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Advances in Social Sciences Research Journal – Vol. 10, No. 5
Publication Date: May 25, 2023
DOI:10.14738/assrj.105.14774.
Tochkov, K., & Williams, N. (2023). The Sad Side of Happy Pills: A Case Study on Psychiatric Medication Across a Woman’s Lifespan?
Advances in Social Sciences Research Journal, 10(5).318-328.
Services for Science and Education – United Kingdom
The Sad Side of Happy Pills: A Case Study on Psychiatric
Medication Across a Woman’s Lifespan?
Karin Tochkov
Department of Psychology and Special Education,
Texas A&M University-Commerce
Nichole Williams
Department of Psychology and Special Education,
Texas A&M University-Commerce
ABSTRACT
The use of antidepressants can have many benefits and many consequences
(American Psychiatric Association, 2010). 12.7% of Americans aged 12 and older
reported taking an antidepressant in the previous month when surveyed between
2011 and 2014 (Pratt, Brody, & Gu, 2017). The purpose of this case study is to
explore the impact these medications have on a person by exploring their role in
the life of one woman, Jane Doe and to urge caution in prescribing practices.
Keywords: SSRIs, antidepressant, case-study, forced treatment, patient experiences
INTRODUCTION
Between 2011 and 2014, 12.7% of Americans 12 years and older took antidepressant
medication in the past month (Pratt, Brody, & Gu, 2017). One class of such medications are
selective serotonin reuptake inhibitors (SSRIs) which have been shown to potentially cause
many side effects in the individual taking them including such side effects as sleep disturbances,
sexual dysfunction, and more (Ferguson, 2001; Crawford et al., 2014; Liebert & Gavey, 2008).
There have also been studies to show different concerns by age group interacting with SSRIs
(Saypol, 2005; Oberlander & Miller, 2011; National Institute of Mental Health (NIMH), n.d.). The
purpose of this article is to discuss SSRI use across the lifespan, from in utero exposure through
adulthood. Specifically, the discussion will explore these shifting factors through the lens of one
person, Jane Doe’s, experiences. This story is Jane’s own and is reported as she describes it,
complete with her opinions. Interwoven is research elaborating on her experiences in relation
to what we know about SSRIs. Additionally, there will be some discussion of tricyclic
antidepressants. The aim of this paper is to show the complicated role these medications play
in the lives of those prescribed them and to urge caution in prescribing practices, by exploring
their use in the context of an individual’s life.
METHODOLOGY
The authors followed the case study methodology outlined by Yin (2017). Jane offered to share
her story with the researchers after one researcher presented at a conference. Jane spoke with
the researcher and described how mental health care had shaped her life. Jane was asked if she
would be willing to be interviewed about her experiences.
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Tochkov, K., & Williams, N. (2023). The Sad Side of Happy Pills: A Case Study on Psychiatric Medication Across a Woman’s Lifespan? Advances in
Social Sciences Research Journal, 10(5).318-328.
URL: http://dx.doi.org/10.14738/assrj.105.14774
When designing the case study, the following aspects were discussed: developing the question,
obtaining consent, deciding on the structure of the interview, and deciding on how to use the
interview to answer the research question. The research question was to obtain a detailed
report about the traumatic consequences the mental health system had on an individual person.
From there, we conducted the case study interview. To do this, the researchers obtained
written consent from the subject vie e-mail correspondence before the phone interview took
place. Jane interviewed on the phone with the second author regarding her experiences in the
mental health system. Jane was asked to describe the experiences she endured over many years
of her life. The interview was unstructured with the only additional questions being those
needed to clarify something Jane reported, such as asking her age at the time of an event
reported.
While she shared her story, the interviewer wrote her story down. The story was recorded as
she spoke with the aim of documenting her story as accurately as possible and using her own
words whenever able. To do this, her story was recorded by the researcher in a bulleted format
as she presented it and exact quotes were written whenever possible. Additionally, an audio
recording was made that was used to ensure the notation was accurate and thorough. Once the
interview was completed, the notes were formed into the chronological narrative that follows.
Steps taken to address subject anonymity were assigning her the pseudonym, Jane, and never
writing down the subject’s real name in any of the notes the researchers took or using it in the
recording. Once her story was organized chronologically, the researchers collected literature
related to the experiences Jane had in an effort to educate on potential causes of the challenges
she faced and to inform others of the complexity of psychiatric medication prescribing. Prior to
submitting it to publication, the article was shared with her to ensure it was true to her story.
JANE’S FAMILY
Jane Doe is currently a 36-year-old married, mother of one. She comes from a very religious and
evangelical family. She was the second born and has an older sister that is 5 years older. Her
parents had a troubled marriage that eventually resulted in divorce. She was an intelligent and
friendly child that did well in school and made friends easily. Her family did not believe in
expressing emotions. According to Jane, they tended to believe if you were suffering, it was
because you did not pray hard enough. Her mother was also a strong believer in doctors and,
according to Jane, almost worshipped them in a religious way. As a child, Jane viewed herself as
being a highly sensitive and empathic child that picked up on the negative emotions not
expressed in her house.
Exposure to Tricyclic Antidepressants While Nursing
Jane Doe’s mother was diagnosed with postpartum depression shortly after giving birth to her.
There appears to be a family history of this, but an additional factor was her mother’s
experience of sexual trauma as a child that was never dealt with. In response to this diagnosis,
Jane’s mother was prescribed an antidepressant, amitriptyline, which is a tricyclic
antidepressant. Research covering long-term effects of antidepressant exposure as a nursing
infant is non-existent to the knowledge of the authors, but there is research showing exposure
to tricyclic antidepressants result in low levels of the medication or its metabolite are
detectable in the infant exposed (Eberhard-Gran, Eskild, & Opjordsmoen, 2006; Burt et al.,
2001). One tricyclic antidepressant in particular, doxepin, has shown up in high levels and
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Advances in Social Sciences Research Journal (ASSRJ) Vol. 10, Issue 5, May-2023
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resulted in anecdotal evidence of respiratory depression and sedation in the infant (Eberhard- Gran, Eskild, & Opjordsmoen, 2006; Burt et al., 2001).
Jane Doe considers nursing to be her first exposure to antidepressants and evidence does
support that at least some of the medication her mother was taking could be detectable in her
system (Eberhard-Gran, Eskild, & Opjordsmoen, 2006; Burt et al., 2001). How this impacted her
in the long term is difficult to say due to the lack of evidence of long-term outcomes of children
exposed to antidepressants during nursing. This is important in terms of current practice,
because the American Psychological Association (APA) charges clinicians with doing good or at
the very least doing no harm (2017). If there is limited information available on potential
outcomes, potential adverse events must be weighed.
Childhood Exposure to Medications
Jane recalls very early feeling her mom’s sorrow and thinking it was her own fault. Around 5
years old, she says she began to mirror the conflict and emotions she sensed back to her parents.
Jane’s mother continued with her antidepressant for a long time until Jane was about 7 years
old. Jane’s father did not support taking psychiatric medications and had pushed her mother to
stop taking them. Her mother was hospitalized for depression due to suicidal thoughts. Jane
now feels this was due at least in part to withdrawal from the medication. Research does
support that her mother could have suffered discontinuation syndrome from stopping her
medication (Haddad & Anderson, 2007, Warner, Bobo, Warner, Reid, & Rachal, 2006;
Yerevanian, Koek, Feusner, Hwang, & Mintz, 2004; Maxiner & Greden, 1998). Discontinuation
syndrome from stopping tricyclic antidepressants can result in several symptoms including
somatic symptoms, problems with sleep, gastrointestinal distress, and affective symptoms
(Haddad & Anderson, 2007, Warner et al., 2006; Maxiner & Greden, 1998). The affective
symptoms can include anxiety, irritability, tearfulness, and/or a generally low mood (Haddad
& Anderson, 2007, Warner et al., 2006; Maxiner & Greden, 1998).
Her mother’s hospitalization was very distressing to her. Nobody explained why her mother
was gone. Jane feels that affected her attachment to her mother. She began to have insomnia,
anxiety, and get upset when her mother would leave the room. She attributes these behaviors
to developing an insecure attachment with her mother.
These behaviors worried her mother and she took Jane to the pediatrician. The pediatrician
prescribed her the same antidepressant her mom had taken, Elavil. This was in about 1987 and
Jane says she was a “guinea pig” because there was limited knowledge of medication side effects
in children. After beginning the medication, she began to care less about school, withdrew
socially, become argumentative, and she had increased daytime anxiety. Increased anxiety,
changes in mood, and changes in behavior are all potential side effects for amitriptyline
(MedlinePlus, 2017a). Not long after she became very sick with mono and once, she recovered,
her doctor switched her to fluoxetine and trazodone. Upon starting these medications, she
began to feel excessively “hyped up” and jittery. She struggled to concentrate, which had never
been an issue in the past. Another troubling side effect was that the medication “killed” her
appetite. This combination of medications is troubling and explains Jane’s experience.
Fluoxetine and trazodone both have the potential of, but are not limited to, loss of appetite,
decreased ability to concentrate, anxiety, and nervousness (MedlinePlus, 2017b; MedlinePlus,
2017c). Additionally, these two medications can have troubling interactions such as chest pain