Essays, general essay

Stray Thoughts: The Modern Version of Laudanum?

PrescriptionI almost wished I hadn’t brought it up.

I have sleep problems. I fall asleep perfectly easily. I just can’t stay asleep.  So while researching some foot problems (because the condescending SOB of a podiatrist wasn’t any real help), I saw that sleep problems are part of fibromyalgia, and I thought let’s ask the G.P.

No, she says. Fibromyalgia is one of those things that’s only diagnosed by observation and when everything else is ruled out. I braced myself for what came next. “It could be depression. Have you considered antidepressants?”

Face plant time. It’s beginning to feel like a conspiracy to get me on antidepressants. Even the condescending SOB of a podiatrist suggested them at one point. My OB/GYN suggested them for my menopause symptoms. I tried HRT instead, which did make me depressed. But when my very nice young GP suggested it, it started to sound like the modern version of laudanum.

Laudanum, a tincture of opiates including morphine and codeine, was prescribed to a lot of women in the 19th Century for female problems and hysteria. Later critics suggested that it was a way of keeping women shut up. I suspect that most doctors meant well – given how effective it was for coughs and pain, it was pretty popular. But there was probably a certain amount of unconscious sexism going on. She’s emotional, she needs calming down, give her laudanum.

I had read that the majority of patients taking antidepressants were women, so I did the research. Interestingly enough, I searched on what percentage of antidepressants are prescribed for women and pulled up multiple articles on how depression is being over-treated. According to a 2011 report from the CDC’s National Center for Health Statistics, one-tenth of all Americans over the age of 12 are taking antidepressants and 23 percent of all women between the ages of 40 and 59. That’s one in four women my age. I mean, I knew there were a lot and at the rate the drugs have been pushed at me, it didn’t entirely surprise me. Still, one quarter of women my age are taking antidepressants. That seems like an awful lot, especially when you consider that according to the World Health Organization, only 5 percent of the population actually has depression. (Note – this particular study focused on Nordic countries, but the stat was cited in several of the articles I read and is footnoted in the study.)

Even more interesting was this article from the Canadian Journal of Psychiatry, by Dr. Joel Paris, MD, which suggests that not only is depression grossly over-diagnosed, so is the prescription of antidepressants, which haven’t really been shown to be effective in patients with mild to moderate depression, although the drugs are very effective for patients with severe depression. Which is exactly what I’ve come to believe. I mean, I know folks for whom the drugs have been literal life-savers. And I want to be crystal clear here – if you need antidepressants, for heaven’s sake take them.

I just question whether I need them. I saw a proposal for a study that suggests that the current screening tests are neither that accurate nor that accurately used. I couldn’t find the conclusion, but the concerns the doctors brought up were pretty unnerving and certainly echo my experience. You see, I’ve been depressed – that little experiment with HRT I noted above. My husband was getting pretty worried about me and, frankly, I was too. And, by the way, I was sleeping better. Now, I will get punchy, whiny and okay, depressed after two to three nights without decent sleep. But I know how I felt when I was depressed and I am not even close to feeling that. Even after this last seven-night jag I was on.

I know women will report depressive symptoms more readily than men. But still I can’t help but wonder if doctors, in an effort to treat something that often does go unreported when it should be, are going overboard. I can’t help but wonder if the medical mind-set is to look at a middle-aged woman who can’t sleep and immediately assume depression instead of trying to find out whether there might be something else. The sleep doctor I consulted with certainly didn’t. He just said that the CPAP I use was helping me not to snore and when I asked if the results showed any other issues, he said I was probably depressed. Not that the results showed it – just that I was acting that way. In fact, nobody has really considered any other potential source for my sleep problems. They’ve all assumed (or have appeared to) that it’s depression and do not seem interested in looking further.

Not unlike the doctors of the 19th Century, they’re reaching for the easy answer.

There is a reason I find this insanely annoying. I tend to get side effects a lot (again, see the HRT). I am not willing to give up two to six months or longer to let doctors play games with my brain chemistry in the hopes that something will work. I am a creative. The deadening effects of antidepressants would be deadly to my creativity at a time when I really need it. In short, antidepressants are a really bad idea for me and I’ll have to be in a really, really bad place before the potential negatives would be outweighed by the benefits.

Depression is a serious disorder and if you are chronically miserable, don’t want to do anything, especially stuff you used to love doing, if you’re spending all day in bed because you just can’t face the world, then, yes, you need to get help and antidepressants may be exactly what you need. For the rest of us, I’m not so sure.

Anne Louise Bannon

4 Comments

  1. 1. You have full autonomy with what treatment options you choose to take.
    2. Antidepressants are not the end all be all for treating depression. There is exercise and there is therapy.
    As you pointed out; severe depression would likely require medications or even ECT (electro conductive therapy) we still use it in modern medicine for the catatonic depression refractive to all other treatments with good results if I might add.
    3. I understand you being the strong woman that you are but if everything else is checking alright and multiple doctors of varied specialties are pointing you in the same direction, there might be something there.

    • Your point is well taken re the multiple doctors. But they aren’t checking anything. They’re just talking off the tops of their heads. Furthermore, I did start the process once. Something just felt really, really wrong. Whenever my gut has felt that bad and I’ve ignored it, it has always ended badly. It’s possible there is some low-grade depression going on, but I have good reason to believe that drug therapy will be worse for me (and possibly only me) than the problem.

  2. People aren’t all alike. It’s not just that we have different experiences and perceptions; we also have different genes, which means different brain receptors and different enzymes that metabolize drugs differently. There’s also more than one class of antidepressants. Finding what works for any given person can be tricky, whether it’s a matter of the choice of medication(s) and dosage, or whether it’s use of other techniques. Anyone venturing into those waters should do so with the advice of someone with expertise – and even then seek a second opinion if things don’t seem to be going as expected. When practitioners make suggestions outside their area of expertise, I don’t think it’s any more reliable than talking to your friend across the street who has some personal experience. Experiences simply may vary. It can take time to find a solution and that means a bit of patience is in order, but any expert practitioner should listen to you and demonstrate some open-mindedness and flexibility.

    • Well, that’s the problem. They aren’t listening. That’s what’s so frustrating. It’s all about the easy fix, which is unlikely to be that easy for me.

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