Patients Sarah

I don t want to go on medication my patient Sarah said to me, ah most in tears. I ve seen what it s done to my mother. She went on antidepressants ten years ago, and it s always the same—they work great for a few months, then they don t, and then she s worse. Then the doctor puts her on some new medication, and the whole thing starts all over again. ... 

Sackeim et al. (2007) also failed to address the real-life impact of these losses on individual patients and did not provide any clinical vignettes. Stating that shock treatment permanently reduces memory and cognitive function, and describing it statistically, failed to capture the manner in which the treatment destroyed the minds of these patients and wrecked their lives. That is why I opened the chapter with the story of Sarah Williams. 

Sarah was unusual among my patients, many of whom come to me eager for the antidepressants about which they ve heard so much. Both physicians and psychiatrists have come to view such medications as Paxil, Zoloft, and Wellbutrin as true wonder drugs, medicines that have succeeded where traditional talk therapy and other approaches have failed. Even Prozac, despite the rash of bad publicity that it got for a while, continues to enjoy a reputation as a cure-all for anxiety and depression. 

But Sarah s mother s predicament—a long-term reliance on medications that often work best only in the short term—is all too common, even if these more mundane problems of antidepressants don t get the public attention of the notorious suicides and psychotic episodes that were associated with Prozac in the early 1990s. Although I do prescribe antidepressants to my patients who need them, I also feel concerned about what I see as the overreliance on medication among psychiatrists, primary-care doctors, and other health professionals. For some people, antidepressants may indeed be a kind of wonder drug, balancing their... 

Sarah s mother had also experienced the opposite problem—becoming more angry or agitated while on medications. Because of her mother s experience, Sarah was particularly anxious about recent newspaper accounts of people acting impulsively, behaving out of character, or even becoming suicidal while on antidepressants. There s still a lot of controversy over these reports, but I personally believe that some people, at least, are at risk for increased stimulation or overactivation, particularly if there is a family history of bipolar illness or if the patient is prone to mood cycle or irritability. 

Sarah had observed this very phenomenon with her mother. Like so many patients who are given medications with no nutritional or lifestyle support, Sarah s mother had gotten into a downward spiral in which med-... 

Ward dynamics can increase tension, e.g. taunting by another patient. Here, you might help by mediating between Sarah and the other patient, or ensuring staff are alert to the problem... 

---