Monday, December 5, 2011

Medication Ambivalence

Many people I know, and even I used to resist taking any kind of medication. This is especially true with prescription medication and those that affect mood, such as antidepressants. Looking back at the reasons I gave against taking antidepressants I realized that most of them were irrational and were based on irrational, culturally constructed beliefs. Through talking to people and personal experience, I devised a list of the most common reasons people give for- and against taking antidepressants.

Reasons People Give Against Taking Antidepressants

• Shortcut, does not involve work. Like plastic surgery
• Not a “natural” solution
• Involves changing something in you. Feel uncomfortable because the better "you" isn’t actually you
• Fear of changes in personality
• Temporary solution
• Fear of dependency and getting addicted (possibly on other drugs as well)
• Fear of having to take it for the rest of your life
• Possible side effects, e.g., nausea, insomnia, sexual dysfunction
• Possible withdrawal effects (under 20% of cases)
• Possible tolerance development (in about 20% or case, antidepressants loose effectiveness)
• Distrust of the pharmaceutical industry
• Cost (can be anywhere from 5 to 100 dollars a month)
• If you stop you can relapse into the illness
• Stigma of taking prescription medication
• Don't want to admit that there is something wrong with you (that you are sick and it’s not under your control) rather than a lifestyle choice.

Reasons For Taking Antidepressants

• If the depression is severe, antidepressants are most effective (scientifically proven)
• A last resort, if alternative remedies have not worked
• Many potential benefits, such as the possibility of complete remission (no more depression)
• Changes in personality
 – Greater self-confidence and less anxiety
 – Greater resilience in the face of set-backs
 – More joy
 – Positive changes in careers and relationships

My Own Concerns:

My initiate concerns about taking medication (form my journal, April 2009):
  • May have adverse unanticipated effects that will cause me to become worse off than I already am
    • Can cause relapse when discontinued, and leave me with even worse symptoms
  • may be unsafe and useless
    • Only half of the people relieve half of their symptoms
  • May cause dependency
    • Especially if it has been used regularly for an extended time or if it has been used in high doses
  • Addresses the symptoms and not the problem
    • Pharmacological interventions are largely palliative
    • Paxil is a symptom suppressant and too many people are taking it under the false assumption that it will cure their ills
    • [Drugs] release people from personal accountability, where lifestyle and self-perception changes would serve better
  • Might interfere with therapy
    • Can interfere with the mechanisms of successful therapy.
  • Can change my state of mind (alter my perception of the world and myself).
    • It will cause me to lose judgment and my ability to control my emotions and actions by deforming my way of thinking and feeling. 
    • They were "spellbound" by the drugs themselves: by the pharmacological properties of the drugs themselves and by the professionals who convinced them that the drugs were going to help.
    • The person taking these drugs is and cannot be objective about the drugs
    • Since Paxil affects chemical communication in your body, your ability to perceive daily experiences or self identity can be affected.
Questions I Had For My Psychiatrist:
  • Q: What is the probability of full remission from the symptoms of depression?
  • Q: What are the probability, duration, and severity of Paxil withdrawal symptoms/discontinuation syndrome (when gradually decreasing the dose).
  • Q: What is the probability of getting physical and emotional symptoms that were not present prior to Paxilor worsened pre-existing symptoms—after withdrawing from the medication.
  • Q: For how long after quitting Paxil will I experience the side effects? (How long does it take for Paxil to be completely out of the system?)
    • Duration: 2/3 chance of symptoms subsiding within a month
  • Q:  Is there a test to predict susceptibility to dependence and likelihood of severe withdrawal symptoms, what they will be, and what the chance of relapse after I quit?
    • Cytochrome P450
    • CYP2D6
    • 5HTT (Serotonin Transporter)
  • Q: What is the probability of relapse after stopping medication?
  • Q: Why did my psychiatrist not inform me of the possibility of withdrawal symptoms when prescribing the antidepressant?
  • Q: If I miss a psychiatrist appointment, how do I ensure that I receive more of the medication, so I wont be forced to quit cold turkey and have withdrawal?
  • Q: What is the probability of developing tolerance?
    • approximately 20 percent of people who take antidepressants — the so-called "poop-out" effect. In such cases, the medications simply stop being effective.
  • Q: How will I know if I'll be taking this medication long-term?
  • Q: Are there harmful long-term effects, such as brain damage?

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