Medics on Antidepressants

[Asysin2leads]

Sorry flight-lp, but your views on antidepressants are outdated. Antidepressants are used by many healthcare professionals, including doctors and nurses everyday, and there is nothing in our job that is so different as to cause concern when taking them, Modern antidepressants have very view noticible side effects. I would much rather have a medic reach out for help and continue to function well in his job, then one to 'stick it out' and turn to illicit drugs or alcohol to cope.

BTW, FAA rules not withstanding, I can bet a significant portion of my next paycheck that many commercial pilots regularly use antidepressants. Its not like you can piss test for them or invade someone's medical records.

[Ridryder 911]

Actually an employer has the right to ask your previous medical history in the form of .." is there any medical condition, that might restrict you and your perfomance in this position?..." I believe pyschological problems should be one of those problems, due to the nature, environment, we work in. Otherwise, employers might be stuck with having to accommodate those with disabilities, that cannot perform the job or purchase high dollar equipment, just to perform a basic task. If one does not, ADA will have the employers rear.

I believe, psychological screening should be more emphasized in lieu of "happy med.'s" . Sorry, I am so tired of hearing and seeing the effects of those that do not have their medication level up to par or to the see the side effects of such medications. Just like any other disease processes, such as diabetes, HTN, medications, employees should be cautious in the environment they perform in . Would we not be cautious of those on prescribed analgesics?

R/r 911

[flight-lp]

Sorry flight-lp, but your views on antidepressants are outdated. Antidepressants are used by many healthcare professionals, including doctors and nurses everyday, and there is nothing in our job that is so different as to cause concern when taking them, Modern antidepressants have very view noticible side effects. I would much rather have a medic reach out for help and continue to function well in his job, then one to 'stick it out' and turn to illicit drugs or alcohol to cope.

BTW, FAA rules not withstanding, I can bet a significant portion of my next paycheck that many commercial pilots regularly use antidepressants. Its not like you can piss test for them or invade someone's medical records.

Hey Asys, long time no hear...................

Hope you took a huge paycut, cause that bet may hurt........... :wink:

I actually do not know any that take them (and I know a few!) Plus, most 135 and 121 carriers have random testing, plus a 1st class medical physical every 6 months. If these don't stop you, then the thought of having your license that you probably spent over $40,000 on and the loss of your career is pretty effective. Get caught lying with the FAA and you can kiss an aviation career goodbye............

Still don't think it is appropriate or safe to have them in your system if your on a truck (or in HEMS). Just my humble opinion as always..............

[studyems]

Most people take antidepressants for a short time.....something to help them cope or deal with negativity going on in their life. There are also people that have been on them for years. I can almost guarantee, there are several people you know right at this moment, whom you thing are fantastic medics/doctors/nurses/etc. that have been taking them. You can't tell who is and who is not on antidepressants. You can tell however, when someone is depressed, antisocial, easily aggrivated, and so on. I would much rather have them take antidepressants for a while then for them to hurt.

[Asysin2leads]

To the best of my knowledge, SSRI's, Tricyclics, and MAOI's are not usually looked for on urine tests. I think if I was a pilot and I was having trouble coping, I would rather go on an antidepressant than burn out and have my life fall apart.

If you want to say the risk of some side effect might adversely affect your performance, you could then use the same arguement to say "well, women shouldn't be allowed given the once a month hormonal changes that could adversely affect them either." The line has to be drawn somewhere.

[Doczilla]

Antidepressants of various kinds are proven to help the clinical manifestations of depression. Despite what the Law Offices of Dewey Cheatem and Howe would have you believe, the risk of suicide with antidepressants is overstated. The media hype over them and subsequent black box warning and giant jury awards have resulted in fewer candidates taking SSRIs, and a resulting increase in suicides among at-risk groups.

Antidepressants in appropriate doses are very well tolerated and have side effects that are rarely anything but annoying. That includes SSRIs, TCPs, other cyclics, and MAOIs. Professionals of all types take them for treating diseases that move far past just depression and anxiety. Chronic pain, muscle spasm, smoking, and irritable bowel syndrome to name a few.

I don't think that they should be taken to "prevent burnout". They are medications to treat a disease, and nobody should be taking them if they don't manifest the symptoms of the disease.

'zilla

[Dustdevil]

I don't think that they should be taken to "prevent burnout". They are medications to treat a disease, and nobody should be taking them if they don't manifest the symptoms of the disease.

Kinda like CISD?

[Virginia NPP]

Hello All,

I have been in the mental health field for 30 years. I have been exclusively prescribing meds for the last 15 as a psych NP. Can I put my two cents in in relation to many previous comments?

"Benzos" are benzodiazpines such as Ativan (lorazepam), Xanax (alprazalom), Klonopin (Clonozepam) Valium ( diazepam ) THESE ARE NOT ANTIDEPRESSANTS. These DO have significant effects on your ability to respond and should not be used by anyone in a position of decision making, heavy machinery or even driving. These are addictive and are routinely screened for in "Tox" screens. In my opinion they are way overused.

Persons with clinical depression (serious depression with physical symptoms) are much more at risk for making poor decisions, irritability and generally poorer functioning then those with a well treated depression.

Depression is NOT, the blues, grief, "tough times" or burnout!! Antidepressants will NOT help these life problems; persons with clinical depression have more difficulty with these stressors and sometimes these situations will reveal the underlying depression.

The side effects of the SSRIs are minimal (sexual dysfunction can be a problem). They do not make you "spaced out" like the benzos can. The TCA have more side effects and are used pretty sparingly these days. These are helpful in LOW doses (much less then antidepressant dose) for neuropathy, headaches and some other pains. These drugs are not found in general "tox screens" . A specific test must be done for them.

I can't tell you how many years I did Psychotherapy trying to help patients with a true clinical depression. It was supportive but didn't help in most cases for more then a brief time. When they were put on an antidepressant they were like new people in 4 weeks. I am not exaggerating here!

The problem is that antidepressants (like so many other drugs) are overused on the wrong patients. They seem to be given to everyone with a complaint of "stress". On the other hand significant clinical depression is often MISSED ( these are often not the people going to the PCP complaining of depression) and these people are suffering. Medication will make them better at their job of being a paramedic, ems, nurse, doctor,etc.

It is important that we all try to understand the difference between clinical depression and other syndromes. Don't let anybody kid you, sometimes this is not easy, ever for experienced people. The problem is that everybody thinks they can do it.

Feel free to comment or ask questions.

Best and thanks for all your good work. ( I had a heart attack last year the the EMS were terrific)

Virginia

[BVESBC]

I would like to think that psychopharmacology would be a last resort and major sign that you need to make some changes in your life. I believe that as a society we are to quick to look for that magic pill before looking for the true problem. I have said it before we as a group are not at the top of the list of healthy people. For most of the providers that I know sleep deprivation, large quanities of caffeine and poor diet in general, are the rountine. I think that our lifestyle choices have a huge impact on us and our families, both physically and psychologically. There is no doubt that these medications, "Antidepressants" (Tricyclic compounds, Monoamine oxidase inhibitors, Lithium carbonate, SSRI's) can have benefits but correct me if I'm wrong in saying they dont treat the cause of the problem.

[Virginia NPP]

Hi BVESBC,

All the things you suggest will help with many problems. However Clinical Depression is hereditary ( think like a physical illness) and truly a chemical imbalance (I hate that phrase its so over used). It will not really respond to these lifestyle changes. I know I did psychotherapy for years with some of these patients, so frustrating for me and them.

Another comment, when someone is truly having a major clinical depression they literally cannot do these things, they cannot force them selves to make changes or "pull themselves up by their bootstraps". It is not a matter of weakness of character or lack of trying. It is a DISEASE with a biochemical cause (may be worsened by many factors) But there are true brain changes in persons with depression.

Major depression can and does result in psychosis (really !!!) and suicide. It is a horrible disease, worse then many physical illnesses.

Again the real problem is misdiagnoses and overuse of SSRIs. They do not work with sadness, personality disorder (another whole story) anger, and lots of other things they are prescribed for.

One of the reasons I think it is difficult for so many to accepting clinical depression as a disease is that we all like to believe we can use our mind to control our mood, other wise we feel out of control ! Oh Well, sorry but this can be true.

Ok enough already, hope I have convinced some.

Virginia

Virginia Duffy PhD Psychiatric NP

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