Friday, November 23, 2007
Depression as Psychic Pain
Comments on the article published in the Finantial Times on November 17th, 2007 by Jessica Apple on the twentieth anniversary of Prozac:
" Happy anniversary "
An artist's rendering of a scientific subject always brings elegance to the analyti
c landscape of scientific facts which are built on convincing data and countless double-blind studies. These facts are the building blocks upon which therapeutic committees draw conclusions and draft future recommended drug regimens. However,the actual experience of the medication user, as revealed through the sensitive eye of an artist, overshadows hundreds of peer-reviewed articles on the subject.
To health care professionals, accustomed to the dryness of pharmaceutical journal literature, Jessica Apple's account on Prozac is a deep and revealing essay on the drug and its intimate relationship with people affected with depression. This intense and sincere scrutiny into the world of the depressed is crucial, as it leads us to better understand the mechanisms which govern our state of contentment with society and with ourselves.
Jessica Apple has stricken the essential cord of the matter when she establishes the term "psychic pain"; a pain alleviated by Prozac, as would be an excruciating headache under the scalpel of a Tylenol tablet.
The suffering brought on by depression, indeed, bears a somewhat strange resemblance to certain types of chronic physical pain such as chronic neuropathic pain (stinging, discomfort, superficial burning, stabbing, deep aches, lancinating, numbness). Such symptoms are the result of multiple etiologies often unknown, but constantly imposing suffering to patients. Within these physical conditions, communication between neuronal networks establish a persistent memory-like state that lead to long-lasting pain. What is even more surprising is the fact that this type of pain does not respond to common analgesics such as morphine and the more popular NSAID's (Advil, for example).
The illuminating fact is that antidepressants such as Prozac are also effective in the clinical management of neuropathic pain by an unknown mechanism. This coincidence is acutely interesting in a pharmacological point of view because antidepressants can alleviate both a body pain and a pain as subjective as the one caused by depression.
Depression certainly brings on "psychic pain" and the antidepressants are effective at numbing that pain since they impart essential relief to millions of people afflicted by the condition. Patients experimenting chronic physical pain often experience the same feeling of shame and dependency when they must obtain their drugs at dispensaries. The shame may stem deeply from our Judeo-Christian experience which has always insisted that new knowledge and certain freedoms should be obtained through the passage of crucifixion and pain. That belief is deeply encrusted into our consciousness and is likely to bring some form of self-questioning at one point during an antidepressant based therapy.
We are certainly not longing for a Christ-like experience at any moment of suffering, and relief from pain is a legitimate motive that should never be tempered with feelings of shame. Nevertheless, this right to subdue suffering should not blind our responsibility to also search and question relentlessly for the reasons of our suffering - especially in the case of "psychic pain".
Antidepressants too often have been used as long-term numbing agents for certain types of depression which could have been resolved by themselves over time, just as headaches vanish by themselves. The constant and permanent use of medications precludes the patient from having to look at his condition, or at the factors that can initiate or dissipate its onset. In the same way, just as an overwhelming and intense light can initiate certain types of migraines, a patient could be blinded to this cause-and-affect relationship, if he were to be sedated constantly for many years.
It is true, however, that certain patients will always have to take antidepressants for the rest of their lives. Certain individuals have no other options. Nonetheless, there is also a large number of people who could stop their medications and have a chance to glimpse into the elements affecting their condition without the umbrella of a pill. The mechanism of depression onset is totally unknown as well as the essential mechanism of action of antidepressants. One will never know when his depression will go away or come back until he is completely off medications and ready to take chances; and perhaps, even engage in some flirtation with pain.
The accessibility of pills have made futile that need to double check the status-quo of our "psychic pain" and the necessity to reassess a new battle plan. We have chosen to always be over equipped, even if the battle does not require the help of these combat "horses".
Drug holidays are particularly important because of withdrawal symptoms that accompany the abrupt stopping of antidepressants. People sometimes mistakenly confuse withdrawal symptoms with their previous states of depression. This is especially common with the newer antidepressants such as Effexor and Paxil that bear a shorter half-life than Prozac. Feelings of anxiety and helplessness rapidly re- surge after missing a couple of doses.
The case of Prozac is even more subtle. Disturbing feelings start to show after a few weeks of drug abstinence. This invariably brings the patient into areas of doubt and uncertainty that so well characterize depression. It is also interesting to note that newer antidepressants present a higher profile of dependency that will enhance far more brutally the love-hate relationship people have with their medication. Too many pharmacists have encountered the wrath of patients caught on the weekend with their last pill of Effexor; or, the countless phone calls to beg for two more pills to make it to the next doctor's appointment. This is perhaps where the combination of psychotherapy and drugs illicit better results, than any one treatment taken separately.
Both physical and "psychic pain" are a slight descent into death, as well as a cold observation of one distancing himself from the forward movement of life. It is because antidepressants deal with death that they should never be taken as "simple drugs"- especially since in our culture we see our death as a fundamentally uninteresting subject against which pharmaceuticals propose a pain-free alternative.
Why our minds sometimes wander and get drawn into the darkness is not fully understood. Yet, we should never stop inquiring nor searching, in the hope of finding clues. As brutal as it presents itself, pain is a fundamental evolutionary signal that opens the door for questions to be asked about our bodies and minds. One should not forget that while pain is alleviated, the beast has not disappeared. It has just only been caged, and is probably studying new ways to counteract our imposed analgesia.
" Happy anniversary "
An artist's rendering of a scientific subject always brings elegance to the analyti
c landscape of scientific facts which are built on convincing data and countless double-blind studies. These facts are the building blocks upon which therapeutic committees draw conclusions and draft future recommended drug regimens. However,the actual experience of the medication user, as revealed through the sensitive eye of an artist, overshadows hundreds of peer-reviewed articles on the subject.To health care professionals, accustomed to the dryness of pharmaceutical journal literature, Jessica Apple's account on Prozac is a deep and revealing essay on the drug and its intimate relationship with people affected with depression. This intense and sincere scrutiny into the world of the depressed is crucial, as it leads us to better understand the mechanisms which govern our state of contentment with society and with ourselves.
Jessica Apple has stricken the essential cord of the matter when she establishes the term "psychic pain"; a pain alleviated by Prozac, as would be an excruciating headache under the scalpel of a Tylenol tablet.
The suffering brought on by depression, indeed, bears a somewhat strange resemblance to certain types of chronic physical pain such as chronic neuropathic pain (stinging, discomfort, superficial burning, stabbing, deep aches, lancinating, numbness). Such symptoms are the result of multiple etiologies often unknown, but constantly imposing suffering to patients. Within these physical conditions, communication between neuronal networks establish a persistent memory-like state that lead to long-lasting pain. What is even more surprising is the fact that this type of pain does not respond to common analgesics such as morphine and the more popular NSAID's (Advil, for example).
The illuminating fact is that antidepressants such as Prozac are also effective in the clinical management of neuropathic pain by an unknown mechanism. This coincidence is acutely interesting in a pharmacological point of view because antidepressants can alleviate both a body pain and a pain as subjective as the one caused by depression.
Depression certainly brings on "psychic pain" and the antidepressants are effective at numbing that pain since they impart essential relief to millions of people afflicted by the condition. Patients experimenting chronic physical pain often experience the same feeling of shame and dependency when they must obtain their drugs at dispensaries. The shame may stem deeply from our Judeo-Christian experience which has always insisted that new knowledge and certain freedoms should be obtained through the passage of crucifixion and pain. That belief is deeply encrusted into our consciousness and is likely to bring some form of self-questioning at one point during an antidepressant based therapy.
We are certainly not longing for a Christ-like experience at any moment of suffering, and relief from pain is a legitimate motive that should never be tempered with feelings of shame. Nevertheless, this right to subdue suffering should not blind our responsibility to also search and question relentlessly for the reasons of our suffering - especially in the case of "psychic pain".
Antidepressants too often have been used as long-term numbing agents for certain types of depression which could have been resolved by themselves over time, just as headaches vanish by themselves. The constant and permanent use of medications precludes the patient from having to look at his condition, or at the factors that can initiate or dissipate its onset. In the same way, just as an overwhelming and intense light can initiate certain types of migraines, a patient could be blinded to this cause-and-affect relationship, if he were to be sedated constantly for many years.
It is true, however, that certain patients will always have to take antidepressants for the rest of their lives. Certain individuals have no other options. Nonetheless, there is also a large number of people who could stop their medications and have a chance to glimpse into the elements affecting their condition without the umbrella of a pill. The mechanism of depression onset is totally unknown as well as the essential mechanism of action of antidepressants. One will never know when his depression will go away or come back until he is completely off medications and ready to take chances; and perhaps, even engage in some flirtation with pain.
The accessibility of pills have made futile that need to double check the status-quo of our "psychic pain" and the necessity to reassess a new battle plan. We have chosen to always be over equipped, even if the battle does not require the help of these combat "horses".
Drug holidays are particularly important because of withdrawal symptoms that accompany the abrupt stopping of antidepressants. People sometimes mistakenly confuse withdrawal symptoms with their previous states of depression. This is especially common with the newer antidepressants such as Effexor and Paxil that bear a shorter half-life than Prozac. Feelings of anxiety and helplessness rapidly re- surge after missing a couple of doses.
The case of Prozac is even more subtle. Disturbing feelings start to show after a few weeks of drug abstinence. This invariably brings the patient into areas of doubt and uncertainty that so well characterize depression. It is also interesting to note that newer antidepressants present a higher profile of dependency that will enhance far more brutally the love-hate relationship people have with their medication. Too many pharmacists have encountered the wrath of patients caught on the weekend with their last pill of Effexor; or, the countless phone calls to beg for two more pills to make it to the next doctor's appointment. This is perhaps where the combination of psychotherapy and drugs illicit better results, than any one treatment taken separately.
Both physical and "psychic pain" are a slight descent into death, as well as a cold observation of one distancing himself from the forward movement of life. It is because antidepressants deal with death that they should never be taken as "simple drugs"- especially since in our culture we see our death as a fundamentally uninteresting subject against which pharmaceuticals propose a pain-free alternative.
Why our minds sometimes wander and get drawn into the darkness is not fully understood. Yet, we should never stop inquiring nor searching, in the hope of finding clues. As brutal as it presents itself, pain is a fundamental evolutionary signal that opens the door for questions to be asked about our bodies and minds. One should not forget that while pain is alleviated, the beast has not disappeared. It has just only been caged, and is probably studying new ways to counteract our imposed analgesia.
Saturday, November 17, 2007
Saturday, October 20, 2007
You and your sleeping pills
Sleeping pills are big sellers at the drugstore. Some of us know just how priceless a good night sleep can be. Yet, we tend to forget that sleeping pills are for short term use, and are inclined to addiction, when taken for prolonged periods of time.
For most people, sleeping problems are usually transient and do not last when the underlying problem is resolved. For Seniors, however, sleeping difficulties seem to be of a chronic nature. More and more of them find themselves unable to sleep without the use of sleeping tablets, whether it is Zopiclone, Lorazepam or other members of that class.
Therein lies the problem. These medications do indeed induce sleep everynight, but come with an arsenal of unwanted effects that the patient often attributes to other causes. Long term use of Benzodiazepines, such as Triazolam, Lorazepam etc. cause depression and a usual daytime "doppy" feeling that goes unresolved. Seniors are often put on antidepressants to adjust their mood when the underlying reason is a side effect of the sleeping pill that has been taken for two long.
While seniors (or anyone else, for that matter) should not abruptly stop their sleeping pills because of withdrawal effects, they should question the possibly overextended period of time they have been using these medications, and explore other options to improve their sleep. There is no point of having a good night sleep, if the consequences lead to spending your days in a depressed mood.
People should know that a sleeping pill is a momentary crutch available to help an individual get through a few difficult nights, during a brief period. Neither doctors nor pharmacists can solve with a pill, a deep sleeping problem, in which the ultimate solution rests with the individual. Sleeping issues, especially with Seniors, take years to develop. Their attempt to be resolved must be addressed with patience, openmindness, and changes of lifestyles.
Tuesday, October 16, 2007
Why am I the last to know when my medication is being recalled?
It is always disconcerting for a patient to learn from the media that the medicine he/she has been taking for sometime has been withdrawn from the market for safety reasons. Health alerts from drug regulating agencies are not directly accessible to patients, as most of these safety news releases do not lead to drug withdrawals.
There is, however, particular warnings that should be brought to the patient's immediate attention, since he/she is the most concerned. Patients are not usually happy with doctors and pharmacists when their drugs are suddenly withdrawn for safety reasons, after leaving the pharmacy the day before with that same prescription. The situation is a tense moment between the prescriber, the pharmacist, and the unfortunate patient.
There is a new group that has a fresh proposition to address this problem: Iguard. Iguard is the brainchild of a physician, Hugo Stephenson. The web site "iguard.org" monitors health safety releases from government drug agencies and drug companies sending alerts to patients by email. The patient goes to the site and registers the medicines that he or she is currently taking, along with his/her medical condition. Users can access on a very simple color coded system the safety level of his/her drug at any particular time. The color green is the most comfortable safety level : "suitable for widespread use", with the color red being the most concerned level: "requires careful consideration of risk versus benefit".
There is an option that allows the patient's doctor to be alerted as well. The physician does not have to face angry patients taking potentially withdrawable drugs such, as with the orange level 4, that advises patients to " create a risk reduction plan with their doctors". This system allows the patient to be more proactive about the safety level of his meds, and be able to address beforehand those concerns with both physician and pharmacist.
A patient should always remember that drugs are not perfect weapons against their diseases. The more they stay informed regarding their therapies the more they will be able to reach the best decisions with their doctors concerning their drugs.
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