How far can you run from your own mind? – Page 13 – Inside The Mind of a Psychiatrist

Antidepressants are medications that are prescribed mainly for depression, anxiety disorders (including panic attacks) and obsessive compulsive disorders. They are also used in pain syndromes, smoking cessation, premenstrual dysphoria and many other off-label disorders. They are BIG BUSINESS — 11 billion in sales in 2010 in the US alone. One in ten Americans are on an antidepressant!

Antidepressants were first discovered in the mid-fifties when researchers were trying to find a cure for schizophrenia. What they found was Tofranil, a tricyclic antidepressant. Sadly, it made schizophrenia worse, and happily, depression better. For the first time, psychiatrists had a tool other than psychotherapy, tranquilizers or electroconvulsive therapy (ECT) to treat the depressed patient. This discovery started the snowball effect, and quickly other drug companies followed suite with Elavil, Norpramin and Trazadone. The problem with this generation of antidepressants was the severity of the side effects.

In 1988, when Eli Lilly introduced Prozac, it was an absolute game-changer — less side effects and more effective. By 1990, annual sales of the “miracle drug” topped 1 billion. It wasn’t perfect, but compared to the competition it was fabulous.

Now there are over a dozen newer antidepressants: Zoloft, Paxil, Paxil CR, Celexa, Lexapro, Luvox, Luvox CR, Wellbutrin SR, Wellbutrin XL, Cymbalta, Pristiq, Viibryn…

So which one is the best? The answer is much less exciting than the question. NONE and ALL. It depends which one works for a particular person, and which has the least side effects for that person. Choosing a particular drug is often a litany of trial and error. There are no blood tests to help us choose the right one.The only real clue we have is if a family member did well or poorly on the chosen drug.

My feeling is that drugs alone are often not the best treatment for depression, anxiety or OCD. What seems to work best is often a combination of medication and psychotherapy. It’s a dual approach that addresses both the physiological and the underlying psychosocial issues. This is a great time to be depressed! Often it’s fixable.

Please feel free to ask any questions and I’ll do my best to answer them. Thanks!

Monday the stock market plummeted over 600 points. Tuesday it went up over 400 points. Wednesday it went down over 500 points.

Yes, there is unrest in the world — wars, financial issues abroad and at home, and intense political conflict. What else is new? This has been going on for years. If it is business as usual, why is the financial community so labile and unpredictable? From a psychological standpoint, and I know that I’m simplifying a very complicated problem, I think there is one overriding factor that has contributed to this worldwide chaos.

President Obama, who I deeply respect and joyously voted for, has made an error. What comes to my mind is analogous to a parent trying to have a reasonable discussion with an out-of-control two year old. You can’t bargain or negotiate with a screaming, immature little being. What’s needed is simply to take charge, set limits, and understand that you are the parent. Our president could have done that. He could have invoked executive power and assured the world that we would pay our debts. He could have stated, “I WILL NOT LET THE US DEFAULT. NOT ON MY WATCH!” He had the power to do this and then let the immature politicians grow up and do what they were elected to do — TAKE CARE OF THE COUNTRY INSTEAD OF THEIR OWN SELFISH INTERESTS.

Everyone is frightened. Buy stock. Sell it. There is no rationality to all this lability. We need our president to stand up and be the same man who stood up against invading Iraq. Walking this terribly dangerous middle-road isn’t working. President Obama is a courageous, brilliant man. He needs to be the solid, reasonable parent that the country needs.

Thanks!