Tuesday, May 06, 2008

Adolescence and Antidepressants

As I was wrapping up my psychiatry rotation, I came across this piece about patients who had come of age on antidepressants. For most drugs, chronic use does not change how people perceive themselves, but with psychotropic drugs, this may not be the case:

“I’ve grown up on medication,” my patient Julie told me recently. “I don’t have a sense of who I really am without it.”

At 31, she had been on one antidepressant or another nearly continuously since she was 14. There was little question that she had very serious depression and had survived several suicide attempts. In fact, she credited the medication with saving her life.

But now she was raising an equally fundamental question: how the drugs might have affected her psychological development and core identity.

It is indeed an interesting question. As the author notes, for patients who are on these drugs whil their brains are still developing may not remember a time when they were not on antidepressants. Their sense of who they are is shaped in part by the medications. This can lead to interesting but distressing side effects:

Beyond these concerns, there are other important issues to consider in long-term use of antidepressants, especially in young people. One patient, a woman in her mid-20s, told me that she felt pressured by her boyfriend to have sex more often than she wanted. “I’ve always had a low sex drive,” she said.

For the past eight years she had been taking Zoloft, which like all the antidepressants in its class is known to lower libido and to interfere with sexual performance. She had understandably mistaken the side effect of the drug for her “normal” sexual desire and was shocked when I explained it: “And I thought it was just me!”

Honestly, sometimes I tend to overlook these "common" side effects as medical students are trained to know the rare / more severe reactions. However, hearing this story makes me realize how little we truly know about these medications and their impact on our patients' lives, especially over the long term.

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