The Known and Unknown Consequences of Antidepressants

Michelle “Shelly” Hart, RN (Registered Nurse). Shelly was born in northern Pennsylvania in a small rural town of Lucinda. She initially studied at Pennsylvania State University in Clinical Psychiatry. She later transferred to Lima School of Nursing through Ohio State University where she graduated as an R.N (Registered Nurse). Shelly was a Cardiac Nurse for seven years before relocating to Seattle, Washington where she worked with the developmentally disabled.

Shelly currently resides in Tucson, Arizona where she is working on her Paxil withdrawal book. Through her nursing care she noted that “Big Pharma” had a disproportionate influence on patient care and noted that more and more patients were started on antidepressants following illnesses and as part of routine care. She went through a difficult time in her life and was prescribed the SSRI (Selective Serotonin Reuptake Inhibitor) antidepressant Paxil, not knowing beforehand the great influence it would have on her life and that she would be burdened with it perhaps forever.

Each time she tried to eliminate Paxil from her life, she noted extreme withdrawal symptoms. Physicians seemed to be devoid of the necessary basic information necessary to facilitate getting off of Paxil. In fact, physicians often are unaware of the serious nature and consequences of Paxil withdrawal symptoms. There seemed to be no scientific information on how to safely withdraw from Paxil readily available to them. In addition, she and Gary have two children who started taking Paxil and who are still taking it because of the consequences of the “discontinuation syndrome.”

Questions and Answers

by Trung Nguyen

What physiological and psychological symptoms are you experiencing as the result of trying to quit Paxil?

Physical symptoms began approximately day three after the weaning process began. They included flu-like aches, fever, nausea, severe calf pain, burning sensations in the legs, zap sensations when turning eyes or head, and excessive restless legs.

Psychological symptoms were mood swings, difficulty concentrating, impulsitivity, excessive aggressiveness, confusion, vivid dreams, hyper sexuality, and eventually panic attacks and two suicidal attempts. I also had homicidal urges and had excessive nightmares. In consultation with my physician, I decided to restart Paxil after experiencing terror from my obsessive thoughts of suicide and the inability to stop the tremors.

You’ve noted that “Big Pharma” had a disproportionate influence on patient care.” Can you provide specific examples of this influence, from the time the patient walks into a healthcare facility, to meeting physicians, and during their stay at the healthcare facility?

Absolutely. From the moment a patient walks into a health care facility, what do they see? They see boxes of tissues from the pharmaceutical companies, they sign in with pens provided by Big Pharma, they see clipboards being carried by the nurses from Big Pharma, name tag holders from Big Pharma, the list goes on and on there.

When they meet physicians they are given trial doses of medication provided by Big Pharma for “free”. Who doesn’t get excited about the notion of trying a med that’s free, right? When it comes to depression and anxiety issues, we aren’t as in tune as we regularly are thus we hear about 1/3 of what the doc is actually speaking to us. We take our “free trial dose” and assume that the physician knows best at this point. We are sent away with our free dose and a brochure written by Big Pharma.

You’ve also noted “more and more patients were started on antidepressants following illnesses and as part of routine care.” Can you provide specific examples of these types of things that you’ve witnessed in your work?

As I’ve mostly worked in a step-down Cardiac Unit, you see a lot of frightened patients. Many have just experienced heart attacks or other systemic problems. With that accompanies fear. Fear of relapse, recurrence, fear or being able to perform sexually again, etc. They may cry, become angry, and feel hopeless. Many of these patients are started on antidepressants soon after the incident from what I’ve seen to taper the anxiety, and keep them stable and help them sleep. I’ve witnessed this from the writing in progress notes. This is not to say that all the doctors did this, but many. Usually not the cardiologist but the family physician.

When you started on Paxil, under what circumstance was it and who suggested it to you? Or did you “Ask Your Doctor” about it?

Actually I slowly started to feel anxious at work from the stress of it. The nurse to patient ratio was worsening and I was feeling the effects of the stress. I found myself unable to wind down after work and dreading going back my entire days off. After a death of one of my patients, I had severe panic attacks. I sought the help of my physician who also happened to be a psychiatrist. I explained my symptoms and he suggested starting the medications. I tried several medications unsuccessfully (Prozac and Wellbutrin), and started to experience severe panic attacks and irritability and was hospitalized, placed on Paxil, and sedatives to get to baseline, and sent home after three days.

Your children are also on Paxil. How did that become to be?

My son stating obsessing over grades at school and stated that he was anxious at his new school. He said he was having thoughts of killing himself but he was “too scared to do it”. I took him to our family physician that gave him a “test” and said he was depressed. He started him on Paxil “since it seemed to be working so great on the rest of the family, it would probably work great on him” He started the Paxil and within months began to self-mutilate and was hospitalized in a psychiatric care facility where his Paxil was increased and he was started on another medication, Risperdal which would “hopefully” have a synergistic effect and help the Paxil work better.

My daughter started having anxiety attacks at school. She too was given a test and put on Paxil “since it was working so great on the family”. After a month she said she wasn’t getting better but felt worse but slowly she stated she thought the pills might be working. After seeing me go through my withdrawal she said she was scared to death to go off the medication and wanted to be on it forever. Both children remain on the medication.

Because of your personal experience with antidepressants, would you recommend them to other people? If yes, why? If no, what are the alternatives?

I would be highly reluctant to recommend antidepressants to anyone, especially children. They have caused havoc and struggles within my family that could have been avoided through education prior to drug usage. As my children have seen their mother trying to withdrawal, they are horrified by the prospect of getting off Paxil. There are so many alternatives before taking antidepressants. I truly believe that at the first moment one realizes they are feeling low, they immediately need to retrain their thinking from “I’m a victim” to “I’m empowered over my thinking”. Exercise and healthy diet play an important part in this as well.

Based on the circumstances in which you and members of your family were prescribed drugs, would it be safe to assume that antidepressants were prescribed in response to life situations and not a chemical imbalance?

Absolutely. It is not unusual for a nurse in this day and age to be overwhelmed with the nurse/patient ratio and the long hours. My husband was going through a brief unhappiness during his previous marriage, and my children were adjusting to new schools after the new marriage. These are normal life situations that families go through. These are also experiences that allow us to feel and grow as a normal part of the development process.

What is your view on the theory of a chemical imbalance being the cause of depression, illness and disease?

Where is the data? That is what I would ask. Was there a lab test of any kind showing my family had a “chemical imbalance”? As a nurse this is a difficult question. We have been trained and have had it pounded in our heads over and over that this is indeed a disease just as real as heart disease. This is a treatable condition that we shouldn’t be ashamed of. This is chemical. Yet as I’ve matured and studied what is out there, it almost seems to be a pseudoscience. I’ve worked as a nurse consultant for the developmentally disabled. I’ve seen children as young as three diagnosed as bipolar, etc and on a list of drugs as long as patients I’ve seen in a hospital in the geriatric unit. It seems to be some science mixed with a lot of guesswork to me. As HMO’s are limiting access to psychiatric visits, the burden seems to lie on the physician who is under trained in treating mental illness. Where did the term “practitioner” come from? We try this, if it doesn’t work, we try this…etc. I feel that we have control over our minds and what I like to call “stinkin’ thinkin".

Before starting this book on Paxil withdrawal I have been working on a book for children as an alternative to antidepressants called just that…”Stinkin’ Thinkin”. The book will give children the tools to cope with social anxiety and depression through learning how to lay new pathways in our brain. We get used to thinking a certain dismal way when we are depressed, just as though you would trample a path in the woods and keep going the same way. It is time for depressed and anxious people to lay down new paths through changing their thinking. WE ARE IN CONTROL OF OUR THOUGHTS AND WHERE THEY LEAD US. If we choose to lie in bed and dwell on our low moods, they will get lower, thus I do believe through time it can change the brain’s chemistry and medication might be needed.

But, I also believe medication generally should be short-term (less than 6 months) giving time for one to learn how to lay down the new pathways and gain control once again of their thinking. When depression gets too far, it triggers the fight or flight syndrome and thus, our thinking is just that…stinking. Again, most of what I’m concerned about at this point is physician education, follow-up, and tapering of those who are already on the “beaten” path. This is what our book is about- personal experiences and putting a face on the withdrawal suffering. I also believe that there may be a certain subset of those being treated for psychiatric disorders who do suffer from chemical imbalances and who need to be medicated for longer periods of time. However, what we need to learn through research and education is how to identify them without overmedicating those who do not need long-term medications.

As a nurse, did you receive any training on nutrition, nutrients, and diet as a holistic approach to health?

Absolutely. However, one of the most difficult things you can do is try to change the diet of a depressed person who is eating as a coping mechanism. The thinking has to be changed first while a new diet is slowly introduced.

This question has several parts. As a Registered Nurse, you work with and are around doctors everyday. And of course, you work with patients.

Part A. Are the doctors you work with aware of other treatment methods other than surgery and prescription drugs?

Many physicians may well be aware of other treatment methods but I have not seen them practiced. For instance, I can’t tell you how many times a patient has been into a doc’s office and has felt as if they shouldn’t have gone because they didn’t receive a prescription. They feel shorted and somewhat ashamed as if they must not really be sick. They may have completely missed the advice being offered that was holistic. Thus, they are reluctant to go back. Docs don’t want that. Patients expect to walk out of the hospital and the office with a fresh white script with something that will fix their problems.

Part B. From your observation, when patients are prescribed drugs, do they question their effectiveness? Are they aware of the side effects?

Hardly ever are side effects discussed until you are at the pharmacy and the pharmacist “consults” with you starting a new medication. May I add the when one is depressed or anxious, the last thing they want to hear about is the horrible side effects they might endure. They may not be thinking clearly at this time and unable to absorb what is being explained to them.

I believe that when someone is given a new drug for anxiety or depression they are constantly questioning their effectiveness. I know from personal experience I would think, “Ok…it’s been a week so 25 % of the drug should be working now. I should be feeling better” and so on. I could live with the side effect of a headache; I just wanted the awful anxiety to go away. I had let my thinking go to far. I was already chemically altered into the fight or flight response.

Part C. What are some of the most common problems that people are being hospitalized for?

As far as common problems that people are being hospitalized for, I would mostly say pneumonia in the geriatric patient, asthma, and heart disease. I know there are data out there indicating people being hospitalized as a result of their medications’ side effects; I have seen this personally only with cardiac meds where most of my experience has been. Sometimes a medication needs changed to reach maximum efficacy of the heart and circulation. Once one is in a position to need cardiac meds and has experienced heart damage, we are getting much past the holistic approaches to medicating. Of course many patients with lung troubles are placed on steroids, which lead to weight gain, and more breathing troubles if they are on the medication long term also. Only occasionally on our floor did we receive psychiatric patients who needed telemetry monitoring for overdose on psych meds, which may or may not have been side effects of a recently started medication. They are quickly shipped to other types of institutions after they stabilize.

Any parting words for our readers?

Yes, if you were or are on the antidepressant Paxil, and experienced or are experiencing withdrawal, I NEED YOUR STORY ( hart.shelly@yahoo.com ). We have to put a face on this problem. Anyone who has been on an antidepressant for more than six months really needs to re-evaluate their position, learn new coping skills, new diets, exercise and be healthy before tapering any medication under the advice of a physician and make sure your physician either knows or learns the importance of a proper tapering schedule. But most importantly, make sure your physician is aware that these antidepressants are addicting before proceeding to agree to his/her tapering schedule. Your life depends on that. Educate yourself while you are thinking clearly, learn the coping skills, and take your time tapering off. There is no metal at the end of the “race” to get off the medication.

In fact, a relapse would be likely leading you to believe you need to be on the medication FOREVER, which may simply not be true. In fact, most of these drugs lose their efficacy over time. If you are on it for years, you are on it because you are dependent on it.

Thank you all for your time.

One more thing: one of the ways we can keep doctors and these Big Pharma companies in check in through lawsuits. There are many out there investigating the potential connection between Zoloft and birth defects.

Insight

The Antidepressant Solution: A Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and "Addiction". The author of Prozac Backlash returns with important and sound advice for patients who are taking antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs) like Prozac and Paxil. "Stopping antidepressants abruptly can cause severe withdrawal reactions," Glenmullen writes, among them aggression, dizziness, vomiting, headaches and suicidal tendencies. The withdrawal symptoms can even, ironically, mimic the symptoms of depression, and this can confuse both the doctor and the patient, leading the patient to stay on the medication (and suffer its side effects) longer than necessary. So how can people safely decide when and how to stop taking the meds? Glenmullen, a clinical instructor in psychiatry at Harvard Medical School, offers a complete five-step program. He explains and describes possible withdrawal symptoms, identifies the signs that a patient is ready to go off his or her meds and gives guidelines for tapering off to avoid unpleasant and dangerous aftereffects. Offering cases from his own practice and drawing from the medical literature, Glenmulllen clarifies how to manage this necessary and often poorly understood process in an important book for anyone taking, or prescribing, antidepressants today.

Once a drug abuser stops using, he or she is likely to experience drug withdrawal symptoms that may vary in intensity.

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