Nursing & Depression

Long Term Care Columnist / Guide · Oct 11, 2002

fab4fan: Please tell us more about seritonin syndrome. I've heard of it, but I honestly don't know much about it, and it sounds scarey. I'm on Paxil and I get weird if I'm out of the stuff for more than a day......feel like I've lost control of both mind and body, my face goes numb & tingly etc. I wish I didn't need to be on meds to be normal, because of the side effects I get when I run out, but I do need it.

defib queen · Oct 11, 2002

I just went through a bout of depression that lasted about 3 weeks. I really don't think it was related to work, I have been dealing with depression most of my life off and on. However, I do believe that trying to work nightshift and having a dayshift family and trying to keep up with them on may days off contributes to it.

abrenrn · Oct 11, 2002

Question for the day:

Can there be enabling in the absence of using? Can there be codependency without a very willing dependent?

This question came after a had worked for almost two years with an MD for whom I worked unpaid hours and made some (offered) economic concessions due to financial strains on the budget. The first time I asked for anything that might cost him anything, a one month extension on health coverage as I had not thought ahead to officially resign one day later. Human resources thought it would be no problem, the MD balked at the cost.

At first I felt deeply hurt. I happened to see my psychiatrist that day who said I had no right to ask for anything in return as he had never asked me to do what I did.

"Oh my god, I'm such an enabler" I thought. Look at how I hurt this MD by sheltering him from poor practice management, not making him face up to his mess. "It's all my fault."

But, I wanted the health insurance. I went to human resources with a list of unreimbursed expenses I incurred primarily for the needs of the practice. Admittedly, I had been willing to assume them as I expected to be there a while, so had no legal recourse. Otherwise, I would be forced to seek unemployment as I needed the money. Yes, I resigned, but when your job requires you to perform outside your recognized duties on a regular basis, you have no choice but to resign and are entitled to unemployment. Yes, it is messy and leads to discussion of things people would rather not hear, but I need the money.

I got my health insurance paid. Seemed rather ridiculous I had to play this game but I felt rather strongly about it.

I thought more about my enabling. In many other circumstances, I would have been seen as a nice person, a good employee. I frequently tried to point out problem areas and he just as frequently blew me off. While he never asked for the concessions I made, he certainly enjoyed them and came to see them as his due.

Enabling is very depressing. Nursing is a profession with lots of enabling - because it is so often expected by people and institutions that will take anything a nurse has to give, then feel betrayed when anything is asked in return. A few are able to set limits from the start but whenever I try, I am accused of having a bad attitude. I am prone to depression and frequently nursing has made it worse. I have been in some very depressing places but, so far, have managed to escape before it pulls me all the way down.

Someone said that we have to take care of ourselves first, then our profession. Somehow, I think we have to try to do both at the same time. As individuals, we have to fight the same battle over and over, figure out how to cope with whatever comes along, and figure out the realities as individuals - things like labor laws, FMLA, etc., etc. It takes some loner than others.

As a profession we can do more. We can assert first our professinalism as a group (rather than each individual having to prove his or her own worth), share information, and present a united front. For some reason, the established representatives of the nursing profession seem to have become more concerned with the needs of the hospitals, colleges and universities, than with the strength and health of its members. Yet a stong, healthy profession committed to its own health and well being, is the best for everyone involved: nurses, hospitals, and, most of all, patients.

Sorry for the length and soapbox, once again. The dilemna I face, leave this profession or accept the conditions in which nurses are forced to work in, is a difficult one. I don't think it should be.

Youda · Oct 11, 2002

Interesting post, Anne. As most of you know, I've been wrestling with these kinds of things for awhile. Once I got a little more level with the anti-depressants, I felt that understanding stress and depression, what causes it, and how to cope with it, would help me in not getting here again.

From what I'm reading, the factors are complex. But the Maslach Burnout Inventory identified three personality traits that tend to be more susceptible to work-related depression/burnout/stress.

* idealistic professionals who have unrealistic expectations about the work situation;

* accomodating, empathic people who pour too much of themselves into their jobs, and

* an individual's reaction to stress coupled with their stress-coping mechanisms.

So, my plan is to say NO more often. To do no more than what I need to do for my own patients. No extras anymore for employers, no matter how "short-staffed."

Environmental work factors identified are:

* role conflict;

* ambiguity;

* autonomy;

* no opportunity to participate in decisions, and

* lack of control of one's job.

So, I've got to start insisting on being part of the decision-making process in things that involve me directly. I think, I hope, that there are ways to avoid depression and burnout. But, I think it's going to require a change in how I view myself in relationship to "others" and becoming more assertive, and valuing myself above my job, even if that means I have to flip hamburgers. I have a feeling, that if I stay out of depression and have a good attitude, I'll end up being the manager of that hamburger joint and earning more money anyway.

Well, anyway, that's what I hoping. I'll let you know if it works! :)

sanakruz, ADN · Oct 11, 2002

AMEN ABRENRN!!!!

There is definately a withdrawal syndrome from both effexor and paxil. I work in an out patient mental health clinic and this was brought to my attention by my clients, I researched and found plenty of anecdotal info on the http://www.There was a article in the Washington post in Aug of this year:"Quit Paxil,And Then Zap!"(washingtonpost.com) One must be a savvy consumer-I tell this to my clients too. There is a lot of misinformation out there as well. the church of scientology is very anti-psychiatry and is behind a class-action lawsuit in Texas against ritalin. This all relates to my pet complaint that there is something deeply wrong about the way we deliver help in our health care system- but you know what? sometimes I think I know how to fix it, and other times I sink into a melancholy over it. We all need to be on the same page somehow...(HOW??)

tattooednursie, LVN · Oct 11, 2002

I always really try o have a sense of humor about everything. All the time I try to ake jokes about everything, and make people laugh, but there are nights when I just go home and cry because some one I was attatched to dies on my shift, or some one had to die alone (my pet peeve) or if some one is dying and I feel they are not going to make it throug the night and I'm afraid that no one will be with them. I havnt exactly created a "hard shell" yet, and I don't know if I ever will.

I get anxiety alot at work too. I have an ulcer that I have had since I was nine. It hadnt bothered me again until I became a CNA. now whenever I get upset or angry at work, and I hold in my feelings I get really SHARP pains in my stomach, and then for the est of the day i feel so nausiated that any foul smell makes me throw up, and in long term care, working with geriatrics and psychs, there is bound to be some BAD smells. I'm sure my co-workers think I'm bulimic or something. I think that I may begin taking anti depressants because I love the field of nursing even though it is stressful.

abrenrn · Oct 11, 2002

Thanks for the new data. I meant to mention something like that in my post, got caught up on my soapbox. Actually the standard or care, now, is to gradually remove antidepressants to avoid this withdrawal syndrome. No, they are not addicting. The sudden removal of any long term med is unsafe (never stop BP meds abruptly else rebound hypertension).

Over many years of experience, I have found that these symptoms are uncomfortable but self limitting, generally pass within one or two weeks. In 1975 I described "zapping in my head" to my psychiatrist who told me "there is no withdrawal from antidepressants" and did not choose to explore an obvious description of neuralgic pain. Over time, I learned that any time I stoppd an antidepressant it would happen, last 2 weeks or so, then pass. I never bothered mentioning it to another psychiatrist as they would always say it was in my head (which, I guess, it was)

sanakruz, ADN · Oct 11, 2002

mandi

I personally would not recommend antideprssants at this point. It's absolutely tragic and wrong that some dies alone and institutionalized. Unfortunately here in the US this happens alot. It has become a cultural norm. What is even worse is some turd is making money- The nursing home industry is private enterprise territory. here in CA it is well known that the staffing ratio mandated by law in the 1970's is woefully inadequate today.The dept of health services levies fines which do nothing because the industry factors that into their overhead cost! To get to the point, you are situationally depressed- not a pathological condition,but a natural reaction of a caring individual in the face of great injustice. Try to keep your sense of humor intact and explore lifestyle changes as a solution to your GI problems. Antidepressants on the market today are really a boon, but they should not be looked upon as a panacea for everything-They are powerful drugs with some really nasty potential sideeffects. And I dont think they should be advertised on TV!

sanakruz, ADN · Oct 11, 2002

abrenrn- we have 3 docs in our clinic. 2 are past 70. They do not listen to the clients- It can be apalling! The ones getting shafted the most are older women. Anyway,clients kept complaining to me(I'm the only nurse, an LVN) that generic paxil was not working as well as the brand name.My spin on this was to take their word for it but remain skeptical.One day I had a opportunity to corner a drug rep- He acknowleged that was real because of the difference in inactive ingredients used as fillers;it can affect the absorption rate and some people can develope ALLERGIES(!) Yesterday I found out that risperdol contains latex to make it easier to swallow! Yeow

sanakruz, ADN · Oct 11, 2002

Whoops! I mean Prozac not Paxil. Without insurance a consumer can spent $140.00 a month on a therapeutic dose regimen of prozac

mattsmom81 · Oct 12, 2002

I don't claim to have all the answers for nurses suffering from depression and anxiety related to the career.

I sure do agree it's all the liability with zero authority, the endless demands on an exhausted, caring and giving group..that contributes to our depresion as a whole.

Getting in touch with these feelings and acknowledging the 'truth'...that I alone cannot 'fix' healthcare, it is dysfunctional and runs on nurse abuse...this was something I had to acknowledge before I could begin to heal. But I am the oldest child of an alcholic...I am a 'savior' so this was hard for me.

We are important...we are worthy human beings. We should not martyr or sacrifice ourselves... it is not worth it. LIFE however, is worth it...and we must strike healthy balances...find a job we can do that doesn't kill our spirit. Find joy in our family and friends, and most of all..DON'T buy into the blame that healthcare puts on nurses!!

Depressed folks need to find a kind therapist to work out the feelings and begin a plan to get better. Meds alone are unlikely to help if you don't do the 'talk' work, IMO. Best wishes all...I'm working on feeling better too...every day!

mattsmom81 · Oct 12, 2002