White Coat Wisdom

Antidepressants: 5 Facts You Need to Know

Prescriptions being written for antidepressant and antianxiety medications are on the rise, especially in the United States. Approximately 1 in 8 Americans take a medication for their mood and the majority of these people are women. Are you surprised by this statistic? I’m not.

I see this in my practice every single day. Women and men alike come to the office complaining of excessive fatigue, lack of interest, difficulty concentrating and irritability.

I’m a huge advocate for antidepressant therapy and I’m not ashamed to admit that I took an antidepressant more days than not over the past ten years. What does surprise me though is how little patients know about these medications, even if they have been on them before.

Here are 5 facts you need to know about antidepressant/antianxiety medications.

They Take Time To Work: Antidepressants are not antibiotics. Unlike antibiotics which begin taking effect after the first dose, antidepressant therapy will not provide improvement in symptoms in the first 24-48 hours. In fact, most of these medications take 4-6 weeks before you will begin to notice a difference.
You Shouldn’t Feel Like a New Person: Let me be clear, you should feel better on the medication but as a general rule I tell my patients “I want you to feel like yourself again. I want you to feel like a better version of yourself than you feel right now.” If your antidepressant makes you feel physically ill, completely numb and void of all emotions, then it is not the right medication for you. This does not mean that antidepressants are not right for you, it means that particular medication is not for you.
Antidepressants Don’t Fix Everything: Life still happens. No amount of medications will make you love your job, fix your relationship or make grief or disappointment disappear. Antidepressant medication will help balance the neurotransmitter chemicals in your brain so that you are no longer clinically depressed or anxious. Happiness however does not come in a pill. Remember that sadness is the opposite of happiness and sadness is not the same thing as clinical depression. A large portion of being content with your life is up to you and for that reason I strongly encourage therapy in some form or another. Ideally I would recommend counseling with a licensed counselor, but if you are hesitant other options include attending church, educating yourself (from reliable resources) about anxiety/depression, confiding in a trusted friend, yoga, meditation and journaling.
Choosing One is an Educated Guess: As medical providers we do our best to tailor medications specifically to a patient, but every patient is unique in chemical makeup and genetics. Prozac may have worked wonders for your coworker, but it may cause horrific side effects for you. Wellbutrin may have helped your aunt’s depression, but it may worsen your anxiety. When starting an antidepressant, make sure you are completely honest with your medical provider regarding your symptoms and any concerns you may have. Up until recently, providers would prescribe a mediation, have the patient return in 4-6 weeks and report on their results in order to determine if the medication was successful. Today we have advanced medical technology that can narrow down appropriate choices for antidepressant therapy based on the patient’s unique DNA makeup. Tests like GeneSite provide comprehensive information on the medications that will work best for each patient. The test requires a swab of saliva from the inside of your cheek and within two weeks a report is generated.
Antidepressants and antianxiety medications are grouped into one of three categories, conveniently color coded as red (stop), yellow (proceed with caution) and green (go). Using these results, your medical provider can narrow down your choices for a medication that will be best tolerated and most efficacious for you. Keep in mind, this test does not diagnose depression or anxiety, but will provide insight as to which medication will work best. If you have been on a medication in the past and either had side effects or found it unhelpful, ask your provider about this test. The answers may surprise you.
Timing is Everything: Deciding to start an antidepressant for your mood is a big decision, but deciding if and when to stop a medication is equally important. The best time to stop a medication is when you expect to have a constant exposure to sunshine, warm weather and fresh air. Let’s face it, most of us feel better in the spring and summer months, especially if you live in the north or Midwest when half our year is spent indoors due to snow and cold temperatures! When you consider stopping one of these medications, discuss this with your medical provider first. Many of these medications require a gradual decrease in dosage and you will feel much better if you do this during late April or early May compared to stopping the medication in January.

Remember, there is absolutely no shame in starting one of the medications; they can do wonders for your mood (I’m living proof).

Talk with your medical provider and let me know if you have any questions about starting a medication for anxiety and/or depression.

The Influenza Vaccine: Making the ‘Scary’ a Little Less Scary

I face many challenges in my family practice office when it comes to convincing patients of the need for certain treatments, medications and preventative measures. However nothing is more challenging than trying to convince a patient (or a patient’s parent) who is hesitant on vaccines that they are safe and warranted. Like most challenges I face in my career, I find that most of this stems from the general public being misinformed or undereducated. Gone are the days where patients agree to a medical procedure or medication simply because their doctor recommends it. No, that sort of blind faith has long disappeared and what is left behind is a large group of people who would rather do nothing than blindly follow their doctor’s recommendation, especially when they are confused or unknowledgeable about a given topic.

I see this a lot with the influenza vaccine. Between the months of September and March, I regularly hear patients refuse the flu shot. Below is my response to several questions and statements I hear regularly regarding the influenza vaccine. Hopefully, the information provided will make you a little less hesitant to receive the influenza vaccine and we can make the “scary flu shot” a little less scary.

How are the flu strains chosen for the vaccine?

Throughout the year, thousands of volunteer influenza centers collect data regarding the incidence of influenza and collect specimens from patients who have influenza like illness. In the state of Michigan, the Michigan Department of Health and Human Services (MDHHS) participates in the U.S. Outpatient Influenza-like Illness Surveillance Network. As a sentinel provider, the weekly total number of patients that visit the facility are reported as well as the number of patients with influenza-like illness (fever >100degrees with cough and/or sore throat). Specimens (nasal swab) obtained from patients with influenza-like illness are sent to the MDHHS laboratory for testing. Data obtained from these reports and lab specimens are tested and recorded by the Center for Disease Control and ultimately sent to the World Health Organization. (The CDC publishes weekly influenza reports that are available for review on their website at http://www.cdc.gov/flu/weekly/index.htm).

Twice a year (February for the Northern Hemisphere and September for the Southern Hemisphere), the data is reviewed and recommendations are made by the WHO regarding the composition of the upcoming influenza vaccine. While the WHO recommends specific viruses for inclusion in the vaccine, in the United States the FDA makes the final decision about which virus strains will be included in the upcoming influenza vaccine.

Once the 3-4 virus strains have been chosen, the viruses must be isolated, grown, tested and mass produced for distribution. Typically most doctor offices receive influenza vaccines in late August for the upcoming influenza season.

I had the flu shot last year, why am I not covered this year?

Influenza viruses change yearly. The actual virus may mutate or strains that were not included in last years vaccine may be predicted to circulate in the upcoming flu season. For instance, lets say that strains A, B, C and D were included in the 2015-2016. But the WHO and CDC predict that strains A, B, Y and Z will be circulating in the 2016-2017 year. You will need an influenza vaccine to protect you from the Y and Z strains since they were not included in the previous year. Furthermore, much like other vaccines, the influenza vaccine does not provide lifetime coverage (this is why you have to get boosters of some vaccines like the tetanus and meningococcal vaccines). Unfortunately, the influenza vaccine typically provides only 12 months of coverage; therefore in order to have ongoing protection, annual vaccination is recommended.

I never get the flu, why do I need to get it?

My kids have never been in a car accident, but I still put them in their car seats. In other words, consider yourself lucky that you “never” get the flu but just because you haven’t gotten it in the past, does not mean that you are exempt from the virus. Influenza has no prejudice.

I couldn’t tell you the last time I had the stomach flu. I never vomit.

Stop.

No. Please understand that influenza is NOT the same thing as the stomach flu. Influenza is a respiratory virus that causes a fever, cough, sore throat, muscle aches and fatigue. The flu shot does not, I repeat DOES NOT, protect against the stomach flu.

How does the flu shot work?

For a better understanding of this, I plan to write a more detailed post about how vaccines work in general but for now here is a brief explanation…

The flu virus strains are isolated and killed; this means that they cannot cause illness in the body. However, once injected, to the body’s immune system they look threatening. Therefore the immune system builds antibodies against the inactivated virus. If during the influenza season you are exposed to the actual flu virus, your immune system has already created an army of antibodies ready to fight. The real virus is recognized immediately upon entry, attacked and killed before it is able to cause symptoms or illness.

Can you get the flu from the flu shot?

The flu shot is made from inactivated (also known as killed) strains of the virus. The body’s immune system recognizes the inactivated virus as the actual flu virus and builds antibodies against it, but the vaccine itself cannot cause illness. Think of the flu vaccine as a one of those lifelike wax statues of a celebrity; preferably one like Al-Pacino in Scarface, Anthony Hopkins in Silence of the Lambs or in my worst nightmares, Chucky (*shudder*). These statues look real and would be terrifying if they were real, but since they are ‘inactivated’ they do not pose as a threat.

What most people fail to realize is that the influenza vaccine takes 2 whole weeks before it protects you from the flu virus. (It takes time for your body’s immune system to make all those antibodies!) Therefore, if you get the influenza vaccine on September 1^st but you are exposed to the influenza virus on September 7^th, there is a good chance you will become ill. However, this is not because the flu shot got you sick! The vaccine won’t be effective until September 14^th or so.

Does this help? Is the flu vaccine a little less intimidating to you now? What other questions do you have about the influenza virus and vaccine? Comment below and let me know!

As always, all medical information provided is to serve as a resource and promote broad consumer knowledge on a range of medical topics and is not intended as a substitute for the medical advice of your medical provider.

Resources: Center for Disease Control. www.cdc.gov

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