Question of the Week

March 4, 2008<


Lately, it seems as though every few days there has been something new in the news about antidepressant medication. One report got the attention of the nation just a few weeks ago as reports came out about the man who shot several people before taking his own life at Northern Illinois University (NIU).

"Kazmierczak had stopped taking Prozac three weeks before his shooting spree on February 14 and had been taking two other medications, [Steven Kazmierczak's girlfriend, Jessica Baty] said. Experts differ on whether Prozac and other similar antidepressants might be linked to violence. 'There's very little likelihood that withdrawal from Prozac could, by itself, cause someone to become violent,' said Dr. Nada Stotland, professor of psychiatry at Rush Medical College and president-elect of the American Psychiatric Association. If people with other psychiatric illnesses had a propensity to violence, then discontinuing drug use 'could make them irritable, and that could be one trigger,' said Stotland, who has accepted speaking fees from the drug industry, but not in recent years. But, she said, 'discontinuation syndrome' does not cause someone to become violent. ... 'The explanations are seldom simple or straightforward, and, especially when attempts to understand would intrude on the confidentiality of medical records, we seldom know enough about perpetrators' lives and minds to determine just what caused their behaviors.' She added, 'We have much, much more to fear from untreated psychiatric illnesses than from the effects of psychiatric medication.'"

The news that Kazmierczak stopped taking an antidepressant just weeks before his shooting spree seems to have brought up more questions than it has answered. While debate over the safety of these medications has raged for years, few question that abruptly stopping the medication is not a good idea. With this recent report, different people are trying to interpret this situation and see what the behavior of this one person can prove.

Does this incident prove that antidepressants can be bad, or does it prove how much this man needed these antidepressants? Was the fact that he took Prozac the issue, or was it the fact that he stopped taking it? There are those who have concerns about the medications, and then there are those who have concerns about the untreated mental illnesses.

When confusion and questions reign, sometimes it can help to go back to basics. What are antidepressants, and why would someone take them in the first place?

"Antidepressants are medicines that treat depression. Your doctor can prescribe them for you. They can improve your mood, sleep, appetite and concentration. It may take several weeks for them to help. There are several types of antidepressants. You and your doctor may have to try several before finding what works best for you. Medicines sometimes cause unwanted side effects. For example, when you first start your antidepressant you may feel tired, have trouble sleeping or feel sick to your stomach. The side effects usually go away after a short time. Tell your doctor if you have any side effects. You should also let your doctor know if you take any other medicines, vitamins or herbal supplements. It is important to keep taking your medicines, even if you feel better. Do not stop taking your medicines without talking to your doctor. You often need to stop antidepressants gradually."

Antidepressants are medicines that are used to treat illnesses. As with any medication, there can be positive effects that help people live more productive, enjoyable lives, and there can be negative effects that need to be weighed against these positives to determine whether or not the patient will have a better quality of life with or without the medication.

Each patient has different needs, reacts differently to medications, and may have different priorities when looking at how the positive and negative effects of each medication will influence his/her daily life. Doctors need to take all of these factors into consideration when trying to decide which medication will be the best fit for each patient. No matter how much research doctors and patients do, it can still be difficult to find the right match.

"Teenagers whose initial drug treatment fails to combat depression, which happens in four out of 10 cases, can be helped by switching medicine and adding psychotherapy, a U.S. study published on Tuesday said. 'The findings should be encouraging for families with a teen who has been struggling with depression for some time,' said Dr. David Brent of the University of Pittsburgh who headed the research. 'Even if a first attempt at treatment is unsuccessful, persistence will pay off. Being open to trying new evidence-based medications or treatment combinations is likely to result in improvement,' he added."

Whenever patients try new medications, it is important for them to keep in regular contact with their doctor to discuss how they are adjusting. Some medications require a gradual increase in dosages until the desired level is reached. Others can cause severe side effects in a few patients, and no doctor can know who those "few" will be ahead of time.

While the many choices will mean that there is a higher likelihood that there is a medication out there that will prove to be a good fit for any given patient, they also mean that doctors and patients have a lot of choices as they attempt to find the right match.

"Major types of antidepressants include: * Tricyclic antidepressants (TCAs) are some of the first antidepressants used to treat depression. They primarily affect the levels of two chemical messengers (neurotransmitters), norepinephrine and serotonin, in the brain... * Monoamine oxidase inhibitors (MAOIs) are another early form of antidepressant. These drugs are most effective in people with depression who do not respond to other treatments.... * Selective serotonin reuptake inhibitors (SSRIs) are a newer form of antidepressant. These drugs work by altering the amount of a chemical in the brain called serotonin. * Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another newer form of antidepressant medicine. They treat depression by increasing availability of the brain chemicals serotonin and norepinephrine."

Whatever the type, the purpose of an antidepressant is to: "... improve symptoms of depression by increasing the availability of certain brain chemicals called neurotransmitters. It is believed that these brain chemicals can help improve emotions."

In many cases, patients who suffer from depression can find relief when they find the antidepressant match that is right for them. The key is finding the right match, and it takes doctors and patients working together, asking questions, and engaging in honest conversations in order for that match to be found.

That said, there are some who doubt their efficacy for all patients.

"Researchers from the U.K., U.S. and Canada analyzed results for fluoxetine (better known by the brand name Prozac), venlafaxine (Effexor), nefazodone (Serzone) and paroxetine (Paxil or Seroxat) -- all members of a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). The researchers' paper, published this week in the journal PLoS Medicine, claims that only patients who are diagnosed 'at the upper end of the very severely depressed category' get any meaningful benefit from the widely prescribed drugs. For the others, the paper says, antidepressants are barely more effective than a placebo (although patients suffering from depression, like those suffering from chronic pain, generally do see a substantial placebo benefit).",8599,1717306,00.html

Questions of the Week:
When do you think a patient should ask his/her doctor about antidepressants? What do patients need to know about the potential positive and negative effects of antidepressants before deciding that they want to begin taking them? What should doctors know about the individual needs of a patient before deciding on a specific antidepressant? When starting or stopping any medication, what do patients need to talk about with their doctors? How can doctors help patients know what to expect, and what warning signs to watch for, when a new medication is prescribed?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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