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Question
Posted by: Dave | 2010-01-22

Antidepressants? What the heck...

Dear Dr I am 52 years old and I have a number of smallish health problems that are more irritating than dangerous - mild IBS, occasional interstitial cystitis, with a migraine thrown in now and then for good measure. I also sometimes struggle to fall asleep, because my head is too full of interesting things to switch off!
I have had an unfortunate experience with two GPs now. The first one knows my medical history, and he helped me to come to grips with the diseases. In fact, for the past five years I have been healthier and fitter than ever before. This doctor saw me a few times when I had short but severe migraine attacks, feeling like death warmed up, and he immediately wanted me to use antidepressants. My opinion was that if he thinks I suffer from depression, I would rather have a specialist' s diagnosis and care. The last time I visited him, I was feeling terrible (migraine) and he just wrote a script for antidepressants. I took the prescription but didn' t buy the pills and I didn' t go back either....
When I visited my new doctor for treatment of my mild IBS and IS, he prescribed Espiride, without telling me what it was. " It will make you feel better."  I had to read on the internet about its uses, and only then discovered what it is. Am I crazy, or should he at least tell me what the side effects are? And if he suspects depression, shouldn' t he treat me for that? I am self-employed, work very hard (sometimes 16 hours a day) and don' t feel depressed at all. On the contrary! I feel better than ever before. I' ve lost 20 kg, I am fit and I regard the occasional IBS, IS and migraines as nuisances, not debilitating diseases. Now what? I would really like a doctor who treats the symptoms and get script-happy with feel-good pills!!!

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Our expert says:
Expert ImageCyberShrink

ANY doctor who prescribes ANY drug for ANY condition or reason, ought ethically and professionally to explain to you what the drug is, what it's side-effects and benefits and risks are, how to take it and what to expect. Not to do that is not to do his job properly.
Now, as for antidepressants. It's perhaps unhelpful but inevitable that that is what we call them - because they are variations on some original meds first developed for other uses, which were found to be useful in Depression. No drug is actually specific to depression as such - they influence the relative brain ( and body ) levels of different body chemicals in ways that are often useful in Depression. But those chemical efects can also be useful in other conditions, whether or not the person happens to be depressed - and they can sometimes be helpful in Migraine, for instance ( though there are, more recently, more specific drugs for use in migraine, based in turn on the "ADs". And because they can affect the movements of the bowel, what can occasionally be a nuisance side-effect in some people, can be useful in IBS.
So there could be real logic and sense in the recomendations your doctors made, and the meds might have been worth trying ; but they should have explained all of this to you.
Because as you know, prescriptions that are not filled, or meds that stay in the bottle, are of no real help at all.
Espiride is a drug beloved by some SA GPs for reasons I canot fathom, and often used non-specifically - I have NEVER found any good reason to use it But other genuine ADS might be useful in some of the situations you describe. Maybe seeing a shrink for assessment might help, if they would agree to discuss all these issues properly with you and help you to make the best decision about treatments

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3
Our users say:
Posted by: Dave | 2010-01-23

Thanks very much for your opinion. All I want to do is to play an active and responsible role in my own health. My previous doctor helped me a lot - I tended to be somewhat neurotic, but once I understood the nature and symptoms of my ailments, my visits to the doctor dropped drastically. I am not against the use of medication, but over the past few years I have realised that I can look after my own health. I have learnt to live with the minor medical irritations, but sometimes I need a doctor' s help to take care of the immediate physical symptoms that bother me.
My problem with the ADS is that they don' t treat these symptoms, but the doctors use them as a quick cure-all for what they perceive to be an underlying cause for the symptoms. This after they' ve seen me for about 10 minutes, while I am feeling a bit under the weather anyway. I go to the doctor for the antibiotics that usually help, and come away with ADS that can open a whole new can of worms! I would at least like to discuss all the do' s and dont' s and the possible long-term effects.
I told my previous doctor that I don' t want to exchange the symptoms that I know and can handle for a new set of unpredictable side effects. Anyway, thanks for the advice - I' ll go the shrink route... and look for another GP!

Reply to Dave
Posted by: Liza | 2010-01-23

Some GP' s do like to prescribe antidepressants too easily. Sometimes they do it because nothing else has seemed to work. What I' ve read from your post, is that you suffer from mild anxiety. Now even if you don' t feel depressed, there are quite a few anti-depressants that would work for the anxiety and lessen symptoms like IBS and migraine.

CS has said the following in the past about Espiride:

Espiride could possible cause a degree of anxiousness. It' s an odd drug, widely used by some SA docs, especially GPs, though there' s not much evidence that its effective for the wide range of situations in which they use it, and it isn[t used this way in most other countries.

HTH
Liza

Reply to Liza
Posted by: cybershrink | 2010-01-23

ANY doctor who prescribes ANY drug for ANY condition or reason, ought ethically and professionally to explain to you what the drug is, what it's side-effects and benefits and risks are, how to take it and what to expect. Not to do that is not to do his job properly.
Now, as for antidepressants. It's perhaps unhelpful but inevitable that that is what we call them - because they are variations on some original meds first developed for other uses, which were found to be useful in Depression. No drug is actually specific to depression as such - they influence the relative brain ( and body ) levels of different body chemicals in ways that are often useful in Depression. But those chemical efects can also be useful in other conditions, whether or not the person happens to be depressed - and they can sometimes be helpful in Migraine, for instance ( though there are, more recently, more specific drugs for use in migraine, based in turn on the "ADs". And because they can affect the movements of the bowel, what can occasionally be a nuisance side-effect in some people, can be useful in IBS.
So there could be real logic and sense in the recomendations your doctors made, and the meds might have been worth trying ; but they should have explained all of this to you.
Because as you know, prescriptions that are not filled, or meds that stay in the bottle, are of no real help at all.
Espiride is a drug beloved by some SA GPs for reasons I canot fathom, and often used non-specifically - I have NEVER found any good reason to use it But other genuine ADS might be useful in some of the situations you describe. Maybe seeing a shrink for assessment might help, if they would agree to discuss all these issues properly with you and help you to make the best decision about treatments

Reply to cybershrink

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