MOTHER'S little HELPERS

By Alison Young, On-line Forty-Niner

May 14,1998

 

Prozac. Paxil. Zoloft.

Pills have become the saving grace for millions of Americans, students included

The treatment of depression and anxiety has never been so straightforward. Sufferers now have the option of taking a pill designed to alleviate their symptoms.

 

And the number of people embracing this new panacea is growing.

 

The impact of these medicines is making medical history. The top three, Paxil, Prozac and Zoloft, account for more than $5.5 billion in sales a year. Prozac alone has been prescribed to more than 17 million Americans.

 

Unknown, however, are the long-term effects of such medications. After 10 years of Prozac research, many unanswered questions remain.

 

None of the drugs have been determined safe to take during pregnancy, a time when women are vulnerable to depression.

And the FDA has not approved the use of antidepressants for patients under 18.

 

What is common knowledge in the medical field, however, is that antidepressants, as a class, can treat major and minor depression, and anxiety disorders.

 

Prozac, Paxil and Zoloft all act by increasing the amount of the chemical serotonin in the brain. Serotonin is a neurotransmitter that alters and modulates mood. In depressed individuals the level of serotonin is low, according to medical experts.

 

The new antidepressants allow for a greater amount of serotonin to remain in a cell for a longer amount of time.

 

Here at Cal State Long Beach, Dr. David Scarpino's job is to evaluate and treat major mental illness as well as any type of psychological stress. As the university's sole psychiatrist, Scarpino advises and treats students with a wide range of symptoms.

"A vast majority of students I see are very anxious or stressed," Scarpino said. The majority of cases of anxiety and depression are due to relationships, school and work, he said.

 

"I see students from all walks of life," Scarpino said. "I see students who are doing well in every aspect, but they are still in a lot of emotional pain."

 

Depression, defined by Scarpino as a profound, depressed mood lasting longer than two weeks, can take on physical manifestations as well. These can include disturbance in sleep patterns, anxiety, decreased appetite and low energy.

 

Students may be prescribed medication on the first appointment, depending on their symptoms, Scarpino said.

 

For example, if a student is experiencing insomnia, Paxil will most likely bring immediate relief because it is the most sedating.

 

Scarpino also considers the cost of treatment, which ranges from $1 to $2 a day. He may occasionally give students free samples.

 

The length of time an individual remains on an antidepressant varies.

 

Statistically, if a person experiences one episode of depression, there is a 50 percent chance of a second episode. If a person experiences a second episode, there is a 75 percent that a third will occur. In the case of a third episode, the recommendation would be to stay on medication indefinitely, Scarpino said.

 

The primary focus, when treating a student, is to alleviate the depression through a combination of the medication, medication management and counseling, Scarpino said.

 

It can take from one week to one month for antidepressants to begin to take effect. Once they take effect, a patient should experience a period of stabilization, without any symptoms of depression or anxiety. Following this period of stabilization, patients are usually advised to decrease their medication slowly. The period of stabilization varies from patient to patient.

 

"I sometimes try three months," Scarpino said. "The recommendation is six months, symptom free."

 

Marcia Bernstein, a licensed clinical social worker, said about 2.5 years is an adequate amount of time for the stabilization period.

 

"I view it like this," Bernstein said. "If you are going to try it, you need to give it a fair shake."

 

Bernstien, who has been licensed and in practice for 19 years, sees 30 patients, seven of whom take some form of antidepressant.

 

"It is so idiosyncratic. There is so much we are still learning," Bernstein said. "A patient can be on Prozac and it can just stop working. These antidepressants are in their infancy."

 

Side effects of the medications depend on the class of drug and the individual taking the medicine. The three most common, Scarpino said, are sedation, weight gain and sexual dysfunction.

 

Adverse effects, which would lead to discontinuation of treatment, include nervousness, anxiety, insomnia, nausea, headaches and dizziness, according to research by Internet Mental Health.

 

Research also indicates antidepressants have not been systematically studied on animals or humans for potential abuse, tolerance or physical dependence. In the classical sense, antidepressants are not addictive: Patients do not experience a decrease in tolerance, or a physical withdrawal.

 

Although antidepressants are not considered addictive, it is a good idea to gradually reduce dosage when coming off of the medication, due to a subjective withdrawal, Scarpino said.

 

Physical reactions to discontinuation of treatment could include lightheadedness, dizziness and nausea. A sudden stop in medication also increases the chances for a relapse, Scarpino said.

 

For a Malibu woman, who asked to remain anonymous, taking Zoloft alleviated much of the depression that hit her at 53.

 

"One morning I woke up and said I can't do this anymore," she said.

 

The Zoloft patient said she would feel weak and would burst into tears for no apparent reason. She did not want to get out of bed, leave her room or talk to anyone.

 

"After a few weeks of taking the medicine, I felt much less reactive and depressed," she said.

 

It has been three years since she began taking the Zoloft. For now, she continues to take a low dosage. In the near future, however, she would like to switch to St. John's Wort, an herb that is medically proven to be effective for mild depression.

 

Some in the mental health community wonder what the implications may be for a society on antidepressants.

 

"There is the concern that if we medicate people's depression we are cutting into society's creativity," Bernstein said."Some of the greats [artists] have created remarkable works out of a depressed state.

 

"But I have seen the opposite. People I see have had more access to their creativity because they are not stifled by the weight of their depression."