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The overprescription of antidepressants: take charge of your mental health.

Three years ago, I sat in my college psychiatrist's office, terrified that I'd never feel like my happy, confident self again. I had been going through major depression for over a year and had reached my breaking point. A few of my friends recommended counseling, and I was so terrified that I would never break out of my funk that finally I decided to try it. I'd never seen a therapist before, so I wasn't sure what to expect; I had images of sitting on a couch every week, pouring out my heart to some stranger who would somehow manage to make me feel better. I was hopeful that having someone to communicate my emotions to could solve my problems. My first experience with a psychiatrist was very different, however.

I stepped into my psychiatrist's office, shook his hand, and sat down. We introduced ourselves; he seemed like a nice guy who was very qualified. We spent the first half-hour discussing how I'd been feeling, and he agreed that I was clearly very depressed. Then he asked me a question that I'd spend the next few years trying to truly answer: "Would you be willing to go on antidepressants?" I simply answered, "Sure." What was I supposed to say? I was desperate for any help I could get; I figured that he was the expert and if he thought it was a good idea, then it must be. He wrote a prescription for Prozac, advised me to call him with any questions, and that was it. I didn't get a follow-up appointment or anything else and I never saw him again. Apparently, Prozac was supposed to be my magical solution.

Over the following weeks, I realized the many questions I should have asked the doctor and the answers he should have provided before prescribing Prozac. Why do I need this medication? What does it do? Why is Prozac a better choice than another antidepressant for me? Are there other options, beside antidepressants? I became very angry that the psychiatrist had just prescribed medication without fully discussing my feelings or current situation. Yet, I continued to take Prozac because I didn't know what else to do.

After about a month, I did start to feel better. I was less irritable and could handle my emotions better. I wasn't sure, however, if Prozac had made the difference or if it was my surroundings: I'd started a new year in college, made some new friends, and was enjoying my classes. I figured that these changes were the real reason for my new happiness, so I decided to rethink the Prozac. I didn't want to go back to the psychiatrist because I feared he'd just listen to me for 20 minutes and tell me I needed to continue on antidepressants. So, I just made the decision myself to stop taking Prozac. This was a catastrophic mistake.

I quickly learned why one should never stop antidepressants cold turkey. Antidepressants are serious psychotropic drugs that you have to gradually wean yourself off Discontinuing Prozac interrupts the production of the key neurotransmitter acetylcholine, and can cause serious side effects like flu-like sickness, headaches, dizziness, and nausea. (1) After stopping Prozac, I experienced several symptoms of mental illness, including irritability and agitation. I didn't feel like myself, had no motivation, and had strong feelings of worthlessness. My depression returned, worse than it was before, but I put off going back to a psychiatrist because of my previous experience. I struggled with my depression for another year until I finally broke down. In order to get the help I needed, I decided to withdraw from college for a semester and go home to my family.

Back home, my mom suggested that I see a counselor. I was reluctant, but she had great experiences with her counselor so I decided to try it. My first appointment with Cindy, my counselor, was a wonderful experience. We spent the entire hour just talking about my feelings and what had been going on in my life. I cried a lot as I told her thoughts that had been weighing on my mind, but that I couldn't discuss with anyone. It was so refreshing to have a counselor who truly listened to me and had my best interests in mind.

These sessions continued for the next several months. Ironically, a month into our sessions, I decided to start taking Prozac again. This time, however, it was a fully informed decision that I knew was right for me. Cindy and I spent a great deal of time discussing the positives, negatives, and alternatives to antidepressants. After weighing all my options, I decided it was the right treatment for me. I also continued my counseling sessions because medication is not an end-all solution. I learned the importance of medication and therapy working together hand-in-hand. At each session, Cindy monitored my progress to make sure that we'd made the right decision about taking medication. Our sessions continued until I returned to college, ready for my senior year. By then, I had already started to wean myself off of Prozac and (since I did it the correct way this time) I had no side effects. I was enjoying life again and feeling like my old self.

Looking back, I realize I was lucky to have a positive experience that improved my view of therapy, and to receive the support and guidance I needed to get well. Antidepressants should only be prescribed after serious doctor-patient counseling determines that they are the correct choice. In addition, patients need to fully understand their decision to take medication, to ensure that drugs are used properly. Finally, people taking antidepressants, like other powerful medications, need consistent follow-up with ah engaged health care professional. Too many people don't fare as well as I did: overprescription of antidepressants has become a major issue in this country.

Antidepressants can be effective drugs for many people, as they have been for me, but they have become too commonly prescribed without first determining if they are really needed and whether other options exist (like psychotherapy or cognitive behavioral therapies). According to the U.S. Dept. Health and Human Services, adult use of antidepressants almost tripled between 1994-2000: 10% of women 18 and older and 4% of men now take antidepressants. (2) Yet, a recent study of the results from 47 clinical trials found that majority of depressed patients on antidepressants did no better than those taking a placebo. (3) There was virtually no difference in improvement for drugs vs. placebo in patients with moderate depression, and only a small difference among patients with severe depression. (3) The researchers concluded there is little reason to prescribe the antidepressants studied to anyone but the most severely depressed patients unless alternative treatments have proven ineffective. (3)

Another major issue is that these medications aren't always coupled with supportive therapy from a mental health professional, which is vital in the first few months of medication. The FDA guidelines for adult patients recommend at least weekly face-to-face visits with a health practitioner during the first month of antidepressant treatment, then every other week for the next month, and a follow-up visit at 12 weeks. But, studies have found that nearly half of all patients have no follow-up visits the first month they're taking antidepressants. (4)

Clearly, many people who begin a new course of antidepressant therapy receive far less post-care than is recommended. Follow-up is needed to effectively monitor patients' response to medications so dosages can be adjusted and patients helped to manage any side effects. This is important because 40 percent of patients don't respond to the first antidepressant they try. (1) Without follow-up care, patients may discontinue their drugs (like I did), with harmful results. Physicians should both stress the importance of follow-up care to their patients and provide this care. For their part, patients need to be proactive and schedule follow-up care. Looking back, I wish I'd taken the initiative to schedule further appointments with my first psychiatrist instead of just taking my prescription and never returning.

Like me, many women trust the guidance of health professionals (like my psychiatrist) and will unquestioningly take any prescription they hand out. After my experience and my time at the Network, I realize that doctors are not always right and that, as patients, we need to step up and be active participants in our own health. It is okay to question our doctors and to ask for second opinions. Maybe if I had immediately questioned my first psychiatrist, I could have saved myself an entire year of depression.

References for this article are available on-line or by emailing editor@nwhn.org

Molly Bayliss is a graduate of George Mason University, where she received a B.A. in Government and International Politics and a B.S. in Health Promotion. Molly was an NWHN intern in the Spring of 2008. In the Fall she will attend California Western School of Law in San Diego; she plans to work in the health law arena.
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Title Annotation:young FEMINISTS
Author:Bayliss, Molly
Publication:Women's Health Activist
Date:Jul 1, 2008
Words:1508
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