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Listening to Readers on Prozac, Depression & the Medical System: Part II

Mark Gorkin, LICSW

DEAR DOC,

THIS IS MY THIRD LETTER TO YOU ABOUT VARIOUS SUBJECTS AND YOU HAVE HELPED ME SO MUCH. YOU ARE MY GROUP, MY ALANON MEETING AND MY OUTLET.

UNLESS I MISSED SOMETHING IN YOUR NEWSLETTER IT SEEMS TO ME IF PROZAC OR ZOLOFT[MINE] WERE AROUND YEARS AGO THERE WOULD BE FEWER ALCOHOLICS. THEN THERE WOULD NOT BE THIS MIXING. I FEEL MOST PEOPLE WHO STARTED TO DRINK, ESPECIALLY HEAVY ARE IN REALITY DEPRESSED. WHAT ARE YOUR THOUGHTS, IF YOU FIND THE TIME? SHEILA

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Hi Sheila,

I definitely agree. Unfortunately, if someone is abusing alcohol and is addicted to some degree, first the individual needs to withdraw from the alcohol. They have habituated to a poison in the system. Once detoxed, and in alcohol treatment, then I would start the antidepressant meds trial.

If not addicted to alcohol, then hopefully the meds could treat the depression for which people are self-medicating through alcohol. But let's not think antidepressant meds will automatically or alone cure a well-established pattern of drinking. But I also agree, earlier appropriate treatment for depression will likely reduce later problem drinking.

But you raise an important point. Thanks much. And thanks for the kind words.

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Mark, Beautifully done with lots of care. For those of us in 12 step programs, you might add:

"Rule 13 for drunks, addicts, etc. Talk over any strategy involving meds with your sponsor, and be sure your doctor knows about your alcoholism/addiction. Make sure the doctor or therapist has read at least chapter 2 of the big book of AA. "

We could argue about whether AA or the like is a "station on the journey of life," or a different way of living, but that would belie the intent of your suggestions.

Best regards,
David G

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Dear David, Thanks so much for your very thoughtful and touching note. And I especially appreciate the sensitive way you note a possible difference. I agree, it certainly can be seen as a different (and richer) way of living.

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Very thought -provoking. ABC Nightly News ran a cogent story tonight (1/6) re: employers' rights to employees' personal computer time while on the job, and segued nicely into the ease with which employers can access the data-bases from their paid-for insurance companies w/ regard to (previously thought to be private medical info of their employees, including anything authorized by that company: any/all prescribed meds and reasons for them, psychiatric referrals + reasons, number of doctor/specialist visits, potentially chronic conditions, etc., which might be of use to the employer to determine Hire / Fire status or promotability of any employee. Is it any wonder that people hide from that Big-Brotherism to keep the wolf from the door? I know that I personally will abstain from seeking help from anyone who keeps records that might be used as an eventual weapon to destroy me /mine. It is rapidly becoming a marketplace where only those who can afford to pay cash upfront will be able to buy and keep their own records, and the older we get the thicker the dossier. Michelle

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I thought these were superb articles. Having been in and out of recurrent major depression for the last five years, and having read very extensively on the subject, I thought your articles caught all of the salient issues. Your personal experience has obviously added to your total sensitivity to the many issues involved.

I'm currently on 3 antidepressants! Pamelor (the old tricyclic), Zoloft and Celexa, along with a small dose of Klonopin. The doc that told you Zoloft and Prozac are alike was INCORRECT. In my case, Prozac worked superbly on the depression - more effectively than anything else (and I've tried almost all of them). However, it gives me a very painful arthralgia of the joints! Wierd. Every time I would take a step, I would get horrible shooting pains in my ankles, knees, etc. Wish it wasn't so. It was so effective on the depression.

I ended up on this concoction after extensive trials, under supervision of a psychiatrist. It really is trial and error. And the meds were never a total solution for me. I've had too many situational factors playing a partial role.

As a former medical group business manager, I can tell you that managed care would like to eliminate psychiatry altogether. As you know, psychologists have been seeking prescription rights (which is WRONG). I think MC wants the family doctor to medicate and to use counselors as an adjunct and eliminate the psychs.

Also, you're right on about "come back in a month, or three months." My own physician is excellent and never did this, but I have seen severely depressed people be given medication and told to return at some distant date. In one case the patient lived alone. This invites a fatal outcome, if you ask me. The meds will not work for weeks, and it's just denying any care at all for the person in the meantime.

I'm glad you mentioned that depression can be a fatal illness. All doctors should know this. However, I have found a very real bias among general physicians against shrinks. To put it frankly, they largely consider them to be quacks. I have heard these discussions myself - I'm not just guessing here. What a sad situation. Medical professionals think that if you can't "prove" an illness by a definitive lab test result, oran mri, or some form of concrete evidence that it largely doesn't exist.

In many cases, general docs are as ignorant of mental disorders as the general public. When I became depressed, the docs I worked for had me audited and then fired me. I had worked for them for fifteen years. Nothing was found to be wrong in the audit - they just don't want you around with a psych diagnosis. As I believe I've told you in the past, a physician in the group and another manager also had to leave with major depression. They never considered that the workplace they had created had a part in all that mess.

You are also right on about the patient's feelings about the illness - I couldn't understand why I couldn't cope this time - after all, I had been able to adjust and cope all my life. What had changed? I suspect that you're right - the body compensates somehow for many years and then with age and wear/tear - the system breaks down somehow and decompensation occurs.

I am still somewhat troubled by taking medication. At one time I was taking twelve psych drug pills a day. I feel pretty decent most of the time - but I am not "Me" as I was before. I sense a blunting of emotion and a most striking loss of the sense of urgency. Kind of a "I don't really care attitude." Hard to tell if that's medication, or lingering depression. It's hard to define the changes on medication. They are very subtle.

When I try to go off, I end up sobbing all the time. That could be withdrawal from the drug, rather than depression. How complex and difficult to decipher.

Also, I work in great spurts of energy - don't sleep but every other day. Then I'm comatose for a day. Yet I don't want to regulate this. Somehow I like it. When I get into my work, I want to roll forever. It's a sense of, "I better take advantage of this feeling before it's gone." (Maybe I'm bipolar after all?)

Enough of this prattle. I wanted to commend you for the accuracy, depth and breadth of the issues you touched upon. Very sharp and very current and full recognition of current financial and social issues as well.

I've been expecting deaths from the indiscriminate pushing of drugs over the Internet, haven't you. It was a disaster waiting to happen - why was it not prohibited?! Reprehensible - make a buck and never mind if you kill someone.

Isn't there a level on which you like all your own quirks? Sure, they get in the way sometimes, but they make you who you are. I know I'm not fully willing to give up all of mine. They're familiar - and they're MINE/ME. On the other hand, I don't want to cry night and day either. Oh, boy! It's difficult.

Keep up the superb work! It will help many people!! T.

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Re: Newsletter JAN 2000. No. 1, Sect. 2 I must be moderately depressed. (1) I get teed off and at age 79 strain to keep up no metter what. (2) I get EXHAUSTED trying constantly to understand this world with a mental IQ of zero. (3) I wildly enjoy my escapes to eating, tv watching, and playing computer games. (4) I told my doctor to take his anti depressants and stick them where the sun doesn't shine. (5) WOW!!!~ I KNOW that my edge is gone. (6) I "treat" myself since I have a minor in clinical psychology. Who wants a psychiatrist messing up your psche? (7) See item #6. (8) Slow sex drive. How about no sex drive? (9) I am not moved to tears but I am concerned about my love for the violence in WW II movies. (10) The miles have mounted. My back is gone. Every body joint is arthritic - arteries are hardening - and I need to trade my "car" in on a new one. (11) I am a real old dog. I simply fail to recognize the new tricks to learn. (12) Nuts - I have wasted our time. I forgot that you were trying to assist me with information related to Prozac, etc. - thus my memory is gone. MARK, you have written a fine newsletter. I am just letting you know that I have read and appreciate the content. Thanks for keeping me on your mailing list. Andy

(Thanks Andy. Your feisty attitude and capacity for absurdity, self-effacing (and skewering) humor make you our poster boy to inspire us to....Practice Safe Stress!

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