Thursday, May 21, 2009

Midwife With A Knife: Infertility, Stress, and Psychotherapy

Okay, so I'm behind the times, here's a cool post from Midwife With A Knife from 2 months ago-- an interesting post on fertility, stress, and psychotherapy. Oh, and lemurs and monkeys and all kinds of critters, fertile and otherwise. I'm even stealing her lemur photos. I can't quite get the link right but it's the post called "Are you reading my blog?"

MWAK asks how to tell stress-susceptible people they may benefit from psychotherapy without making it sound like you think they are wusses (her word, isn't it great?!). What do you think?

I've never seen anyone for a primary complaint of "I can't conceive" but I face this problem regularly with pain patients. I'm left to say that some people's depression gets funneled into their body as pain or physical symptoms, and it's remarkable how treating the depression can alleviate the other symptoms. I could have sworn I once wrote a post called "You Need a Psychiatrist" about how to talk to people about getting care without sounding judgmental, but I can't seem to find it---must have been a dream.

So for tags we have pregnant pigs, bears, turtles, vultures, fish, glow in the dark cats, but no lemurs or monkeys. What kind of blog is this anyway?


Midwife with a Knife said...

I think you should write that post. I, on the other hand, should finish writing the revisions on my thesis and slides for the defense....

P.S. I'm always happy to share the lemur love. They may be the cutest animals ever...But, I'm a fan of critters, if you couldn't tell...

Anonymous said...

Everyone has gone away. Do you ever wonder why? g'night.

Retriever said...

It's a great post,MWAK! So true of so many anorexic, stressed women in my gilded suburb (never saw so many 50 year olds still eating disordered), so many of whom had trouble conceiving. I used to say "Just eat a little more and relax".

And the links with chronic pain are so dramatic. I work in an office with people who have little psychological knowledge or interest, but who grapple with bad backs, knees, carpal tunnel, migraines as well as huge stresses. A couple of them were persuaded to take SSRIs as "a cutting edge pain treatment" and dramatically improved, but would have been very insulted if they had been told that they were receiving antidepressant treatment. "I'm not crazy!"
Given the addictive drugs used to ease pain, it does seem best to try the therapy and antidepressants first. If they work, a whole set of potential problems avoided.
Did you see this?

Anonymous said...

I think we have to be careful about assuming that every pain is due to psychological issues. I wish I had a nickle for every time someone's illness was passed of as due to being psychological only to find it was serious such as having cancer or a stroke. I wish I was joking but I am not.

Retriever, while psych meds aren't addictive in the technical sense of the word, they are very difficult to taper off of. Some of the withdrawal symptoms are horrendous but unfortunately, are blown off as a false return of the illness.

And by the way, even though I have a psych med label which I will do everything in my power to get rid of as I taper off of psych meds, my carpal tunnel is not due to my label. It is because I foolishly haven't taken the time to investigate what is a typing good setup for home use. As a result, I type too much in an awkward position and the fact I do it too much isn't helping.

Well, maybe the act of foolishness is psychological:)) but in all seriousness, this has nothing to do with my label.

Anyway, here is a link to a study about the fact that antidepressant don't ease back pain:

I rest my case:))


Retriever said...

Anonymous, I agree with all your caveats. My closest friend has excruciating migraines that have not abated in 20 years despite every single med in the book and years of psychoanalysis and therapy.

Anyone with (or who has a relative with) a psych label knows the loathsome way "regular" MDs treat one as a "head case" and ignore dangerous unrelated physical symptoms. But I have watched recently as three relatives and four coworkers' near debilitating physical symptoms were completely banished on psych meds. Not all placebo effect either. I know about the antidepressants and tapering too. I think it basically works different ways. Patients who think their ills are solely physiological can sometimes benefit hugely by getting psych treatment and meds (because I do believe that some physical pain is magnified by other issues). ALso, my uneducated guess is that some psych meds just interfere with pathways of pain perception that years of awful physical pain have made over active. So whatever works. As far as patients with psch diagnoses, don't get me started on the bad medical care they receive. A mother, father, brother and sister who have received awful medical care because all their ills were viewed as in their heads (three of them died sooner than they would have done).

But please forgive any offense I may have unintentionally given, or my sloppy writing giving the impression that I do not take pain seriously.

Anonymous said...

Hi Retriever,

I greatly appreciate your comments and I am sorry to hear about your family members dying sooner than they should have. I can't imagine what that must be like.

I know you meant no offense and I should have stressed that in my post.

I just worry that psych conditions are being linked to everything under the sun come heck or high water.

That is great that those people's pain was relieved by psych meds. But I hope there was full disclosure about the meds. I worry based on the concern that people wouldn't accept treatment if they knew they were getting psyc meds that this wasn't done.

Also, people don't realize that if god forbid, someone loses their job, if they have a psych med history, their chances of getting insurance are slim and none. I can't get any even though I am tapering off of psych meds. That is a very scary situation.

But this isn't an either or situation. There are alot of alternative remedies that have been shown to be effective for pain. Of course, they aren't side effect free either but I think the risk/benefit ratio is alot better than with psych meds.

Anyway, I am sorry as I didn't meant to sound like I was jumping on you.


Roy said...

AA, While I agree with your sentiments (as usual), I have to take issue with your (and Tara Pope's) interpretation of the Cochrane study.

This was a meta-analysis. From the study: "The review cautions that existing studies do not provide adequate evidence regarding antidepressants for low-back pain. There is a need for larger and more sophisticated studies to confirm the conclusions of this review. In the meantime, antidepressants should be regarded as an unproven treatment for non-specific low-back pain."

Perhaps a subtle point, but they did not find that these meds did or did not work, just that there was a lack of adequate evidence in either direction. Just sayin'.

Anonymous said...

Hi Roy,

Fair point about the study. That is what I get for not reading it carefully due to insomnia:))

I have been thinking more about this issue. After dealing with the pain of a bruised toe from banging it on Friday, I began to think about what life must be like for people in constant severe pain and not have anything work.

In that case, antidepressants might be a reasonable choice. It seems like in looking at studies that tricyclics are the better bet vs. SSRIs.

I think what I am saying is that as long as people are fully informed about the risks, it might be an appropriate choice in those cases where nothing else has worked.