Selective Serotonin Reuptake Inhibitors (SSRI’s), also known as antidepressants, are used by prescribing medical professionals to aid in emotional disturbances. The majority of patients getting prescriptions come from non-specialist prescribing medical professionals like their primary care physicians (PCP). A consultation with a PCP typically includes a review of medical ailments and if any reference is made to mood, depression, anxiety or mental related concerns a PCP will prescribe psychotherapy, a psychotropic medication, or both. Once a prescription has been given PCPs are recommended to continue treatment in all patients for at least six months after resolution of symptoms, and for at least two years in patients with high risk of recurrent depression (Middleton, Cameron & Reid, 2011).
Out of all the antidepressants available, two independent studies found that Zoloft and Lexapro are the most effective antidepressants with the least amount of side effects (White et al., 2010). In a similar study, psychiatrists and medical professionals were asked what antidepressant they would choose if they were clinically depressed. The answer was Zoloft as their number one choice, followed by Lexapro. The reasons for their choice were indicated by the importance of the efficacy and safety of the antidepressant (Chaudry et al., 2011).
Over the past several years, the use of SSRI medication has grown so much that it is now the third most prescribed medication in the United States. In fact, most prescribing medical professionals are PCPs without a psychiatric diagnoses. “Because of the growing demand in psychotropic medication like SSRI medication many scientists are hoping to gain a better understanding of the factors driving this national trend and to develop effective policy responses (Pies, p.37, 2012).”
Research has shown that PCPs are prescribing antidepressants to patients with poorly defined mental health conditions, though that is not the concern. The concern here is that there are patients that go untreated by their PCPs because these patients are undetected or misdiagnosed (Pies, 2012).
In speaking to two different physicians about the use of psychotropic drugs in their medical practice, I found two very different answers that indicated pro medication and pro therapy. One physician, Dr. Lynn, indicated that the best practice for her patients is to recommend psychotherapy first and if that fails to produce results or desired improvements, than psychotropic medication would be the last resort. Another physician, Dr. Gonzalez, preferred the psychotropic method for immediate relief of symptoms. In asking other medical professionals, there were many professionals that agreed with Dr. Lynn’s view and others who agreed with Dr. Gonzalez’s view of psychotropic method of prescribing. One physician said he believed that patients did not require psychotherapy because they can discuss any concerns with him while in consultation; I personally disagree with this physician because he only gives patients 15 minute consultations, if this physician had proper psychotherapy training and gave patients more than 45 minutes of face-to-face time on a weekly schedule, I would agree with him.
When a personal friend wanted to terminate medication she didn’t think it would be any different than stopping an antibiotic prescription. The symptoms have been controlled and it was time to get off the medication. Her reason for stopping was an issue of dependence; she did not want to become dependent on any medication for the rest of her life, so she just stopped taking Celexa. Three days later she described the following symptoms, “I first started to get headaches, then I felt electric shocks in my head, it was the worst feeling I have ever felt! I was crying uncontrollably for no reason and I was very confused. I was overly emotional all day and especially at night. I was irritable, and I didn’t feel like myself for 7 days. I figured it was the lack of the medication and so I called my doctor and I was instructed to begin my 10mg dosage immediately after having been off for 7 days. I currently take my medication every other day and I feel fine. I wish my doctor would have explained the side effects of stopping cold turkey before I did that (personal communication, 2014).”
The example my friend provided is one example of antidepressant withdrawal and also a reason why most taking SSRIs fear getting off the medication. Researchers from Amsterdam interviewed patients taking SSRIs and found that there were typically two main reasons for wanting to stop taking medication. The first reason for wanting to stop medication was that symptoms were no longer present and the second reason was the fear of becoming addicted to the medication, even though it is not addicting. According to patients in this research the biggest concern in stopping medication is losing the balance in life that they have achieved with SSRI medication (Verbeek-Heida & Mathot, 2006). What Verbeek-Heida and Mathot (2006) found was that patients were fearful of the unknown when stopping medication and that the best solution would be education and guidance by a medical professional like a primary care physician or someone with prescribing rights in conjunction with psychotherapy.
My Personal Thoughts
I personally feel that most people are overmedicated unnecessarily when they can alleviate health concerns through lifestyle and natural choices like exercise, nutrition and psychotherapy, to name just a few. Once patients have exhausted all lifestyle and natural methods, I can support an integrative approach with medication. This is my personal view of course.
Chaudhry, I. B., Rahman, R., Minhas , H. M., Chaudhry, N., Taylor, D., Ansari, M., & Husain, N. (2011). Which antidepressant would psychiatrists and nurses from a developing country choose for themselves?. International Journal of Psychiatry in Clinical Practice, 15, 74-78. doi: 10.3109/1351501.2010.530668
Howland, R. H. (2009). Prescribing psychotropic medications for elderly patients. Journal of Psychosocial Nursing, 47(11), 17-20. doi: 10.3928/02793695-20090930-06
Knorr, U., & Kessing, L. V. (2010). The effect of selective serotonin reuptake inhibitors in healthy subjects. a systematic review. Nordic Journal of Psychiatry, 64(3), 153-161. doi: 10.3109/08039480903511381
Middleton, D. J., Cameron, I. M., & Reid, I. C. (2001). Continuity and monitoring of antidepressant therapy in a primary care setting. Quality in Primary Care, 19, 109-113.
Pies, R. (2012). Are antidepressants effective in the acute and long-term treatment of depression? sic et non. Innovations in Clinical Neuroscience, 9(5-6), 31-40.
Sansone, R. A., & Sansone, L. A. (2010). Ssri-induced indifference . Psychiatry (Edgmont), 7(10), 14-18.
Verbeek-Heida, P. M., & Mathot, E. F. (2006). Better safe than sorry-why patients prefer to stop using ssri antidepressants but are afraid to do so: results of a qualitative study. Chronic Illness, 2, 133-142. doi: 10.1179/174592006x111003
White, C., Wigle, P., Eichel, E., Albert, L. G., & Udom, L. (2010). Answers to your questions about ssris. The Journal of Family Practice, 59(1), 19-24. Retrieved from http://www.jfponline.com
Orlando Zuniga, LMFT is a Licensed Psychotherapist practicing in Los Angeles and most of California. With expertise in mental health counseling, behavioral medicine, relationship counseling, executive coaching, sales training, client relationship management, and organizational-corporate development.