A couple months ago, I was conducting a psych assessment with a pain centre patient with depression secondary to chronic pain and disability. Among other things, he reported low mood and frequent crying, rumination, change in appetite, irritability, poor sleep, and fatigue. After the assessment, I offered him short-term psychotherapy--and suggested the possibility of an antidepressant in addition to the medical interventions he was receiving for pain. (NB: I'm limited to suggestion because psychologists don't have prescription privileges).
The patient was dismayed! His eyes filled with tears and he protested "I didn't think it was that bad!" His reaction took me by surprise. I thought an antidepressant would be a positive intervention that could alleviate some of his depressive symptoms and allow him to benefit as much as possible from psychotherapy and from medical interventions for pain; he interepreted my suggestion of an antidepressant as an alarming sign that he was worse off than he thought.
My patient's reaction got me wondering about the current man-on-the-street perspective on mood-stabilizing medications. Time for a poll!
Method: I sent an inbox message to 169 Facebook friends, inviting them to respond to an anonymous online poll about medication. The question: Have you ever been prescribed antidepressant or anti-anxiety medication? The possible answers were yes, no, and yes but I didn't fill the prescription or didn't take the medication. To encourage participation, I posted three reminders as my Facebook status in the following three weeks.
Participants: Fifty-five people responded. The anonymous nature of the poll precludes official sociodemographic data, but I would describe my sample of Facebook friends as roughly 70% white; 90% Anglophone; 90% urban; 80% professionals with post-secondary education, and ranging in age from 25 to 50 years old.
Results: 64% of respondents (n = 35) reported that they had never been prescribed medication for anxiety or depression. 31% of respondents (n = 17) had been prescribed medication, and 5% (n = 3) had been prescribed medication but hadn't taken it.
Discussion: I expected the percentage of medication-takers to be higher than 31%. This may be a bias borne of working in environments where many patients and clients take medication, but many of my friends, family members, and acquaintances also take or have taken antidepressant or anti-anxiety medication. To me, taking meds is both normal and common.
What do you think of these results? Are 31% (meds taken) and 36% (meds prescibed) greater percentages than you would expect? The statistic could be inflated by a response bias--that is, my Facebook friends who take or who have taken medication may have been more likely to respond. Alternatively, the statistic may reflect an over-prescription of antidepressant and anti-anxiety medication. I have personally had the uncomfortable experience of being handed a prescription for an antidepressant by a general practitioner who had met with me for ten minutes, and I know this isn't an uncommon experience.
Confusion and stigma surround the use of these medications, and it's not always easy to know who is a good candidate. I bet that of the 35 respondents who have never been prescribed meds, a few could have benefited from them at some point. I also wouldn't be surprised if a few of the 17 respondents who have used antidepressants or anxiolytics would have been just as well without it.
Opinion: Taking meds doesn't mean that you're weak, that you're an addict, or that you're severely ill; if you're prescribed medication for symptoms of anxiety or depression, it simply means that you're experiencing a very common symptom that medication can be partially effective in alleviating. I believe in the use of antidepressant and anti-anxiety medication as a tool for coping with or recovering from anxiety and depression, with a few ground rules:
- A person taking antidepressants or anti-anxiety meds should be closely followed by his or her prescribing doctor. The doctor must be available to answer questions about side effects, increase or decrease the dose as needed, and check in once in awhile to make sure the meds are having the intended effect. Otherwise it's really easy to end up taking medication for years without evaluating its impact, or to start independently experimenting with dosage--both problematic.
- For uncomplicated anxiety and non-recurrent depression, medication is ideally a short-term solution and anyone taking meds is also in psychotherapy, working on identifying and resolving the issues that contribute to anxiety or depression. Therapy without medication is also an option, but sometimes symptoms of anxiety and depression can make it difficult to benefit from (or even attend) therapy (e.g., you're too depressed to get out of bed to go to therapy; you're too anxious to sit still for fifty minutes). A well-prescribed medication can provide the stability and lucidity necessary to allow therapy to do its work.
Hi there! I quite enjoyed this poll and post because we've had this discussion in private before. I come from a family and environment where not many people have taken antidepressants - or it is not public knowledge - and it does come across to me, much like your client, as a very big step and a sign that things are getting out of control. Also, I fear that kind of medication that plays with one's natural hormone levels and it seems to me, just from observation, that taking antidepressants has become very "normal" which I find it shouldn't be (which is what you say in the last part of the post too, about it being monitored by a doctor). This may be unrelated, but I recently watched a TED talk given by anthropologist and neuroscientist Helen Fischer about relationships (http://www.ted.com/talks/helen_fisher_tells_us_why_we_love_cheat.html) and she explained that there was a natural balance between three types of hormones that regulated, in the brain, attraction, love and long-term engagement. Her studies showed that people that had been taking antidepressants for numerous years had much more difficulty engaging in long-term relations because the level of hormone associated with it had been tampered with on a long-term basis. I thought that was a really interesting perception and also, I wonder if maybe there shouldn’t be more studies - or maybe I simply don't know them: subject for a future post? - on how our eating habits affect or regulate our moods. For instance, one recent Canadian study concluded that symptoms in autistic children were severely reduced by eliminating gluten and dairy from their diets. That's really powerful, and I think that there is much we could do by education through diet and also by exercising. I am notably thinking of yoga (of course!) with which it is possible not only to strengthen the body but also to stimulate many organs and glands through compression postures. I am not a flaky hippy but I do believe in the healing power of yoga (it is after all thousands of years old and we are lucky that this sacred knowledge has spread into a very accessible practice in the West). And of course, mindfulness, meditation and everything else you are doing at MindSpace can play a big role in the way people deal with their emotions. I think we live in an era where we are very removed from our bodies and we have no consciousness about the effects of our physical neglectfulness on the mind. But the again I am no expert at all. Wow I guess I had lots to say on this topic! Thanks for this engaging post :)
ReplyDeleteI too work in an environment(mental health crisis unit)where just about everyone is on some sort of anti-depressant or anti-anxiety medication. I agree that medication can be an effective treatment of symptoms and I agree there are unfortunately many negative stigmas attached to psychiatric medications. With that said, however, I do believe many of the consumers I work with become dependent on the medications to stabilize their moods. Then when they find themselves in crisis they are without coping skills (other than taking a PRN). There has to be balance, and it this day and age there isn't.
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