As someone who has been on various antidepressants for 23 years and who knows how she crashes and burns every time one of them stops working...I definitely need to be on something. I am getting to the point now where I am thinking about asking my doctor if I can drop one of my anti-anxiety medications, because I'm in a much much better place than I was when I started taking them two years ago.
But I agree that they can be overprescribed. I remember years ago after my grandmother died, my uncle's then-wife (a doctor) prescribed him antidepressants. FFS, he was GRIEVING, not depressed. Then again, there are a lot of reasons that marriage dissolved. She's NOT the kind of doctor you are, Dr. Lucy.
Thank you for sharing this, Stephanie. Great idea to ask your doctor - also a good idea to ask YOURSELF what tools/supports etc you have in place that may already have taken the place of medication - or maybe NOT. :)
Dr. McBride, if only all doctors and nurses thought like you. (I like and trust my PCP but I love my Nurse Practitioner, and I believe she thinks this way)
As someone who is on an anti anxiety med this note is spot on! I never wanted to go on but at the time I needed urgent help and a divorce as it happens!! Now I feel the pressure and stigma to be off it, but a few trials haven’t gone well so as I’ve no big side effects I’ve decided to stay on it for the medium term (mirtazapine) despite the online pressure of various groups pushing back on big pharma (which I understand) but for some of us it’s been a life saver.
An important podcast with Kelly Casperson interviewing Dr. Mark Horowitz, a British psychiatrist who has studied--and personally experienced the problems-- of long-term use of anti-depressants and the huge problem of withdrawal symptoms when trying to stop taking them. And he's witten a textbook for physicians about it. Worth listening to when considering even short term use of SSRIs. https://podcasts.apple.com/us/podcast/372-deprescribing-antidepressants/id1495710329?i=1000769310254
Psychotherapy ought to be included as an option in discussions about managing anxiety and depression. It took a while for me to find the right person, but a profound healing relationship with my therapist helped me emerge from a significant depression without antidepressant medication. Not that she or I were opposed to their use— I had taken a couple of different types in the past without therapy, that I hadn’t found helpful, and had unpleasant side effects. But experiencing the feelings that were buried under layers of depression, and simultaneously learning a form of cognitive therapy, in the context of a relationship with a deeply empathetic and intelligent person helped me emerge with a greater sense of purpose and a greater appreciation for my own innate qualities and worth.
Thank you for this. My sweet, sensitive 24-year-old daughter is struggling with the exact question. Social media takes it to the next level for her generation.
I loved this, Dr. McBride. I white-knuckled through a lot in my life to feel I was strong and could cope. After having physical nerve pains (at 63 yo) after tons of worry about siblings acute health issues, an SSRI not only made nerve pains go away, but my quality of life has been amazing ever since. I never thought I’d take anything and now I’m sorry I didn’t do it sooner, but, like you said, it’s not for everyone and the leap is an individual one, if needed. I love the way you treat the whole person. My only suggestion would be to see a psychiatrist or psychiatric nurse practioner and not necessarily your primary because they may have a leg up on knowledge of meds (present company excluded, doc). Thank you for your great input!!
Such an important topic, thank you for addressing it so well. My “anxiety treatments” include having my husband with me during any appointment or procedure that can make me more anxious, and my five day a week exercise routine. If I’m not moving enough, my mood shifts, and not for the better. And being age 71 isn’t a reason to slow down. You have helped many people reframe how they look at anxiety, thanks, again, for doing that.
I started having panic attacks while driving about 25 years ago. I saw 4 psychologists/therapists and two hypnotists. Then I tried an SSRI (Paxil) and Clonapin, neither of which helped. Then I tried Xanax which does help (still can’t do highways.) Now I’m 70 and I heard doctors don’t prescribe Xanax etc for seniors. I’m afraid of this and thankfully my dr is ok w it. I’m keeping her even though we moved 40 minutes away. PS I just read the “new” anxiety drug is gabapentin. I thought that was for pain….
Glad you wrote in, Karen! Xanax has its role, but it can be habit forming and affect cognition and cause drowsiness so it should be prescribed with care - but it's not a YES/NO in my world ... rather, It's a question of treating the patient, not the rule book, and arming the patient with information and options and guidance that meets them where they are.
Sleepless and restless is not anxiety/panic. Anxiety/panic is literally shaking, not being able to walk outside or drive a car or go to the grocery store because what you are going through is traumatic and lasts longer than 5 minutes.
Love the list of questions you pose!
As someone who has been on various antidepressants for 23 years and who knows how she crashes and burns every time one of them stops working...I definitely need to be on something. I am getting to the point now where I am thinking about asking my doctor if I can drop one of my anti-anxiety medications, because I'm in a much much better place than I was when I started taking them two years ago.
But I agree that they can be overprescribed. I remember years ago after my grandmother died, my uncle's then-wife (a doctor) prescribed him antidepressants. FFS, he was GRIEVING, not depressed. Then again, there are a lot of reasons that marriage dissolved. She's NOT the kind of doctor you are, Dr. Lucy.
Thank you for sharing this, Stephanie. Great idea to ask your doctor - also a good idea to ask YOURSELF what tools/supports etc you have in place that may already have taken the place of medication - or maybe NOT. :)
Dr. McBride, if only all doctors and nurses thought like you. (I like and trust my PCP but I love my Nurse Practitioner, and I believe she thinks this way)
Thank you!
As someone who is on an anti anxiety med this note is spot on! I never wanted to go on but at the time I needed urgent help and a divorce as it happens!! Now I feel the pressure and stigma to be off it, but a few trials haven’t gone well so as I’ve no big side effects I’ve decided to stay on it for the medium term (mirtazapine) despite the online pressure of various groups pushing back on big pharma (which I understand) but for some of us it’s been a life saver.
So well said! This is called the "art of medicine."
An important podcast with Kelly Casperson interviewing Dr. Mark Horowitz, a British psychiatrist who has studied--and personally experienced the problems-- of long-term use of anti-depressants and the huge problem of withdrawal symptoms when trying to stop taking them. And he's witten a textbook for physicians about it. Worth listening to when considering even short term use of SSRIs. https://podcasts.apple.com/us/podcast/372-deprescribing-antidepressants/id1495710329?i=1000769310254
Psychotherapy ought to be included as an option in discussions about managing anxiety and depression. It took a while for me to find the right person, but a profound healing relationship with my therapist helped me emerge from a significant depression without antidepressant medication. Not that she or I were opposed to their use— I had taken a couple of different types in the past without therapy, that I hadn’t found helpful, and had unpleasant side effects. But experiencing the feelings that were buried under layers of depression, and simultaneously learning a form of cognitive therapy, in the context of a relationship with a deeply empathetic and intelligent person helped me emerge with a greater sense of purpose and a greater appreciation for my own innate qualities and worth.
Amen!! Thank goodness for therapy!
Thank you for this. My sweet, sensitive 24-year-old daughter is struggling with the exact question. Social media takes it to the next level for her generation.
I loved this, Dr. McBride. I white-knuckled through a lot in my life to feel I was strong and could cope. After having physical nerve pains (at 63 yo) after tons of worry about siblings acute health issues, an SSRI not only made nerve pains go away, but my quality of life has been amazing ever since. I never thought I’d take anything and now I’m sorry I didn’t do it sooner, but, like you said, it’s not for everyone and the leap is an individual one, if needed. I love the way you treat the whole person. My only suggestion would be to see a psychiatrist or psychiatric nurse practioner and not necessarily your primary because they may have a leg up on knowledge of meds (present company excluded, doc). Thank you for your great input!!
Such an important topic, thank you for addressing it so well. My “anxiety treatments” include having my husband with me during any appointment or procedure that can make me more anxious, and my five day a week exercise routine. If I’m not moving enough, my mood shifts, and not for the better. And being age 71 isn’t a reason to slow down. You have helped many people reframe how they look at anxiety, thanks, again, for doing that.
Glad to hear. Thanks for writing in, Marilyn!
I started having panic attacks while driving about 25 years ago. I saw 4 psychologists/therapists and two hypnotists. Then I tried an SSRI (Paxil) and Clonapin, neither of which helped. Then I tried Xanax which does help (still can’t do highways.) Now I’m 70 and I heard doctors don’t prescribe Xanax etc for seniors. I’m afraid of this and thankfully my dr is ok w it. I’m keeping her even though we moved 40 minutes away. PS I just read the “new” anxiety drug is gabapentin. I thought that was for pain….
Glad you wrote in, Karen! Xanax has its role, but it can be habit forming and affect cognition and cause drowsiness so it should be prescribed with care - but it's not a YES/NO in my world ... rather, It's a question of treating the patient, not the rule book, and arming the patient with information and options and guidance that meets them where they are.
It’s a very small dose, 0.25 mg. Twice a day. I’m sure it’s habit forming, but it’s the only thing that allows me to drive.
I’m on Zoloft. It’s been life changing.
Same, Mike
Well, RFK is the problem, but... that's a different discussion.
Sleepless and restless is not anxiety/panic. Anxiety/panic is literally shaking, not being able to walk outside or drive a car or go to the grocery store because what you are going through is traumatic and lasts longer than 5 minutes.
Sleeplessness and restlessness can be symptoms of anxiety - and yes you are right that panic disorder is more severe :)
Studies have shown that CBT and antidepressants together are more effective than either alone.