Medics on Antidepressants

[fireflymedic]

This is a general question, not meant to be crass in anyway or offensive, but recently I have heard much discussion about my workplace about medics which are on antidepressants. They state due to the typical type A personality of our personnel and the nature of our job (we are extremely overworked and understaffed as is much of ems elsewhere) with a high run volume that many should be on some form of antidepressant to mellow them out and prevent burnout. I have mixed feelings on this, and while I feel it may be beneficial to some I think it is over rated. What are your thoughts or personal experiences on this? I am truly interested in the answers, if do not want to post, you may PM me and answers kept private.

[flight-lp]

All antidepressants, whether they be SSRI's, benzo's, or TCI's, have serious potential side effects that can alter an individuals judgment and capabilities. It is my personal belief that they should not be allowed when operating in an EMS capacity. To have management or any other employee even suggest it to "prolong" a "happy" medic, is just moronic. It sounds like maybe management should look at other options, perhaps attempting to create a better working environment would produce better results................................

There will be no "happy pill" takers on my ambulance unless they are a patient. 8)

[canuckEMT]

If there has been a diagnosis by their physician that requires them to be on antidepressants then fine. To promote the use of prophylactic antidepressants is just rediculous. Instead they should be promoting some kind of health and wellness policy and working towards reducing the stress load on their employees.

Burnout in a high volume area is quite common and so is the decrease in available staff unfortunately. It seems as well that this is going to become increasingly more relevant in the next few years as the retirements of the baby boomer's. I can see this problem becoming more and more prominent as staff has to work more and more overtime to make up for the shortages.

[WendyT]

There is a great antidepressant drug thats really amazing and the side effects are minimal.

Effexor XR

Prozax, paxil, and quite a few other ones I cant think on the top of my head, are ok and not everyone taking Prozac commits suicide or kills someone, it could be the dose, even the drug maynot be the right one for that person and the break down of serotonin in the brain--so they have to try a few and by that time they are so drugged/tired what can the person do. It takes about a month to actually see it working, so in that time frame what is the average paramedic supposed to do?

Ativan, even that drug alone can knock you off your feet, dont drive unless you plan on saving a life which it wont be yours.

[Eydawn]

I know plenty of individuals working in the healthcare field that have been on or are currently on antidepressants. Yes, some of the side effects can be tricky, but can be adequately managed in a fashion that does not alter one's judgment (especially if the individual prescribing it is careful to achieve the maximum possible benefit at the lowest dose). Might take a few tweakings to get there, however.

I believe that those in fire_911medic's workplace are very misinformed about antidepressants and how they work. They won't "prevent" burnout nor create "happy" medics. Antidepressants are a tool to be used in serious cases of depression that alter an individual's ability to function and think clearly. One of the hallmark signs of depression is that characteristic "fog", the inability to make decisions or evaluate the situation that one is in. Trust me, I'd rather have a medic who's actively confronting depression and cognizant of the fact that they *have* it (whether they're taking medication or not), than a medic who doesn't realize that their symptoms may be depression and may be affecting their ability to function. Being aware of it is half the battle.

I would beg to differ that it is better to have unmedicated *diagnosable* depression in the EMS field for fear of side effects from the medication. If the medication is used wisely, in conjunction with constructive therapy sessions, it can help the person cope and make their thinking much clearer. If the medication is misused, (aka aerial Prozac spray) then you have higher potential for side effects and altered thinking where it didn't exist before.

Also, I think people need to realize that there's a difference between your attention seeker "depressed" folks who eat prozac like M and M's, and those who suffer from serious clinical depression. Depression is an illness, just like any of the other things we treat on a daily basis. Mental illnesses are unique in that they have an organic component (altered brain chemistry or structure), and also a cognitive component (thinking patterns, life situations leading to the development of illnesses like depression).

To say that no medic with depression should be allowed to operate in EMS is discrimination. If they are unable to perform their job, then they shouldn't be allowed in the field. You can't say that just because I have asthma and weak joints that I should never be allowed in the field; as long as I'm able to cope with my problems and perform at the same level as anyone else, no one has the right to tell me where I should or should not be working. That goes for any kind of illness or disability, whether it be physical or mental.

If you're rampantly suicidal and/or can't make decisions, then yes, get off my ambulance and take some time off work. If you're coping with your depression and can function just as well as me or the next guy, why should it be anyone's business if you have depression or not?

Wendy

CO EMT-B

[flight-lp]

To say that no medic with depression should be allowed to operate in EMS is discrimination. If they are unable to perform their job, then they shouldn't be allowed in the field. You can't say that just because I have asthma and weak joints that I should never be allowed in the field; as long as I'm able to cope with my problems and perform at the same level as anyone else, no one has the right to tell me where I should or should not be working. That goes for any kind of illness or disability, whether it be physical or mental.

Wendy

CO EMT-B

No one said anything about the diagnosis, the medications are the aspect being discussed...............

And no it is not discimination. If a medication alters an individual, then restrictions can made to that individuals' duties. There are many jobs out there that prohibit antidepressant use and even some that bar employment based on the diagnosis alone. So, yes there are people and agencies out there that "has the right" to tell you "where you will or will not work".

Coping with a disease is one thing in EMS. Medication is another................

[Eydawn]

If there are places that bar employment based on a diagnosis of depression OR treatment of that illness then they are skating a very thin line. That's extremely illegal.

Note, I never said duties shouldn't be restricted if a medication did alter you... but that applies to pain relievers as well, doesn't it? Like common Vicodin for example... some extremely sensitive individuals shouldn't drive or operate machinery. If so, their duties must be changed. You can't fire someone for taking a prescription their doctor has given them for a specific condition. That's discrimination. Do these companies not hire or fire based on painkiller usage?

And let's not forget that every individual responds differently to a medication... dependent upon gender, age, weight, history etc. Not every kid on ritalin is a zombie, and not every person on an antidepressant is altered by the medication.

By the way, an employer can't legally ask you about your medical history. It's called HIPAA, no? You can volunteer that info, but they can't legally require it of you. The only thing I can think of is an involuntary 72 hour psychiatric hold showing up on a background check, thereby falling into a company's criteria and disqualifying someone for a job. That is something that proves to the company that the individual is mentally unstable.

If you're going to profess that everyone with depression is mentally unstable, or that everyone taking an antidepressant has their functional capacity changed in a negative fashion, then I'm going to challenge it.

Again, I don't follow your train of logic (bear with me )... you're saying that it's ok to cope with a disease in EMS, particularly depression in this case, but if coping with that disease involves an antidepressant, the person is no longer fit to work in EMS? You're saying that only treating the disease via one method (let's say counseling) is preferable to utilizing something to balance brain chemistry if the person works in EMS?

That's like saying that you can only treat an injured ACL with rehab and stretching, but once the person needs painkillers and surgery, they're no longer capable of performing any physical activity. Sure, it might limit them some, but think about how many medics you know who wear knee braces... yes, they've got a bit of a deficit, but they still manage to perform their job adequately. Perhaps they need a leave of absence to regain full functionality.... but it doesn't mean they're never going to be fit to perform physical activity.

What I am saying is that depression, like any other illness, has many different levels, and you can't assess how that illness is affecting someone just by looking at the label. If you're concerned about a depressed coworker's performance, you have to assess that performance and not make ASSUMPTIONS about anyone and everyone with depression, including those on medication.

Yes, there are certain medications that should lead to restricted duty, or a different profession, IF THE DEFICIT is indicative of such. If you're going to assume that everyone on Prozac etc. is an incompetent medic, you're going to piss off a lot of people... and you aren't thinking.

Just as a sense of perspective... I'm speaking as someone whose maternal side of the family has suffered depression, ranging from mild to severe depending on the relative. I also have bipolar and depressed coworkers and friends, and have had a great deal of experience in working with and speaking to individuals with depression. It's not as black and white as many people think.

Wendy

CO EMT-B

[Neelfrfghtr22]

I think that as long as the medic go's under an evaluation and passes whats the problem of him or her working in an ems field.

[flight-lp]

If there are places that bar employment based on a diagnosis of depression OR treatment of that illness then they are skating a very thin line. That's extremely illegal.

No it is not, the federal government and all 5 branches of the U.S. military do it every day....

Note, I never said duties shouldn't be restricted if a medication did alter you... but that applies to pain relievers as well, doesn't it? Like common Vicodin for example... some extremely sensitive individuals shouldn't drive or operate machinery. If so, their duties must be changed. You can't fire someone for taking a prescription their doctor has given them for a specific condition. That's discrimination. Do these companies not hire or fire based on painkiller usage?

This we agree on. If someone is currently taking a potentially altering medication, then they should not be performing front line work in EMS. Put them in dispatch, put them in education, or put them behind a desk...........

By the way, an employer can't legally ask you about your medical history. It's called HIPAA, no? You can volunteer that info, but they can't legally require it of you. The only thing I can think of is an involuntary 72 hour psychiatric hold showing up on a background check, thereby falling into a company's criteria and disqualifying someone for a job. That is something that proves to the company that the individual is mentally unstable.

Again, see my first comment. Several employers do require you to disclose this information. HIPAA has nothing to do with it...................

Again, I don't follow your train of logic (bear with me )... you're saying that it's ok to cope with a disease in EMS, particularly depression in this case, but if coping with that disease involves an antidepressant, the person is no longer fit to work in EMS? You're saying that only treating the disease via one method (let's say counseling) is preferable to utilizing something to balance brain chemistry if the person works in EMS?

You should give yourself more credit Wendy, you understand me just fine. That is exactly what I mean. Therapeutic treatment does not always equate to drugs. Therapy, meditation, social groups, etc. All of these are perfectly fine. But when you attempt to play with brain chemistry, then you have too high of a potential to not make sound judgement calls. Yes, I do realize that this may be placing some individuals that tolerate these meds just fine into a "black and white" descriptive group, but so be it. My safety and the safety of the crew, and the safety of the pt. (in that order) will always be my first priority...............

Also, just a little FYI...............the FAA forbids any flight crew member from taking any antidepressant medication. Some air medical services consider their medical crews to be flight crew members (as is allowed under 14 CFR part 135). Hence, some Paramedics are strictly forbidden from taking them.

Even recreational general aviation pilots are prohibited from taking them. If the FAA recognizes the danger (and they are usually pretty slow to recognize things, just look at the accident rates for HEMS), who are we to argue?

[Eydawn]

Hm. Looks like I'm going to have to do some research. Government jobs restricting things... well, that's the government and that's always happened. Wouldn't the FAA fall under that category as well? I assumed the military/government would do that... you choose to work for them, you give up your rights...

Private companies REQUIRING disclosure of health information and basing hire status on the medications being taken as a general class... something still doesn't sound right about that. Paxil and Lithium don't do the same thing and aren't even the same category of drug (as far as I know). One's a controlled substance, the other isn't.... so a policy stating NO antidepressants doesn't make any sense to me.

Can you see what you can pull as far as official policies and studies as well? This sounds like an interesting one to ferret out the details on.

Never fail to learn something new every day in this place...

Wendy

CO EMT-B