Before antidepressants.
After 1 year on antidepressants.
This is a response to a post on the Hopeworks Community blog.I’m sharing it here because it rebuts arguments one commonly hears in favor of antidpressant medication.
Dear Hopeworks Community,
Personally, I believe you overstate the value of medications, especially in bipolar II/depression. (They are indeed quite effective against manic escalation. It is not impossible for someone with Bipolar I to go without meds, but it is difficult and takes discipline.) However, the efficacy of antidepressants is regularly exaggerated by psychiatrists and pharmaceutical representatives. Are you aware of a single long term placebo-controlled study that demonstrates sustained benefit of any antidepressant over time frames longer than a few months? I’m not. Approval trials typically last six weeks. And even in that short time period, usually not much more than half the population benefits (compared to 30% that respond just to placebo). Yes, when people first start antidepressants, they often feel better. But if they are someone with longterm problems with low moods, and many recurrences, (which is the story for most bipolar II patients) when you look a year later they are usually back to fighting depression. Only now they are stuck on medication that causes even worse moods and other symptoms if they try to halt drug treatment. Realistically, don’t you notice that mental health clinics are filled with clients in awful depression who also happen to be taking 3 or 4 or 5 medications? If pharmaceutical therapy works so well, why are there so many people like this? For acute depressions, especially prolonged situational depression, psychoactive agents can really help. They may also give those with more chronic problems a bit of relief while they learn better ways of dealing with their moods. But as a sustained strategy: medication just does not work. If long term antidepressants were often effective, I would be in favor of them; I am not reflexively anti-medication. But they are not.
The psychiatrist who claims he has “seen a few BP2 people who do not have deep depression make it [without medications], but they are the rare exception” is a psychiatrist who loses his patients after they realize they can find ways to deal with recurrent depression and hypomania without drugs. The only ones he sees are those who come back asking to be restarted on pharmaceuticals. Not only that, but once established on long-term drug treatment, it is all-too-true that patients find it exceedingly difficult to stop. But to say that bipolar II patients can’t come off drugs is very different from saying they are better off than if they had never been established on longterm treatment in the first place. And how hard does he work to very slowly taper his patients while providing behavioral means to manage their moods? A close family member required a 2-year taper off prozac, and she was just on the one drug. Imagine how much patience it would take for a psychiatrist to help patients get off 4 or 5 medications. Does he work that hard to achieve something he obviously does not believe in?
Therapy and counseling are indeed helpful. Not always those based on opening up (though for clients coming from traumatic backgrounds, as many with bipolar II diagnoses have, it may be vital), but especially those that provide behavioral advice (including promoting exercise) and cognitive training, along with something like meditation or spiritual support. And peer interaction can be lifesaving. But meds? They are not a rock opposing a hard place. They are just an ineffective pebble (with crushing, boulder-like side effects and dependence potential) opposing a condition that can often be ameliorated without longterm drugs. Unfortunately, those who have difficulty succeeding with behavioral/cognitive changes are unlikely to be helped by ongoing medications. Instead, they will just have drug dependence, with attendant adverse effects, added to their list of woes.
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Larry Drain at http://hopeworkscommunity.wordpress.com
I think I probably said things poorly. I know of no evidence that says that antidepressants work well with bipolar anything. My wife has bipolar and was diagnosed as major depression. Two years of antidepressants left her in a living hell. Most people I know with serious depressive issues are the victim of a system that values pills above people and in my experience are rarely taught the kinds of things that you mention. As chemicals become more and more important less and less money goes to other services and that is a travesty.
The psychiatrist that I talked about does believe in meds. The tapering you talk about is part of his standard operating procedure. He typically has no one on 3 or 4 drugs. He recognizes the fallacy of giving drugs for drugs. He thinks the solution should not be worse than the problem.
Most of the people I know with bipolar believe that they can not make it without meds. They all back this up with tales of when they tryed to stop and the chaos that ensued. They have all had the experience of drugs that dont work and believe they know when meds are helping.
A large group of people that i know refuse to be part of the mental health system because they dont believe it works. They may think the meds work, but they hate the side effects. They think that therapy is useless. I talk about this in my last post.
I am not sure, but I think is substantial ways we agree. I am glad that you took the time to reply.
Ps- Thanks for introducing me to your site. I like it alot
Posted at August 3, 2009 on 11:54am.
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Will at http://willspirit.com
You are right. We mostly (maybe entirely) agree. You seem to be saying, as I tried to, that just because people can’t stop drugs once on them does not mean the drugs have actually helped.
I was on multiple medications for nearly ten years, terribly depressed the whole time, before I started to get better. It was not a new drug that made the difference. It was improving my lifestyle, challenging my negative thinking, meditating, and learning to accept. Unfortunately, I am now having a really hard time getting off the many pills I take. If I go too fast, all joy drains from my life, I get seriously suicidal, and I feel physically awful. So I keep swallowing the pharmaceuticals, chipping away at my chemical burden as much as I can without risking killing myself in withdrawal-induced despair.
I am convinced that if I had never started a single antidepressant, I would be exactly where I am today: pretty satisfied and stable. But I would not be dependent on chemicals that have caused a slew of adverse reactions, some horrible and permanent.
I do not claim objectivity. But I am well educated in the field (since I am a former surgeon and have devoted a lot of time to learning this stuff). My last few posts have covered this material exactly, so it was rather fortuitous to come across your discussion. The more the truth about medication treatment gets disseminated, the better.
Thank you for the valuable conversation.
Posted at August 3, 2009 on 12:17pm.
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San at http://alifewithaview.blogspot.com
Will, thank you much for visiting my blog and leaving such a thoughtful comment. That means a lot to me.
This post is wise. It’s gotten to the point that when people suffer gut-wrenching setbacks–loss of loved ones (through death or rejection), abuse, financial disaster, physical illness or injury–they believe that when they feel sad about the mess, they’re “depressed” and need a drug to convince them otherwise. You’re right. Life is full of pitfalls and causes for misery. This shallow notion that one “creates one’s reality” contributes to it. There’s much to grieve in this life. There’s strife. So, as you so wisely acknowledged, what we need to be concerned with is our inability to enjoy life despite our many reasons to feel unhappy.
There’s redemption in small pleasures–a grocery store clerk who’s having a good day can make mine much better. As can a perfectly brewed cup of coffee. The way the morning light enters the window and makes an unexpected rainbow. When we can’t enjoy these things, yes, we need to be more open to the good in life.
Posted at August 5, 2009 on 11:37am.