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05 Mar 2003

Is chronic medication necessary for stress ?
My husband used to suffer from dormant epilepsy (petimal?), and was on prescribed medication. He stopped the medication about 2 years ago after testing negative for the dormant epilepsy. He has been under alot of stress at work lately, and overworked, which has started him getting "stress" pains in his chest. He also forgot things and misplaced things etc. Fearing his petimal had returned, we consulted a doctor. The doctor said it was highly unlikely for the petimal to have returned (apparantly stress can bring it back ??). He prescribed tablets to help him with the stress (Espiride - 6 day course). They helped tremendously, but now the doctor says he needs to go on it permanently to alleviate the tress and tension. I don't want my husband to take prescription drugs for the rest of his life !!? Is it really necessary ? Can't my husband just learn to deal with stress and pressure like the rest of us ?
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Expert
CyberShrink
cybershrink

01 Jan 0001

Dear Concerned,
I'm inclined to agree with you. Let's look at the elements in your story. Petit Mal, is a specific form of epilepsy, which doesn't involve the sort of major, falling over and twitching fits that one sees in Major Epilspsy ( Grand Mal ) ; but which can cause a range of more subtle symptoms, including episodes of absence" when one sort of switches off one's consciousness briefly, and may lose track of things briefly. Like other forms of epilepsy it can be worsened by stress, but not inevitably so.
I'm not sure what form of test was done for the Petit Mal epilepsy when he was told that it had gone away, as at least an EEG ( that test with all the wires attached to one's head, measuring brainwaves ) would be needed ; and it is possible for the est not to show positive results even when Petit Mal is present, so more than one tast may be needed, if there are symptoms present suggestive of the condition. While it can fade away, I'm not sure under what circumstances I would feel confidnt to assure someone that it would not come back, as this is indeed possible.
So currently, it is possible that sme of his symptoms could be due to a return of the Petit mal epilepsy or some related form of the disorder ; and I would want the opinion of a good Specialist Neurologist, not a GP, before ruling this out.
Now, Espiride. This is an odd drug, chemical name Sulpiride, which frankly, I have never ever prescribed. It was simply not used in specialist circles in Britain, Canada and the USA when I worked there. On my return to SA, I found that it was quite popular in some circles here, I call it an odd drug, because while it's not much discussed in textbooks, it tends to be used for a surprisingly wide range of conditions, including schizophrenia, depression, and anxiety, and various other conditions, which is most unusual in psychiatric drugs ; and personally I have not seen good evidence that convinced me it was especially useful in any of these conditions.
It is certainly NOT a drug I would ever recommend that someone take long-term and indefinitely, and I have not found any good research on its safety taken in this manner for long periods.
There are situations in psychiatry where it is indeed adviseable for someone to remain on medication indefinitely, but this would, in my view be only when there has been a specific and reliable diagnosis made by a specalist psychiatrist after a comprehensive assessment, when there has been a proper trial of several medications to find the one that provide maximum benefit for minimum risks or side-efects ; and in a relatively narrow range of conditions which are generally agreed by specialist psychiatrists.
I would be hesitant to accept long-term Espiride, on the advice of a GP or a general physician / general medical specialist, as they are not sufficiently trained to make such a decision.
On the other hand, where someone faces situtations which render them chronically anxious and stressed, it is very worthwhile to seek some sessions with a shrink, in this situation specifically a psychologist trained in Cognitive and CBT therapies, as some talking therapy, to help him assess, recognize the triggers of his stress, and learn better ways of coping with it and lessening the stress ; could be very effective, and long-lasting in its benefits.
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