How many nurses take antidepressants or antianxiety medication?

[Attheana]

I was wondering and it seems to be quite prominent. Nurses seem to have to take medication alot. Mine started in nursing school. Of course I was a single mom of two, going to nursing school, building a house and living with my mother till it was finished. Talk about stress.. I started having panic attacks. Never before in my life had I had one. I thought I was dying. Well I lived and now not only do I take a PRN order of xanax but I also take an antidepressant. Every nurse I know is either doing the same or has the symptoms without treatment. I was wondering how common indeed it was world wide? Is our profession making us have to be medicated?

[leslie :-D]

and yes, there are those psychiatrists that overprescribe, the candyman.

totally inappropriate meds/dosages.

but one needs to experiment with diff meds before they find a good fit. and yes, we're talking about people whose lives have been debilitated to the extent that running around the block just will not suffice.

the right meds along with therapy is the answer for many many people.

[LindaMarie76]

I am the poster child for Zoloft.

I have had depression and panic attacks intermittently since my teens. I was on and off meds because I hated the stima associated with taking the meds. Last year I miscarried and almost lost my father within 3 weeks of each other. I started to spiral down and a friend finally told me "you need professional help". I started seeing an excellent psychologist but it was my headache specialist who finally convinced me to try a SSRI. This is what I have learned.

Luvox = SSRI; great for increased concentration - helps to focus

Wellbutrin = FANTASTIC anti-depressant; caused me to lose a lot of weight (which of course reinforced my happiness); HOWEVER - caused panic attacks and hypertension

Zoloft = the best thing since sliced bread. Great for depression, great for panic attacks, great in preventing recurrent thinking, helps me to complete a full sleep cycle, great for weight gain :uhoh21: , great for loss of libido

I work night shift. Those of us who try and sleep during the day often are not able to obtain the quality of sleep needed to replenish our neurotransmitters and such. As a result, we often suffer from lack of quality sleep which causes a decrease in our production of endorphins and serotonin. This causes our minds to fragment (have 10 thoughts going on at once, which is of course, a normal part of our profession) and leads to increaed headaches.

The Zoloft has truly been a Godsend. I no longer fear negative responses and proudly tell others how it has helped my life. As a result, many of my colleagues have started going to their doctors to obtain prescriptions.

:balloons: Linda

I am considering taking Zoloft because most of the nurses I know have had excellent results from it..and I need something to help! Alas...lol, my PCP is also who I am trying like crazy to work for...nice huh...so I do tend to fear being on an antidepressant precribed by him and trying to work for him..LOL! But oh well...may have to give that pipe dream up huh? LOL!!!!!!

My hubby says if I don't get an antidepressant, he will divorse me (he is kidding to a point...). So guess it is time! LOL!!!!!!!

[medpsychRN]

It's unfortunate that mental illness still carries the stigma that there must be something wrong with the individual. There is enough physiologic evidence which points to a chemical imbalance regardless of the diagnosis. I wonder, for those who suffer with MI, which came first the illness or the problem. With ongoing genetic studies, I believe we may soon have an answer.

Evaluating the efficiency of medications based solely upon the MR or DD population is fruitless. Medications have proven invaluable to those with other diagnoses allowing them to function in society.

Psychotrophic meds are not perfect. There is no rhyme or reason why one works and another doesn't. It is trial and error with often small adjustments.

I once had the opportunity to spend a day with a women here in the states on a sabbatical from Israel. She worked with holocaust survivers. I wondered about the number of survivers who suffered from MI, the survivers who had no evidence of MI and of course why some did have symptoms and some didn't. Her answer? Survivers with symptoms of MI, probably had the illness before entering the camps and genetics.

[lsyorke, RN]

"There is enough physiologic evidence which points to a chemical imbalance regardless of the diagnosis"

Just curious, where did you find the physiologic evidence?? Through my research it's all just theory. I don't deny the presence of mental illness. I do have a problem with solving everything that makes us sad with a pill. Therapy isn't a quick fix, but it's a permanent one for the situational depression/anxiety that we are currently treating with drugs. If your depressed because your work schedule alters your mind so bad that your depressed it's time to look for another job. If you've lost a loved one allow the grieving process to occur and resolve over time. These drugs are being handed out like Skittles for anything from depression to headaches. Only time will tell what the long term effects of ssri's will be.You can't alter neurotransmitters in a "normal" brain and expect it to remain normal. We're only seeing the tip of the iceberg now.

[happthearts]

I know for a fact Prozac was the drug Most nurses took when I worked in mental health 3 years ago or so .Takeing meds to deal in Utah is a way of life here.

I personally just deal with my problems . Somedays better than others

[leslie :-D]

there is a difference between situational sadness and full-fledged depression.

the former, one does have control over; the latter, i disagree. i think antidepressants combined with therapy are the appropriate resolutions.

of course antidepressants are not a quick fix- there are so many factors involved in deciding whether they would be an appropriate intervention. but when someone experiences anhedonia- apathy, unmotivated, changes in eating/sleep patterns, affecting relationships over a period of time, then i find it safe to say that it's more than sadness. sadness one does or can have control over; depression, one doesn't.

and with so many imbalances in our bodies, why wouldn't a chemical imbalance sound rational or feasible?

leslie

[medpsychRN]

"Most depression has something to do with the physiology of the brain. It's not all psychological or attitudinal," said Dr. Patrick McGrath, of the New York State Psychiatric Institute.

McGrath says he got the proof of this theory through PET scans. A PET scan is a type of medical technology that show the relative activity of various parts of the brain.

For the first time, doctors at the New York State Psychiatric Institute have been able to demonstrate a significant difference between the brains of depressed people and those who are not.

When scans from numerous depressed patients are computer averaged, it's clear that certain brain areas are dramatically less active than in brains of non-depressed controls.

Sonoma State University

Department of Biology - Hanes

Neurophysiology

Anxiety Disorders = the inappropriate expression of fear. Biological Basis

Stressors are normal and normally handled by experience and learning. Anxious people have stressors at the wrong time or place.

The Stress Response - The hypothalamic-pituitary-adrenal (HPA) axis

Avoidance behavior

Increased vigilance and arousal

Activation of Sympathetic Nervous System

Increase cortisol release.

Increased cortisol release is controlled by a part of the hypothalamus -> ACTH releasing hormone -> ACTH from anterior pituitary -> Cortisol from adrenal cortex.

The hypothalamus is controlled by the Amygdala and Hippocampus

The central nucleus of the amygdala is responsible for the stress response. The basolateral nucleus of the amygdala gathers information from sensory areas and projects to the central nucleus.

Hippocampal activity suppresses CRH. The hippocampus contains cortisol receptors and normally regulates this hormone. Prolonged stress and high cortisol levels can cause these cells in the hippocampus to wither and die. Imaging shows decreased activity of this area in people with post-traumatic stress syndrome and hyperactive prefrontal cortex.

Treatments for Anxiety Disorders

Psychotherapy sometimes works. Therapist tries to lessen fears by slowly introducing the fear stimulant and making the stimulant appear harmless - as in phobia of airplane travel.

Anxiolytic Medications

Benzodiazipines (Classified as hypnotics and sedatives these chemicals target mostly CNS GABAA receptors which are direct and fast acting Cl- gates causing inhibition in cells. The benzodiazipines potentiate the effects of GABA and do not work without GABA present.) (Includes Valium, Xanax, Librium, Halcion). Their effects are, in many ways, similar to Alcohol. Alcohol acts in the same way and this may account for the common use of alcohol. It is believed, but not proven that Diazipines are substituting for a natural modulating chemical that is unknown. Results are swift.

PET scans show a deficit number of GABA receptors in people with panic disorders. Fig 21.7.

Serotonin-selective reuptake inhibitors (SSRIs) as (Prozac). Serotonin is a modulatory neurotransmitter diffusely found in the brain. Serotonin works on a G-protein-coupled receptor and the SSRIs block reuptake of serotonin, thus making it more influential. It requires weeks to get a useful response to SSRIs therapy. The increase in brain serotonin is immediate - so it is thought that the therapy comes from a brain adaptation to increases of serotonin. One of the effects that correlates with therapy is the reduction of CRH receptors. CRH is a neurotransmitter in the amygdala and injecting it in this area causes stress response and anxiety.

This is just a quick copy and paste from the web. Obviously, it can go on and on.

All individuals feel sadness. Antidepressants are not meant as a solution to sadness. I don't know when and how people are taught that if they feel depressed it must be for a reason and if they can identify the reason they'll have a solution. Right or wrong, people compare their lives to others and usually tell themselves their problems are not that bad. And when people look at depressed individuals, typically the thought is the depressed person's life could be worse. Sometimes people don't know why they feel depressed or anxious. They just do.

There is a theory that depression has what they call a kindling effect. This means each subsequent bout of depression worsens. This supports treating depression early as untreated depression can lead to a refractory condition.

I don't advocate GP's write scripts for antidepressants. If your depressed, see a psychiatrist.

As far as therapy being a permanent solution, having experience being on both sides of the desk, it's a useful adjunct, necessary for diagnostics but falls way short of the mark as a permanent solution for depression. Please tell me which therapy model does provide a permanent solution as I would be interested in reading about it and incorporating it.

[totallytheresa]

I'm so glad to see this thread. I started on Prozac 10mg maybe 2 months ago, upped it to 20mg a couple weeks ago. I started on it because some days, I would just snap, had no patience at all, etc.... And it seemed to mostly center around my period, so my Dr thought that would possibly help even me out. I don't think it is though... some days, I think it is helping, others, I really don't. I know I have a lot on plate in my life (raising 3 kids alone, 3rd semester nsg school, freezing cold upstate NY weather! etc..), but I wonder if there is a better alternative out there? Plus, my jaw is pretty sore since I started taking it. I know I need to chat with my Dr about this, but I wondered if anyone here could share any tips? Thanks ( hope I didn't hijack the thread too badly)

[teeituptom, BSN, RN]

I dont take meds

I just eat well, exercise regularly

AND PLAY A LOT OF GOLF

with that who needs drugs

keep it in the short grass

[lsyorke, RN]

"The Stress Response - The hypothalamic-pituitary-adrenal (HPA) axis

Avoidance behavior

Increased vigilance and arousal

Activation of Sympathetic Nervous System

Increase cortisol release.

Increased cortisol release is controlled by a part of the hypothalamus -> ACTH releasing hormone -> ACTH from anterior pituitary -> Cortisol from adrenal cortex.

The hypothalamus is controlled by the Amygdala and Hippocampus

The central nucleus of the amygdala is responsible for the stress response. The basolateral nucleus of the amygdala gathers information from sensory areas and projects to the central nucleus."

Use of ssri's also show a drastic increased in cortisol levels. Hence the wait gain! So according to this research we are identifying the problem as a series of biochemical events that cause in increase in cortisol levels which then trigger the depression. The treatment causes the same series of events! Doesn't make sense! Pet scans of those on ssri's and accutane(another serotonin altering drug) show distinct areas of deterioration in brain function.

I'm not saying that pathological depression doesn't exist. It absolutely does and can be debilitating! Where I have the problem is when I hear of people jumping to the ssri's because there "Going to get you over the hump" of a situational depression with a specific cause, ie, grief,bad job,bad husband,not enough sleep, bad diet, etc... When did we as a society become so reliant on drugs instead of taking a look at our lives and changing what is causing the problem?

[peaceful]

"The Stress Response - The hypothalamic-pituitary-adrenal (HPA) axis

Avoidance behavior

Increased vigilance and arousal

Activation of Sympathetic Nervous System

Increase cortisol release.

Increased cortisol release is controlled by a part of the hypothalamus -> ACTH releasing hormone -> ACTH from anterior pituitary -> Cortisol from adrenal cortex.

The hypothalamus is controlled by the Amygdala and Hippocampus

The central nucleus of the amygdala is responsible for the stress response. The basolateral nucleus of the amygdala gathers information from sensory areas and projects to the central nucleus."

Use of ssri's also show a drastic increased in cortisol levels. Hence the wait gain! So according to this research we are identifying the problem as a series of biochemical events that cause in increase in cortisol levels which then trigger the depression. The treatment causes the same series of events! Doesn't make sense! Pet scans of those on ssri's and accutane(another serotonin altering drug) show distinct areas of deterioration in brain function.

I'm not saying that pathological depression doesn't exist. It absolutely does and can be debilitating! Where I have the problem is when I hear of people jumping to the ssri's because there "Going to get you over the hump" of a situational depression with a specific cause, ie, grief,bad job,bad husband,not enough sleep, bad diet, etc... When did we as a society become so reliant on drugs instead of taking a look at our lives and changing what is causing the problem?

Isoyorke,

Your post was thought provoking. Good reminder of the stress response. I agree situational depression should not neccesarily be treated with SSRIs. Serious ongoing depression not responding to therapy should and can be treated with medicine.

[leslie :-D]

i too, just read an in-depth article of the actions of ssri's.

to simplify and summarize:

ssri's (serotonin) increase the corticotrophin releasing factor (crf);

-activates adrenocorticotrophic hormone (acth) which then increases cortisol levels.

these increased cortisol levels are what give us the boost of energy and sense of well being.

but evidentally the constant increases of crf, acth and cortisol cause the down regulation of glucocorticoid receptors, causing a resistance which inevitably lead to depressive symptoms.

this may answer on why ssri's seem to be so short-lived for many.

it appears that you can be taking paxil, prozac, zoloft and all of a sudden it stops working.

it has certainly happened with me when i was on paxil and prozac.

but the reason ssri's were so popular is because they had the least se's.

knowing the mechanisms of antidepressants will hopefully lead to newer, more effective ones with few se's and long lasting positive results.

depending on the level of depression, if you can manage w/o the meds, good for you.

i happen to strongly believe there are those with chemical imbalances.

but depression can be a paralyzing disorder and these are the people that need the meds and therapy and the compassion from their loved ones.

leslie

and there should be no shame in that.