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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?

That is a timely question. There have been 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, optimal screening intervals may not be well established. Until we have better guidance, we default to annual screening in the absence of knowing ideal intervals. But we have also seen patients experience no risk with less frequent screenings for tests such as pap smears, and more recently for bone density testing.

That’s why recently, national recommendations for mammograms changed from telling women to have yearly exams, to telling women that every other year is fine for many women between the ages of 50-74. For younger women, because of differences in breast characteristics and cancer risk, researchers are finding that most positive findings are false positive findings. These false positives create a lot of anxiety, unnecessary follow up studies and biopsies, all of which have very little benefit.

Doctors, therefore have recently become more ambiguous in our recommendations for younger women. As a result, your doctor may not recommend mammograms before 50 and may recommend them only every other year between 50 and 74. Furthermore – and importantly – these recommendations should be based on your personal and family history, and also your values and preferences.

Talk 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?

We are so glad that you are doing better and it is a great idea to consider a trial off of medicine for depression.

We usually recommend staying on medicines like Prozac to treat depression for 9-12 months, and then consider a trial 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 (no parents and fewer friends nearby), and lack of a physician or therapist.

We encourage you to settle in to 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, as that can cause it’s own problems. Some medications need to be tapered off, and monitoring your clinical response can be crucial.  Good luck.

HOUSE Calls is a weekly column by Dr. Adam Zolotor, Dr. Adam Goldstein, and Dr. Cristy Page on behalf of YOUR HEALTH and the UNC Department of Family Medicine.

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