Summer Beretsky felt uneasy as she sat in the doctor’s office.

‘Paxil or Celexa, Paxil or Celexa,’ her doctor pondered out loud over a notepad. ‘Alright, we’ll get you started on some Paxil.’

Beretsky was confused as she wondered to herself, ‘Seriously, is this how doctors make decisions about this sort of thing?’

It all started one night during her sophomore year. It was finals week, and Beretsky recalls lying in bed and suddenly feeling her entire body go numb. Her heart started racing and she thought she was having a stroke.

‘I started shaking and got dizzy. After about two hours of walking around my dorm with a cup of hot tea, I was finally able to calm myself down enough to go to bed,’ said the then-20-year-old at Lycoming College.

A few weeks later, Beretsky went to her family doctor and described the symptoms she had. After taking several tests for her heart, she discovered that what she was experiencing were panic attacks.

To combat them, her doctor gave her a prescription for Xanax, a drug used to curb panic attacks, with the instructions ‘Take them every time you feel a panic attack coming on.’

And she did.

For about a year, until finals week of her junior year, Beretsky found herself having panic attacks daily – sometimes several times a day. She continued to take Xanax as she felt the symptoms, but soon the constant pill-swallowing made her uncomfortable.

She decided to visit her Wellness Center at school, where she was told maybe a daily medication to prevent the attacks would be more helpful.

So, Beretsky sat in the doctor’s office, trying not to let his indecisiveness scare her too much. She ended up leaving the office with a prescription for Paxil CR at 12.5 mg – and a month’s worth of Paxil samples. Beretsky said the small, foiled blister pills came with no instructions or side effects listed.

Prescriptions for drugs, particularly antidepressants, have become really easy for people to get their hands on.

‘If you go to the physician’s office and say you’re depressed, you get a drug,’ said Tibor Palfai, a professor of psychology at Syracuse University. ‘If you complain, you get a drug; even if you just get a placebo drug, you get a drug.’

This is part of the current drug culture in America.

Anti-depressants are becoming readily available for anyone who wants to take them, especially college students. The dangers of simply writing off a problem with a prescription is that users are rarely given proper instructions for taking these medications, creating bigger problems, often making the depression worse rather than improving it.

In Beretsky’s case, the only obstacle between her and her medications was insurance. But once that was solved, her doctor had no problem doling out the prescriptions. Beretsky heard from a friend’s mom that a different type of Paxil prescription, the non-CR, generic version, was a cheaper alternative.

‘The very next day, I asked my doctor if I could switch to the non-CR version of the drug, and he wrote me a prescription for 10 mg,’ Beretsky said.

What are they?Depressive disorders affect about 18.8 million American adults, according to the National Mental Health Institute. This includes depression, bipolar disorder and dysmythic disorder.

The National Institute of Mental Health described antidepressants as medications used to treat depression. The most commonly prescribed type is called selective serotonin reuptake inhibitors (SSRI), which includes brands such as Paxil, Prozac and Zoloft.

‘What the antidepressants do is give the brain more serotonin, which is supposed to affect the person’s mood. Serotonin is a neurotransmitter that transmits nerve signals between nerve cells and cause blood to flow,’ Palfai said. ‘In depression, the person usually has something blocking the passageways, which can affect the mood.’

Antidepressants are currently the most prescribed drugs in the country, but their effectiveness can range from completely helpful to making the problem worse.

Robert Gregory, a psychiatrist and associate professor of psychiatry at the State University of New York Upstate Medical Center, said that while research has proven that antidepressants are effective for a range of disorders, there can be side effects. In addition, when instructions for the pills are overlooked, disaster can begin.

Handle With CareGregory said that antidepressants do not give complete resolutions, and only two-thirds of those taking them will actually respond to the medication the first time around. He stressed that antidepressants aren’t meant to completely clear things, just be helpful.

‘A proven method is to engage in types of psychotherapy in order to substantially improve depression on a biological and social aspect to see how they’re coping,’ he said. ‘This can lead towards healing.’

Beretsky said at the time of her many different prescriptions, nobody recommended any type of therapy to her. Gregory attributes this to the ease in simply prescribing a pill.

‘It’s easy for doctors to prescribe medicine and for patients to take a pill, rather than take a hard look at themselves,’ said Gregory. ‘Instead of making life decisions, people will just take meds to feel better rather than look into what is driving their depression. It’s like putting a Band-Aid on a stab wound.’

Communication between the doctor and patient is key, said Gregory. It’s the physician’s job to delve inside the life matrix of the patient and see what the real problem is. Ultimately, this is the only way to get real help.

Stephen Cottrill, a 22-year-old former Syracuse University student from Whitesboro, N.Y., said that when he walked into the doctor’s office, antidepressants were the first option recommended to him.

‘If you think you’re sad, you can get antidepressants just by asking for them,’ he said.

Gregory finds that commercials and ads contribute to doctors giving antidepressants first.

‘It’s a very big problem – they see a commercial, then demand a drug and the doctors generally go along with that,’ he said. ‘Some physicians try not to do what’s best, but rather what will please the patient as well.’

Hit and missPalfai said there is no real way of prescribing the right medication for a person.

‘There’s no standard test, because you can’t test which drug is best for you to take,’ he said. ‘Doctors listen to the symptoms and take a stab at the treatment.’

The trial and error method that doctors use when prescribing medicine can be detrimental to the patient, especially when it comes to switching medicines, lowering dosages and getting off antidepressants.

Beretsky had three attempts at getting off antidepressants. When she first tried to cut her dosages by taking them every other day, her anxiety got worse and she had to go back to taking the full dosages again.

In addition to reverting back to her old symptoms, Berestsky also started experiencing withdrawal symptoms.

‘I started getting a flurry of uncomfortable sensations, most notably, the zaps,’ she said. ‘The zaps are electrical-shock sensations that are very common in antidepressant withdrawal that begin at your neck and feel like they are running down your spine.’

Berestsky also felt more fatigued than usual as she cut down her medication. One day she decided to resume taking Paxil at her usual dosage, and she felt ‘good as new.’

Cottrill had more of an emotional problem getting off antidepressants.

‘It was hard. Getting off antidepressants is like trying to figure out who you are all over again. The long-term effects of being on them for even a week or two are pretty drastic,’ he said. ‘The first time I stopped taking them, it took me almost four months to be able to feel like I did before for the things that I loved and such.’

Gregory said that patients should be taking the drug for six months to a year before they consider lowering or stopping dosages. It should take this long because the body has to go back to its baseline state.

But Cottrill couldn’t wait that long. He took his first medication, Prozac, for only two weeks and his second, Zoloft, for less than a week.

He didn’t like the numb feeling the medication gave him. Cottrill said the first few days of the medication were the most carefree days of his life. But that quickly changed for him.

‘Life was good until I realized how different of a person I had become. I no longer thought the same, and even though I wasn’t as ‘depressed’ as I used to be, the effect on my personality was negative. I could no longer feel as happy or as sad as things were, how I understood them. It made me not as able to want to survive to live another day,’ he said.

Gregory said recent research has shown that college-aged and younger students run a small risk of becoming suicidal while on antidepressants. This is because the drugs activate before their mental outlets improve, causing restlessness which makes it more likely that the patient will act on suicidal thoughts.

This emphasizes the importance of seeking some type of talk therapy in addition to medication.

Gregory said when it comes to therapy, resources are limited and it can be difficult not only to pay for, but also to find therapists.

‘Insurance companies are more willing to pay for medicine than long-term psychotherapy care,’ he said. ‘Especially with college students. They don’t have much money, and counseling centers only give short-term care.’

kaoutram@syr.edu

Published on March 23, 2009 at 12:00 pm