Bozo and the A, B, C's of Taking Medication

Dear Dr. K,
I've had low moods in the past. About two months ago, my doctor put me on an antidepressant (Lexapro). I'm feeling good now. So, on my own, I stopped the medication last week. My wife thinks that stopping it may not have been such a good idea. What do you think? Other reasons for stopping were some sexual side effects and the fact that I just don't like taking medication-especially a 'mental' one which changes who I am.

D.A., Minoka Falls

Dear D.A.,
You know those commercials on TV where the guy is portrayed as a real bozo who cannot get out of his own way? They always frost my cookies the way they show the fellow. Sure, guys do some dumb things, but never that bad. However, when someone tells me they have decided to take over their own care and increase, decrease or stop their medication on their own (barring a bad reaction where it should be stopped immediately), I quickly nominate him or her for the 'Bozo of the day' award. But I write harshly since, on the other hand, your doctor will be thanking you for relieving him of his responsibility to care for you by doing what you want.

With the advent of Prozac in 1987, antidepressants really took on a new role. It is not because today's antidepressants work any better than those from 20 or 30 years ago. It is because they are less likely, in general, to have side effects, which the older medications most often had. Since they were better tolerated, many more doctors, including generalists and internists, began to prescribe them. With all this increased use by many medical practitioners, I believe we have lost some education on how to use an antidepressant, why a person takes it, how long he or she should take it and what the goal should be. That is on the doctors' part.
However, I still think you are a 'Bozo' to have stopped your medication as you did. You should know that you are not alone.

There are some statistics out that a high percentage of people either do not take the prescribed medication or do not follow directions. I wonder why someone would spend good money going to the doctor in the first place if they do not plan on taking his/her advice. If there are questions, objections or concerns that might get in the way, you should be able to tell the doctor. Things like "Does the medicine make me put on weight?" or "I tried that one before and it did not work" or "Will it knock me out? I have to work" are all issues that might impact on taking the medication. Price is another. If you might not be able to afford it, ask your doctor for samples and whether the drug company has a "Patient's Assistance Plan" which supplies medication for free if you qualify.

Now, Bozo, let us get to you. You are still a bit of mystery. You neglected to give your age, how many times you have been depressed before, whether depression runs in your family, are you drinking or drugging to excess and the dose of the medication you were taking. These factors all come into account.

Antidepressants sometimes several weeks to work. Both you and your doctor's goal should be complete absence of any depressive symptoms and your returning to your old self. Inadequate treatment means you might feel a little better, but not your 'normal' self. Generally, we psychiatrist keep patients on an antidepressant for about nine months after their return to normal has occurred. Research data has shown that the shorter the time you take this type of medication, the more likely you are to have a relapse. At around nine months, that ceases to be a problem. Then, other things like past bouts of depression, how old you are when you got depressed and your family history of depression come in to play. For example, if you are over 55 years old and have had only one bout of serious depression and needed treatment, there is a very high probability that you will have another. So your being on the antidepressant for only two months and stopping it really ups your chances for having another bout real soon. Of course, since you are a Bozo, that will not concern you.
Beyond these, except for Prozac, it is very likely that you could have withdrawal symptoms for abruptly stopping an antidepressant. This sometimes depends on how high a dose you were taking but also can be simply related to your body's response to the antidepressant.

It is true that many of the newer antidepressants (those called SSRI's for 'serotonin reuptake inhibitors' and include some like Lexapro, Prozac, Paxil, Celexa or Zoloft) have sexual side effects in about 35% of people. The side effect can be a decreased sexual arousal and/or a difficulty having an orgasm. That, in my mind, would have been something to talk to your doctor about. There are alternative antidepressants and other ways to deal with the sexual side effects.

Lastly, thank you for your amusing comment about not liking to take medication-especially the 'mental' ones that "change who I am."

Antidepressants correct a chemical imbalance in the brain that causes depression. In patients, for example, who have a strong family tendency to get depressed and who have been depressed a good part of their lives, the medication does certainly 'change' them and makes them 'not' themselves. It helps them to come out of the blackness of depression and be happy and enjoy life, sometimes in a way they never did before. This is just like, in my mind, a person taking iron for anemia and feels more energetic and alive again. They are changed but not who they are other than they feel better.
So, Bozo, here are the A, B, and C's:

A: Take the medication as prescribed. Playing with the dose can be dangerous.
B: Do not stop your medication abruptly. Many medicines now have a potential for withdrawal.
C: If you have problems or concerns with the medicine, talk with your doctor about them. If he or she will not talk to you about legitimate concerns, find a new doctor.

Dr. K is Stan Kapuchinski, M.D., a board-certified psychiatrist practicing with Psychiatric Associates of Charlotte County located at 3390 Tamiami Trail, Suite 104, Port Charlotte, FL. 33952; Phone 941-764-0444 for an appointment. Please write him there with questions or email him at DrK@Sun-Herald.com.