Nursing Voices

Wednesday, November 22, 2006

From the Mailbag

In today’s post, I am offering one of my readers equal time to respond to my rant, “What’s so Bad About Feeling Good.” The reader, Troy Dayton, was the subject of a CNN article about people who use antidepressants even though they are not depressed.

I am publishing his response to my post, followed by my thoughts.










I'm Troy Dayton, the person written about in the original post.

We all do artificial things to enhance our moods.

Most people spend many thousands of dollars extra for a newer, nicer, bigger, or more powerful car than they really need. Why do they do this? Because they think it will make them feel better.

The federal government doesn't threaten the car dealer for selling the nicer car to someone who wasn't depressed when he bought it even if the consequences of this purchase could be devestating to the person.

In fact, society has the opposite way of looking at extravagant purchases then it does at medication. People generally look down or pathologize the person who self-medicates their maladjusted moods through purchasing.

The irony in all this is that while most people think having nicer stuff will make them happier, the data consistently shows otherwise.

Conversely, the data clearly shows that anti-depressants really do make people happier. And very few people will ever go broke paying for anti-depressants. Cars, clothes, and houses on the other hand...

The pursuit of happiness is so intrinsic to the human experience that it is the last three words in one the most important documents of this country.

Happiness is a process more than it is a place to get to. It is a fleeting feeling and almost everything all of us do in life are efforts at attaining it.

It's just that humans are notoriously bad at predicting what will make them happy. New cars, big houses, another drink, more money wagered, a decadent dessert, hating gay people, stopping the dog next door from barking, etc. But those things don't make people happy despite the ever present belief that they will. But as long as those people aren't hurting anyone else I would never dream of supporting a law to coerce them to stop those behaviors.

I use data, reason, my faith and a deep inner knowledge of myself to create happiness.

Most people only take antidepressants if something is wrong. Most people only go to a therapist or get a coach if something is wrong. Why can't drugs and therapy be evaluated on the basis everything else we do in the pursuit of happiness is evaluated?

Do the benefits outwiegh the risks? Does the value outwiegh the costs?

Nurse Ratched and others make it sound as if the risks associated with taking antidepressants changes based on why it's taken. That is false and an absurd notion. The risks are constant. It is the benifits and the value palced on them that changes with purpose.

It is not surprising that medical professionals who are trained to alleviate diagnosable problems put a high value on that and not a very high value on maximizing human potential.

I've studied the risks and benefits of using Wellbutrin. For me and my values, the benifits outwiegh the risks.

I'm all for people having the right to disagree, but when they force their opinions through policy, I rightfully stand in defiance.

You have government coercion on your side. You even threaten doctors for prescribing off label.

How dare you support denying me and my doctor the right to choose the course of therapy we see fit?


Hello Troy, welcome to Nurse Ratched’s Place. I enjoy hearing from my readers and I welcome your comments.

Let me start off by saying I understand you feel that Wellbutrin helps you live a happier and more fulfilling life. However, it’s my opinion that antidepressants should only be used by patients who suffer from clinical depression. The article did not indicate that you are suffering from a mental illness. There are many risks to taking psychotropic medications. If I had a patient who was suffering from major depression and had constant thoughts of putting a gun in their mouth and pulling the trigger, I would advise that patient to take antidepressants because the benefits outweigh the risks. If on the other hand the patient did not suffer from major depression, I would not advise the use of antidepressants. I would encourage my patient to try other options that might make them feel better. You are right when you say that people use many different coping styles to deal with their issues, and as you point out, some of these styles are superficial, but I believe that taking serious pharmaceuticals to get “a lift” is not an appropriate use of antidepressants. There are other options you can use to feel better that don’t have potential side effects.

Does the government have the right to dictate to doctors how to practice medicine? That’s where it gets dicey. I’ve worked with a few doctors during my career who have done some really boneheaded things with their patients, and I believe the government must step in to protect patients from unscrupulous physicians. On the other hand, does the government have the right to bar physicians from prescribing medical marijuana? And what about euthanasia? I know I’m rambling a little, but I hope you get my point. Everyone has a different opinion, and there are many issues that need further examination.


Once again Troy, thank you for responding to my post. Please drop by again soon. I value your thoughts and comments.

22 Comments:

Blogger Kris said...

I'm with you there, MJ. It just seems that Americans as a whole have this notion that everything needs to be fast, simple, and easy. We need plastic surgery, fast foods, and pills to make our arteries stay clean and our emotions muted. Why yawn all the time on the Zoloft when all one needs is a little light therapy? Granted, I have several relatives with bipolar disorder who NEED medications because their own chemistries are out of whack. But most everyone else's aren't so far gone that physical activity, light, social contact, meditation, music, reading, etc, etc, etc can't get the off-kilter days back on track.

12:15 AM  
Blogger Cyndy said...

Medication is necessary for many, many people, my mother being one of them. Without meds, her life is just about no life at all. But Western society is at fault with it's perceptions (and choices) in regard to the things that will make the individual happy in htis world. The materialistic life that is lead, and the constant generational need for "MORE", often results in confusion over what really will make one "Happy". Life is so fast, so complicated that people, and the new generation in particular, have unrealistic expectactions. How do we address this imbalance, and get ourselves back to basics? Does anybody even know what "the basics" are anymore? I don't know...the generation that needs to make the changes would find it all too hard, I think.

PS; I'm the only member in my family without a history of depression or medical intervention of same...so far...except fot my dad, but he doesn't count,,it's probably him that makes everybody else depressed ;)

3:09 AM  
Blogger Mo said...

Well done Nurse for allowing Troy to balance the argument. I'm well impressed!

Although I have a mood disorder, I don't know anyone using Wellbutrin. Here in the UK however, we have a similair mood enhancing drug, freely available without prescription, called alcohol.

4:52 AM  
Blogger SQT said...

I used anti-depressants when I suffered post-partum depression, and I honestly feel they saved my life. I doubt I would have killed myself, but that downward spiral of depression is so horrible that I really can't say where I would have ended up.

Having said that, I am glad I'm off the meds. I like feeling like myself. I have been a teacher and seen kids who were so medicated their eyes were glassy. How sad is that?

I also understand, through conversations with my doctor, that a person can develop a tolerance to anti-depressants, like any other drug, and at some point they may lose their effectiveness. In the long run, I'd rather not have to rely on meds to make me happy. It's like a band-aid for cancer. You have to find the underlying problem and deal with it, IMO. My post-partum depression was a definite hormone issue. I dealt with it and feel much better. The anti-depressants allowed me the time to get to the real problem, but they would never have fixed it.

10:21 AM  
Blogger jbwritergirl said...

A better life through chemistry is a motto I live with off and on. I have children!!!!!!!
Happy Thanksgiving!
JB

11:30 AM  
Blogger Susan Palwick said...

As someone who's currently on antidepressants (for the second time) but really prefers being off them, I applaud your willingness to post both sides of this debate. My concern is that I'd hate to see recreational use of antidepressants create any more misunderstanding among people who don't understand that depression's a real illness.

There's also the fact that we have no idea what the long-term effects of these drugs are, because they haven't been around long enough. That in itself, to my mimd, is a compelling reason to stay off the pills unless they're truly medically necessary.

1:06 PM  
Blogger poody said...

I believe we all have a window of opportunity to be depressed. mean we all live in a messed up world. As a person who is on antidepressants I can tell you I was at my wit's end before I made the decision to seek the help I needed. I also see a therapist and my meds are monitered closely by my Pschy. MD. I simply put had lost all my coping skills. Being a nurse I am like all other nurses and feel that my problems are so small compared to my patients but this time I was overwhelmed. I look forward to the day I can get off these meds.I can build a house with the right tools and instructions. To me that is what the meds and therapy is the tools and instructions.

1:18 PM  
Blogger Iris said...

Often I have heard depression compared to diabetes. Both are a chemical imbalance of sorts. The advocate of anti-depressants will state that depression is an illness (I totally agree there) and that the pills correct the imbalance. Diabetes the illness, insulin corrects the balance. If one is taking an antidepressant in the absence of chemical imbalance, you are putting yourself at unnecessary risk. You are saying, just in case I start feeling depressed, I will take these. If the same were to happen with insulin would that not be ludacris?? I may be way off base here, but I still can't advocate taking any medication that is not medically indicated.

3:10 PM  
Blogger north said...

Kris, I totally agree with the exercise, meditation, imagery concept. Guess I'm old fashioned in that regard. I like the herbal remedies and natural answers to medical problems. Granted, some man-made medicines are necessary. But you hear so many horror stories about drug companies getting sued because their 'miracle drugs' are causing more problems then they are solving(for example, Redux a few years back was supposed to make getting thin easier. Instead, a lot of people ended up with heart problems after taking Redux). The 'fast, simple easy approach' is becoming too fast, if drug companies and the FDA choose to rush through researching man-made drugs. OK, enough of my own rant :P

1:48 AM  
Anonymous Erika said...

I'm someone who has a genuine need for antidepressant therapy; it's not a case of wanting to take them to feel 'happier' - I need them in order not to harm myself and in order to be a good mother and a productive member of my community.

So here's my problem with the 'recreational' use of AD meds: I don't believe that we have an intrinsic right to be the happiest that we can be. Life is full of normal ebb and flow, and when you *choose* to level those out by maintaining a constant mood I think there's a pretty good chance that you miss out on the subtle moods and emotions that are an essential part of being human.

Trust me, if I could be the person that I am now without pumping myself full of chemicals I would. I worry that taking nonessential meds is like taking the path of least resistance; it moves the locus of control nicely into the external and means that you really don't have to change anything else about your life in order to feel better. It really is okay to have to work for the things that matter...and to be flawed and human.

10:02 AM  
Blogger kate loving shenk said...

hi MJ--

you must see the movie: The Secret--

order the DVD online--

www.thesecret.tv --the movie isn't in the movie theatre yet--

it says it all about (drugless) happiness!!

love,

kate loving shenk

10:34 AM  
Blogger Troy Dayton said...

Thank you Nurse Ratched for giving me equal time on your blog. That means alot.

Would you agree that if someone put a much higher value on maximizing their human potential than you, that for them the value of Wellbutrin COULD outwieght the cost?

Or do you believe that in addition to having the legal right to deny someone a medication based on its risks, you should also have the legal right to decide people's values?

I understand everyone's points about overprescribing and unscrupulous doctors who are leading patients astray. But what about a well-informed patient like me? Based on your logic, I should be subject to arrest because some doctors mislead patients and because some patients are not well-informed.

It's like we've replaced priests with medical professionals. It used to be that religious leaders were people's only access to God. And if you disagreed you were subject to government coercion. Now, thankfully, most religions and public policies recognize that the apporpriate role for religious leaders are as experts that one can use as consultants on their spiritual journey.

This same change is needed in medicine. Many wars were fought and continue to be fought over religious freedom.

I'm sure those that have fought on the side of oppression in the many struggles for liberty in the history of our country and others never thought of themselves as such -- especially at times when opposing that oppression was a new or a minority viewpoint.

In the fight for cognitive liberty, I hope your current viewpoint is on the wrong side of history.

You might think that this is simply an interesting discussion about values in prescribing. But there is one big difference in our places in this discussion: I can't have you arrested or deny your personal choice for disagreeing with me.

4:28 PM  
Blogger SQT said...

Troy

I don't think anyone here would suggest you should be arrested because you choose to take anti-depressants, that's just silly.

The argument for me stems from the fact that you are messing with you body chemistry without knowing what the long term affects might be.

You may believe that you are well educated on the issue, but I don't believe there have been any studies done to assess the long term impact of recreational use of anti-depressant drugs. That basically what we're talking about right?

I know that a clinically depressed person can build an immunity to anti-depressants over a long period of time. That was one of the main reasons I wanted to get off of them. I was afraid that if I couldn't maintain an emotional equalibrium without them then I would be in big trouble when they lost their effectivness.

What you can't possibly know is if these medications might not alter your brain chemistry to the extent that you can't be happy or content without them; and then where are you as the effects lessen over time? Undoubtedly you would then have to switch from pill to pill to maintain yourself and for what? A long-term chemical dependancy? I fail to see how that's beneficial in the long term.

5:11 PM  
Blogger TwinMamaLinda said...

I guess I agree with Susan P. I would hate for "recreational" use of anti-depressants to color the opinion of people who fail to see depression as a true medical problem (not just a "you have to pull yourself up by your bootstraps" kind of problem.)

I currently take Wellbutrin seasonally. I have for 9 years now taken it from roughly Halloween until Easter (or roughly daylight savings time) I take it to "feel better and maximize my personal potential." I have not felt the need to go off of the Wellbutrin to "see if I still need it" - other than a pregnancy that ended with Twins in February - I have taken it every year and I started in March that year with nasty PPD.

I guess my point is, everyone has the right, with their physician to decide which course of treatment (or no treatment for that matter - like choosing no chemo) is right for them. Benefits and risks are readily understood by an informed consumer and many people are unable to admit a potential depression. (Not that this is Troy's issue). But I for one, don't think that my medical treament is the business of anyone else. For that matter, I do think that choosing to talk about taking Wellbutrin without depression as a mood-enhancer is reckless. There are people who are not informed consumers that will say "I heard of this person who ...."

So while Troy has the right to take any legally prescribed medicine for whatever purpose he and his provider think is wise - perhaps he should just keep it to himself :P)

Thanks for the great topic ... food for thought!

11:36 PM  
Anonymous Troy Dayton said...

In response to Twinmamalinda and SQT:

SQT says that no one thinks I should be arrested. I should hope not. But that is the current law and I haven't heard anyone on here advocating to change that law, so in effect, you think I should be arrested. Nurse Ratched even threatened doctor's with a reminder that they could lose their license to prescribe if they wrote prescriptions for people without a clinically diagnosable problem.

I read Twinmamalinda's response with intrigue. She recognizes that it is totally reasonable to consider Wellbutrin as a mood enhancer without having a diagnosable problem. But because there might be people who misinterpret my use and act irresponsibly as a result, I should keep my little secret about actually not being depressed to myself.

I was waiting for this sentiment to arise. Kind of like the agnostic in a devout Catholic family. As long as the agnostic doesn't tell his family how he feels they are all able to mutually collude in the fiction that he is a devout Catholic. He gives the wink and the nod when it is time to have his children baptized, etc. Or what about the obviously gay person in a family...everyone knows the person is gay but as long as it is not talked about everyone can have plausible deniability.

The same thing is happening in medicine. Every doctor and most people know that what I do with Wellbutrin is what millions of patients nationwide do. THe only difference is I am honest about it and that honesty threatens the social order.

Conversations heard everyday in doctor's offices: "I've been feeling stressed lately, can I have some Xanax? I've been feeling under the weather...can I have some anti-depressants? The other night I wanted to have sex but couldn't keep an erection...can I have viagra?"

Here is what these conversations often mean: "I'm probably as stressed as the average person. SOmetimes it's nice to take a xanax once or twice a month. Can I have a prescription for that? I'm curious how I would react to an anti-depressent, who couldn't be happier? I tried my friend's viagra and boy does it make my erection extra hard and boy does that give me extra position versatility. Can I have some Viagra?"

As long as the patient understands the risks associated with a medication (which they should know regardless of whether they have a diagnosable problem or not) and the doctor gives their expert opinion on the situation, shouldn't the patient have the right to take that medication? They basically do already. They just need to slightly embellish the truth like millions of Americans do everyday.

But do we really want a system that encourages doctor's and patients to mutually collude in the maintenance of a lie.

That seems more unethical to me than any reason one might decide to take a medication.

12:15 PM  
Blogger SQT said...

Troy

I don't really get where you're coming from. The defensiveness tells me that on some level you know what you're doing is probably not medically sound so you take the best-defense-is-a-good-offense arguement.

On one hand you denounce those who wheedle Xanax from the Doc, and then pat yourself on the back for getting your drugs by being straight forward. But what's the difference? Neither person needs it and you're both abusing the medical system, just in different ways.

I don't really care if you take the pills or not, it's none of my business. But since you brought it up in a public forum, I am going to throw out my two cents for what it's worth.

My only objection to people who don't need certain drugs but take them anyway is that I belive that you will end up doing yourself harm in the long run.

2:13 PM  
Blogger TwinMamaLinda said...

Troy -

I think that what two consenting adults do is none of my business ... whether that be same-sex union, abortion or a doctor-patient conversation. In my mind, while I have an opinion on each of those things I have no right to legislate my opinon on your life. I had no idea it was currently against the law to prescribe for a condition that may or may not be present. I would absolutely be for changing that legislation as much as I am for protecting Roe V Wade. Privacy and autonomy are sacred rights.

As for the idea that you should keep quiet about your discovery - I guess I never thought about it in the way you've presented it. I don't mean to say that you or anyone should (with your doctor) "mutually collude in the maintenance of a lie." What I merely suggest is that you keep the conversation about your health concerns and recreational drug use in the private arena where it belongs. I think that there are people who will not take the time to be as well informed as you clearly are - this is where the problem lies for me.

You have a right to privacy in your medical treatment - whether it involves a diagnosis or not. It is not unethical to request that you keep that private conversation private.

:) Be happy ... be gay ... be agnostic ... just be careful about the public forum.

Be well!

8:41 PM  
Anonymous Candy said...

ARG! Posted on the wrong day -- here it is again, with a caveat: We don't get to decide what level of "happy" is acceptable (or enough) for other people. It's not our job to imprint our values on anyone else -- taking care of ourselves and responsibility for our own happiness is.

That said, Mr. Dayton has a point -- if he and his Dr have discussed the risks and benefits, why shouldn't he have the option to continue a therapy that has worked for him? We don't know what dose he's taking, but it's likely to be under 400 mg, the "buzz" point for Wellbutrin. We also don't know how long he smoked and how difficult it was for him to stop. Nicotine withdrawal can hang on for a looooong time; prophylactic administration may help him stay off cigarettes (which have a much great chance of adversely affecting his health). What would we think if Mr. Dayton chose to continue self-medicating with a couple of Percosets?

We healthcare professionals tend to get on our high horse about what's acceptable and what's not when it comes to meds, but I don't know why. Do we think we know better? Are we threatened?

Mental health issues (and their treatment) are divisive (remember Tom Cruise's rant about antidepressants on the Today Show?); our call is first to do no harm. If the Wellbutrin is not harming Mr. Dayton (and he and his Dr say he's OK), then why do we want to "correct" him?

Defining depression is not an exact science. Would we feel better if Mr. Dayton admitted that he might have felt a little depressed and was continuing the meds to treat that? If that's the case, it's a matter of semantics. After a hysterectomy at 42, I was put on a Climara patch -- it was wonderful and worked immediately. That was 11 years ago. I love my patch -- it evens things out, keeps the hot flashes at bay and lets me sleep without waking up every hour. At my age, I could give it up (natural menopause would be occurring about now), but I don't want to. Should I have to simply because I don't really NEED it now?

Allowing that but not Mr. Dayton to continue his Wellbutrin would be hypocritical.

Sorry -- this was my rant. Recreational drug use with no consideration of the risks at excessive (and unsafe) doses is something to be concerned about. Medication at customary and safe levels by a physician for a patient where the risks and benefits have been discussed and understood is another matter -- and none of our business.

10:32 AM  
Blogger SQT said...

Candy

What a great post. You definitely got me thinking about the topic differently and thats a good thing.

You're right, we don't have the right to decide for someone else how happy they ought to be or what measures they take to maintain that happiness.

Perhaps it is a bit of a high horse to shake our heads at Troy, I don't know.

I am a believer in minimal chemical dependance if I can help it, so my prejudices are showing. I wouldn't take medications that I didn't feel I 'needed' because I think the less chemical interference the better. But I don't have the right to make that call for someone else.

1:24 PM  
Blogger MadMike said...

Well I must admit that I also take Wellbutrin, the XL kind to be exact and it did wonders for me, at least so far as stopping smoking. I had tried everything and was reluctant to use an anti-anxiety drug, as I dislike taking anything, even aspirin. When I sat back, however, and realized that nicotine was nothing more than a drug, and a nasty one at that, I decided to take the Wellbutrin Plunge. Since then I haven't smoked in over a year and haven't even wanted one. So, for me at least, this drug may well have saved my life. For that I thank it and my doctor who worked very hard convincing me what kills and what doesn't!!

7:59 PM  
Anonymous Troy Dayton said...

I'm glad that this thread has generated some new ways of thinking about this topic.

I'm so glad that there seems to be a consensus that me or my doctor should not be punished for what I put in my body.

I also recognize and understand all the risks about taking something that I don't "need".

Maybe the level of medical risk I allow myself in the pursuit of happiness will change at different times in my life.

THis is analogous in many ways to a debate over investment strategies. Some people are very risk averse and some poeple are very safe in their invesments and different people adjust their strategies based on their values and dedired outcomes.

I think we would do well to start thinking in this dynamic way in medicine and that the medical establishment and patients could benefit from thinking of doctors as consultants for health similar to an accountant for finances, rather than the gate-keepers, deciders-in-chiefs, and high priests of medicine.

And it is important to point out that there is a big difference between being reckless and simply being open to more risk. One is intentional and well-thought out with an understanding of risk, benefit, and values whereas the other is arbitrary and indiscriminate.

8:05 PM  
Blogger Spelunker said...

Troy,

I can't agree with the assesment that you and or your doctor should not in some way have to deal with the fact that you are knowingly acting in a way that is not consistant with the law. I find it disturbing that you seem to think that disagreeing with a law is a reason to disobey it. Sorry, I can not advocate that attitude or behavior.

Let me put it this way: I do not always agree with the way that our government spends money, or even all of the tax laws. However, if I decided that my disagreement meant that I could choose not to pay, I would eventually (and rightfully) be getting personal attention from the IRS and the police. In America, we have the right to disagree with the laws of our land and work to change them, NOT to disregard them when its convienent.

I am not a doctor or medical expert of any kind, so I can't really argue properly about your theories of Doctors as Consultants. However, I feel strongly that we have a legal system for a reason. If everyone felt free to simply ignore any laws they didn't like, what would our world be like?

12:28 PM  

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