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  #51  
Old 10-28-2007, 06:36 PM
daveT daveT is offline
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Default Re: Anti-depressants

Reading this thread suggests that the doctors take you off of it after one year. As Veracious Reader's post suggests, you do not understand who you are when you are depressed. It takes pills to be able to bring yourself back and then you will be able to see yourself, the triggers, and the problems that caused depression. Certain mental conditions are due to poor chemical balances in your brain. These conditions, no matter how hard you try to prevent them, will manifest later in life even though there are no good reasons for them. Schizophrenia, bipolarity, anxiety, and severe depression are some of those conditions. Counter to your post, psychotherapy works the exact opposite as you think. There is a reason that mental illnesses run in families: they are genetic.
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  #52  
Old 10-29-2007, 04:33 AM
Coaching Coaching is offline
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Default Re: Anti-depressants



I'd just like to thank all those who contributed to this thread.

I feel I was maybe a bit harsh towards irieguy so I'm sorry for that. Wouldn't like to leave on a bad note.

Good luck to all.
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  #53  
Old 10-29-2007, 07:07 PM
brashbrother brashbrother is offline
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Default Re: Anti-depressants

[ QUOTE ]
I got to say I was very nervous about Ambien or Lunesta because I know how addicting they can be and I have an addictive personality by nature. When I expressed that to my doc, he advised the Paxil and said it works great for sleeping problems which is caused by my anxiety (just didn't realize that!) and he assured me it was safe and non habit forming and he's been taking it for sleeping reasons for years (not regularly, but that's what he uses).

CORRECTION: I looked it up and I got the name wrong, I'm not on Paxil, I'm on Xanax. My bad.

Same side affects though....I think. [img]/images/graemlins/wink.gif[/img]

T

[/ QUOTE ]

This scares me a bit. I am a Family Medicine doc, and I commonly prescribe nearly all the meds listed on this thread. You might want to talk to your doc again about how addicting Xanax (aka Alprazolam) can be. It is intended to help with SHORT term anxiety, due to its immediate sedating effects. By its own pathophysiology, it will build its own demand within your brain, so by definition, it is very addicting. It is a benzodiazepine, same class as Valium and Ativan, only Xanax is shorter acting.

Of course it maeks you sleepy, but I would never in good conscience prescribe it to someone just to help them sleep. Especially someone with a self-professed "addicting personality."

Despite this, I am not surprised by your story, as I have seen any number of patients who are/were in the same boat. Most patients who come to see me tell me they have been taking it for years, what's the big deal?

Those who are alarmed by the news that it is addicting and want to stop, I slowly taper off. If they take it daily, they soon find out what I mean by addicting; many had no idea they were hooked until they cut back.

Majority though, will just plain like their Xanax (1-3 times daily, some of them), and just keep shopping for a doc who will write their Rx.

Benzo dependence is treated much the same as alcohol dependence, so don't try to quit without a doctor's help. If you are not using it daily, you may not be dependent yet. Count your blessings, quit now, and look for a doc who isn't too lazy to look for a non-addicting solution to sleep disorders and anxiety.
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  #54  
Old 10-30-2007, 03:54 AM
VirgilStarkwell VirgilStarkwell is offline
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Default Re: Anti-depressants

Mulcahey, this is just ridiculous:

[ QUOTE ]
"if you take drugs for depression, your not going to figure out why you are depressed. you won't be able to sort it out at all. you just end up taking drugs until the problem goes away, and if the problem is caused by you, then there is no good solution, and you will end up taking drugs for a long time."

[/ QUOTE ]

Imagine someone telling you that you shouldn't take medicine for a sinus infection, because if you do you'll never figure out why you got infected. Sometimes (maybe most of the time) depression really is just chemical.

I've been on a lot of the antidepressants mentioned in this thread. Unfortunately, I don't actually suffer from classical depression-- I'm bipolar. This mis-diagnosis is incredibly common, so OP should definitely make sure he spends a lot of time with his doctor eliminating the possibility of bipolar disorder.

Anti-depressants (prozac, wellbutrin, paxil, etc) are actually harmful if you're bipolar. They induce mania, which feels great and looks like a positive reaction to the medication, but the effect fades and the mania leads directly to depression. The "poop out" phenomenon is probably mainly due to anti-depressants (mostly SSRIs) incorrectly given to bipolar patients.

As far as the medications themselves: prozac by far has the fewest side effects-- no weight gain for most patients and few negative sexual side effects. Most guys notice some delay of orgasm but that's not always a bad thing as noted previously. Diarrhea is really common-- serotonin affects mood AND intestinal movements. Expect to try several, possibly in combinations, before finding a working solution. From what I understand this has to do with which neurotransmitters are being tweaked by the meds-- serotonin, norepinephrin, or dopamine. Cymbalta is a newer med that some people like a lot. Paxil is the only med that ever got me close to suicidal thinking, and that was more about anxiety rather than actually being a danger to myself. Basically it made me really afraid of suicide; it didn't make me want to do it.

Most doctors learn how to prescribe one antidepressant-- they know how to watch for side effects, how to regulate the dose, and how long it takes to work. They just stick with the one med for all their depressed patients. So it's worthwhile finding someone who really knows all the meds and how to mix them into an appropriate cocktail if necessary. If OP is just starting out, try prozac first-- it's the original SSRI and in a lot of ways still the best.

Crazymeds.org is a great resource.

Maybe some of that is helpful. And yeah yeah tl;dr. Sorry for rambling.
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  #55  
Old 10-30-2007, 12:30 PM
katyseagull katyseagull is offline
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Default Re: Anti-depressants

[ QUOTE ]

I am a Family Medicine doc, and I commonly prescribe nearly all the meds listed on this thread. You might want to talk to your doc again about how addicting Xanax (aka Alprazolam) can be. It is intended to help with SHORT term anxiety, due to its immediate sedating effects. By its own pathophysiology, it will build its own demand within your brain, so by definition, it is very addicting. It is a benzodiazepine, same class as Valium and Ativan, only Xanax is shorter acting.



[/ QUOTE ]

Thank you for your informative post. It's great to get a different perspective on this issue.

Since you are a doctor and you say that you commonly prescribe a lot of the medications listed in the above post let me ask you a question. Why do family doctors prescribe addictive medications to people who claim they have anxiety and sleep problems? Doesn't this just trade one problem for another? Also, Xanax is a drug for SHORT term anxiety? What does that mean exactly? If your anxiety is short term why even treat it with meds?

Don't take this personally because it's not intended to be a slam against you. I'm just really perplexed why doctors are so quick to whip out the prescription pad and give people prescriptions for controlled substances. I know a couple people with addictive personalities who have been given endless supplies of ambien and pain medication because they claim they have a bad back or can't sleep. It seems like doctors should interview family members to get a clear sense of the patient and his behaviors before prescribing something as addictive as Ambien. Can you address why doctors wouldn't discuss things with family members before writing out these types of prescriptions including ones for depression?
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  #56  
Old 10-30-2007, 03:49 PM
brashbrother brashbrother is offline
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Default Re: Anti-depressants

[ QUOTE ]


Thank you for your informative post. It's great to get a different perspective on this issue.

Since you are a doctor and you say that you commonly prescribe a lot of the medications listed in the above post let me ask you a question. Why do family doctors prescribe addictive medications to people who claim they have anxiety and sleep problems? Doesn't this just trade one problem for another?

[/ QUOTE ]

Short answer is that I *don't* prescribe recurrent doses of highly addictive meds to people like this.

[ QUOTE ]
Also, Xanax is a drug for SHORT term anxiety? What does that mean exactly? If your anxiety is short term why even treat it with meds?

[/ QUOTE ]

I meant that xanax is a short-term solution, sorry I was not clear. To be diagnosed, anxiety by definition must occur for at least two weeks at a time, for a total of 2 months, within the last 6 months time period. It also must have caused significant life changing events to occur, such as missing work, damaged relationships, etc.

My personal take on anxiety disorder is that it should be treated with a 2-pronged attack: meds plus cognitive therapy (ie counseling). Both of these are shown to be effective when used in combination over time, but both take several weeks of use to be effective. Often, people are having severe symptoms of anxiety, to the point they cannot function in their daily life. In those cases, it is justifiable to prescribe a short-term solution to the symptoms, or a stop-gap, however you want to call it. (This is where xanax and others like it may play a role.) In my practice, I never prescribe refills for xanax when treating anxiety, and I only give someone enough for 2-3 weeks use. I also will start them on another, longer-acting med, such as lexapro, celexa, prozac, wellbutrin, etc., and I refer them to some form of cognitive therapy, such a counselor or maybe their pastor, if available. I do all of this at the first or second visit, once I make the diagnosis. I tell them the goal is to use the xanax rarely, and only as a sedative once they are home from a stressful day or if they actually have a panic attack. I let them know it will not be refilled, and that the other med and the counseling will soon take the place of the xanax completely.

[ QUOTE ]

Don't take this personally because it's not intended to be a slam against you. I'm just really perplexed why doctors are so quick to whip out the prescription pad and give people prescriptions for controlled substances. I know a couple people with addictive personalities who have been given endless supplies of ambien and pain medication because they claim they have a bad back or can't sleep. It seems like doctors should interview family members to get a clear sense of the patient and his behaviors before prescribing something as addictive as Ambien. Can you address why doctors wouldn't discuss things with family members before writing out these types of prescriptions including ones for depression?

[/ QUOTE ]

I actually don't take this personally, since I think I am not guilty of what you describe.

As you can tell from my above methods, I don't get through an office visit for anxiety (or depression) with any speed or efficiency. It takes time, and it takes a patient with um, well, patience. (sorry) Very often, I get a patient who has been treated elsewhere, and for whatever reason, they were prescribed some happy pills like Xanax, with refills, sometimes for years. They are addicted, and they just want that Rx and to get back to their life. It does not take more than a few minutes of explaining the above to them to see them look annoyed and roll their eyes, and explain to me that the "other stuff" just doesn't work. I am wasting their time and mine, and if I will just write the Rx for them, they will be on their way, thanks. These people leave my office with nothing, and find someone who will write their pills for them.

Many of these folks, believe it or not, have insurance and real jobs, and they keep their appointments every 2-3 months like clockwork. (wonder why?) So, I am losing customers with my approach, some of them very good customers.

I wish it were not so, but I can guess why some docs will be quick to write these meds for even the apparently addicted patients: less time in the office visit, it makes customers happy, and it requires little thought and planning. In short, you can do less work and might make more money anyway.
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  #57  
Old 10-30-2007, 10:12 PM
katyseagull katyseagull is offline
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Default Re: Anti-depressants

Thanks for your reply Brashbrother.


[ QUOTE ]



My personal take on anxiety disorder is that it should be treated with a 2-pronged attack: meds plus cognitive therapy (ie counseling). Both of these are shown to be effective when used in combination over time, but both take several weeks of use to be effective.


[/ QUOTE ]

[ QUOTE ]

In my practice, I never prescribe refills for xanax when treating anxiety, and I only give someone enough for 2-3 weeks use. I also will start them on another, longer-acting med, such as lexapro, celexa, prozac, wellbutrin, etc., and I refer them to some form of cognitive therapy, such a counselor or maybe their pastor, if available. I do all of this at the first or second visit, once I make the diagnosis. I tell them the goal is to use the xanax rarely, and only as a sedative once they are home from a stressful day or if they actually have a panic attack. I let them know it will not be refilled, and that the other med and the counseling will soon take the place of the xanax completely.


[/ QUOTE ]


I respect this approach. It's really nice to hear that you stress counseling in addition to drug therapy. My personal opinion is that counseling should be a requirement for all people on these anti depressant and anxiety drugs. It disappoints me that not more doctors take this position.

You sound like a very conscientious doctor and I can't tell you how much I appreciate it. You might think it sounds weird but it's refreshing to find a doctor who actually takes time to thoroughly go over the side effects of a drug and warns his patients of their addictive nature. Not a lot of doctors spend time counseling patients about this issue.



[ QUOTE ]


Many of these folks, believe it or not, have insurance and real jobs, and they keep their appointments every 2-3 months like clockwork. (wonder why?)



[/ QUOTE ]


I believe it. Drug addiction cuts across all socio-economic and age barriers. Thank you so much for taking the time to answer my questions.
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