Antidepressants and Hospitalization

Mystery5 · Dec 18, 2004

I think we live in an over medicated society myself. Nowadays everyone and their brother is on a psyche med. No one has time to grieve. When my husband died of cancer people were really disturbed to see me wearing black, even though I only did for a week. They wanted me to start dating even though I had 4 kids still at home, 2 of whom were 3 and 1!

If there's a sudden death you're supposed to see a 'grief counseler' and get on an antidepressant, and get on with life, because 'life is for the living'. I think that's Bull S**t myself.

I have a very Catholic view of suffering, though. I think it can help one grow spiritually and should be offered up to God. A very unpopular belief, though, in our instant gratification society. (not that I totally opposed to antidepressants in every case)

begalli · Dec 18, 2004

I tend to agree with the OP. The thing that always blows my mind is that something our docs perscribe is an antipsychotic (not antidepressant) for the suppossed side effect of drowsiness in agitated patients!

I ALWAYS question the docs with this one especially when I see an order for Zyprexa. I have personally been through this with someone very close to me, she was not hospitalized, but it doesn't matter. This drug is riddled with horrible side effects, especially s/e that wreak havoc on the CNS (insomnia, tremor, akathesia, dizziness, extrapyramidal crud) and it has numerous drug interactions. Even at the small dose that is perscribed for "sleep", this drug is wrong wrong wrong to give to an agitated (ICU psychosis) patient. I guess their thinking is that the patient is suffering a form of psychosis - so give them an antipsychotic?!?! WHAT!?! I have only seen people become worse....even over time. Do they even think about those side effects?!

I feel somewhat the same about antidepressants. The s/e are terrible until the drug kicks in over time. And so many times outside of the inpatient setting it takes literally a trial and error period of months to get the "right" drug for a particular person.

I have however seen some cases of chronic ICU patients getting some relief from an antidepressant. But these were folks who had an ICU stay of several weeks to a couple of months.

I don't think you're wrong for being so concerned.

NiobiusSwan · Dec 18, 2004

I was doing some CE not long ago for pharmacy, and I had to do one on cancer pain. The article was discussing terminally ill cancer patients and how toward the end, they often request assisted suicide. It stressed that these patients (who were TERMINAL) were not making rational decisions, but were depressed, and should immediately be prescribed anti-depressants :uhoh3:

I think that every situation is different. Some people do need to be prescribed anti-depressants, but I think they are overused. I've suffered from chronic depression for years; anti-depressants helped save my life. What does bother me a great deal, though, is that when anti-depressants are prescribed, not one single doctor has asked me about my diet, excercise habits, how much sunlight I get, or suggested any complementary therapies - omega fatty acids, etc. They have written the prescriptions, and that has been it. The only time the topics ever came up where when I asked about them.

So, I agree somewhat - not just with the ICU patient scenario, but also in general. I think that depression, many times (certainly not always), is a symptom of much greater problems. And it's easier to treat the symptom with a pill than to address our societal problems. I mean, we are experiencing an epidemic of this - obviously something is going on.

People shouldn't be happy about living in poverty, suffering catstrophic illnesses, etc. And they shouldn't be expected to. Something is wrong if they are. But at the same time, sometimes you become so miserable it's difficult to function. And sometimes, it's lethal. I think that patients should be much more informed about this than they are. I think doctors need more education in the area, and I think that medications or not, people need to be monitored, closely. And as a society, we need to address the larger issues as well, although, obviously, with countless illnesses, there is not much to be done.

Thunderwolf, MSN, RN · Dec 18, 2004

You have a genuine concern. The general expectation and push of "psychiatry" is to medicate, especially in the hospital setting where "acute" things/events are deemed worthy of medication to alleviate symptoms. As an old psych nurse who now works in med surg, I see both sides of the coin. You are correct that antidepressants take time to demonstrate efficacy...usually several weeks (2-6 with 4 being the average). I think it is negligent to just rx a pill and no more and not address the other issues at hand. I also firmly believe a pill cannot medicate an environment wrought with stress...doesn't work that way. Effective intervention needs to be environmental, not medicating the person as the end all. And I firmly believe that a pill cannot not make a tragic event go away or get better...unrealistic, but you'd be surprised how quick the pill is pulled out and is considered the salve in answering significant tragedy. I'm not trashing the antidepressants. They have their place, but are not the answer. In conjunction with other interventions, they are helpful. However, interpersonal and grief counseling at the bedside and/or interventions maybe overlooked in our high tech world of gadgets and meds. Real grief is real and it is inappropriate to medicate it. It is sort of condescending to tell a patient who has lost his leg in an MVA that here is a pill to make it all beter, but offer no more to the patient in assisting the patient through his rightful shock and anquish over the loss. If I was a patient just placed on a vent in ICU with a sudden loss of my capacity, my grief is real. The occasional hand sqweeze from an understanding nurse, the nurse talking to me as a person and not as a body to flip and clean would do more for me helping me get through that real and understandable crisis than a pill might. What I'm trying to emphasize is the "other pills of medicine" that may get over looked in helping a patient get through a rough time. I believe in antidepressants. I've worked with them in helping folks with depression. They have their place, but also do other interventions that may be untried or we have so little time to provide.

dekatn · Dec 18, 2004

In my opinion antidepressants are prescribed too much. I worked outpatient psych for 8 loooong years. Pt would come in with the slightest little c/o, give them a pill. I personally think situational depression should be treated for what it is. Take the time to deal/cope with the situation, end of depression! People don't want to deal with reality anymore, just give me a pill to fix it! I say teach them some coping skills not just how to pop another pill. I'm not in any way trying to make light of this subject, there are some things that happen to people that is beyond their control or their ability to cope, this I understand, there are different situations that need different modalities of tx. Too many dr.'s don't take the time to deal with issues that require more than a scrip, then again some people aren't motivated or educated enough about the different tx. to seek more than a pill. It would never cease to amaze me how a pt. could be prescibed an antidepressant one day and feel soooo much better the next. Even though it takes days, sometimes weeks for the effects of the medication to be known.

Thunderwolf, MSN, RN · Dec 19, 2004

I agree with dekatn. Learning new or more adaptive coping skills are often the more appropriate route to go. Some nurses are skilled at this, and some are not. I agree, for many folks, pills are handed out too much or inappropriately without the situation being adequately assessed.

stbernardclub · Dec 19, 2004

Yes....I agree with medical tx intervention early before their depression were to become severe. Many patients experience a feeling of loss once in icu. Its almost as if they feel they may never return to previous health. If it is a cardiac case where they have to change behaviors and learn new ways to prevent further problems, along with new medications with side effects that may cause them fatigue, that also can be depressing to some. And as you know, depression can also cause other illness...so yup, i agree. Its when a physician ignores depression that troubles me.

I'm curious about everyone else's opinions on this, so I thought I'd throw it out here.
Whenever I get a patient in an ICU who becomes depressed over a catastrophic illness, alot of the doctors will prescribe an antidepressant for them. Now I could be absolutely dead wrong on this, but this concerns me a bit. I'm wondering if it is truly appropriate to prescribe these medications for people who have no history of depression who are now depressed, but who have darn good reason to be depressed. They are trying to cope with a loss, and I'm not real sure if treating a situational depression with medication is a good idea.
Most of my coworkers disagree with me, they say it helps them deal with the short term depression. However, my own personal experience with antidepressants (which I've been on almost every one known to man), they have at times some pretty powerful side effects. Also, these things usually take time to become effective, and we usually are not able to evaluate their effectiveness in an ICU setting.
So am I wrong to be concerned? I would think coping with a loss is something you have to work out, along with some kind of counseling or support, and not necessarily medication as the very first line of defense. I could completely understand using them if other things such as counseling or talk therapy did not help, but not sure if it should be prescribed right away. But if any of you feel differently, and have some experience personally with these things, let me know. I'm willing to change my view on this if I'm wrong :)
Sherri

chris_at_lucas_RN, RN · Dec 19, 2004

I am so glad to see this thread, and especially the posts advocating for judicious use of antidepressant medications and the value of actually "living' as opposed to chemically modifying......

My BIL recently suggested that I should take Prozac because I am having a difficult time with some misbehaving family members. This misbehavior is not limited to me, and its onset predates me. He went on to say that IHO, taking an antidepressant would make my social and work relationships more enjoyable!

I was so mad I wanted to spit! As this took place in an email, my response, much calmer after I edited for an hour, addressed the fact that I probably was in a better position to consider whether I needed meds, and also the rare concept among the pharmaceutical advertising audience that chemicals address biochemical etiologies, NOT situational ones!

I learned today that he was going to bring me a PDR so I could look this stuff up for myself!

Geeez!

(The more I learned about pharm, the more I opted away from meds. Now I don't take anything, and I have a doc who tends not to prescribe. The drug companies won't get rich off me, but I won't be medicating the SE's of the drugs I take to address the SE's of the other drugs I take, either!)

Thanks for this thread!

Mystery5 · Dec 19, 2004

I would never even think of turning to my doctor for my personal problems! Now clinical depression is another thing, and then I would want a referal to a specialist, not a regular doc. Yes, there are some folks whose brains don't function properly and they need meds...

But frankly, many people these days are physically lazy, spiritually weak, and ever ready to be a victim. I would be depressed too if I was as sedentary as most Americans are. I personally think that many people would start feeling better with an exersise program.

plumrn, BSN, RN · Dec 19, 2004

I agree. I often hear a request in report to ask the doc for an antidepressant for a pt who is going thru a difficult illness or newly diagnosed with CA or whatever. I think what they are feeling is a normal reaction. If the depression continues, or worsens, then maybe the primary physician can address this at a later time as an outpatient. Adding one new medication after another sure can mess things up sometimes.

zacarias, ASN, RN · Dec 19, 2004

I agree. I often hear a request in report to ask the doc for an antidepressant for a pt who is going thru a difficult illness or newly diagnosed with CA or whatever. I think what they are feeling is a normal reaction. If the depression continues, or worsens, then maybe the primary physician can address this at a later time as an outpatient. Adding one new medication after another sure can mess things up sometimes.

I agree. If these doctors actually looked at the DSM-IV to see what true depression is, maybe they wouldn't be so quick with the SSRI-down-the-throat.