Surviving Your Antidepressants

The major advantage an SSRI has over its TCA counterpart is a much shorter rap sheet related to side effects, thus ensuring far greater compliance and eventual recovery, right?

Wrong. A study published in this month's American Journal of Psychiatry has found that there are "no significant differences" in compliance between the SSRI Prozac and the TCA doxepin (Sinequan), this despite "marked differences in side effect profile."

But wait. How "markedly different" are these "marked differences"? I recall the first time I dropped an antidepressant into my brain, and all I can think of is that movie Das Boot and the entombed U-boat crew riding out a depth-charge attack. Eventually, my psyche righted and stabilized, if you don't count the 30 pounds of ballast I took on and some minor malfunctioning in the bow torpedoes.

Needless to say, these unpleasantries tend to get swept under the carpet. A Brigham and Women's Hospital study recently uncovered major discrepancies between the number of drug complications their patients reported to doctors and the figures that eventually appeared on the medical charts. According to Dr Tejal Gandhi, who led the study: ``Physicians often take these types of reactions for granted in the course of medical therapy. However, it is important to realize that these events are not minor to patients ...''

One doctor has finally come clean on the issue. In the Feb 29 Washington Post, Dr Robert Hedaya, Professor of Psychiatry at Georgetown University, has written: "Sadly, some doctors do not appreciate, or may even dismiss, their patients' complaints about side effects ... This all-too-common response by physicians not only lacks compassion, it's also bad medicine. By dismissing antidepressants' side effects as something patients must learn to live with, doctors are forfeiting their patients' chances for full recovery."

Prof Hedaya found himself treating his patients for depression, only to discover their progress sabotaged by a whole new set of problems:

"They gained weight - sometimes so much that they resigned themselves to the sidelines of social life. Their sex drives deserted them - love relationships and marriages foundered amid sexual apathy and dysfunction. Most critically, they lacked the energy to keep up with their jobs and fully engage the everyday challenges of life. Over and over again, patients told me that although their depression was controlled, they could not fully enjoy life."

Prof Hedaya believes that we should not have to resign ourselves to half a life simply because of our medication. Now here's the catch - his prescription amounts to dietetic boot camp. It's all laid out in his just-published, "The Antidepressant Survival Program: How to Beat the Side Effects and Enhance the Benefits of Your Medication (Crown Publishers)."

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