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What we can learn from Anna Nicole Smith’s death
Palm Beach Post Staff Writer

Sunday, April 01, 2007

My psychiatric nurse practitioner, who prescribes and monitors my medications, found something weird (or should I say something else weird?) about the death of Anna Nicole Smith.

There were no antidepressants in her system.

According to reports, Anna Nicole had been suffering from depression since the death of her son and birth of her daughter in September. Anna managed to get ahold of a smorgasbord of other drugs, but no one apparently thought she should take an antidepressant.

Instead, she was taking drugs that are considered very risky to give to a depressed alcoholic and/or addict: classic “downers” and others that are habit-forming. I don’t know how Anna Nicole got the drugs. I do know this: The girl had a serious substance-abuse problem. That was pretty obvious from watching her painful reality show.

I also know, because my nurse made a huge issue of this when I first saw her, that there are certain drugs that should be avoided or only carefully prescribed to addicts and alcoholics with depression. Drugs like Valium, Ativan and Klonopin, all from a class of drugs called benzodiazepines that are risky to give to an alcoholic and/or addict — especially three at a time.

Ativan is an anti-anxiety medication. My mother took it in hospice, and, boy, did it work. Klonopin is the drug to which Stevie Nicks was addicted. And Valium, well, let’s just say a lot of us know what Valium feels like. Then there was Soma and Methadone, both habit-forming. And finally Noctec, a very old sedative that is rarely used and must be used — especially by an addict and/or alcoholic — with extreme caution.

But no antidepressants.

If we learn one thing from Anna Nicole’s death, maybe it should be this: We all need to be more careful about the drugs prescribed to addicts and alcoholics who have depression. We, the people who suffer from these diseases, and those who love us and treat us, should know this and start paying attention to what’s in the brown plastic bottle and who has access to it.

Unfortunately, a lot of people — including doctors — don’t know this. I’m not passing all the blame onto the doctors. Addicts and alcoholics with depression need to tell their doctors about their addictions before the doctor writes a prescription for a sedative, antidepressant or anti-anxiety medication. There is a lot of denial out there, and addicts and alcoholics can be great liars.

Still, I believe that doctors and psychiatric nurse practitioners who treat depression with any habit-forming or mood-altering drug should thoroughly screen the patient for substance abuse, like my nurse practitioner. How hard is it to ask a few questions? Such as: Is there any substance or alcohol abuse in your family? Has anyone ever told you that you drink too much? Have you ever had a DUI or faced any drug charges? Do you live in a household with an addict or alcoholic (who might want to “borrow” your prescription)? Have you ever been to a 12-step meeting?

Why ask? Because as many as 37 percent of alcoholics and 53 percent of addicts also have at least one serious mental illness. Of people diagnosed with a mental illness, 39 percent abuse drugs and/or alcohol. We’re talking about millions and millions of alcoholics and addicts who are being treated for depression. They need to know — they deserve to know — that their prescription isn’t going to worsen their other mental illness.

So if you are a doctor, a friend, a parent or someone who cares about someone with depression — especially an addict or alcoholic — just ask a few questions about what’s in that little brown bottle.

It’s just a few questions.http://www.palmbeachpost.com/news/content/accent/epaper/2007/04/01/a3d_cs_depress_anna_0401.html?cxtype=rss&cxsvc=7&cxcat=2