WillSpirit

Where Will meets Spirit
∞ A Blog Devoted to Balance, Peace, and Clarity ∞

A formerly depressed physician tells stories of trauma, grief and recovery, and offers suggestions for emerging from darkness, living with mood swings, and awakening to life.








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    • Dear Visitors:
      Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.

    • ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.




The Middle Way

Several recent interactions have pointed out to me that I am way too sensitive. A good friend and I passed emails back and forth, each of us angry about the behavior of the other, and all of it traceable to overreaction on both our parts. Then there was the confusion around my new blog at PsychCentral. I applied for the chance to write for them, and when after a week they had not yet responded, I assumed (incorrectly) that they’d turned me down. Not only that, but I took it personally. There have been some other emotional missteps, but I’ll concentrate on these two.

In both cases, my emotional reactions were too strong and too swift. In both situations, I’d have been better off slowing down, asking for clarification, and maintaining a thicker skin. With my friend, I ended up hurting his feelings and stirring up needless stress. With the blog, I indulged in some online whining and almost abandoned blogging altogether. In each case if I had asked for information, and waited for things to work themselves out, considerable inner and outer turmoil would have been avoided.

There’s a hidden ingredient here. Several months ago I quit my final psychiatric medication. In the bad old days with the psychiatrist who treated my moods between 2000 and 2006, I was overmedicated. At several points I was taking six different medications for my mental health. The side effects were dreadful and humiliating, and my depression hardly improved at all. The only benefit was a generalized emotional numbing. I was free of intense anguish, because I had no strong feelings at all. This seemed like a good idea at first, but I soon recognized that life was passing by while I lingered in a medicated haze. My wife hated the zombie-like affect I presented, and it was impossible to accomplish anything under such sedation.

Since 2006, I’ve been tapering off the medications. I feel more sadness, but also more happiness. I can laugh and cry and think once again. My former passion and creativity have been restored. Unfortunately, many of the damaging side effects appear to be permanent, so I will always be scarred by my foray into the world of psychopharmacology. But if I don’t dwell on the injuries, I feel pretty contented. Or at least I do today. Coming off the drugs has been very good for me, although I am by no means suggesting it would be right for everyone.

And in fact it wasn’t completely right for me. One of the reasons I became so hypersensitive was that, like I said, I had quit the final antidepressant back in March. It had been challenging reducing the medications at every step, but when I discontinued the final drug, I slowly spiraled into a very unpleasant space. To my great relief, I did not contemplate suicide. However, joy and interest drained from my psyche. I continued all my normal activities, but I enjoyed few of them. Worse, I began to overreact to perceived rejections.

Since I restarted that final drug, things have gotten dramatically better. The lesson, I suppose, is that extreme positions are always suspect. I had decided that since six drugs were disastrous, the answer was to take none at all. That turns out to have been too drastic. It looks like I am better off taking a modest dose of one antidepressant, rather than trying to live with no psychiatric medication at all.

It’s been an enlightening experience. My anger at the psychiatrist who treated me so aggressively, and the side effects that resulted, had pushed me to decide that everything about psychiatric medications, at least in mood conditions, is suspect. Now, I’m not so sure. Although I wonder if the antidepressant would be as necessary if my system had never been exposed to any such drugs, the fact is that life is much easier on one medication than it was on none. It’s a good reminder to watch myself, and question my motives at every step. It is very easy to get swept away by strong emotions. As much as I believe feelings are necessary to live fully and happily, it is also the case that when they get too intense they cloud judgment.

It is also vital to keep an eye on what works. If a single antidepressant can make such a big difference, and if it also happens to be one of the few medications that causes me no side effects, why not take it? Is philosophical purity more important than pragmatically doing something to make life more livable? One of the biggest problems in the world today is the very human tendency to get locked into behaviors and attitudes that are rigid and extreme. Inflexible and dogmatic attitudes are damaging. This is as true in an individual life as it is in the case of religious fanaticism and political extremism. As the Buddha said, it’s best to follow the middle way. In most circumstances, the middle position is the most accurate and the most effective.

Patience. Moderation. Trust. Communication. Flexibility. Pragmatism. You’d think by this age I would have mastered these basics. Better late than never…

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The Middle Way was published on August 13th, 2010, with these tags: , , . To date, this entry has received 2 comments.






Atypical Antipsychotics

The so-called atypical antipsychotics are the pharmaceutical industry’s new SSRIs. In the 1990′s the Selective Serotonin Reuptake Inhibitors came on the scene like an explosion. The hype was enough to convince almost anyone with depression to give the drugs a try. Prozac looked like the answer to all sadness: just take the pill and feel better. No need for therapy. No need to work on your attitude or lifestyle. No need to increase your tolerance for adverse moods. Just pop a pill and go on with your life.

Years later, we now know that the SSRIs do not exceed the older drugs in effectiveness. Compared with ‘tricyclics’ (the older antidepressants), drugs like Prozac have different side effects, but not fewer. Perhaps the only real advantage of SSRIs in treating depression is that they don’t kill you if you take too many. Tricyclics are notoriously lethal in overdose.

So the dust has settled, and SSRIs no longer look like wonder drugs. Worse (from the standpoint of the drug companies) most of the patents of the native SSRIs have expired (long acting preparations and other alterations may still be available only in branded forms). So the pharmaceutical industry needed to move on to something new.

Enter the ‘atypical antipsychotics’. They are ‘atypical’ because they work differently from the old antipsychotics. The old drugs were essentially dopamine blockers. The class had been discovered because of an herbal folk remedy for insanity, from which a very effective anti psychosis drug was isolated. It turned out that it worked by blocking the effects of dopamine in the body. This led to the ‘dopamine hypothesis’, where schizophrenia was postulated to be the result of excess dopamine. That idea turned out to be far too simplistic, but there is little doubt that dopamine is one of the neurotransmitters that goes awry in psychotic illnesses.

Atypicals, however, have less effect on dopamine than the older drugs, and more effect on serotonin and other neurotransmitters. (They also may be more discriminating in which of the body’s several types of dopamine receptors they target.) The prototype was clozapine (Clozaril), which had tremendous antipsychotic activity, but life-threatening side effects. Working from the structure of clozapine, researchers created the other atypical agents. These include: olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and risperidone (Risperdal).

Unfortunately, I have taken all of them at one time or another. Oddly, although I have had one episode of psychosis, my psychiatrist at the time prescribed atypical antipsychotics long after the psychosis had resolved. That’s because the drug companies started promoting these agents for mood disorders. First they were proposed for manic symptoms, but eventually some of them were touted as effective agents for severe depression. They are being used more and more for such reasons.

When I took them, they mainly felt like strong sedatives. Sure, they helped with agitation. They made me feel like I’d been hit with a hammer.

Problem was, they had terrible side effects. Well-known problems include incredible weight gain, increased cholesterol, and diabetes. I got the first two, and was well on my way to the third by the time I finally quit the drugs. There are other side effects, it turns out, when these drugs are used in combination with different classes of psychiatric medications. I won’t go into detail right now, because I am still getting up the nerve to talk about how these drugs have harmed me: it is a very sensitive subject for me.

My point right now, however, is that these are toxic drugs. Their side effects are far more dangerous than, say, those of the SSRIs. Given the epidemic of obesity and ‘metabolic syndrome’ in this country, we really should question whether these drugs are being overused. Especially since the evidence for their effectiveness in many conditions is not all that convincing.

Addendum:
Here is a link to a good site to check out if you want to know more about the controversies surrounding atypical antipsychotics. I also just came across an article about the problems with big Pharma and atypicals (with reference to a recent major legal settlement involving Zyprexa) on HuffPost by Dr. LLoyd I. Sederer. My thanks to Liz Spikol for her The Trouble With Spikol blog post summarizing the article.

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Atypical Antipsychotics was published on July 2nd, 2009, with these tags: , , , , , , , , . To date, this entry has received 1 comment.