If you give a mouse a Prozac…

    Posted April 9th, 2010 by

    This morning, for the first time in almost a year, I did not take a pill when I got out of bed. The reason I took these pills, and the reason I stopped, has to do with a word I learned recently:

    Iatrogenic, which means ’caused by the doctors.’

    I’ll start at the beginning.

    For six years, I “balanced” a demanding job, a commute, and raising young children. All things considered, I thought I was managing really well until just before my last child turned one year old. Then, the stress and exhaustion I’d been holding at bay engulfed me. I could barely get out of bed, or eat, or think. I couldn’t work, so I took a leave of absence.

    I made an appointment with a psychiatrist who, naturally enough, prescribed anti-depressants. Makes sense, right? Because by the time I dragged myself into her office, I was really, really depressed.

    I was also really, really anxious. I was having horrible, crippling panic attacks almost daily, and I was waking up in the middle of the night, shaking, heart pounding, unable to go back to sleep.

    The anti-depressants were supposed to help with this also. Unfortunately, they made me jittery. Now, on top of the anxiety I was already grappling with, I couldn’t sit in a chair without jiggling my knee up and down. They gave me other weird side effects: night sweats, headaches, cotton mouth. I started having a lot of trouble sleeping, but it was hard to tell whether it was a side effect of the anti-depressants, since I’d been having trouble sleeping when I was working, too.

    So my psychiatrist wrote me a prescription for pills to help me sleep.

    Things slowly started to get better for me. Summer came and went. I stopped feeling depressed. I quit my job for good. I started eating like a normal person. But still, I couldn’t get a decent night of sleep without taking a sleeping pill.

    I quit coffee and chocolate and started doing a lot of yoga and meditation. Still, I couldn’t sleep without pills. If I didn’t take them, I would wake up between 1 and 3 am, heart pounding, and stare at the ceiling for a good two hours before I could sleep again. After several months of this, I developed an eye twitch.

    My psychiatrist, who was intelligent, thorough, and sincere, suggested I do a sleep study. I packed up my pillow, kissed my husband and the kids good night, and drove to a sleep lab in Berkeley. There, a young women with pale skin and dyed black hair skillfully strapped me to various machines designed to monitor breathing, leg movements, brain waves, and God knows what else.

    Naturally, I had another terrible night’s sleep. Which was sort of good news…

    When the results came back a few weeks later, there were pages and pages of detailed findings. There was a problem with my breathing, with my “index of sleep arousals” and with something called RERAs, an intriguing acronym that was never spelled out. In short, I had a “moderate” version of sleep apnea.

    My doctor called as soon as she got the results.

    “This could be what’s causing your depression!” she said. “We need to get you an apnea machine so you can breathe at night. Katrina, if this works, then all your problems may vanish!” She was triumphant. I was hopeful.

    Six kinds of CPAPs. Because if we can't choose a less stressful life, at least we can choose the most comfortable nose plugs.

    Back I went to my HMO. A respiratory nurse named Joan patiently outfitted me in the latest artificial breathing technology, a CPAP (pronounced SEE-pap) machine.

    “Our newest model,” said Joan.

    The machine itself was slightly larger than a lunchbox, a dark designer gray, with a corrugated hose that looped over my head and three slim black straps that held rubber nose plugs snug to my face.

    “I gave you a medium,” Joan said, looking critically at the nose plugs, which were now plugged into my nose. “If that doesn’t work, you can try the large.”

    The large? I thought. I am not a large person. Is my nose really so out of proportion to my body?

    But it was not the time to be vain.

    Joan snapped on the machine. Oxygen flowed up the vacuum-cleaner hose on top of my head and through the nose plugs. When I opened my mouth, air came whooshing out, like I was some kind of human leaf blower.

    “Don’t open your mouth,” Joan said.

    I closed my mouth and nodded.

    That afternoon, I took the machine home for a two-week trial. I hated the Darth Vader breathing sounds, the itchy nose plugs, sleeping with a hose on my head…but I used it diligently. If it worked, I was going to have to buy one—about $1,000. My insurance wasn’t going to pay for it, so I had to be sure it was right for me.

    After ten days, I caught one of the worst head colds I’ve ever had. I couldn’t breathe through my nose at all, so I gave up on the machine. I was still sick when I brought it back to Joan.

    “I don’t think it helped,” I said. I could see she was disappointed. We stared sadly at each other for a moment.  I sneezed. She wrote me a referral to see a pulmonary doctor that afternoon.

    The first question the pulmonary doctor asked was, “Are you sleepy during the day?”

    “Tired? Yes. Sleepy…not really.”

    “Do you take naps?”

    “I find it hard to nap,” I sniffled. “I mean, I find it hard to sleep. Period.”

    “If you’re not sleepy during the day, then you don’t have sleep apnea.”

    “What about the sleep test?”

    “There are different ways to interpret the results,” she said. “But the breathing issue that came up, that could be from the sleeping pills you’re taking. They depress the central nervous system. They could definitely cause shallow breathing. Especially if you’ve been taking them for a while.”

    “I’ve been taking them for ten months.”

    “That could do it.”

    “But it I don’t take them, I can’t sleep!”

    “Yes, the antidepressants you’re on can cause insomnia in some individuals.”

    We smiled at each other. Because the whole thing was so stupid.

    “And on top of it all, I got this horrible cold,” I said, because suddenly I was feeling really sorry for myself.

    “Oh, yeah, I see that all the time,” she said. “The CPAP can dry out your nasal passages and make you more likely to catch a virus.”

    Let’s recap here:

    1. Trying to work full time and raise young kids put my body under unendurable strain.

    2. My body broke down.

    3. The doctors decided that something was wrong with me, so they prescribed pills.

    4. Those pills made it impossible to sleep, so they prescribed more pills.

    5. The second pills depressed my breathing and made it look like I had sleep apnea.

    6. The doctors gave me a machine to treat the sleep apnea, which dried out my (medium-to-large) nose and made me sick.

    !

    I called my doc and told her the whole story.

    “In conclusion,” I said, after pausing for a breath. “I don’t think there’s anything wrong with me. I just needed to quit my job, which I did. Now the only thing making me sick is the meds.”

    “There’s a word for this,” she said thoughtfully. “Iatrogenic. It means ’caused by the doctors.’”

    Here’s my diagnosis: It is crazy to put working parents in impossible situations where they are bound to go crazy, and then act like there’s something wrong with them for going crazy.

    Why am I telling you this story? Because there is a public health crisis afoot. We are suffering from a chronic state of busyness, particularly families with young children and two working parents.

    We are also suffering from our adherence to a childish ideal of rugged individualism, which keeps us from supporting each other and from asking for help when we need it. This is not an individual pathology that can be solved with a pill (the effectiveness of which is now debatable) [1], but a massive cultural pathology that dictates everything from our individual relationships to laws and workplace policies that fail to support working families.

    Make no mistake—at every step of this bizarre journey, I was in the hands of a competent and caring health care professional. They used every ingenious tool at their disposal to help me. The problem was, they didn’t have the right tools. Where I needed work that challenged me without sucking the life out of me, they had anti-depressants. Where I needed someone besides my overworked husband to watch the kids for a Saturday, they had sleeping pills. Where I needed the support and encouragement of my peers, they had breathing machines.

    So I’ll leave you with this question: If our doctors can’t help us, then who can?

    Cross posted from the MomsRising column, A Peaceful Revolution, at the Huffington Post. A Peaceful Revolution is a blog about innovative ideas to strengthen America’s families through public policies, business practices, and cultural change. Done in collaboration with MomsRising.org, read a new post here each week.

    Also cross-posted on Working Moms Break.

    [1] NEWSWEEK, “The Depressing News about Antidepressants: Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse,” by Sharon Begley, February 8, 2010

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    9 Comments

    May 8, 2010 at 9:14 am by MomMD

    i hear ya! i wasted my 20′s living in libraries, hospitals, clinics with ZERO time for myself, friends, family dedicating myself to the cause of becoming a doctor and helping people just to find out that within a year of finishing training and getting a job…the medical communiy was not supportive of me finally wanting to work part-time for my children/family. also as a pediatrician i’m finding i can’t help these multiple children with behavior problems, obesity, etc because they are a victim of our society that does not value family time. how in the world can a parent address their kids issues when they are expected to be at work ALL the time! then they come to me expecting me to fix it. NO WAY. this is a societal problem and we’re seeing the consequences in our youth. wake up people! as a victim and someone who’s trying to make it better for my patients…wake up America! “ain’t no pill gonna solve this problem. “

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    Yvette Reply:

    @MomMD, I’m so sorry for posting another comment, but I stumbled onto this blog and I could NOT ignore this article! My dear, when I was at work, I was told the SAME thing “you need to take depression medicine”. I asked if I took the pill and rubbed it on the people causing the problems in society, woudl it make them go away? Because even if you take these pills, it doesnt make the situation and reality correct its self..its still there.

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    April 16, 2010 at 3:44 pm by Liz Carlson

    I mean this in the nicest way: You can’t have it all!! Be a Mom or have a career. All of these “problems” that you whine about could be solved simply. It can be done!

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    Yvette Reply:

    @Liz Carlson, Oh my lord! Maybe I am naive or somwthing else, but I agree witht he other woman who commented. It’s absolutely insane! Right now, I’m going through hell and back with my soon to be ex and all the ignrance and money hungry lawyers and going back and forth to court, then not to mention at work, they make it even more unecessarily hard. Not to mention, people that want to take advantage of your situation. It’s wrong then the schools make you feel like a “criminal”! To think I had to even threatedn to take them to court for harassment. I don’t know but I see why my mom put up with the abuse. She knew the horrors of the so called wonderful world out there. But I will never ever ever be able to show her more love for all the pain she went through. Women just need to earn the same, especially when she is the single parent. Its not worth living in the old days and fairy tale that the guy will love you and always be there and that is why the man shoudl earn more, its JUST wrong.

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    April 15, 2010 at 12:23 pm by Abbey

    Thank you for sharing this post. I’ve been familiar with sleeping problems because I suffer from sleep apnea and got tested for other stuff, too. But I’ve never heard of RERA.

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    April 12, 2010 at 9:15 am by Heather

    Thanks for this–I left my job in Manhattan just about 3 years ago, because I felt like the juggling was starting to impact my health. I quit and started my own consulting business, and that was enough of a reboot to make me feel human again. I’m lucky I was able to walk away and start over, and I have a lot of empathy for those who cannot.

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    April 10, 2010 at 11:16 pm by Katrina Alcorn

    Melody and Amy@UMW,

    Thank you so much for sharing your experiences. I think it’s important to talk about what’s really going on in our lives, instead of pretending everything’s fine when it’s not.

    Just for the record, my journey didn’t start with the psychiatrist. I tried every other alternative available before I turned to medication. (Naturopathy, acupuncture, talk therapy, nutritionist, you name it). In the end, the pressure trumped all.

    Melody, you said you want to get involved but don’t know where to start. I just wanted to tell you I think you’re in the right place–momsrising is at the forefront of these issues, working toward making the kind of policy changes that can give all of us parents a little desperately needed breathing room. (They don’t pay me to say that. I’m just a guest blogger here.) I’m glad you’re here.

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    April 10, 2010 at 1:47 pm by Melody

    I really really appreciated your posting. The pressures of parenting, ridiculous expectations on our children in schools (Take all AP or honors courses in every subject and make As, be thin, athletic, do community service, take test after test after test in elementary, middle and high school so you can get into college and take more tests so you can be “successful,” be more productive at work with less support is nuts and driving us nuts. My daughter and I are both taking antidepressants which may have been necessary at one time, but I think are creating more problems now than they’re solving, but that’s the only answer the medical profession seems to have. A director at a major local medical center told me that parents are coming in and bringing their kids in to get them diagnosed with ADHD so they and their kids can get amphetamines so they can study 4-5 hours a night (half the them do not have ADHD at all). Then they come back wondering why they can’t sleep. We need drastic change now. I’d love to be involved, but don’t know where to start.

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    April 9, 2010 at 8:12 am by Amy@UWM

    Wow. What a journey! I’m a full-time working mom who hit that same wall about a year and a half ago. I went on a similar journey myself but fortunately, started with a psychologist (vs. psychiatrist) who had alot of experience with women like us and she helped tremendously. Through talk therapy, she helped my husband understand how integral he was to making me sane, helped us set up some support systems that worked for both of us and helped me see how important it was to pare down my obligations, delegate some responsibilities and take some time for me. On top of that, a better diet and regular exercise took me leaps toward sanity. I also am on a mild anti-anxiety drug, but I started taking it toward the the end of my journey vs. starting there. Anxiety runs rampant in my family (I’m seeing it in my 7 yo)and its been something I’ve struggled with my entire life. I’m sure hitting that wall didn’t help the anxiety, but still feel the medication was part of the solution for me. The combination therapy, diet and exercise and medication have been wonderful for me. I’m a whole new, MUCH happier person.

    But the true message of your post and my point to all women struggling with this very same issue (and there are thousands out there just like us) is that medication should be the very last resort if all other efforts to make your life more manageable fail.

    I couldn’t agree more that the chronic state of busy-ness is causing a public health crisis. Aside from stress, depression and anxiety, it has to be contributing to the obesity epidemic as so many of us turn to food for comfort and have very little time to fit exercise, health check ups or even cooking home cooked meals into our lives. The answer to your question of who can help us, unfortunately, is that we’re going to have to help ourselves. We have to first and foremost put ourselves on the priority list and take care of our own health and well-being. We have to be vocal advocates in our own workplaces for more flexible work arrangements. And we have to push our government to do what it can to mandate things like paid leave and affordable childcare.

    What really scares me is this question — how do the busiest people on the planet fit “changing the world” onto our to-do list???

    [Reply]

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