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House Calls, June 21, 2012

Posted on June 21, 2012June 21, 2012 by Staff

Practicing family physicians from the UNC Department of Family Medicine have teamed up with The Carrboro Citizen to bring you a weekly feature responding to your questions about health and medicine. Send your questions or comments to yourhealth@unc.edu

This week we respond to questions about mammograms and stopping antidepressants.

Dear HOUSE Calls, Doctors don’t seem to have as much confidence in mammograms as they used to. Why?

There are a couple of important developments in breast-cancer screening over the past several years that have helped physicians update their thinking and the current guidelines. Whenever a new screening test is introduced and evaluated, the optimal screening intervals may not be well established. We default to annual screening in the absence of knowing ideal intervals until we have better guidance. We have seen less frequent screenings with pap smears and more recently bone-density testing. Recently, national recommendations for mammograms have changed from yearly to every other year for women aged 50-74. For younger women, because of differences in breast characteristics and cancer risk, most positive findings are false-positive findings. These create a lot of anxiety, follow-up studies and biopsies with very little benefit. We therefore have recently become more ambiguous in our recommendations for younger women. So your doctor may not recommend mammograms before 50 and may recommend them only every other year between 50 and 74. Further, these recommendations should be based on your personal and family history, as well as your values and preferences. Talk to your primary clinician and understand his/her recommendations and make sure she/he understands your position on this test.

Dear HOUSE Calls, I am about to go to college and have been on Prozac for several years for depression. Things are going great now. What would you advise regarding stopping this medication?

It is a great idea to consider a trial period off of medicine for depression. We usually recommend staying on medicines like Prozac to treat depression for nine to 12 months and then consider a trial period off of medicine. However, there are several important considerations. If the current episode is a recurrence, or if there was a suicide attempt or very severe symptoms, we might recommend staying on the medicine. We are also concerned about the major transition you have coming and how you will respond. There could be significant academic and social stress, lack of support (parents and friends) and lack of a physician or therapist. We encourage you to settle into college life, find a new physician and get some guidance on discontinuing the medicine with some plan for follow up. Don’t just stop an antidepressant without the guidance of a physician. Some need to be tapered, and monitoring your clinical response can be crucial.

House Calls is a weekly column by Dr. Adam Goldstein, Dr. Cristy Page and Dr. Adam Zolotor on behalf of Your Health and the UNC Department of Family Medicine.

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