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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- Please Get Back on Your Meds! (friendtoyourself.com)
The FAA would not issue a private pilot’s license if one used a psychotropic such as fluoxetine. I understand that they are/did change that policy. Apparently it was realized how many licensed pilots were flying who needed or were using medication.
The use of medicine for depression or the condition of depression itself is very often not understood and used as a topic of humor.
On the other hand, I was concerned when a doctor, who I had going to for 18 years, asked about religious preferences on a new health form. We were not of same mind. His comment to me about it made me feel ackward and I wonderd if he had “prejudice” against patients with similar views and could he treat them effectively. I suspected his view was that depression may be in part to the incorrect religious view and, if true, how could a depressed person be fully treated in his eyes?
Hi Richard. Thank you for reading and commenting!
I’ve been thinking about what you wrote on and off through the day. You’ve been through many changes in medicine over the years and have watched a lot changes happen in the world of psychiatry – social and clerical views, medications available. Prozac came out in the 80’s and it’s been fast forward since then.
In regards to the psychiatrist you saw, I can’t say anything for sure of course. I am able to let you know that asking about religious preference is part of the social history and expected. If there is a review done on our clinic practice, that is actually part of the investigation – if we are asking about it. The thought is that if we do, we can do the opposite of what you perceived was done. So… we can say in your case, it wasn’t helpful! 🙂 I’m sorry you went through that especially after so many years in a trusting relationship w him.
Keep on!
I’ve always been in awe of what a delicate creation we are. Just too much or not enough of one chemical or neurotransmitter…and we become subject to a host of awful or challenging feelings. It makes one in awe of the human body, of the mind.
My belief is that if one needs to take a medicine, then one needs to do it. There is no shame in it. It is like drinking water when we feel thirsty. Sometimes if I don’t have enough water on board, I notice changes in my mind and body… Or eating chocolate or sugar. Everything we consume affects our feelings, and we continually adjust the delicate balance of our bodies in many ways. Exercise is one example. As a culture we would never ostracize someone for exercising to feel better, and nor should we shame someone for managing their brain chemicals with helpful drugs.
If I find myself at some point in life in a part of my journey in which I needed to take care of myself through the use of psychotropics, I would. My fear, I think, would be not so much the dependence—but what would happen if I did need that medicine and it suddenly became unavailable, like I couldn’t get my prescription because of a natural disaster or something like that. That may sound silly, but my mind thinks of things like that… Would going off of those meds cold turkey put me at a real disadvantage? I guess another way to look at it would be: once one starts a medicinal path, would the symptoms become worse than they were before the meds if the meds were stopped?
I can understand what my dad (Richard) is thinking about: there is still a line of thought in our culture that if we just hold the “right” world view, we can control every aspect of our minds. I worry that depression is still not totally understood by those who do make jokes about it. For so many years, I think there has been the assumption that those suffering with depression can somehow control it or talk themselves out of it. Although I do think our minds have great power to help us regulate our feelings, I definitely believe that our minds are just as susceptible to medical needs as the rest of our bodies.
Lovely comments Sarah! Thank you.
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