March 21, 2006Rethinking Psych Meds--Schizophrenia, Bipolar Disorder And MeToday's New York Times has an article on a few renegades in the psych profession who are challenging conventional wisdom about how to treat schizophrenia. It is an important article and you should all read it. As you know, the conventional wisdom holds that the illness must be treated with antipsychotics at the first onset of psychosis--and that it must be treated very aggressively almost without any regard to the age of the patient. There are no options to this approach, schizophrenics are told. I am not an expert on schizophrenia, but I have always felt that this advice is far too broad. In my professional and personal life, I have encountered a fair number of schizophrenics who don't respond well to antipsychotics. They continue to experiences hallucinations, delusions and crippling paranoia. This is true even if they are on extremely high doses of antipsychotics. What's more, the meds beat the hell out of their bodies, their cognition and, in my opinion, their souls. Their lives and their suffering are staggering. Ever time, I walk into a state hospital, for example, it is difficult to look into the faces of patients who have taken large doses of antipsychotics for many years. There is very little there there. I once drove away from Western State Hospital in tears after touring its wards. I wouldn't want to guess at what percentage of schizophrenics don't respond to treatment--and whether the driver is that, for them, the meds don't work or that they are that profoundly ill. But I'd say the percentage is fairly high. Think I am joking? Take a look at how many people are housed in state hospitals, residential treatment programs and transitional housing (the latter two have essentially become quasi-state hospitals), as well as the homeless (about 50 percent of them are estimated to suffer from some form of mental illness). These are all people for whom their illness has proven so disabling that even with treatment, they are unable to live typical workaday lives. Or for whom the standard treatments just don't work fully enough. Most of these people would either be schizophrenic, bipolar or have extreme depression. We are talking several million people here. In the State of Washington, there are about 100,000 people who are in the various levels of the public mental health system or are homeless. I have done a lot of reporting on these people the last few years and have interviewed many dozens of them and observed even more at close range. I'd have to say that well over half of them have an unsatisfactory response to standard treatments. I don't think it's wild to expect that we are talking about several million Americans for whom there is no thorough effective treatment within the current mental health paradigm. The reason for all my gibbering and half-assertions is that the Times article floats the question of whether meds are always necessary when treating schizophrenia. The article was inspired by a forthcoming paper in Schizophrenia Bulletin. I want to congratulate the Times for poking into the matter, especially since I have long been a critic of the paper's coverage of mental health. I want to be very careful with asserting just how many schizophrenics could do just fine without meds, but the article puts the number at between 10 percent to 40 percent. At 40 percent that would work out to 1.2 million American schizophrenics who might do well without medication. I'm sure that there are some in the psych and pharma and policymaking worlds who would prefer that such news didn't get out. To be clear, I am not saying that all the folks with mental illnesses, especially schizophrenia, whom I've encountered would do well without meds. I am simply saying it's hard to make the case that meds work well for them--and that's always made me wonder what their deal would be like without meds. It's made me wonder about my own situation as well. So how would these people get their illness treated? Beats the hell out of me. But it's obvious that something about the current paradigm isn't working well. And that does make people like me begin to wonder about what the hell else can be done to address mental illnesses. You just want to rethink the whole psychopharmacological revolution when you see millions of Americans not getting relief even if they are playing by the rules. There is, of course, some division within the psych business on whether every schizophrenic must take antipsychotics at all times and forever. Most docs would say all-meds-all-the-time. But there are enough who'd say No that there has long been a quiet debate within the psych world about the meds question. Of course, it's been a quiet debate because the media has done a poor job of paying attention to sources in the psych world beyond the prototypical researcher saying Med X works darn well for treating schizophrenia or bipolar disorder and, as a result, the dissenters within the psych field have largely gone ignored. To be fair, even the dissenters will generally say that meds are highly useful in crises. The sticky problem is the long-term. Regular readers know my thoughts on the sticky part. Certainly, the sheer numbers of patients in the real world who keep having problems lends credibility to last year's landmark CATIE study. It showed that atypicals perform like shit in patients. The STEP-BD study is also showing plenty of problems on the bipolar disorder front, although that study's data on atypicals will be thinner than CATIE's, owing to differences in study design. For the three-four-five-six-whatever million Americans with bipolar disorder this question is as important as it is for schizophrenics. That's because we are now being encouraged/asked/forced to take the same meds as schizophrenics. These are atypical antipsychotics. In some cases, bipolars take them at the same dosages as schizophrenics do. They have the same effects on our bodies and minds and souls. So it is important the same questions that the Times article floats about schizophrenia get asked about treating bipolar disorder. These questions need to be asked about the anti-depressants many of us take as well, since their side effects are problematic, albeit milder. Legitimately, you can ask these same kinds of questions about ADHD drugs and mood stabilizers as well. I've been asking these questions in print, in small and in large, for about two years. At times, I have been attacked for writing articles like this. I've been asking them on this blog since last September. I've been asking them in my own life on-and-off for almost 17 years, although most acutely over the last three years. Here's where I am at: Next month, I will discuss with my doctor, whom I trust and who actually gets me, the possibility of my going off meds altogether. Right now, I am only taking Lamictal. Since, phasing atypicals out of my life last summer, I have done much better than I thought I would, excepting a tough patch here and there (but I was having those tough patches with meds!). Logic demands that I consider how far to push this. But I will be careful and judicious in my decision--but it is my decision after all. Experience reminds me, though, that the one time I went off-meds in all those years I didn't have a great experience. So we shall see. But I am rethinking all of this. I hope to god I come up with an answer someday. Posted by Philip Dawdy at March 21, 2006 12:14 AM
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best of luck. Its a hard decision. Very interesting article. I really respect my psychiatrist, but him trying to shove risperdal down my throat is very strange.. to which i refuse every month. My daughter was discharged from Western the 20th. The faces I saw there, the people and souls behind them will never leave me. I love them, it was a joyous, yet equally frightening occasion leaving with my daughter. Waving goodbye to the ones that followed us to the door, I want to know how they are doing, I loved visiting with them, and hope to explain and let all know, how many people long for visitors and love at Western. There are dangers there also, and for that I am concerned for them as well. It is hard to get well and maintain a safety boundary at the same time, actually it is impossible. I driven away sobbing for the patients. Posted by: Stephany at March 21, 2006 02:32 AMI sure as hell am NEVER going to Western!!! And futhermore, I HATE schiozphrenia, I HATE medication, I HATE doctors, I HATE everything about mental illness!!! I HATE it all!!! And do you know what -- I'm going to UW Honors next year, where I'll be rid of mental illness!!! I'll never have to face it again!!! I'm going to be surrounded by brilliant, scholarly people, and I'm going to have the best time of my life, and I'll NEVER have have schizophrenia shoved down my throat ever again!!! I'm passed it all!!! Good bye, and good ridence!!! Posted by: Gwen at March 21, 2006 08:40 AMyes, it is your decision to go off meds. i think we all ask these questions. this june will be my 20 year anniversary, my long affair with meds and therapy. over the last 20 years there has not been one day that i haven't questioned taking my meds because I have never felt a peace, a middle ground. and there have been days I chose to go off meds. moments i decided i was tired of spending the money on something that didn't work. those days led to weeks and months. more creativity. feeling high and thinking, wow, I can see clearly now, without the meds. no more days of sleeping 14 hours. depression lifted. and then, drinking most nights until i passed out or waking up in a strange city, without a car, no idea how i got there. excessive sex. excessive shopping which led to debt i will never recover from. loss of friends due to my actions. jail. Usually around the 3 month period, med-free, I would breakdown. I once found myself in a parking lot hysterical, pushing, fighting, screaming at those who tried to calm me. Or the time I checked into a hospital and i saw and experienced what over medicating does to ones body, mind and soul. but it was my last hope. I was desperate. i was alone. everyone had given up on me. they were tired of me. i was tired of me. but i never gave up. and so many people do give up at that point. That crucial point when you are left to pick up the pieces once again. they decide they are tired of picking up the pieces. they are tired of life. they are tired of the pain they continue to inflict upon others. it is a scary place to be. and each time it gets scarier. after each high, the low is even lower. you ask the question how would one be treated without meds and that is a very important question. or when will we see meds that actually work. until that day, i think we should go with option B the article mentions, "far less than is typically prescribed," because i do not think my experiences med-free are unique. we are definitely over medicating. esp with the atypical antipsychotics. they are not working. we must remember we are not in control here, the pharma companies are in control and they are laughing all the way to the bank. and we are letting them. I had a schizophrenic break approximately four years ago. Because I didn't know that's what it was called in this culture I didn't seek medical care; because I didn't seek medical care, I didn't end up on anti-psychotics. Instead, I went into the pyschosis and fully engaged the emerging content. To date, I have not received any form of therapeutic medication nor any formal therapy. I have been working for the past 2.5 years, I've attended classes in college, and my primary relationships are stable and healthy. Recently, another schizophrenic I know made the choice to attempt to do the same thing I had done when he sensed he was on the verge of "a break". A fascinating inner journey arose as a result that he feels was very beneficial. He was not on any medication through that process, nor has he been on any since. You are doing the right thing. The capitalistic doctors in this country are pure evil, have nothing but contempt for people with bipolar and other things, and on my soul, I have had several top doctors as my close friends. (including valedvictorians from top schools, on my mothers soul)
Patients are CLUELESS what these "helpful" doctors really think of them. they are "consumers" "objects" and dog guinea pigs to them. They look down on them and treat them in a private moment (which Ive heard and you havent) like they are some low life form to be humilated. People are so utterly clueless of what most doctors are like. We were NEVER meant to have that sewage in our systems in the first place. you hear all these people talk about the Garden of Eden and God, and all their crap, yet they forget that NOONE was meant to have that poison in their body in the first place. I never took meds for 32 yrs and had no problems except when my family starting getting terribly harassed. (this was documented) Like a fool, I allowed myself to be conned into taking the useles s Depakote which is nothing more than posion that depresses you, and on my eyesight does NOT work, and Lithium Carbonate, which I read so much toxic garbage on, I threw it in the trash can. None of that stuff helps. These Mom's that would EVER let their children be conned into drug cocktails by filthy, deviant doctors that claim and think they know something, when they know NOTHING, are fools, and deserve massive bad Karma for what they are doing to their kids.
The doctors in this country are ignorants full of greed, needles, and drugs, not like REAL doctors who listen, know the patient is his own best doctor, and the type that love, care, and communicate with their patients. (the type you see in rural countries)
They should be used for intervention, not maintenance.
What is life if poisoned with that crap. That is life? YOU can have that life. Enjoy yourself. There is no reason to be alive, if you arent going to live as intended.
She died and i betrayed her memory by doing something for 10 yrs that never worked , but only betrayed me and destroyed me. In the end, either you face it, walk it, figure it out, or die. Life wasnt meant to be living on that FILTH and any person that says it was deserves everything they get and I have no sympathy for them. And belive me, I know what sufferring is, and Ive handled my share of suicides, both when an RA in college, and otherwise. Long term medication and the doctors that populate this country are both EVIL and I dont use that word lightly. Ive hung around LOADS of those guys and gals and even got to the point of tape recording them and replaying it for other people to prove what was said about "them" behind closed doors, with people that they THOUGHT shared their prejudices. (and we are talking groups of 60-70 doctors---I know tons of them personally, and several of my closest friends were doctors, so help me. Do as your life was meant to be. To help things out, use mindfulness tapes, meditation not lonked to crap but beautiful good meditation, healing music, soaking in natural waters, eating a Organic Vegan balanced diet, EXERCISING like there is no tommorrow, getting outside in the SUN EVERY SINGLE DAY OF YOUR LIFE, and things like that. Play the healing music in your car, at work, and in your bedroom. Everywhere. It works so help me God. Try mindfulness. It works and has been used for 2500 yrs and even some doctors are starting to get a clue on it. One drink wont kill you (I dont drink), and its far better than that FILTH they intimidate you into taking.
Once you realize you have two choices, live the eay you were meant, or die---that is when you finally get the message that this is going to be tough, but you need to choose the right path. DO THOSE THINGS EVERY DAY above and it does work. Procrasitnation KILLS and complacency kills. If you get away from the above things that can save you, it can literally kill you, if you have bad thoughts. Even soaking in the tub with Chlorine filtered water helps relax people, as does Yoga and massage. THERE ARE ANSWERS. It just takes non-lazy people and non-lazy parents to find them and make sure they do it every God damn day! |
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