Zoloft Magic Or Poor Public Relations?

 

 

Nona, Carol’s mom,  https://shirahvollmermd.wordpress.com/2011/10/28/zoloft-magic/ came to tell me that I “saved her daughter’s life. You just don’t know how hard it was for me to find you. I saw so many specialists and no one suggested Zoloft, yet it has made such a big difference, I just can’t tell you.”  Nona tells me with glorious praise. “I appreciate the gratitude, but I also feel terrible that you had such trouble finding the right kind of physician to help Carol. I wish there were a public relations campaign which helped the lay public understand that if their kid has extreme worries, then there is relief available.” I said, thinking that both the professional community and the lay public are unclear as to how children suffer from anxiety and how there is relief available. “Child Psychiatry should launch a campaign like the anti-smoking advertisements, which let people know that cigarettes were dangerous.” I say, articulating my fantasy to Nona. “Yes, but it is hard to prove the damages with an anxious kids. People die from cigarettes, but with kids there is no tangible problem with anxiety.” Nona explains to me in a way that makes tremendous sense. “Yes, it is not like kids end up in a wheelchair because they did not get Zoloft. The crippling of anxiety is much more subtle than that.” I say, knowing that in some ways mental illness is invisible in our society, yet in other ways, like when kids have no friends or they have multiple negative self-statements, mental illness is painfully visible. “Maybe you should just accept the gratitude,” Nona tells me, as if I am being self-deprecating. “I appreciate what you are saying, and I do feel good that I have helped Carol, but I also feel bad about your journey with Carol before you landed in my office. Both the educational institutions and the multiple medical professionals all sent you down blind alleys. I wish they had sent you to a child psychiatrist in the beginning of your journey since that would have saved you and Carol a great deal of grief.” I say, wondering why child psychiatry can be so obscure to so many people in the field of child welfare. I do want to see a public relations campaign which educates people about Child Psychiatry, in that we help children enjoy their lives so that they can grow and develop in the best possible way.

Zoloft Magic

Carol, seven years old, was easily aggravated. She worried about middle school even though it was four years away. She worried her parents would die, even though they were both healthy. She worried about being upstairs in her house alone, even though she had lived in the same house for her entire life. She worried when she was separated from her mom, be it at school or at a friend’s birthday party.  Carol tried play therapy and behavioral therapy. She enjoyed both experiences, but she still had her worries. As a last resort, Carol and her parents came to me. After much deliberation, we decided to give Zoloft a try. Both parents had histories of anxiety and both parents had positive responses to SSRIs in the past. Carol started on Zoloft and within a week, she was more “fun to be around,” according to Carol’s mom. Separation was no longer a problem. Carol reported that her worries “went away”. Carol had no side effects, only the positive benefit of not worrying all the time. Success-at least, for now.

See also…..https://shirahvollmermd.wordpress.com/2010/11/17/zoloft/

Zoloft

Jack,  was feeling quite depressed for a sustained period, months. I started him on Wellbutrin, along with twice a week psychotherapy, but he was still tearful, he had concentration problems, he lacked motivation to see his friends, he felt pessimistic about his future. I proposed adding Zoloft, at very low dose to his regimen. He was desperate; he agreed. The next week, I asked him “how is the Zoloft going?” He looked at me as though that were a strange question. “Gee, I have not thought about it. What am I supposed to look for? ” “Well, are you feeling worse? Are you more agitated?” I ask, trying to see if there are negative effects. “I don’t think so,” he responds with some hesitation and surprise at those questions. The following week he comes in and immediately says “I stopped that Zoloft. After you asked me the question, I have been thinking about it. I noticed that I was so agitated and even more depressed. Of course, I did not attribute those feelings to the medication, but then after our last appointment I realize that the timing was such that I was feeling more depressed and more agitated since starting the Zoloft and now that I stopped it I feel much better.” Jack says with relief that he took action which improved his mental state, at least temporarily.

Monitoring of medication is one of the most important jobs of any prescribing physician. Checking in allows both the doctor and the patient to decide if they are on the right course. Too often, medications, particularly psychotropic medications, are prescribed with multiple refills, such that the expectation is that the medication either helps or it does not help, but that observing closely for side effects is not a critical part of the intervention. Of course, when the patient and the doctor pause, observing how the medication interacts with each person’s biochemistry is going to be a unique experience and as such, no generalizations can be made. To some, Zoloft is like it says in my picture; it makes some folks more tolerable. To others, like Jack, Zoloft might be exacerbating his already disturbed mental state. The level of distress is the target; Zoloft, like all psychotropics can help, do nothing, or make it worse. It is that simple. It is also mandatory.  Checking in involves spending time and attention to the patient’s change in mental state. That is not simple, nor is it done as often as it needs to be.