“Many People Taking Antidepressants Discover They Cannot Quit”
Does this headline concern you? If you read the accompanying article in the New York Times and you’re on medication for anxiety or depression, you might feel alarmed. And if you’ve decided to start a medication regimen, you might even change your mind.
The article reflects a bias many people still harbor towards mental health issues and medication: you should be able to deal with your problems by force of will; if you can’t just get on with it, you’re weak. As the Times article suggests, “Daily pill-popping leaves them doubting their own resilience…” Pill-popping? Seriously?
No medication is completely benign. Yet few would question taking drugs commonly prescribed for high blood pressure, seizures, muscle cramps, and infections, many of which can have discontinuation side effects. Clearly, a double standard applies to the pharmacological treatment of psychiatric conditions..
The writer acknowledges that “many, perhaps most, people stop the medications without significant trouble,” but then goes on to relate the personal anecdotes of a handful of individuals who attributed “all the symptoms of withdrawal,” including increased anxiety and insomnia, to medication discontinuation. He neglects to point out one of the most common reasons for deciding to go back on medications for anxiety and depression after trying to come off them: a resurgence of the symptoms being treated.
It’s true, as the article points out, that primary care physicians write the vast majority of prescriptions for antidepressant and antianxiety medications. Follow-up is not as rigorous as it should be, and office visits are typically too short for an adequate assessment of mood changes and side effects. But it’s very misleading to assume, as the writer does, that “a useless [my emphasis] prescription may be continued for years—or a lifetime” because “improvement…is based on the passage of time or placebo effect.”
I’m not in the pocket of Big Pharma. I can’t prescribe medication. I don’t get a kickback from my psychiatrist colleagues for referring patients to them. When someone in my practice expresses a preference for trying cognitive-behavioral therapy without medication, I’m more than happy to oblige—with the understanding that we’ll revisit the decision at a later date if the therapy yields less-than-optimal results.
I believe in helping people find the maximally effective treatment for them. If that means recommending a trial of medication, I’ll suggest a referral to a psychiatrist who can address their concerns fully, monitor them regularly, and work with me to provide the best care.
Medication isn’t a magic bullet. But it can be a powerful tool. Making any health care decision should involve weighing the costs and benefits–with the help of professional guidance and not anecdotal horror stories–to determine the course of treatment.
If winter is getting you down, consider putting a spring in your step—literally—to feel more energetic and happier.
It’s not hard to recognize people who are sad or depressed from the way they carry themselves: slumped shoulders, lowered gaze, downturned mouth, and shuffling gait. Happy people, in contrast, stand up straighter, make eye contact, smile, swing their arms, and bounce along at a brisk pace.
Short days and post-holiday doldrums can take their emotional toll; temperatures in the single digits may worsen the seasonal blues by limiting our exposure to sunlight and causing us, when we do brave the elements and venture outside, to bow our heads, hunker down against the cold, and pull our arms in tightly against our chests.
Posture, it turns out, can affect mood. The results of some recent research point to a connection between how we walk and how we feel.
In one study, undergraduates (who, due to their ready availability and incentives to participate, are the most commonly tested subjects in psychology experiments) were told to attempt to move a gauge as they walked on a treadmill. For one group, the gauge moved when they bounced along at a fast, “happy” clip; for the other, the gauge responded to a slowed, “depressed” pace.”
After being given a list of 40 words—half negative, such as “ugly” and half positive, such as “happy”—the subjects in the depressed group recalled more of the negative words. Another study by the same research team, which used people actually suffering from depression rather than randomly selected undergraduates, produced similar results when half the participants were told to slump. Subjects instructed to sit upright recalled fewer negative words.
Although more research with larger samples (each of the above studies tested fewer than 40 subjects) would be required to draw any broad conclusions, the results make intuitive sense. They also lend support to the framework underlying cognitive-behavioral therapy: making even small changes in behavior can help alter moods.
If walking isn’t an option–say you’re sitting at your desk and feeling in a funk with a deadline looming–try smiling. The act of putting on a happy face can activate neural pathways to boost serotonin and dopamine, two of the neurotransmitters targeted by most antidepressant medications.
To be clear, none of these microphysical adjustments will cure a serious case of depression. If you suffer from more severe, intractable mood problems, please seek professional intervention. But for the garden variety blahs so common this time of year, why not try walking happy? It just might help.
This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.