I can see the headlines now…

“Housewife wacks husband. Claims prozac made her do it. Details at 6.”

Now there was a time when a certain subset of people claimed that they felt a little more murderous while on prozac. I noticed this when I was working with a group of VietNam veterans that had PTSD (post traumatic stress disorder). Interestingly enough, every one that I worked with who had had this “feeling”, took personal responsibility for it, stopped the medication and reported how they felt so we could list it as an adverse effect to help insure that they would never get this medication again.

No lawsuits. No headlines. Just action.

THEY EACH took responsibility for how they felt and made a change. They did not use it as an excuse to go out and wack someone – then blame the medication for the action. Heck they COULD have – as they were some of the most highly trained killers our society produced for warfare.

However these ‘killers’ grew up in an era of conscience, social awareness and patriotism. They had good role models, heroes of substance, values and a strong value system. They knew what respect, responsibility and commitment were. And most were brought up with an understanding and fear of God.

They were not homocidal maniacs.

So when the medications made them feel a way the did not want to feel, they each took personal responsibility for how they felt and choose to not feel that way…and they stopped taking it immediately.

Now society has changed. The whole idea of taking responsibility for your actions…well that is NOT the theme of the day.

So with the new ruling of the FDA that drug packaging must include a warning that it can make you suicidal – where is that going? Or should I say, “Are lawyers going to have a fiasco with that?”

Let’s set the record straight.

For YEARS psychiatrists have known that when a person starts to get better, starts to respond to the antidepressant, there is a chance for increase in suicidal behavior IF they were having suicidal thoughts before they were placed on medications.

Why?

Many persons who suffer from depression have no energy. Lack of energy is one of the vegetative symptoms of depression. So as the pill starts to work, you can expect your energy levels to increase. Now IF you haven’t changed your thought processes, are still hell bent on self-destruction, you now have the energy to potentially do yourself in.

Again, nothing new. I learned this 20 years ago.

What has changed has been the role of the psychiatrist and the value systems of society at large.

Because of managed care, many are being relegated to the role of pill pushers, and not doing any therapy because managed care doesn’t compensate them to do so – they cannot make their business work if they did therapy…and many of us love to do therapy. Therapy is being ‘delegated’ to therapists of varying degrees of compentency. MANY times it takes several weeks if not months for someone to get into see a therapist. That gap could prove to be a big problem.

Now with teens and kids (children and adolescents), you can schedule weekly followups when initating medications (if your schedule allows) OR put them in the hospital if they are suicidally depressed. But managed care will dictated how long they can be hospitalized. Eventually they have to be released.

And hopefully a treatment liason will have been made where they will self disclose what they are feeling, and contract against self harm. Many kids do not tell you what they are feeling right off. They may hide that they are having thought of killing themselves by either not telling you, or lying to you when you ask the question point blank.

Now enter the treatment…a medication that can help them get better. And if their issue is low self-esteem, some catastrophic loss or inappropriate guilt, the chances for acting out negatively increases…especially if they have not dealt with the underlying issue or make a treatment liason.

There are some people who are just hell bent on self-destruction. NOTHING helps them because they choose to not be helped. Or better yet, they choose the conditions on which they will get better and accept help; conditions that are usually quite unrealistic.

Many times these same people never sought any sort of treatment. So when they take their life in the middle of a corn field with a handgun while under the influence of Jack Black or drown themselves in a lake, who do you point the finger at?

There is a saying that goes, “You can’t rape the willing.” You also can’t help someone who doesn’t want to be helped. It is clear that antidepressants have their place. There are MILLIONS of people who will validate this.
(Sorry Tom…you are so misguided)

So again my question is…”Why the warning?”

Maybe it was to alert the lawyers. Who knows…

I’ll still take a prozac with my mornin’ coffee, thank you very much.

cheryl
aka Dr. J
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