WillSpirit!

Where Will meets Spirit
∞ Love, Clarity, Balance, Peace, & Bliss ∞

A science, mental health and spirituality blog written by a physician.








  • Red_Exclamation_DotDisclaimer
    • 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.


Pity the Deluded Psychiatrist?

Duane Sherry, an online friend, frequent commentator, and creator of the valuable site Discover and Recover, alerted me to a discussion sparked by a comment of mine on another site. The blogger who wrote in response to my story calls himself 1 Boring Old Man, and is a psychiatrist who criticizes his field.

My contribution was nothing more than the saga regular readers here already know: after neck disease ended my surgical career, I suffered major mental health problems and then even worse difficulties caused by psychiatric drugs.

These days I don’t write so much about psychopharmaceuticals, their marketing, or their toxicity. But in the past these topics occupied many blog posts. Even so, I’ve never been much of an anti-psychiatry activist.

There are reasons for my low profile in this debate. For one thing, I’m more interested in highlighting tools that can help us safely achieve mental wellness than in dwelling on treatments that can’t. More important in the present context is the fact that justifiable anger about psychiatric drugs too often gets expressed as attacks on psychiatrists. Such contempt, bordering on hatred, sounds to me both unhealthy and unproductive. Some of the responses to the 1 Boring Old Man discussion remind me of this troubling trend.

Maybe such language bothers me because I’m a physician myself. Even though I no longer practice Western medicine (I administer acupuncture to alleviate emotional and physical pain), I spent many years among conventional doctors and learned to understand them. There is no denying they can be arrogant and insensitive, but most started their careers with the best of intentions and strong callings to help. Psychiatrists of my era were trained during a period of great optimism about brain science. Although it was relatively new at the time, the assumption that mental conditions were due to diseased nervous systems (as opposed to unconscious conflict or problematic upbringing) was unquestioned in residency programs. Drugs given for psychiatric problems often conferred dramatic short term benefit. When first administered (before the side effects accumulated), they looked like miracle cures.

And of course there was the tsunami of pharmaceutical marketing, which promised a revolution in mental health care based on what looked like impressive research. To give you a sense of the naivety common among doctors, take a closer look at my own case. When I started taking potent psychiatric drugs and was confronted with lengthy warning labels, I refused to read them. I assumed the medications wouldn’t be allowed to reach market if they weren’t proven effective and basically safe. It seems so stupid in retrospect, but my training instilled in me solid faith in the medical system. It was only as I became obese, mentally clouded, hormonally impaired, sexually dysfunctional, and diabetic that my trust began to waver.

These complications were happening in my own body, not someone else’s, so they hit home in a powerful way. To the average psychiatrist, watching patients develop such side effects may have been troubling, but rather easy to write off since the suffering wasn’t personal. Yes, doctors should have been more compassionate, but they believed the drugs essential to wellbeing. The accepted wisdom was that mental disorders were so awful that bodily deterioration represented a reasonable trade-off.

My goal here isn’t to make excuses, but to point out that psychiatrists are human like everyone else. They are just as susceptible to delusions as are their patients. Like all of us, they can easily blind themselves to what Al Gore would call inconvenient truths.

They should change. They must. But my goal is to help us all find reliable paths toward health. To promote better methods, we must publicize the fact that medications are dangerous and ultimately ineffective. But the people who most need to hear such information are the psychiatrists, and they won’t listen if they hear hatred.

Although to speak out and agitate for change is vital, accusing psychiatrists of being soulless monsters is both wrong and counterproductive. Doctors are far more likely to change if their critics look rational, open-minded, and kind than if they sound unreasonable and blinded by anger. If psychiatrists hear venomous attacks rather than reasonable appeals, they will simply harden their views. That is human nature.

The real monster in this story is capitalism. In my opinion it’s nearly always an evil, but it’s especially destructive when serving as the driving force behind health care. The inevitable result of developing psychiatric treatments with a market mentality is that profit becomes the over-riding value: not healing, not safety, not compassion, but the bottom line.

The capitalist system, the governments that serve it, and the health care systems developed by it, have been built by people but are not people. Let us direct our contempt at the structures directly responsible for harm, and then help those trapped and deluded by capitalist values and marketing learn the error of their ways. This means speaking the truth firmly and loudly, but also rationally and calmly. It means minimizing accusations about past behavior (although we must be clear about the historical facts that led to the current disaster in undermined mental health care), and concentrating on gathering support for future improvement.

>> Share on Facebook
>>





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.

>> Share on Facebook
>>





Archives