Tag Archives: antipsychotics

Health, Psychiatry, Schizophrenia

Why Dr Steve Balt, Psychiatrist, is Not Sure Medications Work… And GOOD for him for saying so!

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Antipsychotics - NOT

From KEVINMD.COM and Steve Balt’s WONDERFUL ThoughtBroadcast.com

Why I’m not sure that psychiatric medications work

STEVE BALT, MD | MEDS | JANUARY 25, 2013

I have a confession to make.  I don’t think what I do each day makes any sense.

Perhaps I should explain myself.  Six months ago, I started my own private psychiatry practice.  I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions.  I figured that an independent practice would permit me to be a more effective psychiatrist, as I wouldn’t be encumbered by the restrictions and regulations of most of today’s practice settings.

My experience has strengthened my long-held belief that people are far more complicated than diagnoses or “chemical imbalances”—something I’ve written about on this blog and with which most psychiatrists would agree.  But I’ve also made an observation that seems incompatible with one of the central dogmas of psychiatry.  To put it bluntly, I’m not sure that psychiatric medications work.

Before you jump to the conclusion that I’m just another disgruntled, anti-medication psychiatrist who thinks we’ve all been bought and misled by the pharmaceutical industry, please wait.  The issue here is, to me, a deeper one than saying that we drug people who request a pill for every ill.  In fact, it might even be a stretch to say that medications never work.  I’ve seen antidepressants, antipsychotics, mood stabilizers, and even interventions like ECT give results that are actually quite miraculous.

But here’s my concern: For the vast majority of my patients, when a medication “works,” there are numerous other potential explanations, and a simple discussion may reveal multiple other hypotheses for the clinical response.  And when you consider the fact that no two people “benefit” in quite the same way from the same drug, it becomes even harder to say what’s really going on. There’s nothing scientific about this process whatsoever.

And then, of course, there are the patients who just don’t respond at all.  This happens so frequently I sometimes wonder whether I’m practicing psychiatry wrong, or whether my patients are playing a joke on me.  But no, as far as I can tell, I’m doing things right: I prescribe appropriately, I use proper doses, and I wait long enough to see a response.  My training is up-to-date; I’ve even been invited to lecture at national conferences about psychiatric meds.  I can’t be that bad at psychiatry, can I?

Probably not.  So if I assume that I’m not a complete nitwit, and that I’m using my tools correctly, I’m left to ask a question I never thought I’d ask: Is psychopharmacology just one big charade?

Maybe I feel this way because I’m not necessarily looking for medications to have an effect in the first place.  I want my patients to get better, no matter what that entails.  I believe that treatment is a process, one in which the patient (not just his or her chemistry) is central.  When drugs “work,” several factors might explain why, and by the same token, when drugs don’t work, it might mean that something else needs to be treated instead—rather than simply switching to a different drug or changing the dose.  Indeed, over the course of several sessions with a patient, many details inevitably emerge:  persistent anxiety, secretive substance abuse, a history of trauma, an ongoing conflict with a spouse, or a medical illness.  These often deserve just as much attention as the initial concern, if not more.

Although our understanding of the pathophysiology of mental illness is pure conjecture, prescribing a medication (at least at present) is an acceptable intervention.  What happens next is much more important.  I believe that prescribers should continue to collect evidence and adjust their hypotheses accordingly.  Unfortunately, most psychopharmacologists rarely take the time to discuss issues that can’t be explained by neurochemistry (even worse, they often try to explain all issues in terms of unproven neurochemistry), and dwindling appointment times mean that those who actually want to explore other causes don’t have the chance to do so.

So what’s a solution?  This may sound extreme, but maybe psychiatry should reject the “biochemical model” until it’s truly “biochemical”—i.e., until we have ways of diagnosing, treating, and following illnesses as we do in most of the rest of medicine.  In psychiatry, the use of medications and other “somatic” treatments is based on interview, gut feeling, and guesswork—not biology.  That doesn’t mean we can’t treat people, but we shouldn’t profess to offer a biological solution when we don’t know the nature of the problem.  We should admit our ignorance.

It would also help to allow (if not require) more time with psychiatric patients.  This is important.  If I only have 15-20 minutes with a patient, I don’t have time to ask about her persistent back pain, her intrusive brother-in-law, or her cocaine habit.  Instead, I must restrict my questions to those that pertain to the drug(s) I prescribed at the last visit.  This, of course, creates the perfect opportunity for confirmation bias—where I see what I expect to see.

We should also make an effort to educate doctors and patients alike about how little we actually know.  The subjects in trials to obtain FDA approval do NOT resemble real-world patients and are not evaluated or treated like real-world patients (and this is unlikely to change anytime soon because it works so well for the drug companies).  Patients should know this.  They should also know that the reliability of psychiatric diagnosis is poor in the first place, and that psychiatric illnesses have no established biochemical basis with which to guide treatment.

Finally, I should say that even though I call myself a psychiatrist and I prescribe drugs, I do not believe I’m taking advantage of my patients by doing so.  All of my patients are suffering, and they deserve treatment.  For some, drugs may play a key role in their care.  But when I see my entire profession move towards a biochemical approach—without any good evidence for such a strategy, and without a fair assessment of alternative explanations for behavior—and see, in my own practice, how medications provide no real benefit (or, frequently, harm) compared with other treatments, I have to wonder whether we’ve gone WAY beyond what psychopharmacology can truly offer, and whether there’s any way to put some logic back into what we call psychiatric treatment.

Health, Medication

ADD ABILIFY?!

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PHYSICIAN ABILIFY SAMPLES
PHYSICIAN ABILIFY SAMPLES – DO NOT ADD  TO ANYTHING! THIS IS NOT AN ANTIDEPRESSANT. THIS IS AN ANTIPSYCHOTIC AND A DANGEROUS DRUG.

I know, I know, you have probably seen the commercials, but I am new to television and I only just started to watch them…and I just saw one that has been running probably for years now with the sad little pill that gets people to “add Abilify” to their so-called “anti-depressant” in order to boost its effectiveness. I learned about this advertisement recently from a friend of mine who innocently enough told me, told me, that Abilify is “just another antidepressant”.

Excuse me? I said to her. Abilify is NOT an antidepressant.

“Yes it is,” she insisted.  “I saw it on TV.”

“No, Abilify is an atypical antipsychotic drug, not unlike Zyprexa or Risperdal. I don’t know what you are talking about, calling it an antidepressant.”

That’s when she told me about the sad little pill commerical. Well, okay, so the pill isn’t sad, the woman in the commercial supposedly is, and when the nice doctor she sees, adds the nice little Abilify pill to her so-called anti-depressant, she perks right up like an obedient child and, wow, the two pills work like magic to make the world right again. WOWEE!

So again the public is sold two lies, or maybe three or maybe half a dozen. First we are sold the lie that antidepressants do something in the first place. WAIT A MINUTE. Okay, they do do something, I admit it. They change the levels of neurotransmitters in the brain, yes, they do that. They alter something. Yes, and doing something, making a difference, altering anything makes people feel DIFFERENT and doing anything to change people’s feelings about ANYTHING when they are depressed can lead them to feel that it is better than doing nothing. ‘

But you have to understand that taking a mind altering substance to do something, anything at all, just to feel different, is not at all the same thing as actually treating a pre-existing chemical imbalance. And they know now that there is no such thing as a serotonin imbalance in the brains of depressed people. NO SUCH THING. In fact, they cannot figure out why people become depressed at all, but they do know that serotonin levels are not involved in any such simplified ways that the SSRI drugs purport to “treat.” Even Prozac researchers have admitted as much. Prozac researchers knew that their drug did not work way back in the 80s when Prozac first came out. They knew it induced suicidality in a large number of people, but they rushed it onto the market because Lilly needed a blockbuster drug, period to pad their pockets.

But that aside, the researchers to this day know that antidepressants do nothing to actually treat depression, because they have admitted that they do not understand what causes depression.

That said, does anyone who takes an anti-depressant understand what they are doing when their friendly psychiatrist or family doctor  “ADDS ABILIFY” to their nice little psychoactive cocktail? Well, in addition to experiencing some or all the terrible  but COMMON side effects of, say, Zoloft or Prozac (these are just those for Zoloft):

Inability to have an Erection Severe
Sexual Problems Severe
Altered Interest in Having Sexual Intercourse Severe
Drowsiness Less Severe
Dizzy Less Severe
Chronic Trouble Sleeping Less Severe
Low Energy Less Severe
Excessive Sweating Less Severe
Involuntary Quivering Less Severe
Loss of Appetite Less Severe
Weight Loss Less Severe
Head Pain Less Severe
Feel Like Throwing Up Less Severe
Gas Less Severe
Diarrhea Less Severe
Stomach Cramps Less Severe
Feeling Weak Less Severe

they might well experience  these COMMON side effect of Abilify:

A Feeling of Restlessness with Inability to Sit Still Severe
Feeling Restless Less Severe
Indigestion Less Severe
Incomplete or Infrequent Bowel Movements Less Severe
Drowsiness Less Severe
Dizzy Less Severe
Chronic Trouble Sleeping Less Severe
Increased Hunger Less Severe
Head Pain Less Severe
Feel Like Throwing Up Less Severe
Throwing Up Less Severe
High Amount of Triglyceride in the Blood Less Severe
Anxious Less Severe

These are the commonly reported side effects from common antidepressants Celexa and Lexapro: in terms of Psychiatric Disorders, to which one might be told to “add Abilfy”:

Frequent: impaired concentration, amnesia, apathy, depression, increased appetite, aggravated depression, suicide attempt, confusion.

Now, I ask you, everyone, DOES THIS SOUND LIKE A RECIPE FOR CURING DEPRESSION?  Any fool would look just at the list of side effects and say, uh, I would be more depressed if I experienced even two of these….But doctors think that people will feel better if they take drugs like these two together, and put up with these side effects, just because they are told  that “by adding abilify” and  their depression will go away.

The point is, the doctors are IN THE DARK. They read mostly what you do, and they see the same commericals you do. Most of them have no more idea whether the drugs work than  you do, and they only know what they are told by the drug reps and the drug companies….DO NOT BELIEVE THEM when they tell you that you have a chemical imbalance. They are either lying to you, or believing a lie they were told by someone else. ASK THEM questions, investigate. Ask  precisely what is the correct balance, what are the correct numbers…Do not be sheep. What were the studies showing any proof? Who did the studies and who  paid for them? Changes are you won’t get good answers, or if you do, your answers won’t make you any more secure than I am. Because drug companies pay for most of their own studies and they only pay for the results they want, ie what they want to hear…They do not want to hear that Abilify hurts patients, or doesn’t actually work, or that Abilify does not boost Zoloft’s anti-depressant IN-efficacy. No, they want to lie and “prove” a lie or else not prove it by not actually doing the study to prove anything. They want to market the drug and advertise things that have NOT BEEN SHOWN TO BE TRUE AT ALL. They want to market a lie, sell a drug and make money, without doing any research to prove anything, and pick up the pieces billions of dollars later, if at all.

I say, BULL SHIT

My advice? Don’t add Abilify. Add only Sunlight and Truth to everything.

Art, Health

Antipsychotics Block Pleasure in Life: It’s All About Dopamine…

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It has always been about Dopamine, but they never told us that impeding our dopamine receptors would impair our ability to feel pleasure and the high of "reward" -- No wonder our "negative symptoms of "not wanting to do" so many things! The drugs blocked our native dopamine flow! (Decades ago they knew that it has NOTHING whatsoever to do with schizophrenia, but they persisted in the lie nevertheless...
It has always been about Dopamine, but they never told us that impeding our dopamine receptors would impair our ability to feel pleasure and the high of “reward” — No wonder our “negative symptoms of “not wanting to do” so many things! The drugs blocked our native dopamine flow! (Decades ago they knew that it has NOTHING whatsoever to do with schizophrenia, but they persisted in the lie nevertheless…

To explain the picture/letters above, I was practicing some lettering, briefly, and did not know what I was writing until later…which makes what I wrote all the more interesting a message from my subconscious.  Clearly I agree with almost everyone else I have ever heard from: Haldol is the drug from hell!  About the rest of it, well, Psychiatrie macht frie derives from the sign that was posted above Auschwitz and other concentration camps during WWII, Arbeit macht frei, or Work makes (you) free. So this transposition is meant to suggest (sardonically) that psychiatry will free you in just the same way… NOT!

What particularly sickens me personally is the damage the fiction called the Dopamine Hypothesis  — how an excess of dopamine causes schizophrenia — may have done to the millions of people like me who have taken antipsychotic drugs for decades, unknowingly buying into the medical model and this notion that we somehow had too much dopamine coursing around in our brains.

Life is ALL about dopamine, LIFE has always been about dopamine. Here are some of the human functions to which dopamine is essential

  • movement
  • memory
  • pleasurable reward
  • behavior and cognition
  • attention
  • inhibition of prolactin production
  • sleep
  • mood
  • learning

Why on earth would anyone deprive another human being of the one neurotransmitter that allows us to feel good about things? It would seem to be a diabolical plot, if anyone actually did such a thing, right? And yet, for decades right on through today, that is what doctors want us to do, block the transmission of dopamine to the brains of those of us diagnosed with schizophrenia. They know, of course, that it is impossible, that the brain up-regulates the flow of dopamine in such a way as to thwart at least in part the antipsychotic receptor blockade. Homeostasis will be re-established eventually, even if at abnormal levels due to the drug’s presence.*

No one can live without dopamine, after all. But to understand the necessity of dopamine, and that they have known for years that an imbalance of dopamine metabolism is NOT implicated in schizophrenia, and finally to “grok” that they have nonetheless perpetuated the lie that is the “dopamine hypothesis” just boggles the mind with its enormity. How can we believe anything they tell us about negative symptoms, now, when  as one website informs us:

“Low D2 receptor-binding is found in people with social anxiety or social phobia. Some features of negative schizophrenia (social withdrawal, apathy, anhedonia) are thought to be related to a low dopaminergic state in certain areas of the brain.”

The atypical AP drugs induce a D2 receptor blockade as a matter of course. After all, if you don’t feel any reward-sense from your life and living, your normal dopamine being in an antipsychotic blockade, why would you want to change your clothes, or take care of yourself, much less bother to go to work or even think? But we have been led to believe that such negative symptoms are part of schizophrenia and NOT part of the drug treatments for it! No one told us they were taking away all our incentive to do anything, to even move or think. They told us they were helping us, not hurting us, not destroying our lives!

Even more diabolical, to my way of thinking is the idea that some doctors actually add an atypical antipsychotic onto the treatment of mere depression. Can you imagine how you would feel if you were taking an SSRI (which is ineffective) and which already deprived you of sexual satisfaction or any sexual feelings at all, and then you are given an adjunctive antipsychotic that subsequently deprives you of dopamine? It might add twenty to forty pounds or even more in no time, up your cholesterol and blood sugar, and then deprive you of any feelings of reward or pleasure…Ah but it will boost your antidepressant’s antidepressant activity? J’en doute fortement… I doubt it highly!

What do the doctors care? Either they bought into the drug company’s literature and haven’t read anything independently since med school…or they are on the take themselves from Big Pharma in some fashion and don’t give a damn.

We need to be on the look out for ourselves, because god knows the doctors are not on our sides, most of them. They cannot be. This is their bread and butter, folks esp the psychiatrists and if they cannot prescribe pills, what will they do? They won’t be “real doctors” any more and their prestige will plummet yet again…OH NO! The fact is, they need to learn to do psychotherapy again, or get out of medicine because they cannot prescribe pills that do not work, and there are none that do! None that do reliably and well or better than placebo. In fact, except for the occasional use of a benzodiazepine, and the judicious use of cognitive enhancers for the proper people, and meds for sleep, I am convinced that precious few drugs in the psychoactive armamentarium are worthy of anything but the dustbin.

I think most are ONLY placebos, if they do anything at all. Frankly. And I say this despite having once written testimonials in praise of Zyprexa and other drugs…I dunno, I dunno. How could Zyprexa be anything except a placebo? It is a dirty drug that hits nearly every known neurotransmitter of importance…And yet we do not know how it does what it does…and it has horrendous side effects. That much we know. Since we do not have any reason to think  it is the action on dopamine or serotonin that is the “antipsychotic” activity, in essence we cannot say why or if it does anything at all. ALL the AAPs drugs work on the neurotransmitters in a more or less dirty fashion. In fact the OLDER drugs were less dirty, being more specific to just dopamine!

I reiterate, there is no “chemical imbalance” in schizophrenia, or bipolar “illness’ or in depression. No one has ever proven or shown any such animal ever. Only after patients have taken a drug to “treat” such conditions is there ever an “imbalance” and this imbalance is a direct result of having taken the drug. PLEASE remember this and question your doctors next time they warn you that if you stop your meds your “chemical imbalance” will reassert itself and make you sick again. Ask, “What chemical imbalance and where did it come from? What chemicals and what is the normal level I should have?” I know I know, the doctor will say, dopamine, if you “have” schizophrenia, or “serotonin” if you “have” depression. Lord knows what she will claim if you “have” bipolar tendencies of one sort or another, as so many millions upon millions of Americans these days have been told they now do…But it isn’t true. Not even if they claim it is. There has never been any proof of altered neurotransmitter levels and in fact it is the opposite: drug-naive people with schizophrenia and depression, that is to say, those who have never taken any medication, have been shown to have the exact same dopamine and serotonin levels as anyone else!

As for those who suffer from the condition called “bipolar” — You know, it used to be a very rare condition,  manic-depression. Now, you see “bipolars” coming out of the woodwork everywhere. One used to have to have been crazy-manic at least once, to the extent of having been hospitalized to qualify for the diagnosis, and this made sense as it was restrictive and not a broad umbrella. Given that the illness was considered a very serious one, no one wanted to bring too many within the definition. Now, with so many drugs used to “treat” (ha ha ha) the condition,  and with the help of DSM IV and 5 to bring patients to the drug companies’ financial assistance, you need only complain of a garden variety “depression” to be counted as bipolar…

But remember: 1) the drug companies treating bipolar etc only want to make money, 2) the drugs treat something — a neurotransmitter imbalance that doesn’t exist 3) bipolarity is a fiction that keeps lengthening, like Pinocchio’s nose, with every newly expanded definition…

Think about malaria, a real illness. It doesn’t make more people ill just because it gets redefined. Malaria is caused by a protozoan (injected through the bite of a mosquito), and it sickens people who are vulnerable to the ravages of that organism inside the body…in the same way each time. You don’t “get” malaria more because a financially- interconnected organization of doctors/drug companies decides to change the definition of what constitutes malaria. No, you  get malaria the way people always gotten malaria, largely through not using mosquito nets and other preventive measures…i.e. via a mosquito bite.

Ay, this is NUTS! It should not be so fricking easy to fit everyone into a diagnostic category of mental illness.  Emotions are NOT illnesses by definition, they are normal and necessary, even excessive emotional reactions are quite normal; they happen every day to everyday normal people. Some cultures define themselves by their emotionality! It behooves us to remember this and not pathologize it.

So too, think of this: depression frequently is just sadness, folks. We used to know the truth of the saying, “This too will pass…” There are problems in living that are just problems in living, and I think that some people for whatever reason are simply miserable, without having a mental illness. They would not do better being labeled with an illness or being treated for one. In fact, I have seen people in states of abject misery do a great deal worse under the burden of a label…

I have had it. I do not trust a drug company or a prescription at all, none of them. The foxes are in charge of the chickens and they are up to no good, no good at all. So this weekend I am OFF all Abilify. HURRAY! After that I start cutting out the Geodon…(I have already halved the Ritalin simultaneously with the decrease of Abilify. I had to, I simply don’t need the Ritalin as much, as I am not as sleepy. After Geodon, there is only the Topamax, which I take for seizures and migraines.. Have to decide about that one. I want to be off it, I really do. But can i?**

*Note that although some of these conclusions are my own, I drew most of the research I have based them on from my readings in Robert Whitaker’s fine books MAD IN AMERICA and ANATOMY OF AN EPIDEMIC. I highly recommend reading both of them, which can be accessed through the link I provide at the top of the page in my blogroll. The link goes directly to ANATOMY but MAD can be found easily through there. Good reading! And please do let me know what you think at any time. (Adding this note at a later time, very much the same information can be found in Dr Joanne Moncrieff’s books — a British psychiatrist who came to similar conclusions as Whitaker. Her book on antipsyhcotics is THE BITTEREST PILLS, and her book on psychtherapeutic drugs in general is THE MYTH OF THE CHEMICAL CURE.

**writing in Dec 2017 i have never been able to get off the Geodon or the Abilify, nor the other drugs, though i have cut the Geodon in half somewhat successfully. (I am unable to speak at present, but i do not believe the two are linked, as i dropped the Geodon/ziprasidone dose more than a month ago and the muteness started less than a week ago). That said, i still do not believe they help me. I just maintain that once you have been on these drugs for literally decades as i have been, more or less by force, then your brain changes in response and ends up “imbalanced” and in that sense alone does need the drugs.

Medication, Mental Health, Uncategorized

Use, Overuse and Abuse of Psychotropic Medication: the risks and the facts

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Please note about the post below that I already accept that some people will  object to all I say, even accuse me of encouraging people not to take their “meds.” I have not done any of that. Education is education, and if you or your loved one needs to be kept ignorant in order to obediently accept being medicated, please don’t read this or let them read it either, that’s my best and only advice.

 

If you want to know someone else’s arguments on the subject, read THE ANATOMY OF AN EPIDEMIC, by Robert Whittaker. I do not agree with everything he writes there, but it certainly was a springboard for my thinking.

 

So! This post deals with what I see as a gross failing in 21st century psychiatry, the over-prescription of psychotropic drugs. Sometimes driven by psychiatric practitioners who have neither the time nor interest or training to do “talk therapy” or even basic counseling, sometimes driven by the desires of consumers/patients themselves for a no-trouble, “quick fix” for their problems (not all of which are strictly speaking pathological), it is driven certainly by the demands of pharmaceutical companies for profit.

 

This last, Big Pharma’s requirement for increased profit, has led to massive advertising campaigns and the legal and not so legal encouragement of “off-label” uses, a band wagon upon which both practitioners and, I would add, eager consumers leap. It is not without consequence that both the drug companies and many if not most psychiatrists / prescribers would have consumers believe that psychotropic drugs “treat” illness, that is to say that the drugs target a specific neurotransmitter that has been conclusively shown to cause a given condition and to be measurably “out of balance” compared to levels in so-called normal persons.

 

THIS IS NOT THE TRUTH. I repeat: It is not true that psychotropic drugs treat illness, not the way antibiotics treat infectious diseases. An antipsychotic or antidepressant drug is NOT a silver bullet specifically targeted at a pathological culprit. These drugs are prescribed to alleviate symptoms, to alleviate, for instance, hallucinations or delusions, and maybe, sometimes, to elevate a person’s mood when pathologically depressed. They may be prescribed for other “reasons” as well, though to call a drug that is used by a doctor/patient for a presumed condition a “treatment” is not the equivalent of saying that the drug is either indicated or effective. It only says that someone has decided to use it as if its purpose were to treat a supposed condition.

 

What do I mean? Well, take, for instance, antibiotics. Most of us know by now that they are useful and indeed curative in many cases of bacterial infection. We also know that sometimes ABs are prescribed i.e. used, in cases of viral infections and illnesses. But antibiotics can neither treat nor alleviate conditions caused by viruses. So if a physician gives a person a prescription for penicillin in the case of a cold or flu, (and for whatever reason) he or she may be said to “use” the drug for such and such, yes, but it says nothing about whether the drug is useful or effective or necessary. Which of course in such cases it is not.

 

Ditto some prescriptions for APs and ADs. Ditto maybe ALL such prescriptions: yes, they can use APs and ADs as if they targeted a “mental illness” but just because one takes a pill “for something” does not mean or definitively indicate that the drug is useful, helpful or harmless.

I know, I know, many people who will object that such drugs have helped them function in life much better than before, when they were self-described (or otherwise) “basket cases.” I cannot take that away or even deny that a couple of APs seem to have helped me more than they harmed me. Although I now swallow the APs Abilify and Geodon together (I cannot take them separately without ill effect) taking one AP, Zyprexa, seemed to me to have near miraculous consequences in my life –I have detailed these elsewhere but “take my word for it” I felt like life’s lights had been switched on in my brain. At the same time, Zyprexa’s other effects were devastating: obesity, high cholesterol and triglycerides, pre-diabetic blood glucose levels yada yada yada. (By the way, why is one effect a “treatment” and the others “side effects” and therefore discountable? Aren’t all effects of drugs effects of the drugs?)

 

So I am not saying that the drugs do “no good” ever or at all. And I am emphatically not advising anyone to stop taking whatever they have been prescribed. For one thing, abruptly stopping medications, particularly psychotropic ones, can be a prescription for disaster. Not only could the physical consequences be unpleasant, but to suddenly stop a med only sets one up for what looks like “relapse.” If your body is used to taking a drug, and it is abruptly and completely withdrawn, doesn’t it make sense that you will feel untoward effects similar to those the drug is supposed to treat? I used to take Inderal for headache prevention and akathisia, but another effect of it was that it lowered my blood pressure and slowed my heart rate. In one hospital, for some unknown reason, they stopped giving me Inderal (propranolol)  — one day I was taking 40mg three times a day, and the next day I was taking, well, zilch.

 

Is it any wonder that within the next day or two, my “vitals”, though normal before I ever took the Inderal, rebounded way over normal limits, my heart racing painfully and my BP sky-high? Of course not. This was no proof that my heart-rate was pathologically rapid nor that I “had” high blood pressure. Of course, the doctor tried to tell me so, but in fact all it proved was that carelessly and rapidly stopping a beta blocker drug resulted — like a rubber ball dropped onto the pavement – in what was essentially withdrawal and temporary rebound.

 

So if you abruptly stop your meds because you think my argument here “holds water” you will be setting yourself up for two things: 1) apparent relapse of illness even if it is really just withdrawal or rebound symptoms, 2) possibly mistaken evidence that you need the drug. However, if you and your doctor decide that you might do okay without the medication, and you very, very slowly reduce it, then you have a much better chance of not inducing a relapse, and/or “proving” that the drug is essential to your mental health.

 

Note that whether a given medication really helps or not is up to you and your doc to ascertain. All I mean to say is this: do not drop any AP or AD without considering all the consequences of stopping it without a gradual taper.

 

Now I want to segue into some information from “reputable sources” so-called so you can see where I am coming from. Please continue below the following if you already know all this. I neither endorse it nor argue with it. I am just providing this official “information” – true or not so true — in order to further my argument below it.

 

For the purposes of the discussion, I deal only with antipsychotic drugs (APs) and antidepressants (ADs) of the SSRI, SNRI and tricyclic variety. I know there are other important medications used in psychiatric settings and treatment but for space and energy’s sake, I will limit this post to those two categories because for good or ill they are often prescribed together.

__________________________________________

 

Forgive me, NIMH, but I need to crib a short section from your website on the side effects of various psychotropic drugs http://www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml before I begin my discussion about them. Any emphasis (italics) or bracketed word/s are my own.

 

 

First NIMH (National Institute on Mental Health) has this to say about “anti-psychotic drugs”:

 

“Some people have side effects when they start taking these [antipsychotic] medications. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

  • Drowsiness
  • Dizziness when changing positions
  • Blurred vision
  • Rapid heartbeat
  • Sensitivity to the sun
  • Skin rashes
  • Menstrual problems for women.

 

“Atypical antipsychotic medications can cause major weight gain and changes in a person’s metabolism. This may increase a person’s risk of getting diabetes and high cholesterol.1 A person’s weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication.

 

“Typical antipsychotic medications can cause side effects related to physical movement, such as:

  • Rigidity
  • Persistent muscle spasms
  • Tremors
  • Restlessness.

 

“Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can’t control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication.

 

“Every year, an estimated 5 percent of people taking typical antipsychotics get TD.”

 

ANTIDEPRESSANTS

 

Antidepressants are common psychotropic drugs frequently prescribed. Here

is  a block of quotes from the NIMH site regarding the use and side effects of SSRIs, SNRIs, and tricyclics. MAOIs are also mentioned, though they are far less often prescribed than in the past.

 

“Depression is commonly treated with antidepressant medications. Antidepressants work to balance some of the natural chemicals in our brains.* [see discussion that follows] These chemicals are called neurotransmitters, and they affect our mood and emotional responses. Antidepressants work on neurotransmitters such as serotonin, norepinephrine, and dopamine.

“The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). These include:

  • Fluoxetine (Prozac)
  • Citalopram (Celexa)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Escitalopram (Lexapro).

“Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta). Another antidepressant that is commonly used is bupropion (Wellbutrin). Bupropion, which works on the neurotransmitter dopamine, is unique in that it does not fit into any specific drug type.

“SSRIs and SNRIs are popular because they do not cause as many side effects as older classes of antidepressants. Older antidepressant medications include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs). For some people, tricyclics, tetracyclics, or MAOIs may be the best medications.

What are the side effects?

“Antidepressants may cause mild side effects that usually do not last long. Any unusual reactions or side effects should be reported to a doctor immediately.

“The most common side effects associated with SSRIs and SNRIs include:

  • Headache, which usually goes away within a few days.
  • Nausea (feeling sick to your stomach), which usually goes away within a few days.
  • Sleeplessness or drowsiness, which may happen during the first few weeks but then goes away. Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects.
  • Agitation (feeling jittery).
  • Sexual problems, which can affect both men and women and may include reduced sex drive, and problems having and enjoying sex. [Note that this side effect is NOT listed as temporary, as indeed it is not, and this is extremely important to understand…]

“Tricyclic antidepressants can cause side effects, including:

  • Dry mouth.
  • Constipation.
  • Bladder problems. It may be hard to empty the bladder, or the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be more affected.
  • Sexual problems, which can affect both men and women and may include reduced sex drive, and problems having and enjoying sex.
  • Blurred vision, which usually goes away quickly.
  • Drowsiness. Usually, antidepressants that make you drowsy are taken at bedtime.

“People taking MAOIs need to be careful about the foods they eat and the medicines they take. Foods and medicines that contain high levels of a chemical called tyramine are dangerous for people taking MAOIs. Tyramine is found in some cheeses, wines, and pickles. The chemical is also in some medications, including decongestants and over-the-counter cold medicine.

“Mixing MAOIs and tyramine can cause a sharp increase in blood pressure, which can lead to stroke. People taking MAOIs should ask their doctors for a complete list of foods, medicines, and other substances to avoid. An MAOI skin patch has recently been developed and may help reduce some of these risks. A doctor can help a person figure out if a patch or a pill will work for him or her.”

___________________________

First of all, do ADs treat a chemical imbalance? Is that statement even true, or just a fiction made up to “prove” that ADs work? If true, what does a “normal” balance consists of? Does anyone know how to measure the levels of these neurotransmitters, and if so, please let me know — give me numbers — where and what the “imbalance” ADs are correcting is.]

 

So all right, thems the “facts.”. Note that I say nothing about efficacy in what follows; I speak only of the side effects. But what about these so-called side effects? It seems to me to be hardly inconsequential when an AD, taken to improve the quality of one’s life and increase ones ability to feel pleasure, which is often absent in depression, simultaneously blurs ones vision (so you cannot read), causes weight gain (as tricyclics tend to do) and has sexual side effects that include reduced sex drive, and problems having and enjoying sex. For many people, maybe even most people, sex is one of the greater pleasures in life, at least sometimes. It certainly promotes better intimate relationships for most people and lets face it, people like it. So what is one to think of a drug that “treats” depression by inducing reduced sex drive, and problems having and enjoying sex. Is the reduction of pleasure in sex without importance? Or is the doctor saying, well, you can give up sex and sexual pleasure, what does it matter?

 

The thing is, reducing any pleasure, especially in a person who has trouble feeling pleasure at all, is not, in my considered opinion good treatment. Who has the right to tell a patient that if she or he takes an AD that they will have include reduced sex drive, and problems having and enjoying sex but that this isn’t important in the general picture. Of course it is important. Think of all the men who are devastated by “simple” impotence. To clinically induce impotence or the female equivalent, to clinically, biochemically reduce the ability to enjoy sex or to enjoy pretty much anything, is not just bad treatment it seems to me nearly criminal. How many people who have taken ADs and found themselves experiencing reduced sex drive, and problems having and enjoying sex actually got better? Well, okay, if perhaps you are not told and so do not understand that the drug itself causes this effect you might just say, “Ah well, I dunno why but sex is not important, I don’t really give a damn about it anymore..”. In short, you might “forget” — having no sex drive tends to do this — that sex was pleasurable and attribute it to your natural state. But in that sense you simply are denying that what you “don’t know” or feel any longer was ever important or a source of pleasure because you do not feel it now. Instead, you might accept that it is and always was a trivial concern.

 

But no one has told the millions of users of ADs that while they might feel some increase in pleasure elsewhere in their lives, their intimate lives will be fraught with reduced sex drive, and problems having and enjoying sex. How many people now feel utterly depressed because of their unexplainable reduced sex drive, and problems having and enjoying sex? Do they even understand that is is not “they themselves” not some inner deficiency, but a side effect of the drug that is/was supposed to make them “feel better.” If I were more paranoid than I am at the moment, I would say it sounds like some sort of ugly conspiracy by doctors and drug companies to avoid even informing patients of these serious consequences lest they refuse the drugs in the first place…So I ask you, how many of you, or how many people in general, would voluntarily, not to mention eagerly take a pill the effects of which include reduced sex drive, and problems having and enjoying sex?

 

 

Argh, it is getting very late and this has been a long treatise, impassioned in a curious way for someone who has never, drugged or undrugged, cared about sex…I so wanted to get to the APs and the dangers of adding them willy nilly to an AD “cocktail.” If reduced sex drive weren’t bad enough, is anyone telling these people who are being prescribed an AP either off-label or unnecessarily that it will almost certainly cause some weight gain, with all the usual concomitant consequences, and may even induce diabetes? Is anyone telling them about how it feels to suffer from akathisia, a very common effect of APs?  Drug companies may discount it as mere “restlessness” but akathisia does not mean that you simply want to take a walk every afternoon…it is completely agonizing, those of us who have experienced it will with alacrity tell you. No one simply accepts akathisia – restlessness, hah! – and ignoresit. You cannot ignore it and it is devastating to all feelings of pleasure and all sources of enjoyment, should you, after losing your sex drive, have any left.

 

But as I wrote above, it is getting too late at night for me to write more, and perhaps I have said enough. You might accuse me of having “done enough damage” too, I dunno. But I believe these things and I think they need to be said, whether or not anyone takes them seriously.