Use, Overuse and Abuse of Psychotropic Medication: the risks and the facts

Please note about the post below that I already accept that some people will  object to all I say, even accuse me of encouraging people not to take their “meds.” I have not done any of that. Education is education, and if you or your loved one needs to be kept ignorant in order to obediently accept being medicated, please don’t read this or let them read it either, that’s my best and only advice.

 

If you want to know someone else’s arguments on the subject, read THE ANATOMY OF AN EPIDEMIC, by Robert Whittaker. I do not agree with everything he writes there, but it certainly was a springboard for my thinking.

 

So! This post deals with what I see as a gross failing in 21st century psychiatry, the over-prescription of psychotropic drugs. Sometimes driven by psychiatric practitioners who have neither the time nor interest or training to do “talk therapy” or even basic counseling, sometimes driven by the desires of consumers/patients themselves for a no-trouble, “quick fix” for their problems (not all of which are strictly speaking pathological), it is driven certainly by the demands of pharmaceutical companies for profit.

 

This last, Big Pharma’s requirement for increased profit, has led to massive advertising campaigns and the legal and not so legal encouragement of “off-label” uses, a band wagon upon which both practitioners and, I would add, eager consumers leap. It is not without consequence that both the drug companies and many if not most psychiatrists / prescribers would have consumers believe that psychotropic drugs “treat” illness, that is to say that the drugs target a specific neurotransmitter that has been conclusively shown to cause a given condition and to be measurably “out of balance” compared to levels in so-called normal persons.

 

THIS IS NOT THE TRUTH. I repeat: It is not true that psychotropic drugs treat illness, not the way antibiotics treat infectious diseases. An antipsychotic or antidepressant drug is NOT a silver bullet specifically targeted at a pathological culprit. These drugs are prescribed to alleviate symptoms, to alleviate, for instance, hallucinations or delusions, and maybe, sometimes, to elevate a person’s mood when pathologically depressed. They may be prescribed for other “reasons” as well, though to call a drug that is used by a doctor/patient for a presumed condition a “treatment” is not the equivalent of saying that the drug is either indicated or effective. It only says that someone has decided to use it as if its purpose were to treat a supposed condition.

 

What do I mean? Well, take, for instance, antibiotics. Most of us know by now that they are useful and indeed curative in many cases of bacterial infection. We also know that sometimes ABs are prescribed i.e. used, in cases of viral infections and illnesses. But antibiotics can neither treat nor alleviate conditions caused by viruses. So if a physician gives a person a prescription for penicillin in the case of a cold or flu, (and for whatever reason) he or she may be said to “use” the drug for such and such, yes, but it says nothing about whether the drug is useful or effective or necessary. Which of course in such cases it is not.

 

Ditto some prescriptions for APs and ADs. Ditto maybe ALL such prescriptions: yes, they can use APs and ADs as if they targeted a “mental illness” but just because one takes a pill “for something” does not mean or definitively indicate that the drug is useful, helpful or harmless.

I know, I know, many people who will object that such drugs have helped them function in life much better than before, when they were self-described (or otherwise) “basket cases.” I cannot take that away or even deny that a couple of APs seem to have helped me more than they harmed me. Although I now swallow the APs Abilify and Geodon together (I cannot take them separately without ill effect) taking one AP, Zyprexa, seemed to me to have near miraculous consequences in my life –I have detailed these elsewhere but “take my word for it” I felt like life’s lights had been switched on in my brain. At the same time, Zyprexa’s other effects were devastating: obesity, high cholesterol and triglycerides, pre-diabetic blood glucose levels yada yada yada. (By the way, why is one effect a “treatment” and the others “side effects” and therefore discountable? Aren’t all effects of drugs effects of the drugs?)

 

So I am not saying that the drugs do “no good” ever or at all. And I am emphatically not advising anyone to stop taking whatever they have been prescribed. For one thing, abruptly stopping medications, particularly psychotropic ones, can be a prescription for disaster. Not only could the physical consequences be unpleasant, but to suddenly stop a med only sets one up for what looks like “relapse.” If your body is used to taking a drug, and it is abruptly and completely withdrawn, doesn’t it make sense that you will feel untoward effects similar to those the drug is supposed to treat? I used to take Inderal for headache prevention and akathisia, but another effect of it was that it lowered my blood pressure and slowed my heart rate. In one hospital, for some unknown reason, they stopped giving me Inderal (propranolol)  — one day I was taking 40mg three times a day, and the next day I was taking, well, zilch.

 

Is it any wonder that within the next day or two, my “vitals”, though normal before I ever took the Inderal, rebounded way over normal limits, my heart racing painfully and my BP sky-high? Of course not. This was no proof that my heart-rate was pathologically rapid nor that I “had” high blood pressure. Of course, the doctor tried to tell me so, but in fact all it proved was that carelessly and rapidly stopping a beta blocker drug resulted — like a rubber ball dropped onto the pavement – in what was essentially withdrawal and temporary rebound.

 

So if you abruptly stop your meds because you think my argument here “holds water” you will be setting yourself up for two things: 1) apparent relapse of illness even if it is really just withdrawal or rebound symptoms, 2) possibly mistaken evidence that you need the drug. However, if you and your doctor decide that you might do okay without the medication, and you very, very slowly reduce it, then you have a much better chance of not inducing a relapse, and/or “proving” that the drug is essential to your mental health.

 

Note that whether a given medication really helps or not is up to you and your doc to ascertain. All I mean to say is this: do not drop any AP or AD without considering all the consequences of stopping it without a gradual taper.

 

Now I want to segue into some information from “reputable sources” so-called so you can see where I am coming from. Please continue below the following if you already know all this. I neither endorse it nor argue with it. I am just providing this official “information” – true or not so true — in order to further my argument below it.

 

For the purposes of the discussion, I deal only with antipsychotic drugs (APs) and antidepressants (ADs) of the SSRI, SNRI and tricyclic variety. I know there are other important medications used in psychiatric settings and treatment but for space and energy’s sake, I will limit this post to those two categories because for good or ill they are often prescribed together.

__________________________________________

 

Forgive me, NIMH, but I need to crib a short section from your website on the side effects of various psychotropic drugs http://www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml before I begin my discussion about them. Any emphasis (italics) or bracketed word/s are my own.

 

 

First NIMH (National Institute on Mental Health) has this to say about “anti-psychotic drugs”:

 

“Some people have side effects when they start taking these [antipsychotic] medications. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

  • Drowsiness
  • Dizziness when changing positions
  • Blurred vision
  • Rapid heartbeat
  • Sensitivity to the sun
  • Skin rashes
  • Menstrual problems for women.

 

“Atypical antipsychotic medications can cause major weight gain and changes in a person’s metabolism. This may increase a person’s risk of getting diabetes and high cholesterol.1 A person’s weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication.

 

“Typical antipsychotic medications can cause side effects related to physical movement, such as:

  • Rigidity
  • Persistent muscle spasms
  • Tremors
  • Restlessness.

 

“Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can’t control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication.

 

“Every year, an estimated 5 percent of people taking typical antipsychotics get TD.”

 

ANTIDEPRESSANTS

 

Antidepressants are common psychotropic drugs frequently prescribed. Here

is  a block of quotes from the NIMH site regarding the use and side effects of SSRIs, SNRIs, and tricyclics. MAOIs are also mentioned, though they are far less often prescribed than in the past.

 

“Depression is commonly treated with antidepressant medications. Antidepressants work to balance some of the natural chemicals in our brains.* [see discussion that follows] These chemicals are called neurotransmitters, and they affect our mood and emotional responses. Antidepressants work on neurotransmitters such as serotonin, norepinephrine, and dopamine.

“The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). These include:

  • Fluoxetine (Prozac)
  • Citalopram (Celexa)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Escitalopram (Lexapro).

“Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta). Another antidepressant that is commonly used is bupropion (Wellbutrin). Bupropion, which works on the neurotransmitter dopamine, is unique in that it does not fit into any specific drug type.

“SSRIs and SNRIs are popular because they do not cause as many side effects as older classes of antidepressants. Older antidepressant medications include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs). For some people, tricyclics, tetracyclics, or MAOIs may be the best medications.

What are the side effects?

“Antidepressants may cause mild side effects that usually do not last long. Any unusual reactions or side effects should be reported to a doctor immediately.

“The most common side effects associated with SSRIs and SNRIs include:

  • Headache, which usually goes away within a few days.
  • Nausea (feeling sick to your stomach), which usually goes away within a few days.
  • Sleeplessness or drowsiness, which may happen during the first few weeks but then goes away. Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects.
  • Agitation (feeling jittery).
  • Sexual problems, which can affect both men and women and may include reduced sex drive, and problems having and enjoying sex. [Note that this side effect is NOT listed as temporary, as indeed it is not, and this is extremely important to understand…]

“Tricyclic antidepressants can cause side effects, including:

  • Dry mouth.
  • Constipation.
  • Bladder problems. It may be hard to empty the bladder, or the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be more affected.
  • Sexual problems, which can affect both men and women and may include reduced sex drive, and problems having and enjoying sex.
  • Blurred vision, which usually goes away quickly.
  • Drowsiness. Usually, antidepressants that make you drowsy are taken at bedtime.

“People taking MAOIs need to be careful about the foods they eat and the medicines they take. Foods and medicines that contain high levels of a chemical called tyramine are dangerous for people taking MAOIs. Tyramine is found in some cheeses, wines, and pickles. The chemical is also in some medications, including decongestants and over-the-counter cold medicine.

“Mixing MAOIs and tyramine can cause a sharp increase in blood pressure, which can lead to stroke. People taking MAOIs should ask their doctors for a complete list of foods, medicines, and other substances to avoid. An MAOI skin patch has recently been developed and may help reduce some of these risks. A doctor can help a person figure out if a patch or a pill will work for him or her.”

___________________________

First of all, do ADs treat a chemical imbalance? Is that statement even true, or just a fiction made up to “prove” that ADs work? If true, what does a “normal” balance consists of? Does anyone know how to measure the levels of these neurotransmitters, and if so, please let me know — give me numbers — where and what the “imbalance” ADs are correcting is.]

 

So all right, thems the “facts.”. Note that I say nothing about efficacy in what follows; I speak only of the side effects. But what about these so-called side effects? It seems to me to be hardly inconsequential when an AD, taken to improve the quality of one’s life and increase ones ability to feel pleasure, which is often absent in depression, simultaneously blurs ones vision (so you cannot read), causes weight gain (as tricyclics tend to do) and has sexual side effects that include reduced sex drive, and problems having and enjoying sex. For many people, maybe even most people, sex is one of the greater pleasures in life, at least sometimes. It certainly promotes better intimate relationships for most people and lets face it, people like it. So what is one to think of a drug that “treats” depression by inducing reduced sex drive, and problems having and enjoying sex. Is the reduction of pleasure in sex without importance? Or is the doctor saying, well, you can give up sex and sexual pleasure, what does it matter?

 

The thing is, reducing any pleasure, especially in a person who has trouble feeling pleasure at all, is not, in my considered opinion good treatment. Who has the right to tell a patient that if she or he takes an AD that they will have include reduced sex drive, and problems having and enjoying sex but that this isn’t important in the general picture. Of course it is important. Think of all the men who are devastated by “simple” impotence. To clinically induce impotence or the female equivalent, to clinically, biochemically reduce the ability to enjoy sex or to enjoy pretty much anything, is not just bad treatment it seems to me nearly criminal. How many people who have taken ADs and found themselves experiencing reduced sex drive, and problems having and enjoying sex actually got better? Well, okay, if perhaps you are not told and so do not understand that the drug itself causes this effect you might just say, “Ah well, I dunno why but sex is not important, I don’t really give a damn about it anymore..”. In short, you might “forget” — having no sex drive tends to do this — that sex was pleasurable and attribute it to your natural state. But in that sense you simply are denying that what you “don’t know” or feel any longer was ever important or a source of pleasure because you do not feel it now. Instead, you might accept that it is and always was a trivial concern.

 

But no one has told the millions of users of ADs that while they might feel some increase in pleasure elsewhere in their lives, their intimate lives will be fraught with reduced sex drive, and problems having and enjoying sex. How many people now feel utterly depressed because of their unexplainable reduced sex drive, and problems having and enjoying sex? Do they even understand that is is not “they themselves” not some inner deficiency, but a side effect of the drug that is/was supposed to make them “feel better.” If I were more paranoid than I am at the moment, I would say it sounds like some sort of ugly conspiracy by doctors and drug companies to avoid even informing patients of these serious consequences lest they refuse the drugs in the first place…So I ask you, how many of you, or how many people in general, would voluntarily, not to mention eagerly take a pill the effects of which include reduced sex drive, and problems having and enjoying sex?

 

 

Argh, it is getting very late and this has been a long treatise, impassioned in a curious way for someone who has never, drugged or undrugged, cared about sex…I so wanted to get to the APs and the dangers of adding them willy nilly to an AD “cocktail.” If reduced sex drive weren’t bad enough, is anyone telling these people who are being prescribed an AP either off-label or unnecessarily that it will almost certainly cause some weight gain, with all the usual concomitant consequences, and may even induce diabetes? Is anyone telling them about how it feels to suffer from akathisia, a very common effect of APs?  Drug companies may discount it as mere “restlessness” but akathisia does not mean that you simply want to take a walk every afternoon…it is completely agonizing, those of us who have experienced it will with alacrity tell you. No one simply accepts akathisia – restlessness, hah! – and ignoresit. You cannot ignore it and it is devastating to all feelings of pleasure and all sources of enjoyment, should you, after losing your sex drive, have any left.

 

But as I wrote above, it is getting too late at night for me to write more, and perhaps I have said enough. You might accuse me of having “done enough damage” too, I dunno. But I believe these things and I think they need to be said, whether or not anyone takes them seriously.

 

3 thoughts on “Use, Overuse and Abuse of Psychotropic Medication: the risks and the facts”

  1. Hi Michelle,

    Thanks for your long and thoughtful, if frustrated, reply. I absolutely understand where you are coming from. I wanted to tell you this: my liver enzymes were “off” for years — maybe 30-40 points higher than normal — and I worried about it until my infectious disease doctor told me that essentially unless they were sky-high I should treat the milder elevations as chronic “irritation,” not good, but not a hugely adverse reaction either, esp if the medications helped me. That did help me calm down a bit about this, and since then the enzymes have regularized. I do not know if this would happen in your son’s case, but if the elevation of his enzymes are not great, perhaps (if the meds worked) it was something to watch rather than quit the drug over. At least that was the advice given me…

    As for Zyprexa, it was indeed a miracle drug for me, but I too was on the verge of diabetes and everything else. And I refuse to tolerate weight gain that did not seem even to level out at 60 pounds. So after 4 years and more of struggling with that non-stop, I began to “screw around” — stopping it whenever I couldn’t tolerate the side effects any longer — with disastrous results. It was only when we found the combination (and I MUST take the two together) of Abilify AND Geodon, that I began to get better. Now, I have to say that the Abilify does tend to put on weight for some, but the Geodon does not. I take, or am starting Topamax again, which helps me not gain weight. On the other hand, Topamax has its own side effects. So on it goes!

    On another topic you mentioned, I agree that just as docs used to blame weight gain and obesity on schizophrenia (recent research showed that people with schizophrenia BEFORE the medications were thinner than most), the same nonsense is happening with diabetes and I suspect it has to do with a collusion between the docs and the pharmaceutical companies this time rather than anything more innocent. In any event, we have NO diabetes in our family, though we do have schizophrenia, so do not tell me that the two go together! That is such a load of hogwash. The reason that people who have sz get diabetes is because the drugs induce metabolic syndrome and usually massive sudden weight gain…It is the exact same reason, no mystery there, why the whole country has an epidemic of diabetes: epidemic obesity. Everyone seems to want to deny this, but that is to deny the obvious. It always amazes me the degree to which this country wants to hide its head in the sand…But for doctors and psychiatric practitioners to blame those with sz first for obesity and then for the diabetes that the drugs clearly induce in both cases seems to me criminal at best.

    Well, I could go on a rant again but I do not have the space here or time. I do not know what Whittaker would tell you, or me. I think he might say that he was simply raising some questions…Maybe if he were really honest he would say more than that, I dunno. It certainly sounded as if he had some stronger opinions than merely questioning received wisdoms. However, I did want to know what he has researched. Even though I believe there is a flaw in some of his reasoning, or that it doesn’t go far enough, it is always refreshing to read a new take on old ideas. Certainly his research on research should not be discounted but used as a springboard for reinvigorated thinking on these subjects.

  2. PS I just remembered you have a Zazzle store. My friend Leslie Sigal Javorek, from the blog, IconDoIt, also has a store. I will try to remember to visit yours the next time I visit. I love Zazzle!

  3. Dear Pam, I like your post. Honestly, I must say, I was, for lack of a better word, expecting, more about the effects of antipsychotics, and/or your personal opinion of what Mr. Whittaker writes in his book. With that said, I don’t think you’ve said anything at all, not one word, that is inappropriate or would cause a person to stop his or her medication, but then, perhaps I assume(d) that people; patients/consumers, are aware of these effects you speak of. (As I write, I realize, I should not assume this).

    You have a strong voice, and I respect your opinion and experience, so your words mean a great deal to me.

    My son knew nothing about Zyprexa causing weight gain and diabetes. He went to a new doc, without me, and he had been taking a very low dose, as per needed, the latter of which is nearly unheard of right? I mean, who gives a person with a diagnosis of schizophrenia a low dose of an AP AND on an as per needed basis? Well, my son’s psychiatric nurse practitioner (who prescribes his meds) did. I like her and appreciate her willingness to be open-minded and to try the lowest possible dose for him. Plus, at the time, he wouldn’t take anything, so the APN and low dose was acceptable to him. The new doc told him Zyprexa can cause diabetes. Well, after this, he stopped taking it altogether. The new doc had mentioned the word poison! So, my son’s regular psychiatrist (not the nurse practitioner whom I like a lot), became very upset at the doc who told my son about diabetes. She sent over a social worker who told me that he could bring a medical book over for my son to read about Zyprexa, telling me that, “it doesn’t say anything about diabetes in this particular book.” I asked him why not and if it was outdated. He didn’t answer. I told him my son was not dumb and could read. I told him my son had a right to know the truth and if we didn’t tell him, that he would find out eventually on his own. The guy had another approach. He said, “Well, Zyprexa may sometimes trigger diabetes, but it isn’t proven.” Then he went on to tell the tale the psychiatrists are telling now, which is that –people with schizophrenia have a genetic predisposition for diabetes, so it probably isn’t Zyprexa, but instead, the illness! (Even if this turns out to be the truth, which I am highly skeptical of, the facts remain the same). Zyprexa caused my son to gain almost sixty pounds in two and a half months (they had increased the dose from 10mg APN (usually was every other day) to 20mg daily). This caused rapid weight gain, pretty severe depression and extremely high triglycerides, symptoms of diabetes, and finally, his family physician diagnosed him with severe metabolic syndrome. (And yes, it is a wonder drug as far as reducing symptoms!). He has since weened off the drug, but the symptoms have returned. He’s taking Latuda, but it isn’t doing any good.

    Wonder drug or not, patients should be educated and not have somebody bring over an outdated book and tell him or her that all this news and proof about Zyprexa’s negative profile is not true. It just gets my blood boiling! The docs who gave him the higher dose blamed the effects on anything they could think of other than the drug. It was (is) insane in my opinion.

    The same psychiatrist who sent the social worker with the outdated book to our house, (which I never let him open b/c I felt that it was a flat out lie) told me this: “Every person who takes an antipsychotic, no matter how low the dose is, will get TD. It is just a matter of time.”

    Sorry for such a long comment, but this is heavy on my mind. I’d like to speak personally to Mr. Whittaker and ask what he would do in my shoes, b/c I sure don’t know what to do! I am watching my son go downhill, although, we are working with a holistic practitioner and he has helped my son. Indeed, I believe without his help, my son would be much worse as I write. He is taking high doses of vitamins, including Niacinamide and Vit C, and a super green food tonic. I’ve gained almost ten pounds and my son has lost 12 since we’ve been seeing this person. I am most grateful, esp., since he is working with us, at this time, without a fee.

    Abilify made my son’s liver enzymes abnormal, as did Zyprexa. We do not know yet if the Latuda is doing this, but will find out this week after more labs. Still, the drug isn’t working at the low dosage. I am so worried. I feel like if I wasn’t sick myself, that perhaps I could do something. I could make sure he is getting more exercise or cook the greatest healthiest food in the world for him or something! I could do something! Alas, I don’t know what to do.

    Thanks for the space to share what is on my mind, and thank you again for your post.

    Sincerely,
    Michelle.

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