« 911 For Cell Phones | Main | Recent Poll Numbers on Hillary Clinton »
May 23, 2005
The War Against Legal Drugs
I usually don’t talk much about personal things on here, but in this case I feel it’s my responsibility to get this out. My husband and I have had severe problems with a class of drugs called SSRIs over the past few years. They are the reason that my husband was manically banging his head against the shower wall a year ago. They necessitated me going into the ER in the middle of the night because of an anxiety attack. They are the reason that life is hell for us right now. I believe they are a case of the cure being worse than the disease.
SSRIs are a class of antidepressant drugs that include paxil, prozac, effexor, cymbalta, celexa, zoloft, and many others. The abbreviation stands for “selective serotonin reuptake inhibitor.” Serotonin is one of the neurotransmitters that help to regulate mood. It is released by neurons and activates receptors on other neurons, then is reabsorbed, (a process which is called reuptake.) SSRIs work by preventing serotonin from being taken back up from the synapse, which increases serotonin levels in the brain and makes serotonin signals stronger. This helps people with depression because they generally have lower serotonin levels. (Some of the drugs also work on other neurotransmitters, such as Norepinephrine.) A similar thing happens when you take cocaine.
Over time, the brain chemistry adjusts as the body tries to go back to what it sees as “normal.” The neurons actually produce less serotonin than they did originally. This means that the body develops a tolerance to the drug: the same amount no longer works as well and more of the drug must be taken to have the original effect.
This also helps explain the effects of withdrawal. If the user all of a sudden stops taking the drug, reuptake will no longer be prevented but the brain will still be making less serotonin, meaning that the serotonin levels will actually be lower than they were before the user started taking the drugs. In some people this causes severe side effects, ranging from flu like symptoms to more “mental” problems such as nightmares, suicidal thoughts, anxiety, hallucinations, and just a general sense of being “f’d up.” This can often be worse than the depression was in the first place.
I can’t even begin to describe how scary it is to go through this. The first time it happened to me, it was because I had missed a few doses. I was having dreams about raining blood and I felt disconnected from reality. I had no idea that missing a few doses of your antidepressant could cause this, so I thought it was all me. I seriously thought I was going crazy.
The second time it happened, I had run out of my medication on a weekend and had no way to get any more. I knew what was happening and I thought I would be able to handle it, but after a few days I just couldn’t hold out anymore and had to go to the ER and pay them exorbitantly amounts of money just to get a few pills. This time I felt like a drug-seeking junkie.
The ER docs didn’t have the foggiest clue what I was talking about. They wanted to pump me full of all sorts of other interesting drugs for anxiety when I kept saying “all I need is one of my antidepressants.” In fact, for some asinine reason, doctors in general don’t really know much about the phenomena and most of the ones who do don’t really know how serious it can be in some people. They often prescribe the drugs much too easily for mild depression. They either don’t mention withdrawal at all, or mention “that you should be sure not to miss any doses” but don’t really stress the importance of why. This means that when people go off the drug (or miss a dose or two) and have a bad reaction, they or their doctor assume that their depression is worse and coming back full force and go back on the drug. This often results in people who really aren’t all that depressed taking expensive drugs and enduring their side effects for way too long, rather than just getting some good therapy in the first place.
The part of all this that really upsets me is the instance of the drug companies that SSRIs are not addictive. The addiction may be different than an addiction to cocaine, alcohol, or barbiturates; but it’s still an addiction and I think it’s very misleading for doctors to tell their patients that there is absolutely no risk of addiction or dependence. If some people have such a hard time stopping the drug, I don’t know what else it should be called!
After my two terrible experiences, I was determined to quit the drug. I did some research and decided to do it by tapering, which means taking successively smaller portions of the pill for at least several weeks. By reducing my dose by an 1/8th of a pill every 4 days or so, I was able to get off the medication with few problems.
My husband also had a bad reaction to one of these drugs last year, and so asked his psychiatrist to put him on a non-SSRI. She said “oh, ok” and gave him another drug. Turns out the drug isn’t an SSRI, it’s a SSNRI – which is like a SSRI times two. Now he’s quitting this drug because of all the other side effects and going through the withdrawal for it, all because we listened to his stupid psychiatrist.
Drug companies and doctors do wonderful things. They make it possible for us to live longer, healthier lives. But they are also human and are as prone to human foibles as the rest of us. Drug companies often downplay side effects and risks. Doctors often throw out prescriptions like candy without exploring milder but more time consuming options.
The best medical advice I can give is to know your body and research everything your doctor tells you before you choose a path of action. Weigh your options and seriously consider things like lifestyle changes before popping a pill. If your doctor won’t address your concerns, find another doctor. It’s hard work in the short term, but you could save yourself a lot of pain and suffering.
(Note: I’m not suggesting that no one should ever use SSRIs, just that fewer people should and those who do should be aware of potential problems.)
Linked at Outside the Beltway.
Posted by illuminaria at May 23, 2005 03:12 PM
Comments
Thank you for sharing that story. I've always been suspicious of drugs in general, but it is helpful to hear from you that there can be a realistic basis for those suspicions.
Posted by: Bob V at May 24, 2005 09:46 AM
It's important to note that no physiological cause for depression has been established. Decreased serotonin levels are CORRELATED with feelings of depression, but correlation is not causation. Serotonin levels could just as easily be an effect. Recent research has pointed to so called "clinical depression" being no different from the bad feeling one gets upon hearing terrible news - it's an result of depressing cognitive knowledge. This research indicates that all depression is caused by depressing cognitive beliefs that may or may not agree with objectively observable reality, and when they don't agree with reality, the solution is not to treat the symptom with drugs, but discover and correct the faulty cognitive belief. If the cognitive belief is not false, then something in the patient's life needs to change.
Think about this - when things go badly, our serotonin level drops, and we feel depressed. Why would we evolve a response like this if it didn't serve a useful purpose? The mechanism exists for a reason, and SSRI's throw a monkeywrench in the mechanism.
Posted by: dweeb at June 2, 2005 12:59 PM