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More caution should be used before prescribing psychiatric medication

Published on 2015-03-25 by in Personal Stories

drug-621843_640By guest author Andy Alt, mental health consumer, blogger

Andy’s blog is http://mentaldimensions.net/

I’m somewhat concerned about treatment options available for mental illness. I’m of the opinion that psychotropic drugs are over-prescribed. I believe their efficacy is overstated, and the risks understated.

It’s especially challenging to track and record the cases in which medications have done more harm than good. For instance, on NAMI’s website, under Medications ->Paxil -> common side effects:

Feeling nervous, restless, fatigued, sleepy or having trouble sleeping (insomnia)

Those symptoms can cause depression, or are symptoms of depression. I believe that doctors who are qualified to prescribe SSRI or SNRI class medications do not have the tools necessary to, in many cases, make a clear, science-based distinction between cause and effect. This isn’t their fault of course. The technology, medical or otherwise, simply isn’t available. This isn’t true for all situations–if a doctor does a thorough job of documenting case history and listens carefully, there can be obvious signals that help define and distinguish how a medication might be negatively or positively impacting an individual.

From NAMI’s web site, under Medications -> Paxil -> serious side effects:

Serotonin syndrome (symptoms may include shivering, diarrhea, confusion, severe muscle tightness, fever, seizures, and death), seizure

If death is included as a side effect, how do the risks outweigh the benefits? Would there be sufficient warning signs before that happened? One big problem, for both patients and their doctors, is that many people who suffer from mental illness don’t have a good support system, and the suggestion that people who start on any new medication should be monitored closely is a very unrealistic expectation.

Again, from NAMI’s web site, under Medications -> Paxil -> summary of black box warning:

Suicidal Thoughts or Actions in Children and Adults

– Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.

– Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications. This risk may persist until significant remission occurs.

– In short-term studies, antidepressants increased the risk of suicidality in children, adolescents, and young adults when compared to placebo. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. Adults age 65 and older taking antidepressants have a decreased risk of suicidality.

– Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or healthcare professional.

– All patients being treated with antidepressants for any indication should watch for and notify their healthcare provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.

Now this goes back to my previous point about the challenge of tracking and recording the number of people harmed. If someone who is being treated for severe depression and suicidal thoughts starts a medication and it causes him to die by suicide, will there ever be an investigation to determine how much the medication played a role? Is it even possible to make that determination through available scientific means?

There are many sites and blogs operated by people who chronicle both positive and negative experiences they’ve had with treatment involving medication. However, it seems that anecdotal “evidence” is often dismissed—but if doctors aren’t required to document every relevant piece of data, and if data isn’t submitted to a “centralized-database” where it can be comprehensively analyzed, then it becomes very easy to dismiss the anecdotal evidence and say there’s no scientific evidence.

I first sought treatment when I was about 20 years old (circa 1992). I first had thoughts of suicide three years after my father died by suicide when I was 11. At the time when I went to get treatment, it was because my employer suggested it, and I wasn’t against the idea. I’d been having problems getting to work on time. I was doing a great job while I was at work, but my attendance was suffering. I was giving a 566 question test, and after two sessions with a psychiatrist and two with a psychologist, I was diagnosed with depression and anxiety, and was prescribed Prozac, Stelazine, and Cogentin. (The treatment methods I’ve used and medications I’ve been on since then are beyond the scope of this article.

Prior to that, I’d never attempted suicide. I really believe I could have benefited from CBT, DBT, and mindfulness meditation as a first-line defense. I wasn’t in any immediate danger, I had no history of attempted suicide, I was working full-time, owned a car, went grocery shopping, etc. I was struggling though, no doubt about that. There was some devastating experiences and instability in my childhood, and I had never learned stress management skills as a child. Today, are coping skills and stress management tools even taught to children as a matter of routine? I believe that in many cases, psychotherapeutic methods should be a priority over pharmacological tools. I’ll outline some of the reasoning behind by beliefs:

    1. Discontinuation syndrome and physical dependence
    2. It’s unrealistic to expect someone with increased depression, suicidal ideation, anxiety, paranoia, etc. to call their health care professional to report it
    3. Because it can take several weeks for the effects of a drug to build up in one’s system, it takes time for it to clear out if a doctor decides that a different course of action is needed and the patient should stop taking the medication. That can create a particularly nasty situation if a person is having a severe adverse event or reaction from a medication.
    4. The medication “cocktail.” Again, it takes time for a drug to clear out of one’s system, and it’s virtually impossible to accurately determine the degree a drug may be negatively impacting an individual. To start combining drugs and changing doses when traces of others are still in one’s system; added to other variables that could be affecting or aggravating someone’s mental illness (i.e., external stressors, major changes in life events, mood swings that are typical in that individual); added to the possible side effects of medication… I don’t mean to imply that finding the “right” combination of drugs is impossible. It has been achieved for some people. However, what a person has to go through during that time may very well prove to be unnecessary if priority is given to non-pharmacological tools.

I understand that doctors base their treatment plans on the available information (from drug studies, journals, etc.) at the time, so I don’t always “blame” the doctors, but quick-scripting and expecting patients to be cooperative while their bodies are being inundated with potentially harmful chemicals is still a matter of routine practice, as far as I can tell from what I read and people I speak with.

I did have my first suicide attempt within two years after I started treatment. Of course, I can’t say whether or not it would have happened if I’d never been on an SSRI. I only know I felt better prior to getting treatment. There were a lot of variables at the time, so honestly I can only speculate about my personal experience.

The NAMI site does have a mindfulness page, which I think is great. But near the top:

While the combination of therapy and medication is crucial to recovery, the addition of self-awareness tools and skills can also be beneficial. Whether you are just beginning your recovery or are further along on your journey, the holistic practices discussed on this page can be an excellent compliment to therapy and medication.

Medication is crucial to recovery? Isn’t that statement a bit general? People get depressed and stressed and anxious and those are natural human reactions, but often these days it seems that if one has those “symptoms” one is quickly diagnosed with having a mental illness.

I’ll concede that some people don’t deal with those problems as well as others. But I also think many people never learned coping skills and stress management as well as others, and therefore are more “susceptible” to not being able to deal with problems as efficiently as others. But people are able to learn those tools, though it may be harder if one didn’t learn them during their formative years or their adolescence, the risks of learning outweigh the benefits.

My father died by suicide in 1981. He had no history of suicide attempts. Shortly before he shot himself, he saw a doctor because he was had some pretty bad insomnia. Some extra life stressors were going on at the time. He was prescribed Restoril(temazepam), a benzodiazepine.

From a Wikipedia page about benzos:

[…] Depression and disinhibition may emerge. […]

Paradoxical reactions, such as increased seizures in epileptics, aggression, violence, impulsivity, irritability and suicidal behavior sometimes occur. […]

Again, no proof can ever be obtained if the medication caused negative side effects, and I’m likely to be labeled as a Scientologist because I have bad things to say about medication. That’s one sweet deal for billion-dollar corporations. I’m glad I never thought of it. I’m curious though, are there any medications that were proved to be safe, only to be recalled later, after people have died or suffered permanent physical damage?

This article is on the LaTimes website (New test suggests antidepressant Paxil may promote breast cancer, Feb. 18, 2014 By Melissa Healy)

[…] In a trial screening of 446 drugs in wide circulation, the new assay singled out the popular antidepressant paroxetine (better known by its commercial name, Paxil) as having a weak estrogenic effect that could promote the development and growth of breast tumors in women.

This is important because as many as a quarter of women being treated for breast cancer suffer from depression — a condition most commonly treated with antidepressants known as SSRIs (selective serotonin reuptake inhibitors), including Paxil, which has been on the market since 1992. Almost a quarter of American women in their 40s and 50s are taking an antidepressant, mostly SSRIs. […]

As an example, I’ve primarily used Paxil (a.k.a. Paroxetine or Seroxat) in this article, but many SSRI and SNRI share common side effects, serious or otherwise. I have no information or opinion that suggests Paxil is “the worst one.”

Does anyone have an opinion they’d like to share, address any points I’ve made, or help fill in any gaps I failed to cover? After all, where there is one Traci Johnson, there’s likely another—anecdotally speaking of course—and it would be great to have this issue resolved in a timely manner.

The article was reposted with the author’s permission. The original source https://www.linkedin.com/pulse/more-caution-should-taken-before-prescribing-psychiatric-andy-alt

 

 

 
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