Knowledge is the Best Prescription for Antidepressant Success

AntidepressantsFayPsych Staff

Antidepressants are now the second-most-prescribed drug in the United States, to the tune of about $10 billion dollars each year, and more and more Americans are turning to their primary care physicians to prescribe antidepressant medication. According to an article recently published in the journal Health Affairs¹, seven percent of all visits to a primary care doctor now involve the doctor prescribing an antidepressant for the patient during their visit – an increase of 3 percent over 1997 figures.

Since roughly 15 million Americans² are affected by depression each year, it is heartening that so many more of those individuals who are suffering from depression are seeking treatment. But there are dangers to these increases in the prescribing of antidepressants: the glut of advertising aimed at American consumers promising a “quick-fix” for depression has left many people confused about exactly what they can expect from these drugs, when they can expect it, and how these drugs differ from other medications the public is accustomed to taking. This confusion can lead patients who try antidepressants to “give up” on antidepressant therapy when they experience minor side effects or don’t experience immediate relief “like the woman in the t.v. commercial.” It is a terrible thing to see patients who might be greatly benefited by these drugs walk away from them when just a little education could make all the difference.

When properly prescribed and monitored, the right antidepressant can absolutely work wonders to help alleviate the debilitating symptoms of depression for many people. From patients who have struggled for years with chronic depression, to those who are coping with a more isolated bout of clinical depression, many people can benefit significantly from the use of these amazing drugs. When combined with talk therapy, these drugs have been shown to be even more effective and provide even longer-lasting relief from depression symptoms.

However, these medications can, and sometimes do, have side effects that patients should be aware of and that should be monitored. It’s also important for patients to know that it is sometimes necessary to try more than one antidepressant before the “right” one is found to achieve maximum symptom relief and that there is no one-size-fits-all medication that works for everyone. Knowing that there is more to antidepressants than what is portrayed in pharmaceutical company ads is very important in order to get the full benefit of what these drugs have to offer.

Important things you should know about antidepressants:

• When you visit your doctor to discuss an antidepressant prescription, be as open and honest about your depression symptoms (as well as your other health conditions) as possible. The more information your doctor has, the better job he or she can do of matching your symptoms with the right medication. And don’t be afraid to ask questions – the more informed you are about your depression and about the medication your doctor prescribes, the better.

 • ALL drugs, including antidepressants, have side effects. Talk with your doctor and/or pharmacist about possible side effects and drug interactions that might affect you when taking the antidepressant. Most patients find these side effects to be minor and that they go away over time. If you find you experience side effects that are worrisome, contact your doctor for assistance, but again, remember all drugs have side effects.

• Most antidepressant medications TAKE TIME TO BEGIN WORKING. Sometimes it takes weeks before a patient begins feeling any positive effect from the medication and they may be tempted to stop taking the medication because “it’s not doing anything.” If you have not achieved the symptom relief that you and your doctor discussed within the expected timeframe, contact your doctor to talk about your options. There may be other medications that will work better for you, or, your physician may feel a dosage change to your current medication may be appropriate.

 • Each person reacts differently to antidepressant medication. So, if your sister felt better taking Drug X in a week, it does not necessarily guarantee you will react the same way if your doctor prescribes Drug X for you. That doesn’t mean that Drug X may not ultimately work well for you, it means it may just take a little longer to work for you than it did for your sister.

• It is very important that you communicate with your doctor about your symptoms and how you are reacting to your antidepressant medication for the antidepressant treatment to be successful. Just going to your doctor for the initial appointment to get a prescription isn’t enough – you must talk to him or her about any side effects that you experience, or if your depression symptoms are not improving, as well as any other concerns you may have. And don’t give up on your antidepressant without talking to your doctor first. This is the most common mistake we see patients make in regard to antidepressants.

• If you try an antidepressant and it “doesn’t help,” don’t assume antidepressants aren’t right for you. Your doctor may need to work with you to find the right antidepressant for you (there are a number of choices available), or, he or she may need to work with you on adjusting the dosage of your current medication until you achieve better results.

• The combination of talk therapy and antidepressants has been shown to be very effective in treating depression³. Talk with your doctor or psychiatrist about adding talk therapy to your antidepressant therapy for further, longer-lasting symptom relief. Studies4 have also shown that patients treated with talk therapy and antidepressant therapy were more likely to avoid relapse of their symptoms than those who were treated with antidepressants alone. Your doctor or psychiatrist can refer you to a qualified psychotherapist who can help you better understand the issues that are at the root of your depression and help you learn skills and strategies to better cope with the difficulties you encounter in your life.

• Not everyone needs an antidepressant. Just because television commercials have popularized the use of antidepressant drugs doesn’t mean that they are the right choice for everyone. Only you and your doctor can determine if they are an appropriate choice for you. Many patients choose to pursue talk therapy alone to successfully alleviate their depressive symptoms.

We believe strongly that antidepressants are a very beneficial tool for many patients, and our clinic works closely with local physicians and psychiatrists to coordinate the care of patients taking antidepressants. Our goal is to assure that each patient has the most satisfactory outcome possible from the use of antidepressant drugs. Most psychologists and psychotherapists will provide a similar service for their patients – if yours will not do so, find a new therapist that will help coordinate your care, as clinical feedback from your therapist to your physician can be invaluable in identifying the right medication and dosing levels for you.

Antidepressants are by no means a “silver bullet,” but they are powerful tools that have helped many people suffering from depression find relief from their symptoms when used correctly in the hands of patients educated in their use.

¹ Proportion of Antidepressants Prescribed Without A Psychiatric Diagnosis is growing, Health Affairs Vol. 30 No. 8 August 2011

² National Institutes of Mental Health

³ National Institutes of Mental Health, Publication No. 11-3561

4 Interpersonal Psychotherapy for Depression: A Meta-Analysis, Am J Psychiatry, Mar 1, 2011 168: A50

Copyright © 2011 Fayetteville Psychotherapy Associates, PLC

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Apologetic Parenting – Why It’s the Kids Who Are Sorry

FayPsych Staff Fayetteville Psychotherapy Associates, PLC

I was standing on the cookie and cracker aisle of the local supermarket the other day, when I witnessed the most amazing transaction between a young boy and his mother.  The boy, who appeared to be about four or so, announced in a loud voice that he wanted “COOKIES!” as he snatched a box of chocolate chip cookies from a low shelf where the store had cleverly placed them.  His mother, who was following along behind him with her shopping cart, promptly parked her cart. A very lop-sided power struggle then began between the boy and his mother right there among the saltines and the vanilla wafers.

Mom: Now sweetie, I’m really sorry, but we can’t have any cookies today.

Boy: But I want cookies.

Mom: You know you’ve already had sweets today at grandma’s, Nathan, so we have to put the cookies back. 

Boy: (clutching the box of cookies tighter)  NO!  I want these cookies! 

Mom: No sweetie, you really have to put the cookies back now – I’m really sorry.

Boy: (teary) NO!!! I hate you!  I want cookies!

Mom: Nathan, that’s not a nice thing to say about Mommy.  We don’t use words like that.  Now, please put the cookies back.

Boy: No, no, no! You’re stupid!

Mom: Please, Nathan, I’m sorry, but it’s time to put the cookies back now…

Boy: (screeching) No mommy! No! I told you!

And with that, little Nathan and his box of cookies dashed off down the aisle and disappeared around the corner.  His mom ran after him and I heard screaming and crying a few aisles away.  I continued my shopping, but saw them again in line at the checkout.  Nathan was red-faced,  his mom looked harried and the box of cookies was on top of the other groceries in their shopping cart.  To the victor go the spoils – and it was clear who had been the victor in the cookie battle.

What was particularly interesting about how the whole cookie transaction played out is that Nathan’s mom is not a poor communicator or a poor negotiator.  I recognized her from our local bank where she holds a fairly powerful position in which she regularly conducts intense negotiations for the commercial loan department.  Despite her business skills, she began their little interaction with an incredibly weak move – an apology.  I highly doubt she would ever do this in a business context.  Her pleading, over-explaining and continued apologizing gave her four-year-old son the upper hand throughout the entire interaction.  She started weak and it was downhill from there.

What I witnessed at the grocery store is played out time and again all over this country – apologetic parenting.  Rather than approaching our children confidently and establishing appropriate boundaries, knowing that we are acting in their best interests, we feel we need to apologize for doing our jobs as parents.  When we come at our kids from this sheepish, half-hearted approach, they begin to discover from a very young age that we are gutless and unenthusiastic about enforcing the rules, discipline, and boundaries that they need to learn in order to become happy and successful members of our society.  They begin to react like Nathan – begging us to restrain them.  Why do we parent this way?   Perhaps we feel guilty because we are working parents, or we feel our parents were too harsh with us; whatever the reason for our hesitance, we are creating a whole lot of little Nathans with our apologetic approach to parenting.

I felt for Nathan’s mom.  The scene at the grocery store had to have been embarrassing for her.  She still had on her name tag from the bank and I’m sure she had had a long day at work before the battle with her son began. But more than this, I felt sad fearing for her for what the future held if she does not come to grips with her parenting of Nathan.  Today the battle was over a box of cookies, but in the future, the struggles would progress to much more important things, and she will have far less power over Nathan at that point.  At four, he had already figured out how to best her – what would he be like at twelve? At sixteen?

I also felt for Nathan.  Nathan needed his mom to tell him “No” – to REALLY tell him NO.  He needed to hear, see and feel that his world had limits and that his mom was willing to enforce them.   Having such boundaries makes children feel safe and secure.  From the little glimpse I got, Nathan was living in a world in which he was calling the shots – a wild west with few clear boundaries. 

What Nathan wanted much more than cookies was to know that he was loved and for his mom to show him – clearly and without apology, how far he could go with his four-year-old power and what role she, and by extension, other adults would play in establishing the limits on his power.  These are the boundaries and limits every child wants.  Nathan could then use that information in his dealings outside his relationship with his mother – with his grandmother, at school, and at church; and this knowledge would help him to behave appropriately and to enjoy his relationships with others.  

A few key reasons why it’s so important for Nathan to learn about boundaries and limits now:

  • Without learning about these limits now, how would Nathan understand and follow his teacher’s request that he sit at his desk when he begins Kindergarten?
  • How will he understand how to make and keep friendships without knowing how to respect personal boundaries?  As it is, he is learning that if he perseveres, he can wear down his opponent.
  • How will he know how to respect other peoples’ property once he has more freedom to move about on his own?

So, it may be hard as a parent to say no to our children’s demands  and to limit their freedoms when we know they are going to protest (sometimes loudly).  We do not need to apologize for setting appropriate limits as parents – not ever.  We are making an investment in our children’s future ability to have healthy relationships and in their ability be a functioning part of our society.  It is through our tutelage that they learn these important lessons.  Sometimes, through our fear or reluctance to dissapoint our children we abdicate our role as teachers of these important lessons.  We instead choose to apologize for our roles as parents, which may reduce our anxiety in the short run and short-circuit some of the daily battles we have with our children.  But, in the long-run, we doom our children to lives of anxiety and chaos when we choose this path.  Nathan deserves better.  All children deserve better

Copyright © 2011 Fayetteville Psychotherapy Associates, PLC

Structuring Family Life Reaps Benefits for Everyone

Dr. Bill Spaine

Couples with children face many challenges. Balancing the needs of the couple (or the needs of a single parent), work, extended family, and other aspects of daily life can be stressful on both parents and children and may often lead to an overall sense of chaos in the home.

Patients often tell me that they feel overwhelmed from the minute they walk through the door at home. I often hear from them that their homelife feels like “controlled chaos.” Rather than enjoying their family, they just feel stressed. The idea of enforcing rules and setting boundaries can seem like just another burden at the end of a long work day. In reality, establishing a family structure is an investment in their children and in the peaceful coexistence of the family.

To help restore order, I suggest that my patients with children develop a consistent structure for daily life in the home. Research has shown over and over again that children need and want structure and consistency to feel safe and secure.

I suggest that parents start by developing a set of household rules that they will stick to and enforce consistently. Children are reassured by having boundaries within the family and within the home. They also benefit from what they learn about respecting rules and boundaries at home when they are in school or in other settings outside the home.

Here are some simple guidelines I give them to start with:

  • Give each child a set bedtime (and STICK TO IT!)
  • Set clear guidelines and limits for watching t.v. and playing video games as well as using cell phones
  • Each child should be given daily, age-appropriate responsibilities
  • Parents should establish regular age-appropriate chores for each child
  • Define expectations of how children are to treat one another, their parents and guests in the home
  • Establish age-appropriate consequences for each child if they fail to follow household rules.

While such rules may seem obvious, many of my patients find that they don’t really have much consistency in how their family life operates because they are so busy. When a family really establishes a structure and sticks to it, parents are amazed at the difference it makes in their stress level and the outlook their children have.

Copyright © 2011 William E. Spaine, Psy.D.

Family Rituals: Little Things Mean A Lot

Dr. Bill Spaine

In a family life busy with soccer games, business meetings and household responsibilities, many families find it difficult to connect with one another on a regular basis. In the rush to try and get everything done, many families feel like they’re missing out. Parents feel they aren’t really connecting with each other, or with their kids – they’re just going from one activity or responsibility to the next. Most parents see their kids for just a few hours a day, and they tell me those hours are a chaotic blur.

I urge parents to develop family rituals that will help them to connect with their kids in the the precious time that they do have to share each day. Having a strong sense of belonging to a stable and nurturing family provides children with the foundation they need to tackle the challenges they will face in the wider world.

Here are some of the simple rituals I suggest to parents:

Eating meals together as a family regularly.

Meals should include family discussions and time for kids to share their experiences with their family and talk to their parents. Meals should not include televisions or phone calls (by children OR parents). Putting the world “on hold” to share a meal together signals to the children that they, and the family, are important.

Bedtime rituals for younger children.

I suggest parents set up a regular process of preparing for bed that can include reading a story, prayers together, or any other quiet activity that allows parents contact with their children and helps the child “wind down” for sleep. Parents are amazed that when children get into the habit of following a bedtime ritual, getting them to sleep is easier, and they begin to look forward to bedtime as a time to connect with their parents.

Spending time with children individually.

In a busy household with more than one child, getting time alone with a parent means a great deal to children. Individual time allows the child to share his/her interests with the parent, and for the parent to share his/her interests with the child. One-on-one time between child and parent may even minimize the child’s sense of needing to compete with siblings for attention. Parents may be concerned about finding the time to spend individually with their kids, but building a strong connection helps other aspects of homelife go more smoothly – this is a time investment that will pay off now and in the years to come.

There are other family rituals parents can develop to help bring joy and security to family life. These can range from holiday and birthday traditions to weekly family rituals. They don’t need to be complicated and they don’t have to require a lot of work on the part of parents or kids to be successful. Rituals don’t even need to be serious. I know of a family that had a special Green Eggs and Ham breakfast every once in awhile in honor of their child’s love of Dr. Seuss books and as a way to share time with one another. This simple breakfast ritual not only brought the family together, but gave the child the sense that his interests were acknowledged.

Little things can mean a lot over time. Although their son is now grown, this family still laughs about those silly breakfasts, and the son is planning on continuing this tradition when he has children someday.

Copyright © 2011 William E. Spaine, Psy.D. (Excerpted from Pathways, Fayetteville Psychotherapy Associates’ Newsletter, 2007, Volume 1, Number 2)