By Dr. Aaron Wilson, contributor to In Public Safety
Sometimes, working with a therapist or medical professional is not enough to help first responders recover from anxiety, PTSD or depression, and they may be prescribed medication. Many responders worry about taking medication and how it could affect their job performance. These are legitimate concerns and first responders should have candid conversations with their healthcare professional about taking medications. It’s also a good idea for them to keep a log of any side effects they have so they can discuss them with their doctor.
Here are some of the most common questions first responders have about medication:
1. Shouldn’t I be able to get better without medication?
In other words, “Is taking medication a sign of weakness?” Medications may not be necessary at all. However, if left untreated, depression, anxiety and post-traumatic stress can last longer or even worsen. These problems can seriously interfere with your ability to function, including the ability to perform at work, and also affect your personal relationships and family life.
While medications are not mandatory, for the right candidates, they can treat chemical imbalances to improve one’s ability to engage in therapy, which may expedite the road to recovery. I often tell my patients, “Medication is just another tool in your toolbox.”
2. How do antidepressants work?
Depression, anxiety and post-traumatic stress are conditions in which factors such as genetics, chemical changes in the body and life stressors play an important role. Research suggests these conditions may be linked to changes in how brain chemicals called neurotransmitters function.
Current research focuses on the serotonin, norepinephrine and dopamine systems. Imbalances in these three systems can produce profound changes in your mood and behavior. Antidepressants are thought to correct some of the chemical imbalances, essentially helping to re-calibrate the system.
3. Why is my doctor prescribing an antidepressant for my anxiety or post-traumatic stress?
These conditions affect common areas of the brain and have many neurochemical similarities, so they respond to the same class of medications (antidepressants). For example, Zoloft, which works on the serotonin system, has been approved by the FDA to treat depression, anxiety, panic attacks and post-traumatic stress, as well as a few other related conditions.
4. Which medication will work best for me?
There are almost 30 antidepressants currently available. Like shoe sizes, not every medication is the right fit for every individual; a medication that worked well for a friend may not be the best fit for you. Your healthcare provider will discuss medication options based on your particular symptoms. The goal of treatment is to effectively target your symptoms while producing the fewest (if any) side effects.
Advances in technology have made it possible to determine how your body metabolizes many different medications, which may guide your provider’s treatment choice. It is important you ask your healthcare provider about any concerns you have about a medication or its potential side effects.
5. What are the most common side effects of antidepressants?
Antidepressants are generally a safe treatment option in otherwise healthy individuals being treated for depression, anxiety and post-traumatic stress. Like most prescribed (and some over-the-counter medications), antidepressants may cause mild and usually temporary side effects. Side effects vary by medication and generally decrease with time. Potential side effects include:
- Loose stools or constipation
- Sleep changes
- Dry mouth
- Blurred vision
- A change in sexual interest or functioning
Your healthcare provider or pharmacist can provide additional information regarding potential side effects. While the internet is an excellent source of information, I encourage patients to speak directly to healthcare professionals with specific questions regarding diagnoses and medications to avoid being inundated with confusing, conflicting and potentially harmful information.
6. Am I going to become addicted to this medication?
As a class of medication, antidepressants are not considered addictive. During years of practice, I can’t think of a single patient who has abused them.
It is important to note that other classes of medications, particularly benzodiazepines (e.g., Xanax, Ativan, Valium, Klonopin) that are sometimes prescribed for moderate to severe anxiety or panic attacks, do have addictive potential. These medications should be taken exactly as prescribed and are generally meant to be used on a short-term basis. Because of their potential to slow reaction times, they are generally not recommended for first responders while on duty.
7. What is the first step in considering a medication?
Before prescribing any medication, your healthcare provider will need to get a thorough understanding of your symptoms, medical history, medication use and drug or alcohol use. Be honest. For female patients, it’s also important to discuss issues of pregnancy and birth control use, because some medications may be potentially harmful to a fetus or nursing infant, or may have a reaction with birth control medication.
8. Why do they say it’s not a good idea to drink alcohol while taking medications?
Alcohol is a powerful depressant. Many people self-medicate with alcohol and drugs, not realizing it produces exactly the opposite desired effect over time. Alcohol can also interfere with the effectiveness of antidepressants by interfering with how your body metabolizes them. Consuming alcohol while on antidepressants can potentially worsen side effects, or cause blackouts, impairment or unpredictable behavior.
9. How will I remember to take a pill every day?
I typically tell patients to link their medications to a daily activity, such as brushing your teeth. If you need an extra reminder, I would suggest setting a daily reminder on your phone. Taking medications as prescribed is extremely important. The effectiveness of antidepressants decreases significantly with missed doses.
Unlike Ibuprofen, you cannot take antidepressants on an as-needed basis, skipping doses on good days. It is important to avoid taking catch-up doses if you forget to take the medication as prescribed. It is also important to not increase or decrease the dose without consulting with your healthcare provider.
Medication can be extremely effective in helping first responders recover and regain a healthy balance in their lives. While medication may not be necessary for all responders, it is worth considering based on the advice and expertise of your healthcare professional. Don’t do yourself a disservice by dismissing medication options just because you think it will be seen as a sign of weakness.
About the author
Aaron Wilson, MD, was named chief medical officer at Sierra Tucson in February 2018. Previously the medical director at Valley Hospital, Dr. Wilson led the Freedom Care Unit, which addresses the specific mental health needs of military service members and first responders. Dr. Wilson has worked closely with active-duty personnel, veterans, retired military, police officers, firefighters, border patrol agents, correctional staff and EMTs with a high acuity of mental illness. Currently, he is an active member of the mental health community in Arizona, serving as president of the Arizona Psychiatric Society and as chairman of the Arizona Disaster Psychiatry Task Force. He is also a co-founder of the Arizona Inter-Professional Behavioral Health Collaborative. To contact the author, email IPSauthor@apus.edu. For more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter.