Are meds the long term answer?

Dear Dr. Gould,
I am a 33 yr old healthy female. About 5 years ago I was prescribed 10 mg sarafem (prozac) for severe PMS. I took these pills once a day 2 weeks out of every month before my cycle. My husband lost his job and his best friend during that time and problems between us escalated. I was able to support us both financially. I became extremely stressed out, annoyed and bitter with this situation. At 28 I should have been moving up in life, planning to have children, and a great marriage. In addition to the stress, I had become somewhat moody and sad about the situation. Despite all of this, I still have a great career. There have been problems thoughout the past 5 yrs with my husband's job stability, but I still love him. I am trying to be supportive and stick by him tough this tough time. A couple of years ago, I went to a psychiatrist. He prescribed 10 mg of Lexapro once a day. I have been on 10/15/20 mg depending on my stress levels. My sex drive became non existent, which only made things worse in my marriage, plus I gained so much weight. My original weight was 125/130 at 5'4, it went up to 155. I was so unhappy at this weight. In ref to your website, shrinkyourself.com I was medicating myself with additional food to feel better.....but I had never gained that much weight in my life. I discussed these issues a few months ago w/ my psych Dr and he tapered me down to 5 mg of lexapro and added 300 mg of wellbutrin. Plus I have been excercising regularly fo a couple of years. This combo is working ok for me. I still have a pretty low sex drive and my weight is coming down now to 148-150. I want to have children in the near future, and I still feel like I am all drugged up and not thin enough. Any advice you can give me is much appreciated.

[Venora Moonwind]

This isnt the doctor forumn but you cna cut and paste your question in the doctor forum you really need to look inot therapy along with the meds It takes both to beat this.
good luck
Love Venora

[jkittie]

I realized afterwards that this is not a Dr forum. I keep trying to post this question in
the "mental health" forum and the site tells me to try back the next day b/c it is all full.
This has been happening all week......has this ever happened to you before?
I guess I will just wait until it goes through. Thanks for your post. : )

[suzi-q]

I guess a lot of us need help!  LOL

[JSGeare]

I'm not Dr. Gould, and I doubt that he's here. This is where all the patients and victims hang out and help each other along. We may not have medical degrees, but trust me, we are all students and graduates of the school of experience. Welcome to 5th floor.

The answer to your question, which I impart not as a medical person but rather on my personal experience, the collective wisom here and what the pros tell me- is that when it comes to anxiety and panic, long term use of meds is rarely the long-term answer -if by that you mean, "a cure."

Notice, I said rarely. Not never. Let's walk up and down the waterfront here and look at various situations. First of all, let's get clear on the idea of "cure." I'm not aware of ANY thing that medical science has ever "cured," if we mean some substance that just makes a problem go away all by itself. Cures on any kind -panic, broken legs, organ failure, whatever, are done by your own body and mind. The drugs, treatments and therapies are the tools that give your body and brain an edge to do the healing. Sometimes, that edge is the critical difference between life -and the alternative. But, YOU are the one who does the healing.

That said, what is a "cure" when it comes to panic and anxiety? That's kind of based on what you say it is, but let me give you my idea of what it means to be "cured" of panic and anxiety, because it is how I describe myself. It means to be free of the psychological material that manifests itself through panic and anxiety, and therefore to be free of major symptoms, and free of thinking about symptoms for so long that you A) regard panic as a thing of the past and B) do not expect it to return.

That's MY definition; your mileage will vary. But its not a bad idea -and often is an exercise in therapy, to actually decide what it is that will let you think of yourself as being "well" again. Consider it.

Can we think of any circumstances in which meds may, in fact, be the long term "answer?" I think we can, and I'll use diabetes as an example. Someone whose diabetes is "controlled" by insulin and who otherwise lives a normal life is not considered cured, because they are insulin dependent. That is, the person needs to take in artificially what the body does not produce on its own. But that person probably would describe themselves and being healthy and well, too. And most everyone who knew the person would agree.

But suppose we take a person whose panic and anxiety results from or is a side-effect of a major organic pathology of some kind. Maybe something like a very serious bi-polar disorder which came about because of physical injury. (I just made that up -don't know if it ever works that way). For that person, medication may be the ONLY answer, and will be required for the rest of his or her days. Do not make the mistake of comparing this, however, to the insulin-dependent diabetic. There is no comparision, it is a very different situation. In the case of the diabetic, we know what is needed -insulin! Provide it, and the person is OK. But in the case of people with mental disorders, syndromes or diseases, we haven't yet figured out exactly -or perhaps even approximately- what biochemistry is needed to return to "situation normal." And what we do figure out for one may not apply to someone else. It is maddeningly complicated. But what we CAN say is that in some severe cases, the meds are the only treatment, and they are going to be required for as long as the person lives.

Now, let's go the other way -to that group of folks who have a particular, highly defined phobia or mental block which rarely gets in the way and be clearly defined. Flying, public speaking, bridges -you get the idea. While there probably underlying conditions that create these problems -and you could dig them out with enough therapy, it simply makes no sense to chase down a problem that comes up so infrequently. For that person, meds may also be the long term answer. You don't take them every day, only "as needed." But you take them, as needed, for ever.

And that leaves everyone else between the two extremes. And judging from what YOU wrote, it looks like you're in that camp. In this situation, the meds help you deal with anxiety, panic or other feelings that interfer with your ability to function, are very uncomfortable and frequently or unpredictably present, or which serve to magnify other feelings to the same effect. But that's all the meds can do. Remember when we said that we don't have the same exact medication match for stuff in the head that we have for diabetes? Well, if we DID, it would mean that whatever's bugging you would somehow become comfortably integrated into your thoughts and feelings and no longer trigger anxiety or panic. How cool. But we DON'T, so all we can do is treat the symptom. This is like burning your finger; you put ointment on the hurn AND pull your finger outa the fire! The effect and the cause are both addressed -OK? The closest we have yet come, to the best of my knowledge, is a class of drugs called SSRI's which act to let your body's own home-brew (seratonin) hand around a little longer so there is a generalized calming effect and a little more mental time to think about things. And that is sometimes enough to let you work out whatever external or underlying issues are the prime movers behind the panic and anxiety. Sometimes. More often, however, a good course of talk therapy, in combination with the SSRI's (or whatever they think you should take) has very stunning results in terms of working everything through in your head so you can work it through in your life. I experienced this as something like strength training: yes, the weight was still heavy, it was just that I could lift and move it -and know when to stop. It was difficult, but the more I did it, the better AT IT I got,a nd the better I got, period. Today I take no meds, have no symptoms, am content -etc. And so, while there will be as many variations to this approach as there are people who suffer the condition, in most cases, the meds help you feel better so you can do the therapy to GET better.

I hope this answers your question, and encourage you to show it to a mental health professional who can sanitize it for my errors and ommissions.

And welcome to the forum; we are glad you are here and hope you'll contribute.

[jkittie]

Dear JSGeare,
Wow that was a very in depth, philosophical look at how we can deal with panic issues.
Thank you very much, it is kind of you to take all that time to write it. To make things more clear, the whole panic/anxiety thing became apparent after I got married and into the "real world". At 28 I was still pretty sheltered, living an easygoing life. Coming from a nice family environment, without too much stress and the constant support of my loving parents. I was able to support myself nicely in an apt in NYC and had/have a nice career in a creative field. Once I got married and things were not exactly what I expected, I freaked. Especially b/c there were a ton of problems which I did not anticipate. My normal response would be to run from the situation (eg. get a divorce and start over)....or constantly worry and nag my husband, thinking that would change things. The latter was my choice. Today with some maturing and help from the meds, I am doing a whole lot better. Like you said, I think it is important for me to get to a place where I am strong enough to try life without these meds and see how it goes. For now I am doing my best without worrying my head off and trying to keep my weight down w/excercise and healthy eating. My moods are pretty stable and I am able to function pretty well. I guess I just want to able to live the rest of my life without depending on these drugs for help.

Some of the things I worry about on occasion:
My husband needs to get a full time job. He is currently consulting on a full time basis,
making good money...it's not stable enough for me, esp if we want to buy a house and start a family. I worry I am getting older and that I still have no children. Some of my friends are having their second children. I worry life is going to pass me by while I sit and wait for these issues to work out. I will be to old to have children by then, maybe 40. I have a dream of being a young enough mother to do physical activities with my child. I don't want to be 60 when my child is in college. As I wrote before, I am 33. I realize this sounds a bit ridiculous after writing it all down. My problems seem so insignificant compared to others with more serious problems. Even though these problems may not seem so bad to others, they are important issues to me and my life as an indvidual. I can't help but think about these things. I try to get through the days and have a positive outlook that things will work out for the best sooner than later.
Hopefully they will.  

[JSGeare]

Sounds like you've got a grip to me, my friend, and I'll bet with some talk therapy tossed in there you'll be amazed at how quickly it moves along. I'll take a groping lunge at some possible "points of entry" therapy-wise and you take it from there. You report that your husband "is currently consulting on a full time basis, making good money." And also say that is is not stable enough for YOU. Two possible problems here: first, how stable is "stable enough?" And, you need it to be stable enough for YOU? Hmmmmmmmm. would agree that the earlier sheltered life you describe may have insulated you from that shock of reality and I'll just betcha the therapy will help you come to terms with that.

Nothing you wrote sounded ridiculous to me, and your problems -ANYbody's problems are exactly as big as you perceive them to be. I know a lovely, active lady who has a minimal income and is going blind, and she tells me she is so happy to have been sighted most of her life and will just have to figure out how to be blind. Talk about a well adjusted personality -wow!

Hopefully, schmopefully, Kitty. Get in the fight -get some therapy and use that creative, exquisite brain of yours to squeeze out a few chemicals of its own. Now I'll close with a funny and true story. You are a "creative" type and are in the Big Apple. I don't know if you had ever heard of Norman B. Norman (I swear that was his real name) who is deceased of maybe 15-20 years now, but he was a rags-to-riches story and took his retirement from the Foote, Cone and Belding Agency which probably now is owned by someone else. Among his great advertising triumphs was the market he created for the Oil of Olay people. "You did that?!" I asked. "My wife uses that stuff -she swears by it!How did you figure out what to do to make it so popular?" I was expecting some psychology about the somewhat mysterious and exotic looking face with hands around it which is their logo. Now mind you, Norman was a pretty powerful guy. His office was on Park Avenue just up from Grand Central -60 floors up there and overlooking the city. He sat at a Louis XV desk and had just one thing on his desk: an American Heritage Dictionary. White haired and patrician in his bearing and speech, I was expecting a reply of enormous depth. He stared through me with a penetrating gaze, then this is what he quietly said.

"Just tell the women it will make them beautiful. They always fall for that s**t."

Sometimes, the complications we face are there because we expect them to be.

Take good care.

[Sam888]

Good post!

Actually, the analogy of diabetes was used when someone has been diagnosed as having a mood disorder and anti-depressants/anxiety meds are prescribed. It's not a temporary solution but an "answer" to a chronic medical condition.  But, that's what the doctors say. However, in studies, antidepressants have shown to have little or no more of any effect than a placebo. Sadly, we never hear about these studies.  It's not something the drug companies want you to know about.

Common sense bottom line: many drugs work and they can help you get better, but hey, for most chronic condition, if there’s some other way to get better that is under your control and that does not involve the use of foreign substances, why not try that either first, or at the very least, why not try that mode of therapy along with a drug rather than just relying on the drug as the first choice be-all and end-all of getting better?

[Sam888]

I forgot to add, it's still debatable, even controversial in determining if one is suffering from low levels of seretonin. In fact, one doctor suggested that 1/2 hour of cardio was equal to 50 mg of Zoloft (meaning it increases your seretonin to that level).  Unfortunately, there is no test out there that can determine if you have low seretonin levels in the brain.  It's all subjective and personally, you would be wise to avoid SSRI's altogether.

[jkittie]

Great stories and advice!! Very appropriate, as it turns out my husband happens to be a creative director in the advertising industry. You must be a mind reader. I am very familiar with the agency you are talking about. I will look up the executive you are talking about. My Mom swears by Oil of Olay products : )

Back to the issue at hand. We are both trying to make it big in the Big Apple, as you say. It has not been easy by any means. I am a fashion designer for a public company...I won't go into too many boring details. Yes, I do try and use my creativity to make my life a bit more exciting. The whole stable thing...well for me it means having a "staff" job (not freelance) and staying there for some time, moving up in your career, and being able to buy a home and support a family. That is really what I am looking for out of my husband. I realize my expectations are high, but thems the breaks. I realize inflation today is incredible (esp in NY) and the economy is not so fab, so I will probably have to work along side him to help support a house and kids. I have a feeling these issues are common among young middle class couples today.

My psychiatrist suggested talk therapy as well. Perhaps I will try that in the future. I know it always helps to get your problems off your chest. With that said, I am still not sure if meds are the long term answer. For now they are helping me. I can only take it day by day  and try not to stress out too much.

I admire your friend who remains so positive under the circumstances that she is going blind...When I think of people like that, I feel so silly worrying about my own probs. She must be a saint.

The large picture window in my office overlooks Broadway in midtown (the garment center). People watching can be fun...I see a woman almost every week whoes hair is green, so is her clothing, shoes and accessories....pretty funny.

Anyway, take care. I hope the weather is a bit warmer in VA than the frozen tundra of NY. Have a wonderful day.