I saw this gentleman walking by the pharmacy. Every day he would walk by at about the same time. He was not in a hurry, didn’t look like he was going anywhere in particular and he never had anyone with him. One day I was out eating lunch and I saw him walking by. I spoke up and asked him if he wouldn’t mind chatting for a moment. I explained that I had seen him walking by the store on a daily basis for months now. I was just wondering what he was up to.
The gentleman looked at me quizzically and said that he wasn’t up to anything. He just said that his doctor had told him to start walking. He said that he gets up every morning, gets ready for the day, and starts walking. He continues until the end of the day and then goes home, cleans up and goes to bed. I asked the gentleman if the doctor had mentioned anything else like how long he was to walk each day, or for how many days per week he was to walk? Had the doctor recommended that he talk with anyone on a regular basis to see if the walking was working for him? How was he to know if he was walking fast enough, or walking to long, or if he was even walking in the right direction?
I let him know that, in my opinion, when doctors advise their patients to start walking, there are usually some parameters associated with it. He thought for a few minutes and slowly began telling me that he doesn’t even remember exactly why he had gone to the doctor in the first place. He remembered that he hadn’t been feeling very good, perhaps a little depressed; however, he agreed that he didn’t know how long he was to continue this walking. After a few more words, we concluded that it would be a good idea for him to have a conversation with his doctor and discuss whether he needed to continue his walking.
What do you think of this story? I made up this story to illustrate a point. It is actually similar to how some patients take their antidepressant medications. The last few months I have run into quite a few patients who have been prescribed an antidepressant medication and have been taking it for years. We have a short discussion about the medication, asking them how they think it is working, and more often than not they do not know how well the medication is working.
Antidepressant therapy should not be taken with a set-it-and-forget-it mind set. This category of medication works best when the patient is an active participant in the therapy. When someone picks up an antidepressant medication for the first time at our pharmacy, I always spend some time with them describing to them how it works. Depression is real. When your neurotransmitters (the message carrying chemicals in your brain) become low for some reason, your body may receive mixed signals about emotion, behavior, body temperature, and many other functions we take for granted. This process of decreased and mixed signals about how we feel may sometimes be diagnosed as depression. We discuss the neurotransmitter function so the patient has a general understanding of what neurotransmitters are. We also discuss how the medication will help elevate and then balance the level of neurotransmitters in their system.
The patient needs to understand that this is not an overnight success story. It may take 7-14 days for the neurotransmitters to become balanced, and a good five weeks before they see how well this particular dose is going to work for them. At that point, the patient will visit with the doctor and discuss if they have gotten to where they need to be or if the dose needs to be adjusted.
It is important to realize that psychotherapy goes hand in hand with anti-depressant medication treatment. This is crucial for two reasons; first, your therapist will help you see and understand what it was that triggered the decrease in neurotransmitters and led to the depression, and second, it is a good idea to have a non-biased, third party, that you can discuss with how well the medication is working. They will help you define where you need to get to and help you know when you are there.
This is the point I was trying to make with my walking analogy at the beginning of this discussion. If you don’t know where you are going, how will you know when you get there? Many people will take anti-depressant medications for years. This is appropriate if they are under a doctor’s care and are regularly following up with their psychotherapist to make certain the medication is still helping them get to where they need to be. If you have made it there and are comfortable, it is reasonable to discuss the option with your doctor about tapering off of the medication.
While you or your loved one is taking one of these anti-depressant medications, it is a wonderful idea to learn as much as you can about how the medication works and all of the other counseling information associated with your particular medication.
About the Author
Dr. Steve Leuck is the owner and founder of AudibleRx, medication specific counseling sessions and relevant pharmacy topics provided in audio format.
This medication summary is for information only and is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider.
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