One Woman’s Questions About Psych Medicine
By Shelley McIntire, LPC and David A. Morris, LCSW
When Katona (name changed for privacy) was diagnosed with moderate to severe major depression, her therapist suggested that she try an antidepressant; an SSRI, to be specific. She was concerned. She thought it would make her “seem like a zombie”. “Maybe I won’t be myself anymore”. She felt ashamed, “I could not work out my depression without medication”. She also worried it would also create other issues; such as dependency, side effects and weight gain. She was sad that “they won’t really work”.
A Brief SSRI History
SSRIs came on the medication scene in 1987 with the introduction of Prozac, or Fluoxetine, as it is known generically. Before SSRIs, or Selective Serotonin Reuptake Inhibitors, were introduced, the medications used to treat depression were known as tricyclics. These medications had safety-based side effects.
SSRIs target more specific receptors in the brain, therefore, have fewer side effects than tricyclics. Serotonin is a chemical in the brain that assists the information being passed between the synapses. SSRIs work by keeping more serotonin in the brain by stopping our brain cells from reabsorbing it into the cells.
Katona Agrees to a Psychiatric Evaluation
Katona Agrees to a Sounds scary? But in reality, it is just a meeting with a psychiatrist to discuss her symptoms, struggles, medical history and goals. Then various types of medication for major depressive disorder and their effectiveness are reviewed. The psych med provider will leave it up to her on whether she wants to get started. The plan will be to methodically work up to a full dose.
The Psychiatric Mental Health Nurse Practitioner also discussed side effects, risks, benefits, and alternatives to medication. Katona was warned to not stop her prescription without notifying the office due to risks of Serotonin Syndrome. Serotonin syndrome, or serotonin toxicity, occurs when there is too much serotonin in the body. Mild symptoms such as diarrhea and shivering, can occur as well as more severe symptoms such as confusion, seizures, agitation, fever, and muscle rigidity*.
Katona and her psych med provider also reviewed the need to refrain or reduce the use of alcohol while taking medication, as alcohol, a depressant, can make depression worse. In addition, alcohol can increase the side effects of SSRI antidepressant medication, such as drowsiness. The combination of alcohol and SSRIs can increase the normal effects of alcohol alone. Using alcohol when taking SSRI antidepressants can increase already slowed reaction time, lack of coordination, and impaired judgement. **
When talking to the majority of psych med providers, they agree that alcohol effects our entire body. A general rule of thumb is that alcohol interacts with all medicine. It is a depressant. If someone is taking an SSRI to treat depression, and they consume alcohol, the treatment will probably suffer.
Katona asks Good Questions
“How long does it take for the medication to begin to make a difference in my mood?”
The Psychiatric Mental Health Nurse Practitioner related that SSRI antidepressants typically take anywhere from 4 to 6 weeks to begin to work fully. The first few weeks are used to attain a therapeutic dose.
“What about side effects?”
Her psych med provider reviewed potential side effects; some of which usually decrease over several weeks and some which may not. She mentioned that Katona may experience anxiety, irritability, and restlessness when first starting this type of medication. They also reviewed potential ongoing side effects such as weight gain, sexual dysfunction, and sleep issues.
“I don’t know, is this really worth it?”
Her psychiatrist conveyed that SSRIs are generally effective for more chronic, moderate to severe depression; however, dosing and finding the right fit may not always happen with the first trial. The goal would be to start Kaitriona on a drug that is generally found to be effective for patients and that is well-tolerated. She was asked if there were any side effects that she would rather avoid (such as stomach upset versus sexual side effects), and if there is a perception that possible benefits would outweigh possible side effects.
“Should I keep seeing my therapist?”
Yes. The psych med provider encouraged therapy, explaining the skills learned in counseling can often be better utilized once the med trial is effective.
Several psych med providers have noted the numerous studies done that prove therapy, specifically CBT, in conjunction with medication therapy is the most useful and effective treatment for many mental health disorders. Both fields tends to agree they work synergistically. It is important to note that the goal of medication is to provide symptom relief, increase energy, improve mood. Often times, once the shadow starts to fade, a person is ready to tackle their symptoms and process the therapy better.
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Katona Decides to Move Forward with an SSRI
After considering all of the pros and cons, Katona decided to try a low dose of the SSRI antidepressant. The Psychiatric Mental Health Nurse Practitioner provided her contact information for any questions or concerns. She was scheduled with a follow-up appointment in one month.
For Katona , starting an SSRI antidepressant seemed worth it to her to decrease her symptoms of depression. She felt comfortable knowing that she would be able to discuss her hesitancy and her concern around the stigma with taking antidepressants with her therapist, and, if this medication was not a right fit for her, that she and her psych med provider would work together to find one that would.
* If not treated, severe serotonin syndrome can result in death. However, serotonin toxicity is rare and symptoms usually begin within hours or a day of starting a new SSRI or increasing the dose of an existing SSRI. Serotonin toxicity most likely occurs when two drugs interact.
**If a person who suffers from problematic alcohol use is in need of treatment with an SSRI, alcohol should be reduced gradually over time and under the supervision of a health care professional and not abruptly stopped to avoid serious withdrawal concerns including a hypertensive crisis, seizure, and even death.