Nursing Voices

Saturday, November 18, 2006

What's So Bad About Feeling Good

The illustration is by Bob Watts, and appeared in Salon Magazine's article, "Wonderful Wellbutrin?"


I’d climb on my soapbox, but I can’t because I’m still on crutches. This is a rant.

Yesterday, CNN released a story about a guy who takes antidepressants. The problem is the guy doesn’t suffer from depression. He said he takes Wellbutrin because it makes him feel good, really good.

Troy Dayton started taking Wellbutrin when he was kicking cigarettes, but now he doesn’t want to give his little helpers up. Troy said the medication makes him feel great, and that the medication gives him the ability to think more clearly. It sounds like Troy has found pharmaceutical nirvana. Some of my past patients have told me that Wellbutrin gives them a rush, the same kind of rush they get when they take amphetamines.

Now hear this! Antidepressants aren’t sugar pills, they are serious medications that have risks as well as benefits. If you take them long enough, you might become physically or psychologically dependent on them, and they can trigger manic-depressive illness in susceptible people. Troy’s physician, Dr. Feel Good, should be reminded about what happens to doctors who promote and/or prescribe drugs for uses not approved by the FDA (read my post about Dr. Peter Gleason), and be counseled by his or her peers.

End of rant…….

28 Comments:

Anonymous Mr. Code Brown said...

I agree. I don't even like taking unnecessary medications myself. I don't think anything should be taken long-term unless you have a true need for it and the benefits outweigh the risks associated with taking it.

3:06 PM  
Blogger Cyndy said...

I heartily agree with you, Mother Jones. We have evolved into a society of control freaks, who aren't willing to expose ourselves to the full gamut of the emotions that life has to offer. Medicalisation of "depression" has been overwhelming since the 50's and 60's... my mother is one of the "Mother's Little Helper" generation, and sleep still eludes her to this day, and she continues to be plagued with depression. People are no longer able to differentiate between sadness and depression, nor do they wish to cope with, or want to be sad, or even anything less than "great". The result of this is that the "lows" seem to be exacerbated and overwhelming. But a pill will fix all that..in a hurry... Why bother looking into the root cause for the sadness, and making changes to your life to suit?
And that's my rant.
Thank you MJ, ;)

3:45 PM  
Blogger The Angry Medic said...

Spot on. Cyndy's also right about the 'overwhelming medicalisation of depression'. Many people who aren't depressed pretend that they are in order to get out of doing work (like med students, for example. Not that I'd know anything about that).

But hey, like your post title asks, "What's So Bad About Feeling Good"?

5:29 PM  
Blogger Mo said...

Oh dear angry medic... "What's So Bad About Feeling Good"?

How dare people try and get happy. Surely ordinary folks should be encouraged to live in abject misery and discouraged from accessing anything that makes them happy.

That "summer of love" business put an end to the glory that was Vietnam. God forbid that this new drug has a similair effect on the masses and puts an end to the killing in Iraq.

No, allowing the proletariat free choice would surely be the end of our hard fought for democracy.

(I've had a few beers and I just know I'm gonna regret this post in the morning. Apologies folks.)

7:09 PM  
Anonymous Anonymous said...

Cyndy, your post is excellent. There is value to us in differentiating between depression and sadness, and there's value in actually experiencing both. I've dealt with depression off and on throughout my life. It isn't pleasant, but it requires me to get really honest with myself (sometimes with the help of a close friend) about what's going on in my life, what are my goals, what are practical measures I can take to eliminate destructiveness from my life, what are positives I can add, etc, etc. It requires work, tears, and strict honesty about the good and the bad.
I like the challenge and the power of the fullness of my humanity.

8:15 PM  
Blogger SQT said...

How about the doctors who prescribe anti-depressants for everything? I've been struggling with my thyroid since I had my kids. I try to get my doctor to test me and they just say "your depressed" and try to hand me some Prozac. Huh?

I don't think I'm depressed at all. I'm frustrated because I run 4 miles a day and eat sparingly and can't lose any weight. And that translates into depression?

A bunch of my girlfriends have had the same thing happen. One women went to her doctor and asked to be tested to see what was wrong with her since she wasn't feeling well. He ignored her and tried to push anti-depressants on her. Fortunately she kept trying and went to several different doctors until she was tested. They finally found out she had cancer.

What the heck is going on that a woman with a distinct set of symptoms can't get her doctor to test her? I've given up because no one will listen to me. They say I "look fine" and won't give me the time of day. Now that's enough to depress anyone.

8:19 PM  
Blogger Iris said...

sqt,

I completely agree with you on that one. And made worse by an actual history or real depression, of course that is the route that the drs take. In my case, I don't run, my thyroid isn't whacked, but my life of working nights and chasing around with 4 kids has screwed my metabolism right out of business.

9:35 PM  
Blogger SQT said...

Iris

A history of depression is part of the problem. I had post-partum depression after having my daughter. But I know what depression feels like and I really don't feel depressed at all. But once a doctor see's it in the chart that kind of becomes the go-to diagnosis. It's maddening.

11:05 PM  
Blogger apgaRN said...

MJ,
I think we'd all be surprised at the prevalence of over-prescribed anti-depressants and mood elevators. My mother-in-law once told me that she was the ONLY one in her office (out of 8-10 co-workers) NOT on Prozac. The other women suggested that she give it a try, too. I was absolutely flabbergasted, but happy to hear that she would never consider medicating unnecessarily.
N

11:41 PM  
Blogger Jean-Luc Picard said...

I read in the paper about a four year old who takes antidepressants.

12:03 PM  
Blogger Iris said...

JLP,

My one son was on antidepressants for a period of about 2 years. He was clinically depressed, stemming from my divorce and a multitude of other issues, not the least of which was my own Post Partum Depression after he was born which carried over into Major Depressive Disorder. I was medicated for about 3 years, and with the support of my dr and my family, chose a trial of getting off the meds. It worked and I am med and depression free. The same for my son, he is 10. He wanted to get off the meds, so with the support of his counsellor and his psychiatrist, we weaned him off.......and he is now fine......no meds, no depression. They work for people that need them, it is all the ones that are being prescribed them that don't need them that is a concern.

1:13 PM  
Blogger Forty_Two said...

Why do all of those who suffer from depression seem to live in a depressing environment? Is this really a medical problem or is it just one more reason to dipense profitable pharmaceuticals?

4:22 PM  
Blogger Bohemian Road Nurse... said...

I agree, medications are dangerous if not used correctly, and antidepressants don't always have the same effect on different people. I've seen some patients in which Wellbutrin not only worsened their symptoms but also created extreme anxiety. One thing about the doctor thing: I too have experienced the phenomenom of being prescribed an antidepressant whenever I have asked my doctor about my thyroid, migraine headaches, or blood glucose functioning. Not sure what's up with that issue... (But eliminating sugar from my diet has made a world of difference, whodathunkit.)

4:59 PM  
Blogger Deacon Barry said...

It's important to know what kind of depression somebody is suffering from before starting down the pharmacological route. Reactive depression, which is most common, can respond to therapy and counselling, whereas bipolar depression is a result of brain chemistry disorder and can only be treated with medication. Someone close to me suffers from the second type, so I speak from experience.

6:54 PM  
Blogger howling said...

Some arty pants call for creative output is a silly excuse / ?justification for dependence to drugs. But why take the pill if you don't want to win the Nobel Prize for Literature?

Stupid artists.

Taking the pill to avert war and spread love to the whole wild world is quite cool though. We just love them - hippies.

7:16 PM  
Blogger north said...

Ookkk....I might be a graduate nurse, but what in the name of Hades is a doctor doing prescribing Welbutrin for CIGARETTE addiction???!! Whatever happened to good ol' Nicorette or Nicotine patches? Please tell me someone is investigating "Dr Feelgood"!

7:25 PM  
Blogger Mother Jones RN said...

Hi North: Zyban is another brand name for bupropion, or Wellbutrin. Zyban is prescribed to help patients kick cigarettes. Drug companies rename old drugs so they can get a new patent, and make more money.

MJ

7:52 PM  
Blogger Amber Lee said...

Every day I take a little pink pill and a slightly larger yellow pill. I hate them and I tell them that every day. I waited until I was 19 to finally accept that I have a chemical imbalance after years of downing benadryl and nyquil and just generally being the poster child of Major Depression. Besides daily exercises, good nutrition, going to a counselor and LOTS of sun, I still have to take these stupid pills. My mother doesn't have to take, my aunt is able to take care of herself without pills, but my grandmother will be on anti-psychotics until the day she dies. At least menopause changed her chemicals and she's off lithium (after 40 years of it.) While I am diagnosed with severe major depression, I am always nervous that I might wake up like my grandmother - manic depressive and having grand delusions.

I have no idea where that was going really. Just a ramble.

8:37 PM  
Blogger poody said...

I take wellbutrin and busbar for depression. I also see a psych. Dr and a therapist. Just taking a pill is not the answer. The medication helps keep me on an even keel. It took a long time to get the right meds and the right dose.I can't say they make me feel good but I will say that ever since I started taking the Busbar I have seriously orgasmic dreams. Nice for a single girl!

9:38 PM  
Blogger Irene said...

That was a good, much-needed, informative rant. Thanks for sharing and keep at it! You're a cool nurse! ;p

10:44 PM  
Blogger Lorena said...

Thank you, thank you, thank you! I have SUCH a problem with doctors who are not psychiatrists prescribing psychotropic drugs. THAT IS NOT YOUR SPECIALTY!!! Let alone stupid doctors who prescribed these meds to peole who aren't depressed. UGH! Makes me sick. THANKS for your rant.

8:09 AM  
Blogger The Curmudgeon said...

Still on crutches? Hope you're free of them soon.

I always joke that, as child of the '60's my motto (like Dow Chemical) is "Better living through chemistry."

But I am very uncomfortable about pills that make me feel different or act different.

Although I'm quite certain that, if my behavior could be modified by pills, there'd be several people, family members included, lobbying for my doctor to issue a prescription....

9:49 AM  
Blogger Spelunker said...

Hope you get to run around freely without crutches soon!

This topic is somewhat dear to my heart. I worry that we are creating an expectation of all happiness, all the time. Reminds me of a book I read in school, where the state supplied drugs to everyone...

12:47 PM  
Blogger Christopher said...

In some defense of the doc, I don't know that I could have quit my smoking addiction without Zyban (which was prescribed as Wellbutrin so my insurance would pay for it). I was smoking a pack and a half a day, and after three weeks of the med, I was down to half a pack before even making my real attempt to quit. I stayed on it for 10 weeks after quitting, and have been smoke-free for over a year now. My doc happily gave me the script for the Zyban, and he's someone who will hardly prescribe an aspirin.

I'm curious to hear MJ comment on the common usage of the ADHD drug Adderall among students at highly competitive universities. I had never heard of it until I started law school, and one of my classmates (a Vandy alum) mentioned she wished she had some for finals. It is all the rage among the kids using it as mental steroids...who knew?

9:42 PM  
Blogger north said...

OIC Mother Jones, thanks for the insight!

3:38 AM  
Anonymous Troy Dayton said...

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?

3:36 PM  
Anonymous marachne said...

I too think we (at least in the U.S.) are an over-prescribed society in many ways, and take the labeling and drugging of the county disturbing. That said, as a gerontologist I am very upset at the UNDER diagnosing of depression in older people ("they're old, of course they're depressed") men over 65 have the highest rates of completed suicides (they tend to use guns -- usually a pretty lethal way to go). Depression can be misdiagnosed as cognitive impairment, and it can also exacerbate both delirium and dementia.

Ok, off my soapbox now.

12:06 AM  
Anonymous Candy said...

I agree with marachne -- depression is very under-diagnosed in the elderly and is a significant health risk.

However, 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 are 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.

9:56 AM  

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