The Myths About Antidepressants

Antidepressants are the mainstay of treatment for clinical depression and anxiety disorders.  These medications are effective and safe for the general population. However, many remain skeptical about antidepressant treatment and many myths remains.

1. I will become reliant on antidepressants and be addicted.

This is one of the main concern that my patients have when they have to be started on an antidepressant medication. It is important to realise that unlike sleeping pills, it is not possible to be addicted to antidepressants. Antidepressants do not cause tolerance or cravings like street drugs do. The fact that there are no street values with antidepressants attest to the fact that they are not addictive. However, if a patient is on high doses of antidepressants for a long time, it is best for him or her to seek the advice of the psychiatrist and not stop medication abruptly as this can cause "discontinuation syndrome". Discontinuation syndrome can lead to physical discomfort and can be completely avoided by weaning off the medication slowly in a few weeks.

2. My condition will become worse that when it started if I stop the medications.

Your condition will not worsen or rebound simply because you stop your medication. Antidepressants treats your depression or anxiety and also protects you from future episodes. If you stop the medication, it is like you taking off your armour. You will be vulnerable to depression or anxiety again.

3. Antidepressants have terrible side effects.

Newer classes of antidepressants like SSRIs are currently the mainstay of treatment. Unlike older antidepressants, these newer medications are well tolerated. At times, side effects can still occur to the minority of people. Known side effects include weight gain, sedation and rarely sexual dysfunction. These side effects are reversible and if any these side effects arises, you must inform your doctor who will switch you to another medication.

4. My brain will be affected by the medications!

Sometimes patients worry that they will be "changed" by the medications and their brain will become different. Antidepressants normalises the neurotransmitters in your brain  and this in turn makes your mood normal again. Antidepressants are not "happy"pills. They help by making you cope better so that you can solve the problems you have in life and it is up to you to find new meaning and happiness.

5. I'll have to take medications forever!

Many patients are afraid that once they are on medications, they cannot come off it. Majority of patients will become better once they have been treated and will come off medications. Some patients who have multiple episodes of mood or anxiety problems and may decide to stay on the medications long term. Your doctor will discuss with you the pros and cons of taking medications and how long you will require them. Ultimately, you have the choice of whether to take medications and the choice to stop them.

Can Changes in Diet Improve ADHD Symptoms?

Parents often ask me if certain food may make the ADHD symptoms of their children worse. One of the purported culprit is sugar and the "sugar rush" phenomenon is well known. Despite a lack of studies to support these claims, anecdotal reports are aplenty. In this news article a mother reports success with diet changes such as adding vitamins and omega 3's, avoiding addatives- red dyes in particular and skipping the simple processed sugars.

Read about symptoms of ADHD here.

Most adolescent suicidal behavior preceded by mental health treatment

A recent research(1) showed that the lifetime prevalence of suicide ideation among adolescents was 12.1%, suicide plans 4%, and suicide attempts 4.1%. One-third of adolescents with suicidal ideation went on to develop a suicide plan and 33.9% made an attempt. Most adolescents (88.4%) who transitioned from planning suicide to attempting suicide did so within a year.

Most adolescents who had suicidal ideation (89.3%) and attempted suicide (96.1%) met lifetime criteria for at least one DSM-IV mental disorder, which included major depressive disorder, specific phobia, oppositional defiant disorder, substance abuse, intermittent explosive disorder and conduct disorder. Most disorders significantly predicted suicidal behaviors, and the prevalence of mental disorders generally increased with the increasing severity of suicidal behaviors.

From this study, we can see that it is important to identify and provide early treatment for these troubled youths. Unlike physical illnesses, parents tend to ignore mental health issues and to believe that such problems will go away by themselves. Otherwise, they may feel that seeking help from a mental health professional is too stigmatising and may do more harm to their children.

Such ignorance, often lead to delay in seeking treatment and may result in the youths and parents defaulting follow-ups. Today, suicidal behaviors are among the leading causes of death in Singapore and worldwide, especially among adolescents and young adults. Seek help early and contact a psychiatric clinic in Singapore.

(1) Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents Results From the National Comorbidity Survey Replication Adolescent Supplement  
Matthew K. Nock, PhD; Jennifer Greif Green, PhD; Irving Hwang, MA; Katie A. McLaughlin, PhD; Nancy A. Sampson, BA; Alan M. Zaslavsky, PhD; Ronald C. Kessler, PhD
JAMA Psychiatry. 2013;():1-11. doi:10.1001/2013.jamapsychiatry.55

Hobbies: Do you have one?

As a psychiatrist, I often ask my patients about the things that they like to do, such as their hobbies. This can help us identify any changes in their interests towards things and gives us an indication about their mood.

The only problem about hobbies is that many Singaporeans don't have one! Patients would often tell me that Singapore is so stressful and "how to afford" a hobby in their busy schedule.

Some may think, "Is that possible, someone without an interest??!!"

When I first started out with my practice, I too often thought that patients who told me that they do not have hobbies were just having me on. Later, I found out that there were indeed a group of Singaporeans with no hobbies. They work from Monday to Saturday, rest at home on Sunday and go back to work again on Monday. They may sit in front of the television, but may not watching the shows at all. At best, they will sit on their usual seats in the corner of their HDB flats reading Wan Bao.

These are people from the babyboomers generation. Hard working and responsible, what life means to them is simply work and to provide for the family. These are great virtues in an Asian society. A man's worth is measured by his work and contribution to society.

But the problem arises when one day, the individual has to retire and many baby boomers have reached or are reaching this age. Suddenly, he is without a job. Suddenly, he is no longer useful. The day after retiring from his job, he is not only without a job but without any aim or meaning in his life.

It is no wonder that many of these people would become depressed. Sometimes, they may not recognise or refuse to admit their difficulties in their emotions and these may manifest as physical symptoms such as headaches, body weakness, chronic pain and giddiness. Severe cases become suicidal. Not having a job is an important risk factor for suicide.

All these because of (the lack of) a hobby?

Perhaps preparing for one's retirement is the more pertinent issue. You may be the most successful Head of Department but that does not equip you with the skills to live life upon retirement; unless you become an avid golfer. Retirement needs to be planned. One needs to slowly prepare and change his mindset and find new meaning of life beyond the present work.

And hobbies are a great way to do so.

Doing fun things and things you find interesting helps you to relax and relieve you of the stress of work. Upon retirement, you have something to look forward to; something you can put your focus and energy on. Hobbies need not be frivolous fun, they can be journeys of learning and can sometimes become a second career!

So it not about how you can afford to have a hobby. It is about how you cannot afford to live without one.