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Medication: Weight or Baggage? 09/10/2011

Ever want to hear a room full of doctors or mental  health workers stop talking?

Introduce debates that have been raised in recent years questioning the effectiveness or the place of medications in the treatment of mental illness.  Suggest that there might be evidence of options that would be more appropriate starting points for treatment.  Ask them whether they would be ready to choose to live with the side effects that may result from some of the anti-depressants that are out there.

Have I surprised you?

I am not anti-medication by any means.  I use medication.  Unfortunately, at present, a lot of it although I hope in time to be in a position to reduce this.  There are some people who are.  They say that Depression can and should be managed by using strategies such as those that I discuss in “Beyond Medicine” with use of lifestyle strategies with regularity and discipline as well as well evidenced ‘talk therapies’ that build skills and resilience like CBT and Mindfulness.  Some even think that medication makes depression worse.

There are now groups who go over research that comes out about treatments to see what standards people are using to measure ‘success’ of treatments against and how it really measures up with other treatments if judged by the same criteria (eg http://www.power2u.org/medication-optimization.html ).

My depression falls within the ‘major depression’ and severe spheres.  That is within the spectrum of severity where it is clear from research that anti-depressants have a measurable effect.  It can be proven that they make a difference.  Research is finding not much evidence to prove that medication makes a measurable difference as opposed to placebo or other forms of therapy for mild depression and little more so for moderate depression.  Now, that’s not saying that there are no cases where it doesn’t work and all cases where it won’t be worth a shot – or that you won’t underestimate how severe your own depression is.  I certainly did at first.  What it does say is that it is worth asking some serious questions and exploring a range of other treatments either before or instead of medications.

Consider the some of the side effects of antidepressants.

Short term side effects of SSRIs can include nervousness, anxiety, muscle tics, suppression of REM sleep (and then drowsiness), nausea, dizziness, diarrhea, gastrointestinal problems, different types of sexual dysfunction, emotional blunting and apathy.  With long-term use come risks of cognitive changes.  Now most short-term effects will pass as the body gets used to the medication, but still …

Tricyclic antidepressants have potential side effects that include blurred vision, dry mouth, constipation, bladder problems, sexual dysfunction, dizziness, drowsiness and increased heart rate among others – again some settling after a short time and others continuing.  Not everyone gets any or all side effects, but most experience some.

If you take MAOI anti-depressants, then you can’t eat certain types of food.  Potential side effects here include low blood pressure, constipation, vomiting,  headache, altered sleep, dry mouth, drowsiness, fainting, sexual dysfunction, weight gain and lower alcohol tolerance.

And people wonder why people stop taking medications!!?!  Do you want to take them?  How will they help you?  Sometimes trying the non-medication based therapies first does make a lot of sense.  While it seems easier to just take a tablet, how confident can you be that the tablet will make you feel better?  Mine do.  But remember, firstly, my Depression is severe and secondly, I also need to bolster it with management strategies that aren’t medication-based.  I need both.

Here’s the thing though.  What ever you do decide to do – make sure that you are fully informed.  Do your research.  Also – ask your doctor the hard questions like:

“Why this medication?”

“What are the side effects?  How long would I expect them to last?”

“Are there any risks associated with this medication?”

“Will I be able to keep working while I start taking it (if you are working) or will it affect my performance?  Should I take a few days off?”

“How will I know if the medication is starting to work?  How long should it take?”

“Are there any precautions that I should follow over the next few days/weeks?”

“What happens if this medication doesn’t work?”

If you do agree to try a medication, stick with it as advised.  The time frame your doctor gives you for how long it should take to work will be only an estimate.  Also, some medications are dangerous to stop unsupervised.  If you are trying a medication, consider it a joint experiment by yourself and your doctor.  You bring your expertise of your experience and the effect that the medication has upon you.  Your doctor brings medical training and independent observations.  Both are needed to make an informed decision about where to go with your medications.

If you are on long-term medication, you doctor and yourself share a partnership.  Again, you are the expert on yourself, your symptoms, experience and how the medication is (or isn’t) impacting your life.  Your doctor is the expert on the medical facts, observations and assessments as well as the medication itself.  In any partnership for decisions to work to their best advantage both people should be involved in the decision-making event – even if the right of decision is mostly with one person.  This means that both people’s expertise can be used.  Sure, ultimately, it’s your life and your right to agree or disagree with your doctor’s medical opinion – but when there’s medication involved and you want to change it or come off it, at least informing them is a smart thing to do.  They can then tell you if you need to know about any risks and you can ask them what you need to know to make sure that you are safe.  You can also make a judgement call about how much you think you can manage with your own strategies with a lower dose of medication in place and work to negotiate this with your doctor.

Ultimately, I think it comes down to the type of depression that you have.  Some don’t need medication.  For some the decision could go either way.  And there will always be some that need it.  However, the question about whether we do or don’t use medication is weightier than deciding whether we can tolerate side-effects or would rather carry a load of self management strategies that may seem burdensome when we feel so amotivated.

We all need the self-management strategies.  These have been proven to be effective in reduction of depression regardless of the level of severity.  Our decisions about medications need to be weighed carefully.  How much of the work are we expecting them to do?  They are a tool, not a workshop and not a finished project.  They are designed to equip us to work at life.  If they’re working, you’ll be able to take up the management strategies that are more lifestyle driven and see your mental health improve to wellness.  Sometimes with meds still in the background.  Yet for others, in time a mutual farewell to the partnerships with doctors and health workers gives way to a continuing lifestyle-driven means of managing wellness.

 

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