SSRIs

[Guest DSheerin]

Hey hows it going?

 

Just wondering about what percentage, if any, of med students take SSRIs?

 

I'm personally on paxil and was somewhat ashmed of that fact till I found out that most of my friends are on one SSRI or another. Of these people most were the concurrent ed program (here at Trent) or hoping to go to either law school or are like me and want to go to med school.

[Guest aneliz]

Not something that med students would usually go around proclaiming to the world....nor is it something that anyone keeps stats on. Personally, I can't think of a single person in my class...but that doesn't mean that there aren't any. (If you asked me how many people in the class had asthma or diabetes, I would be similarly stuck...but that doesn't mean that there aren't any.) Med schools do not ask their classes these types of questions...nor do they publish the stats. Someone, somewhere may have done some research on it...try searching pubmed...you never know what you might find.

 

That said, med students are pretty similar to the rest of the population (believe it or not)...so if you can find out what % of the population aged between 22-32 is on an SSRI, you can bet that the med student number will probably be similar (assuming that the med student population is a random sample of the total population - which I know is a dangerous assumption...but it is the best we've got).

[Guest UWOMED2005]

I know of at least one friend in 2005 who is on an SSRI (paxil). He was actually quite open about it in our PCL class. I'd be absolutely shocked if there weren't others in the class, and even more shocked if there wasn't at least someone on an SSRI in the 2006 class (actually, I know for sure of one person who was on an SSRI in the UWO class of 2006.)

 

Problem is, unfortunately many med students probably aren't as sympathetic as they should be when it comes to mental illness. Which is surprising considering the amount of OC/Type A personality traits. . . something many med students wear as a badge of honour even when it affects their interpersonal interactions. So I'm sure there are med students in the class on SSRIs who would rather not share that information with their classmates.

 

If I were you, I wouldn't go out of my way to share the same information with your future classmates. But I wouldn't be paranoid about it either - there is no reason for someone on an SSRI to not be in medical school, at least not for just being on an SSRI. And most of your classmates should be sympathetic.

 

I'll repeat there is no reason for someone on an SSRI to be in medical school. In fact, there's probably a few more med students who SHOULD be on SSRIs considering how med school correlates with anxious personalities, cluster C traits, and questionable anxiety related disorders (Here's a new one for the DSM-V: MEAD, or "Med school Exam Anxiety Disorder" .) And while it's often not made public, there are lots of physicians out there with various mental illnesses. In fact, we were explicitly told in lecture that while physicians as a group have better physical health than the general public, their mental health is on the whole WORSE than the average Canadian. And mental health issues does not preclude one from success in medicine. . . I know of one former cardiologist in London who was known to have been supposedly bipolar, or at least that's the story according to one of the internists who worked with him, and I've been told at least one of the surgeons in town is bipolar as well.

 

Bottom line: don't worry about it, but I wouldn't go around telling everyone in your future class that you're on an SSRI.

[Guest Kara]

That's an interesting question. I thought I would share a personel story which I haven't mentioned in previous posts. I have severe performance anxiety (especially public speaking anxiety). I basically lose it during interviews and always avoided courses that involved oral presentations, seminars, etc. Years ago I got interviewed at Western meds twice and both times I bombed my interviews because of my anxiety. The following year, I got interviewed at Univ of Sask and asked my doc for some valium. This helped. Without my anxiety, I was able to be myself without the anxiety. I guess I did well in the interview since I got accepted. Unfortunately, I ended up quitting medicine after 1.5 years because I still couldn't handle the anxiety associated with the hospital rounds where you have to present cases to clinical instructrors and fellow classmates. I wasn't taking any medication. In hindsight, I wish I had known about medications for anxiety because it cost me a career that I think I would have enjoyed.

 

On a side note, I think SSRIs have been overly promoted by pharmaceutical companies wrt effectiveness for anxiety and their side-effects under-reported (although this is strarting to change). Paxil is probably the worse SSRI wrt side-effects. See UK yellow report cards and WHO data on SSRI dependency/withdrawl problems. In my opinion, benzodiazepines with long half-lives like clonazepam are much safer and effective for many anxiety disorders even though physicians are reluctant to prescribe them for long-term use.

[Guest mgupta]

actually benzodiazepenes are known for being HIGHLY addictive, whereas the side effects commonly seen with paxil or other SSRI's include weight gain, sedation/drowsiness, gi bleeds, decreased libido, etc... so i think thats why benzo's are not prescribed over SSRI.

[Guest marbledust]

Bottom line: don't worry about it, but I wouldn't go around telling everyone in your future class that you're on an SSRI.

 

I think this statement isn't very appropriate...nothing like adding to the stigma

 

Maybe more people wouldn't feel so ashamed if they didn't hear things like this from other med students (or others). Not to slam this particular post, because I have heard similar things from others in medicine.

 

If you are on an SSRI and feel comfortable talking about it, then there is no reason why you should have to hide it. If you tell your future or current classmates and they have a problem with it, it is their problem, not yours.

 

marbledust

[Guest cheech10]

That's not adding to the stigma; it's just pragmatic. Going around telling everyone that anyone with depression is crazy or avoiding people with depression would be adding to the stigma. But when there already is such a stigma and particularly within the existing medical body depression is seen as a distasteful disease that no one enjoys treating, not advertising the fact that one has depression is just good advice. It's not just classmates that you have to worry about. Analogously (a bit of a reach, but still), many in med school smoke pot, but how many would go around telling everyone of that habit?

 

Don't accuse me of prejudice, I have nothing against those with depression (and with a 5% prevalence, that's a LOT of people, diagnosed/treated or not), I just think the advice was good.

[Guest cheech10]

mgupta,

 

The addictiveness of benzos is a problem, but for anxiety, SSRIs alone just aren't as effective, which is what I think Kara was getting at.

[Guest marbledust]

"That's not adding to the stigma; it's just pragmatic. Going around telling everyone that anyone with depression is crazy or avoiding people with depression would be adding to the stigma."

 

It does add to the stigma by insinuating that taking an SSRI is something that needs to be kept secret. There is nothing to be ashamed about. I don't think anybody is going to go around with a sign proclaiming it, but if somebody feels comfortable discussing it they should be encouraged, rather than discouraged. It may help the person to talk about it or it just might help somebody else they talk to.

 

 

"depression is seen as a distasteful disease that no one enjoys treating, not advertising the fact that one has depression is just good advice."

 

Another questionable comment. I think many family doctors and psychiatrists would disagree with you. Many people who suffer from depression, or those who care about them, would also not find this statement true. What is "distasteful" is attitudes that perpetuate sigma and shame.

 

 

"It's not just classmates that you have to worry about. Analogously (a bit of a reach, but still), many in med school smoke pot, but how many would go around telling everyone of that habit?"

 

Yes - smoking pot and suffering from depression/taking medication is analogous. This statement would be humerous if it wasn't so ridiculous. SSRI's are taken because of a medical condition that a person has no control over. Would you tell a diabetic they shouldn't tell people about their medication or their condition?

 

 

"Don't accuse me of prejudice, I have nothing against those with depression (and with a 5% prevalence, that's a LOT of people, diagnosed/treated or not), I just think the advice was good."

 

I'm not accusing you of anything. Statements and attitudes speak for themselves unfortunately.

[Guest UWOMED2005]

Bottom line: don't worry about it, but I wouldn't go around telling everyone in your future class that you're on an SSRI.

 

Actually, if you read the entire post, I would have hoped you would have realized I am very, very much against the negative stereotypes associated with mental illnesses. The LAST thing I wanted to do was encourage further stigma.

 

I'm currently working with schizophrenics, and the thing that kills me is that most of them are unwilling to accept the diagnosis and take the meds that could improve their lives, because they're unwilling to accept the negative stereotype that goes along with that. And I can understand that - imagine you're 26, in medical school, and develop schizophrenia. All of a sudden you have to start taking meds with some serious side effects and deal with society's stereotype for schizophrenia, which is complete off when it comes to the disease (multiple personalities? murderers? please!?!). Who wouldn't have problems accepting that?

 

And like I insinuated in my previous post, I'm sure some of my classmates could benefit from SSRIs in terms of their own problems dealing with anxiety around exam time. For all I know, they are on SSRIs but if not I wouldn't be surprised if the reason was not wanting to admit there was a problem for fear of stigma.

 

Marbledust - I can see where you are coming from, this is a sensitive and complicated subject, but Cheech is correct: my advice was meant in an entirely, 100%, pragmatic sense. Look, I would love to say the original poster should be proud to show off the fact they had the courage to admit they had a problem and ask their doctor for SSRIs (if only more people who would do that!) but the reality is that there are med students, residents and doctors out there who aren't enlightened when it comes to mental health, and for some of them hearing a student was taking psychiatric meds could negatively impact their career.

 

For an example in the real world, I'll relate one of my experiences from clerkship. I was working in the ER, and a rather nice 35 year old came in with a legitimate complaint. I was about to present the case to my consultant, when he noted the name and immediately proclaimed "That guy - he's an ass. You know he's bipolar? He came in one time all crazy and high and sh--.* What the he-- is he whining this time for?" I was disgusted, particularly as the guy was currently stable, nice during the interview, and had a legitimate complaint. Worst of all, my impression was that his care was compromised by the doc's example.

 

Do you want another example? I was on-call for psych this week and a patient who regularly presents to the hospital with psych complaints (usually anxiety disorder, hypochondriasis, and cluster B traits) showed up with the police and got an automatic referral to psych, no questions asked. As it turns out he was just drunk - he just needed some time to sober up, but because he'd been labelled a "psych" patient by the emerg staff he was an automatic referral to psychiatry.

 

I could offer a few more examples but they'd involve personal details about classmates and I'd rather not. The fact is, there are medical professionals out there who make certain assumptions when they hear someone has a particular mental health condition or is on a particular psychiatric drug.

 

I wish these incidents didn't happen, that the stories weren't true - but they are. I'd also like to point out that this is a limited scope of the medical field and most docs I've met don't hold these biases - but you never know how a doc/resident/medstudent you're working with might react to hearing about your psych history. So I'll repeat my advice which was intended as pragmatic not biased: there is no reason on the planet someone taking an SSRI should be withheld from studying medicine just for taking an SSRI, but if I was taking an SSRI I don't think I would rush around making that known.

 

But I'd also like to point out you shouldn't worry if someone finds out about it either!! For most people it won't make a difference either way. But if you don't have to offer that info, why do it?

 

* Of course the patient came in high, I thought, he's bipolar - and sometimes bipolar patients go manic and need help. It wasn't really his fault!

[Guest Kara]

>actually benzodiazepenes are known for being HIGHLY addictive...so i think thats why benzo's are not prescribed over SSRI.

 

Have a look at the dependency/withdrawl data looking at drugs that physicians in UK report as causing the most problems for users trying to quit:

 

www.socialaudit.org.uk/4390EU61.htm

 

5 out of the 6 drugs causing most problems are SSRIs not benzos. In fact, the problems reported with SSRIs are far greater than was the case when benzos were given out like candies in the 1980s. Similar findings are reported in WHO data among other European countries:

 

www.socialaudit.org.uk/43800047.htm

 

Is there really any evidence that benzos cause more dependency or addiction problems than SSRIs? Here’s a recent article by Dr. Healy discusssing this issue:

 

www.socialaudit.org.uk/58...WITHDRAWAL

 

Some interesting quotes:

 

"There is in fact no basis for distinguishing clinically between the normal dose dependence produced by benzodiazepines and the normal dose dependence produced by the SSRIs. There almost certainly will be some differences between the two in various animal models, just as there are between different antidepressant groups, but at present there is no systematic set of clinical criteria to distinguish the two phenomena."

 

"As of 1988 the CSM produced a clear statement saying that benzodiazepines cause dependence. The warnings derived from this statement are still in force today. These warnings use a version of the word dependence, which, if it were applied to the SSRIs now, would have to lead to the SSRIs being regarded as dependence producing.”

 

"The statement regarding the benzodiazepines was not based on laboratory experiments, nor was it based or animal research demonstrating drug dependence nor on clinical trial evidence demonstrating a severe, long-lasting, or serious condition. The statement regarding the benzodiazepines was not based on any of the points pharmaceutical companies now insist be demonstrated for SSRIs before they can be regarded as dependence producing."

 

Since I suffer from anxiety, I’ve also spent considerable amount of time looking at the research and visiting various anxiety forums. Without question, there is a major preference of benzos over SSRIs wrt anxiety-reduction in those who tried both. The preference is based on greater efficacy and less side-effects with benzos. Wrt research, while few direct drug comparisons have been done, two recent meta-analysis (Blanco et. al, 2003 and Federoff etal. 2001) comparing drug effectiveness wrt social anxiety, suggest greater (but not statistically significant) effect size with benzos. Also note, that studies involving SSRIs were funded by pharmaceutical companies who still have patents on many of the SSRIs (so there may be some biases) while benzo studies were independently funded. In fact, some prominent clinicians/researchers have pointed out a number of problems with the SSRI studies. Surprisingly, at the discussion section both of these authors still recommend SSRIs as first line therapy for anxiety for the reasons you mention (but provide little evidence that benzos are more addictive than SSRIs).

 

Consider the following:

 

1. Wrt efficacy, a strong case can be made that benzos are more effective than SSRIs. Development of tolerance to anxiolytic effects does not appear to occur with benzos.

 

2. Since generics are available for benzos they are less costly.

 

3. Benzos don’t necessarily require continual dosage and can be taken as-needed unlike SSRIs which require a daily dosage regimen.

 

4. Wrt side-effects, benzos are also arguably, the winner. Some recent and closer inspection of drug company data suggests that many of the SSRI side-effects were under-reported (see Healy article).

 

5. So the big negative with benzos is supposedly the dependency issue. But have a look at the UK and WHO data and Dr. Healy’s article. Is there any real evidence that benzos have cause more dependecy/withdrawl problems than SSRIs in patients with anxiety?

[Guest aneliz]

I don't think it is about the stigma at all...you really shouldn't be going around proclaiming to everyone exactly what medical condition(s) you have and what drugs you are on...it just isn't done (unless you are about 85 years old and you spend your days one-upping your roommate on the longterm care ward...)

 

I really don't care to know what my classmates are taking and why. As long as they can function and get the job done, that is fine with me.

 

The way I see it, it is just as 'damaging' to your ambitions to be a med student to proclaim to everyone that you meet that you have MS or severe asthma or insulin dependent diabetes as it is to tell the world that you are on an SSRI or have Schizophrenia and have been on Risperidone for the past three years....

 

I have to agree with Cheech on this one.

[Guest cheech10]

It does add to the stigma by insinuating that taking an SSRI is something that needs to be kept secret. There is nothing to be ashamed about.

I think many family doctors and psychiatrists would disagree with you. Many people who suffer from depression, or those who care about them, would also not find this statement true.

I never said there was anything that should be shameful in depression, and hoped that things did not come across that way in my post. As for psychiatrists and family physicians, I am well aware that many of them have no qualms about treating depression, however, taking doctors on the average, particularly those in secondary and tertiary care that you are likely to find in medical school, the attitudes about depression and all mental illnesses ARE very negative. This is an attitude that you will see much more clearly in clerkship. Should we try to change those attitudes? Yes. But when most secondary care physicians see depression uncommonly and find that it slows down their workday and forces them to try multiple SSRIs or combinations, it is difficult to change these attitudes without educating them or exposing them to more depressed patients and helping them treat them in a positive light. Will they listen to clerks trying to do this? No. So in the end, revealing that you are taking SSRIs to faculty could be quite damaging to your future ambitions. Hence my advice that it not be proclaimed from the rooftops.

 

As for my analogy, I stated that it was a bit of a reach. Unfortunately you interpreted differently from the way I was trying to present it. Like depression, many of the faculty physicians associate pot smoking with a stigma, and no one would advertise their use of pot to them for similar reasons as above. This had NOTHING to do for the reasons with the medication/drug usage, it was simply an effort to show how other stigmatized actions would similarly be hidden.

 

Also, the views above are not my views on depression. They are however the views that many faculty physicians have developed over their practice years.

[Guest bridge]

I think context is the most important factor in the decision about whether to tell people about your mental health or other medical conditions. I'm sure we've all met at least one med student who continually seeks validation by telling his or her story to everyone they can - not just to friends and not just to clarify a patient-perspective issue for their classmates. This type of behaviour usually makes me question whether this person will be able to maintain professional boundaries when they are talking mainly with patients rather than colleagues.

 

The bottom line is your own comfort level. I'm sure most people here are perceptive enough to have a pretty good idea of when it is appropriate to share any personal information. Wait until you are in the situation and make your decision. I think as long as it is in context, you won't raise any eyebrows or make anyone change their impression of you in a negative way.

[Guest UWOMED2005]

Actually aneliz, I disagree. In PCL classes, a number of my classmates have shared experiences with traditional medical illnesses ranging from Graves' disease to a prenatal birth. Their sharing of these stories has been most rewarding, and I'd seriously doubt they've suffered any stigma. I've also seen one courageous student share a story of psychiatric illness. . . also very rewarding, and for the most part they suffered no stigma. For the most part - unfortunately, I'm not as confident everyone was as non-judgemental on that issue.

 

This has become quite the discussion, and in trying to make some points I'm somewhat concerned I might be causing unnecessary anxiety for the original poster. I'd like to take this moment to summarize my opinion as follows:

 

1) There is no reason you need to be worried about not being able to get into medicine because you are on an SSRI.

2) It is too bad more people didn't have your courage in admitting they have a problem with anxiety or depression and consult their doc about going on an SSRI

3) Likewise, unfortunately some medical professionals aren't enlightened when it comes to mental health and might let the fact someone is on an SSRI or has a psychiatric condition affect their perception

4) But the VAST MAJORITY of classmates and docs won't see you any differently for taking an SSRI, in fact some of them are probably already on SSRIs. . .

5) There really is no need to tell people what medications you are on

6) Considering points 3) and 5), I'd suggest not making it overly public that you are on an SSRI. But I also wouldn't worry if people found out about it.

 

Hope this helps.

[Guest mollybear]

Wow - I really think its fascinating the wide range of opinions everyone has on this issue.

 

I think the decision to tell people about a medical condition/medication is a very individual one and its based on comfort level. I also think class dynamic and how close you are with your classmates are factors as well. On the first day of med school, each student had to tell the rest of the class why they wanted to go into medicine and some individuals talked about having illnesses, including mental illness, and for many, their experiences have contributed to them wanting to become physicians. I know that personally, hearing their stories and struggles to get to medical school and how much they have accomplished with everything they had to deal with made me appreciate them and admire them in a very profound way.

 

Med students aren't immune to any illness. I don't think its very good advice to suggest people shouldn't tell anyone about their medical condition. As we all know, one of the most important factors in overcoming illness is support - from family and friends. I think its crucial to have support from friends (which may in fact be fellow classmates) and that should be encouraged. If future physicians can't be sympathetic to someone having depression/anxiety or any illness for that matter, then there is a BIG problem. Also, we can learn so much from those who have suffered with an illness.

 

I know that at my school, the faculty has set up a specialized wellness program for med students having difficulties whether that is with mood problems, anxiety or anything. And the faculty want us to come to them and tell them if we are having problems so we can get help early on.

 

Telling people to "hide" their condition could make them feel alone, could make them feel shame, and could influence whether they get help or not. Again its a very individual thing, but I think those that feel comfortable and want the support should confide in others, including classmates.

[Guest marbledust]

If future physicians can't be sympathetic to someone having depression/anxiety or any illness for that matter, then there is a BIG problem. Also, we can learn so much from those who have suffered with an illness.

 

Thank you Mollybear for raising two very important points that have unfortunately been overlooked or dismissed at times in this thread.

 

There seems to be a consensus here that mental illness is still viewed in a negative manner both in the medical system and outside of it. Fortunately this is slowly changing. Just my opinion, but as *future physicians* perhaps it would be prudent to help provide impetus to that change by encouraging openness and understanding. I am talking in a very general sense, not targeting this to those who post here.

 

I do understand that it is an issue that makes many people uncomfortable, medical students included. But why are *we* so uncomfortable with it? Because it is not well understood? Because of fear? Because we are conditioned to believe it is a taboo subject even before we enter medical school? (Rhetorical questions only.)

 

Does it really help break down the barriers when a medical student (or anybody else) is told that it is not a good idea to discuss their experiences? No. It just sends the message that it should continue to be something that shouldn't be discussed, that a person should be ashamed of, or isn't worth talking about. Not very healthy in a medical education program...

 

I am not writing this to change anybody's mind, just in the hopes it may help the issue be seen in a different light.

[Guest Ian Wong]

Floating back to the top.

 

Ian