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– Really, no painkillers? You are a sensation! Most of those sitting in this cafe have already swallowed something, will swallow something or simply will not leave the house without them. We are chasing euphoria – I hear from Dr. Maja Polikowska-Herman from the Medical University of Warsaw, with whom I talk about coffee, drugs and depression.
Zuzanna Opolska, Medonet: Doctor antidepressants are ..
Dr Maja Polikowska – Herman, Medical University of Warsaw: Antidepressants, substances that improve mood and restore the biochemical balance of neurotransmitters. They act on the receptors of nerve cells, which become more or less sensitive to the uptake of substances such as serotonin, noradrenaline and dopamine. Their story begins in 1952, when two pulmonologists, Selikoff and Robitzek, are researching drugs originally intended for the treatment of tuberculosis. It turns out that after taking it, patients begin to become more and more active and “full of vigor”. In the 60s, interest in these drugs was so low that companies didn’t even promote them. Benzodiazepines were much better sold. Nowadays, escitalopram, an SSRI drug, is the drug that dominates the pharmaceutical market among antidepressants. It is definitely the most selective, that is, it has the fewest side effects. At the moment there is no psychiatrist who would not prescribe him. It can be used in disorders related to emotions, such as anxiety, depressive or obsessive-compulsive disorders. It is administered in the form of coated or orodispersible tablets.
Any side effects?
Typical. Nausea, dry mouth, stomach tightness, disturbed appetite. As a rule, patients lose weight. In the US, this drug is approved for the treatment of bulimia eating disorders, but in completely different dosages. With us it is 20 mg / d, there it is 60 mg / d. On the packaging of each antidepressant you will find information about suicidal thoughts and the risk of committing suicide. These types of drugs improve drive first – the will to act, and then the mood. A sick person can buy coffee and he can kill himself. It takes about two weeks to think that the world is not over and that I can still do a lot. Of course, if the patient receives the appropriate support and care, the risk of suicide is low. I run a fanpage on Facebook (https://www.Facebook.com/sztukaterapiiamici), I get about 20-40 messages every day. Whoever leaves the office is not the alpha and the omega. He comes home and starts thinking, starts up the computer and it gets worse. One toxic post on the forum is enough – “take these drugs off, they almost killed me.” And there is no way to ask a doctor, because the door of the office is closed and the next visit is in a month.
- Do the test and see if you may be depressed
In the United States, antidepressants are most often purchased after cholesterol medications. Is it the same with us?
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And we in Poland already have similar statistics. And in fact, antidepressants are most often prescribed by Polish doctors. Number two is pain medications. Of course, these results are a bit biased because they only apply to prescription drugs. If you counted the prescription painkillers and not, the order would be reversed. You don’t have any pills with you?
Not…
You are a sensation! Most of those sitting in this cafe have already swallowed something, will swallow something or simply will not leave the house without them. We are chasing euphoria. The effect of happiness, and more precisely of calming down, after taking a painkiller is immediate, but short-lived. With new generation antidepressants, such as escitalopram or sertraline, we have to wait two weeks for the first effects. Usually, the full effect of the drug develops within 4-8 weeks of use and in most cases this is the period when we can assess the effectiveness of treatment.
Can we become addicted to antidepressants?
No, we can only talk about the habit of taking them. Addiction negatively affects the quality of professional and personal life. And we take antidepressants when we are sick. The amount of antidepressants sold and bought is a score of the burnout, anhedonia, and mood disorder scale. We still do not have an appropriate program for people with depression. Drug therapy is an introduction to getting ahead, getting out of the house and buying a coffee. But what then? The patient still suffers from the syndrome of life nonsense. You have to teach him how to change the habit of taking the pill into the habit of life. Unfortunately, due to the lack of good solutions, we go the easy way.
And we buy another package …
This is not an optimal solution. Antidepressants kill true emotions in some way, leaving us indifferent. In an ideal world, we don’t scream or cry. The question is, who do we want to have in society? A group of clones that nod and talk at the same pace, or individual individuals with emotions, screaming and crying. Patients come to my office who say: “I will not stop taking my medications because I will be nervous”. What? The fact that the husband left the keys in the lock and the house was open all night? I do not know the so-called healthy person who is not upset by this. It is worth getting nervous about such things in life.
Americans are the “people of Xanax”, is alprazolam equally popular with us?
Alprazolam belongs to the benzodiazepines, a group of drugs that relieve anxiety. In the XNUMXs, he was advertised in the United States as a “mother’s little helper”. Unlike antidepressants, benzodiazepines are dangerous and highly addictive. With long-term use, the body’s tolerance to many of their effects develops, and the original dose becomes insufficient.
Are many patients asking to prescribe them?
Fortunately, less and less, the public awareness of the dangers of benzodiazepines has increased in recent years. The problem concerns family doctors, mainly due to poor organization of health care work. At the time they need to persuade the patient to stop taking the drug, they simply write out a prescription for it. As a rule, I do not. In depressive disorders, when the level of anxiety is manageable, antidepressants are sufficient.
What are the side effects of taking benzodiazepines?
First of all, death from respiratory arrest. You cannot drive or operate machinery. Muscle relaxation, balance disorder, fractures, memory impairment, anxiety, drowsiness, emotional instability, hallucinations.
Dementia persists for the second day?
This is how the patients describe it. And in the morning we have to get up, send twenty e-mails and make targets or sales plans. Guaranteed mistake. Another misfortune is mixing benzodiazepines with alcohol.
Effect?
Short-term memory disorders, we do not remember the most recent events, their sequence and circumstances. A rape tablet is composed in a similar way.
There is talk of cross-tolerance, what is it about?
It is a very simple mechanism of reinforcing the dependence of one on the other at the same time. We become even more addicted, and the Gordian knot becomes more difficult to untie. Another modern nightmare is tramadol, a pain reliever, a derivative of opiates. Dependence on it is becoming more and more common. In Dr. House’s last phase, such drugs induced psychosis.
How quickly do we become addicted to sedative medications? In a month?
It is not known. The book says that there is a risk of addiction if we take it for 4-6 weeks at the maximum dose. Life shows something completely different. There are patients who will take the drug once and never stop again. It does not necessarily have to be the highest dose, it may be the lowest and taken every now and then.
Are there people who take alaprazolam for life?
Undoubtedly. I had a patient who came to me at the age of 79. She had been addicted to alaprazolam for over 30 years, but took it in the lowest dose. The medical history showed that she saw the doctor once in seven months for one package. I continued prescribing the drug due to the patient’s age and the possible consequences of discontinuation of the drug. Each half tablet was divided into four to eight pieces which she put in her pocket, purse, and bra pouch. Without alaprazolam, she did not leave the house.
How are these types of drugs discontinued?
Caution due to the risk of epileptic seizures. We gradually discontinue benzodiazepines, reducing the dose or using a less harmful substitute.
From the same group?
At the beginning, you can choose a less dangerous drug from the same group. Especially in the case of patients less susceptible to psychotherapy, very addicted, with severe anxiety disorders. Antiepileptic drugs can be added later. It is a long process with long patient follow-up. Recovery after many years of taking benzodiazepines is like regenerating the body after a hard operation.
Let’s move on to notropics – brain enhancers, popular in the West …
They are pro-cognitive drugs that improve cognitive function and affect memory and mental clarity. 50 percent of studies show that they work, and another 50 that they don’t. The number of publications on their topic is huge, I have been dealing with this topic for a long time – I wrote two articles. My conclusions are similar, 50:50.
Are there many prescriptions for these drugs in Poland?
I think this is the standard average.
Are there any patients who take nootropics for breakfast and benzodiazepines for dinner?
Everything is possible. Patients can use the advice of three different doctors and have a different set of drugs from each of them. But that’s not common. We use alcohol more often, which heals for the evening. A glass of wine, a drink or a beer will help you relax and fall asleep. At least seemingly, the percentages actually deteriorate the quality of the REM phase, i.e. the moment of mental regeneration.
Will s-ketamine be the drug of the future?
Perhaps the research has been going on for a long time and the first reports are spectacular. So much so that the research centers were monitored threefold and fourfold. The controllers who controlled the controllers were audited, jokingly speaking. Ketamine is a psychoactive substance that is used in anesthesia to induce anesthesia. We administer S-ketamine intranasally, and patients feel phenomenal after half an hour. This is a great opportunity for people suffering from drug-resistant depression.
So there is hope?
It is big. On the one hand, due to technological progress and the constant search for better solutions than tablets – the example of s-ketamine, and on the other hand, evolution that teaches us how to adapt to the changing world. We live too fast, too hard, because of this the scale of the problem of depression is huge, and the statistics of taking antidepressants are elevated. But take it easy, as I say – we have an evolutionary program to maintain the continuity of the species and to be as healthy as possible, so we will definitely be able to overcome the emotional disorders that are plaguing us at the moment.