Day: September 19, 2010

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Afraid of Meds

A colleague told me,

I want to get off my sleep meds because I don’t want to be dependent on anything.

Dependence.  Lazy, pass-the-buck, unimaginative, immoral, chemical abuser.  Maybe even doctor-shopper depending on who is speaking.  When someone says it, before we talk about medication use, biology, etc… we need to know what is behind that word.  Working with the tip of an iceberg of prejudice might sink us before navigating much treatment.  Even physicians after 25+ years of education and more of medical practice, find it hard to shed these cultural prejudices about psychotropics (medications used in psychiatry).  What does the word dependence mean to you?

To psychiatrists, substance dependence means that the body has become accustomed to something.  We don’t get as much physical or emotional boost we used to using a substance, such as to nicotine, alcohol, illicit drugs, or prescription medications.  We now need more to get the same effect we would have gotten before with less amount.  It includes physical and emotional cravings – like sweating, shaking and yearning.  A lot of time is spent to do whatever it takes to get it.  Can’t cut back.  Keep doing it even though spilling into personal and professional space.  Keep using even though aware body and mind are worse for it.

Was this a description of my “dependent” colleague?

How about abuse?  Substance abuse is when we do dangerous, mean, and/or irresponsible things when using.  Was he hitting his wife when he was under the influence of a sleep medication?  Was he taking sleep medications when he was at work because he liked how they made him feel?  Driving with them?  You get it.

This guy is no dummy.  Yet he felt guilt and shame about appropriately using a medication for a medical reason.

I was seeing a woman for the first time in my clinic.

“Doctor is this medication going to make me addicted?”

We spoke about her fears.  Turns out, she thought her medication would prejudice the world against her.  Change her personality.  Make her crave it if she ever wanted to stop.  Steal from her geriatric mother and eventually, who knows?  Panhandling?  Now how am I supposed to work with that?  How she ever got the courage to come and see me in the first place with all that on her back, must be pure grit.

So here’s the dirt.  Some medications have no dependency risks.  Some medications do.  Some people abuse any medication they can get their hands on.  There are rave parties where there is a kitty – a bowl full of whatever pills anyone in attendance donates to.  They take them out randomly and swallow to get whatever surprise awaits them.  Is one class of medication more often abused than another?  Yes.

As a prescribing physician, I have sworn to not intentionally do any harm.  As a patient, you contract with me to take your medications as prescribed and safely. We’re in this together.  We will talk about any recommendations and you will hear the risks and benefits to treatment.  You will decide.  There is no conspiracy to turn Americans into bad citizens through psychotropics.

Self Care Tip #52 – Find out where your fear is coming from.  Be a friend to yourself.

Question:  What are your fears about psychotropics?  Agree or disagree with this post?

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