Saturday, February 13, 2010

Should We Put Prozac in Our Drinking Water?

Prozac in our drinking water? Why not! After all, they did it with fluoride. You can make the same argument about many other medications and supplements. Newer antidepressants have relatively few side effects; it's hard to resist giving a happy pill to all woeful patients.

So what's the downside? Well aside from the potential for up-regulation, an increase number of re-uptake receptors that may decrease the effect of neurotransmitters, there is potential for "atrophy of the coping mechanism". Each of us cope with stresses in life differently. Some better than others. If all we do is take a pill when the slightest conflict presents itself, we will not learn healthy coping skills that will help us throughout life.

Then there is a philosophical/ moral issue we must consider. By prescribing medication that blunts emotion and passion are we "anesthetizing" the psyche. An illustration of this case would be a patient in an abusive relationship. Prescribing an "emotional anesthetic" may negatively influence the proper choices that need to be made by the patient. Then there's the yin/ yang argument. Overcoming hardship may be the key to a more joyful and fulfilling life.

So how does the practitioner reconcile issues around prescribing antidepressants. First and foremost, the goal is to a relieve suffering, maintain function and improve quality of life. I like to use the broken leg analogy. We will cast the leg and relieve pain. But we will work with the physical therapist to ensure proper function restored. When we use an antidepressant, we should use therapist to restore full psychological function and prevent "atrophy of the coping mechanism".

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