have shown that this class of medications is only effective in roughly half of those who take them. And some of the indications granted to drugs in these classes of medications may be considered disease mongering tacitly performed by the makers and marketers of these drugs to again grow the market share for particular drugs of this type.

This is combined with drug companies who make these types of meds either forming or creating front groups in order to have more diagnosed with various medical problems that may not exist so their medication can be utilized more.

And as mentioned earlier, such pharmaceutical companies have been known to either create or support front groups to ultimately encourage who may be normal people to get evaluated for the diseases indicated with these medications. Of course, such tactics implemented by such pharmaceutical companies are deceptive, inappropriate, unreasonable, unnecessary, and potentially if not actually dangerous to others.

Perhaps of greater concern and danger with these particular psychotropic medications involve the adverse effects associated with these types of drugs, which include suicidal thoughts and actions, violence- including acts of homicide, and aggression- and this is only to name a few. Such events are devastating and have been demonstrated by those who have or are taking these types of drugs.

It has been reported that the makers of such drugs are suspected to have known about these toxic and dangerous effects of their drugs and did not share them with the public in a timely and critical manner until forced to do so.

While most SSRIs and SNRIs are approved for use in adults only, prescribing these meds to children and adolescents has drawn the most attention and debate with others for understandable reasons, which have included those in the medical profession as well as citizen watchdog groups.

The reasons for this attention are due to the potential off-label use of these meds in this population of children, yet what may be most shocking is the fact that some of the makers of these meds did not release clinical study information about the risks of suicide as well as the other adverse events related to such populations, combined with the true decreased efficacy of SSRIs in general, which is believed to be only less than 10 percent more effective than a placebo.

The makers of Paxil caught the attention of the government regarding this issue of data suppression some time ago, this hiding of such important information- Elliot Spitzer specifically was the catalyst for this awareness, as I recall.

Furthermore, that drug is in the spotlight once again years later. Some believe the drug maker knew about possible risk to the youth as early as 1991. Yet did not disclose such danger associated with their drug to the public or the FDA, and this was done with intent.

And there are very serious questions about the use of SSRIs in children and adolescents regarding the possible damaging effects of these meds on them as they get older- these children and teenagers who are prescribed these drugs. Others are asking if this is really necessary- and are these drugs doing more harm than good for their children.

For example, do the SSRIs correct or create brain states considered not within normal limits, which in effect would possibly cause harm rather than benefit a patient on such a drug? Are adolescents really depressed, or just experiencing what was once considered normal teenage angst?

Do SSRIs have an effect on the brain development and their self identity of such young people? Do adolescents in particular become dangerous or bizarre due to SSRIs interfering with the myelination occurring within their still developing brains?

No one seems to know the correct answer to such questions, yet the danger associated with the use of SSRIs does in fact exist, as demonstrated by others. It is observed in some who take such drugs, but not all who take these drugs.

Yet health care providers possibly should be much more aware of these possibilities, possibly, along with the black box warning now on SSRI prescribing information for the youth that has existed since 1994. There are other medications health care providers could prescribe for such patients that have no less benefit for them then the serotonin drugs discussed.

Finally, if SSRIs or SNRIs are discontinued by a patient rapidly, abruptly, and without medical supervision, withdrawals experienced by many of these patients are believed to be quite brutal that follow soon after this drug is not taken anymore by a former patient. This in itself may be a catalyst for one to consider or attempt suicide, others have suggested.

Many are aware and understand that discontinuing these SSRIs and SSNIs leaves the brain in a state of neurochemical instability for some great length of time as the neurons need to recalibrate after existing in a brain over-saturated with serotonin and neuron alteration.

This occurs to some degree with any psychotropic medication, yet the withdrawals can reach a state of danger for the victim in some classes of meds such as SSRIs and SNRIs, it is believed. And this seems to concern many, yet does not inhibit health care providers for continuing to select such therapy with these drugs for their patients.

SSRIs and SRNIs have been claimed by doctors as well as patients to be extremely beneficial for the patient’s well -being regarding their apparent mental issues that resolve in time. Yet overall, the factors associated with this class of medications may outweigh any perceived benefit for the patient taking such a drug that can harm themselves and others.

Before these medications mentioned were developed, doctors praised trycyclics, another class of anti-depressants mentioned earlier, in a similar manner since their advent in the 1950.

Considering the lack of efficacy that has been demonstrated objectively with these new serotonin specific psychotropics, along with the deadly adverse events with these SSRI and SSNI meds only recently brought to the attention of others, other pharmacological and non- pharmacological treatment options should probably be considered, but that is up to the discretion of the prescriber.

And the perception of the benefits derived by these types of drugs may be flawed, as there has been no decrease in incidences of suicide or remission of depression since these drugs have been available, many have concluded.

Yet antidepressants in general have been considered by others to create amotivational syndrome, which is a lack of interest in various activities, as well as creating a state of flat affect of users of antidepressants.

Furthermore, recent studies have suggested that the supplement, St. John’s Wart, has shown to be as effective as medicine for major depression. Deficiencies in vitamins B12 and Folate have been suggested as a cause for depression as well. One study showed that a small jog performed by a depressed patient offered similar if not greater relief than a SSRI drug.

It is my hope that such a prescriber rules out possible other etiologies for their patients’ mental conditions before they conclude that such a patient is suffering from true mental illness requiring the medications mentioned earlier, such as asking their patients about life stressors and other medications these patients have taken or are presently taking. Because at times, a doctor can in fact do harm without intent.

“I use to care, but now I take a pill for that.” ---
Author unknown*

www.nmha.org

Dan Abshear