Taking Antidepressants But Still Sad

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Taking Antidepressants
But Still Sad

continued

They looked at 573 patients from primary care practices and found that about a quarter of the patients who took an SSRI for depression stopped it after about three months and did not try anything else. An additional one-fifth of the patients switched, usually after about six weeks, and then half of the switchers stopped altogether within three months.

More than half of those who switched said they did so because the medicine didn't work. But of those who stopped altogether, 73% did so because of the side effects: nausea, anxiety and agitation, insomnia and sexual dysfunction.

A recent study in the American Journal of Psychiatry found that of 829 adults who took antidepressants, 42% discontinued use during the first month and only 27% continued the therapy for more than 90 days. Those who continued the treatment were more likely to do so if they also received psychotherapy, had completed 12 or more years of education, or had private health insurance.

Kupfer of the University of Pittsburgh School of Medicine points out a crucial problem in communication between doctors and patients. In many cases, patients simply do not know what to expect, and then become discouraged with what is happening to them.

In 2001, the National Depressive and Manic Depressive Assn. conducted a major survey of 900 randomly selected primary care physicians and 1,000 patients receiving treatment from them for major depression. The study found that nearly half the patients surveyed reported that they had experienced side effects from the medication and that 17% of them had skipped doses, while 55% stopped taking the medication altogether.

The problem, researchers found, was basic communication. Most doctors — 69% — said that they told their patients about a loss of libido and 47% said they mentioned weight gain. But patients had an entirely different experience: Only 16% said that their doctors had told them about possible side effects, and 34% said that doctors had not warned them about any side effects when prescribing the medication.

For Susan, a teacher and a mother who lives in Oakland, the years that she was on Paxil were the biggest mistake of her life. With her children grown, her marriage unraveling, her mother dying and menopause engulfing her, she had been impelled to seek a psychiatrist. After months of therapy, her psychiatrist suggested that she try an antidepressant, explaining that easing the depression and anxiety would make her therapy more productive.

"I said 'No way, I'm not taking pills,' " she recalls. But eventually she relented. "First of all, I liked it. It … worked for me. It is only in retrospect that I could see how much damage it did."

She described herself as "comfortably numb" for several years until she suddenly became violently ill. She woke up incontinent, developed a primary immune disorder and was given blood intravenously every three weeks. She started falling and was constantly dizzy, particularly frustrating for a former gymnast and dancer. For three years she suffered — receiving a medical-school curriculum of diagnoses, including Addison's disease and the possibility of atypical cancer.

Finally she looked up the side effects of Paxil and saw every single one of her symptoms. She stopped taking the antidepressant and experienced horrible withdrawal. Then, on the advice of another doctor, she tapered her dose over three months. Within three weeks of her last dose, she says, her physical symptoms disappeared.

"Of course, I still battle with some anxiety and mood swings," she says. "But I am me again — yes more anxious, but physically healthy and mentally clear. And I am a lot happier."

A cautionary progress

The enormous complexity of depression as embodied in the lives of Lindsey, Susan and Jennifer illustrate that the single magic pill that will transform a life from depressed to fulfilled is exceedingly rare.

Certainly the medicines are generally safer than antidepressants of the past and can offer enormous improvements in quality of life. On the other hand, they often come at a high — many would say too high — personal cost.

"I think it is a double-edged sword," says Schwartz. He describes some patients who refuse the medicine because they see managing depression as a question of will. Others refuse therapy and simply want to pop a pill to make all their troubles go away. "Some say, 'I saw Tom Cruise; I should never use them.' Others say, 'I saw Brooke Shields, and I should use them all the time.' "

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Each year, however, new research produces greater understanding in the treatment of this often-debilitating illness. And physicians are becoming more appreciative of a holistic approach to treating it, using not just therapy but diet and physical activity as well.

"The trouble with being depressed is that it affects your brain and you can really start doubting yourself," says Lindsey. "But you just can't hand over control or all the decision-making to other people. You know yourself the best. You have to be a part of it."

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Source: LATimes

Last updated: 3/06

Taking AntidepressantsBut Still Sad

A cautionary progress

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Taking Antidepressants
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