Friday, June 24, 2011

Psych Meds are THE Problem: A Post for Duane Sherry

Shrink Rap prides itself on being a take-all-comers place for open dialogue about the issues and controversies in psychiatry.  Five plus years, and the feel of our blog has gone through many evolutions.  In the last 6-8 weeks, things have gotten very heated around the topics of involuntary hospitalizations and the question of whether medications cause illness or treat illness.  

I see patients who walk in the door in distress.  The only people who walk in feeling well are those who have been treated by someone else and are coming to continue treatment, either because their shrink moved, they moved, something changed.

Once in a while, someone comes in and they are in distress and they are already on psych meds and I look at the regimen and say "No wonder you feel badly, you're on way too much medicine" and I stop things.  Mostly though, I start new medicines and I see people who were sick get better.  Some people have problems with medicines, but not like I hear people talk about in our comments section.  Here at Shrink Rap, people hate anti-psychotics. Very few patients tell me  that very low dose anti-psychotics bother them.  Medicines need to be added carefully, at low doses, and increased gradually.  The patient is supposed to get better: it they don't, the medicine should be stopped.  Sometimes people end up on a zillion medications, no better, and it's not clear why they are on them.  See: Medications: The Good, Bad & Ugly, and  You're Supposed to Get Better.  These are some of my views on treatment and medications.

It's not unusual that patients come in and casually mention in the course of a therapy session, "oh, I stopped taking the meds."  I ask why.  Side effects?  Felt they were no longer necessary?  I ask if they feel better without them (some do, some don't).  I'm here to help, and since I work in a totally voluntary setting, I may spout statistics, especially to someone with a high risk of relapse who was having no side effects and no problems with the meds and feels no differently off them-- but hey, you don't want to take medicines-- it's fine with me, and I'll hang out with you in therapy anyway. 

Duane Sherry has been visiting us for a while now in the comment sections and he feels strongly that medications are the problem, not the answer, and that people who think they are better are wrong.  He and I are seeing different before & after shots.  He asks if I give informed consent (funny, I do) and thinks people should explore different options such as orthomolecular therapies.  He's posted many links, and something gets troubling about the repetitive nature of it (at least to me) and something gets troubling about the accusatory tone, though he has really toned down the blatant --you're an idiot-- comments. Thank you, Duane, this has meant a lot to me.

So let me give Duane a moment here to get out his message of Meds are Harmful / Psychiatry Sucks here on the main page of Shrink Rap.  Duane, you're still welcome to comment, but please stop with the repetitive links, and please keep the tone respectful.  You might want to consider getting your own blog where like minded people can have a forum.

Duane says:
The drugs numb.
They provide temporary relief.
And that's all they do.

The greatest injury happens in their long-term use... They are addictive, because they meet the medical definition of physiological addiction in two vital areas:

a) Increased tolerance
b) Measurable effects during withdrawal

Have your patients look at the "side effects" more closely... Really look at what the drugs do.

Then see how many want to be placed on them.


Here is Duane's website...funny, no place for comments:
http://discoverandrecover.wordpress.com/wellness

Here are some links Duane likes:

http://www.foodforthebrain.org/content.asp?id_Content=1635
http://www.vitamindcouncil.org/health-conditions/mental-health-and-learning-disorders/depression/
http://www.townsendletter.com/Nov2009/hoffer1109.html
http://www.youtube.com/watch?v=aBjIvnRFja4&feature=channel_video_title
http://www.madinamerica.com/madinamerica.com/Timeline.html
http://breggin.com/index.php?option=com_content&task=view&id=40&Itemid=52
 http://recoveryfromschizophrenia.org/therapists-guide-to-reducing-medications/

Duane, Please put any other links you'd like in the comment section of this post: your personal space on Shrink Rap.  If you'd like, in future comments you can say "I'm putting links up in my space on Shrink Rap" and link back to this post and put them in the comment section here.
 
For the most part, we need to agree to disagree.  I don't believe I am going to sell Duane on the idea that medications sometimes help people live better lives.  And I don't think he's going to sell me on the idea that they should never be used. 

To my co-bloggers: please forgive me. 

51 comments:

rob lindeman said...

Drugs are fine if people want to take them (and if they can pay for them, but that is a subject for another day). The issue always has been coercion. We physicians, including yours truly, must do a much better job avoiding coercion when treating our patients, particularly when prescribing drugs. For example, right at this very moment I am going to speak to a mom and her son who just got a positive strep test. Rather than simply tell them I'm going to send a prescription for Amoxicillin and he's going to take it, I'm going to suggest it as a recommendation, and see what they say. If they refuse, I will not fight them, but I'll document it (this is not likely)

To my psychiatric colleagues who care for distressed people incarcerated in psyche hospitals (particularly against their wills), please think about this.

wv = imsho, some of the time, mostly imskeptical

Anonymous said...

Psychiatrists won't know about most of the patients who get poor results with meds, because after awhile, the patient gives up and doesn't come back. Maybe they get better through some other avenue later, but the psychiatrist won't know about it if they did.

I think placebo effect has a lot to do with the benefits of treatment. I was told that I am a rare case, that most people get better with medications, but I no longer believe that is true, based on all these new meta analyses coming out and the drug company dishonesty that has been exposed. I really think that if lithium doesn't fix your bipolar (Ok, it did fix my mania, but never helped the depression one little bit), you're screwed.

I have posted here before as an anon, and I will say, that all the people I know who have mental illness require social services help, so they are pretty much the sickest of the sick. This may be distorting my opinion somewhat, but I think those meta analyses are correct, and this is why my buddies didn't get better with treatment either. At least not better in the sense of being able to go back to work and have a family (or not having their children taken away by the state).

Duane Sherry, M.S. said...

Rob,

Thank you for offering a little sanity to the conversation, particularly on the subject of psychiatric drugs by force.

Dinah,

Marcia Angell, M.D. -

http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/?page=1#fn-1

Psychiatry has made quite a mess. Perhaps it's time some of you cleaned it up, huh?

Duane

Carolyn Cummings said...

One of the things I don't think people always understand is that its a choice between the lesser of 2 evils. Are many medications addictive? Sure. Is it better than cutting, self-medicating with marijuana and meth, and frequent suicide attempts? Absolutely!!!! People WILL treat their problems. Medication gives them an opportunity to do so under supervision in a safer way than the other forms of "medication" they prescribe themselves. A lot of my hyperactive kids used to do huge amounts of Marijuana to mellow themselves out. Now they don't take any drugs because they are receiving appropriate levels of tested medication being supervised by a psychiatrist and not the creepy guy on the corner. I have seen depressed girls go from cutting and drinking and other risk-taking behaviors to being able to benefit from CBT approaches in treatment because the medication gave them the control they needed to actually think clearly enough to make better choices. I don't think people realize the cost-benefit analysis that is required to decide whether medication is necessary or not. Do I want all my clients to be able to improve their mental health without meds? Of course!!! I like their livers and kidneys and I don't want them to have potential long term medical problems. But I also like their brains, major arteries, and necks, which are in more immediate danger from self-harm and self-medicating.

Duane Sherry, M.S. said...

Marcia Angell, M.D. (the end of the article) -

"Above all, we should remember the time-honored medical dictum: first, do no harm (primum non nocere."

IMO, THIS is what is missing in conventional psychiatry!

Duane

Anonymous said...

Marcia Angell, M.D. (the end of the article) -

"Above all, we should remember the time-honored medical dictum: first, do no harm (primum non nocere."

If Dr. Angell really takes "do no harm" so literally, why isn't she railing against oncologists? Does she know what cancer patients go through?

What about you, Duane? Would you decline treatment for cancer?

Anonymous said...

Perhaps the reason you don't get a lot of praise for antipsychotics from your blog readers is because they are the people who had bad side effects of all sorts. I do not doubt that for many people the drugs do work well. Thos people would not be surfing the internet looking for anything except maybe off of EBay or Amazon. Your readers who are patients probably are still looking for the right answers for themselves and haven't found the meds they are on to be that answer.
There a a bunch of meds I would try but I am unable to due to other health problems. Maybe they would have helped me, who knows? I know that my doctor has only tried their best for me. I do stil say that there is a lot of rot in the system but my doctor is not part of it. I am sure your patients feel you are a good doctor, too.
I do feel that psych drugs can do a lot of damage although not for everyone. I take what I take with a grimace because if I didn't take it I would be dead. I may develop major problems from them one day and I think about this a lot. Right now I am alive today because of what I take. Sometimes I stop and my doctor, while wishing I didn't, tells me the choice is mine. It is mine. I choose to take a stick of dynamite before ending back in a hospital. I cannot agree that doctors are ignoring first do harm when they prescribe meds. Maybe for some people the mega vitamins do good. For those people, that is the right choice. if they worked for me, my doc would never prescribe another dose of all the drugs I love to hate. There is no magic wand. If I had cancer I could choose treatment or not. Some people die from the chemo before the cancer would have killed them. It is a choice. I suppose docs become docs for a host of reasons but I doubt there are very man who go into medicine to do harm. Harm sometimes happens. S--t happens. Not everyone who got through med school should have been given a license. Most of my bad experiences have been at the hands of unsupervised residents, nurses and nurse's aides. And still, I have had some very good exeriences with people who fall into each of those categories.
People do come here to vent sometimes. Life is lonely and frustrating and none of these things is anything I could say to a workmate, neighbor or friend. A lot of us live in the shadows. We swallow pills to make us function. or we take vacations that are really stays in hospitals which explains the lack of pictures. So don't take it too hard when people come here to complain. Most of us do not hate shrinks. We hate what we go through. Like you say, no one has to listen. It just helps to put it out there sometimes especially when a post triggers a very bad memory. I think for most of us commenters, there is no other agenda.
Anon to the extent that you aren't able to track IPs. As if.

jesse said...

Can medications hurt people? Absolutely! Do they routinely do more harm than good? No, unless they are not being used correctly. It is always a risk/benefit balancing act. But I think the problem is different from the opposite poles often expressed here.

Most of medicine and surgery exist as discrete problems that can be diagnosed and treated in easy to formulate ways. The diagnosis itself may be devilishly difficult to make, but once made the treatment is generally straightforward. The patient then is helped to understand the problem and cooperates in the treatment.

Psychiatry is very different, because 1) the mind itself is subject to disease, and 2) the difficulties are far less able to be condensed down to a simple factor, for which a treatment is readily available. There are other difficulties, including the reticence of the public to entertain that emotional/mental problems could affect them. This last point is true in spite of the mountains of data that show how prevalent mental problems are. It is easy to imagine we could get cancer, or a have a heart attack, but not develop a major depression. It may take a lot of time before a frightened patient can tell the psychiatrist symptoms or difficulties that would be very important to relate. And psychiatric problems make other medical personel anxious, so they often do not treat patients well.

So one result of all of this is that psychiatry is very hard to practice in an optimum manner. It takes a lot of time with patients and that is hard to come by. It is squeezed by insurers to the bare minimum. The public sector of psychiatry may be even harder to practice well than the private, and it must do with little resources. So yes, medications can be overused and not properly used. That is a fact. Patients need to know side effects. Good treatment is a cooperative process. But let's not throw the baby out with the bathwater.

Duane Sherry, M.S. said...

Jesse,

We disagree.

Dinah,

You say that I'm against the use of medication entirely. That is not accurate.

This is where I think psychiatry needs to move when it comes to "treatment" with drugs:

Informed consent
Adults
Not children
Not seniors
Information on how to slowly taper off medication at the onset

In a perfect world, psychiatry would exhaust all other options before drugs are used, inluding providing information on recovery.

Unfortunately, the vast majority of psychiatrists know no other options (other than "talk therapy"), and are strangers to the concept of recovery, especially full-recovery.

I'm for doing things better.
Doing things the right way.

Duane Sherry

Anonymous said...

I agree that it comes down to the lesser of two evils.

When I start a medication, I am expecting some side effects, but the side effects are usually, for me, more tolerable and important than the lack of meds &/or my skinny jeans- and a lot of them go away if you wait things out for a while.

I love my atypical anti-psychotic.
I go right to sleep and it seems to help me throughout the day.

I have gone from being a size two to a size ten( Some eights!;)in a year. This part sux.

But guess what?:) I'm trying to work it out and stay on the med, as it helps me. I just bought a treadmill, I walk at lunch, and limit my midnite snacks to a couple of pieces of dried fruit( prunes! Ha! two birds with one stone), that I keep in my bedside table.

We'll see how it goes.
Green tea?

I do, however, worry about long term use of my medications..kind of scares me. My diagnosis is in the bipolar spectrum, and I may take meds for a very long time, if not for the rest of my life.

~~ & yet if I stop, my life span could easily be much, much shorter w/out the meds*

It's hard.


Tippy

Anonymous said...

Wait a minute -- Is Duane saying that "seniors", a group that can include anyone over 49 years of age these days, are not "adults", able to make their own medical decisions?

RH

Anonymous said...

Duane, at the risk of being accused of being a psychiatry hater, great post.

Dinah, there is alot I would like to say but let me respond to this specific exert:

"I ask if they feel better without them (some do, some don't). I'm here to help, and since I work in a totally voluntary setting, I may spout statistics, especially to someone with a high risk of relapse who was having no side effects and no problems with the meds and feels no differently off them--- but hey, you don't want to take medicines-- it's fine with me, and I'll hang out with you in therapy anyway. "

Warning, rant coming.

Just because someone doesn't feel better off of meds does not mean that someone is relapsing. Usually that happens because many of your colleagues have tapered patients way too quickly off of meds. The person is experiencing withdrawal symptoms that look like a return of the illness but aren't.

As a result, they are falsely deemed as needing meds for life when the solution was to slow the taper to a very slow rate like 10% of current dose every 4 to 8 weeks.

I think it is shameful and disgraceful that psychiatry keeps spouting these relapse statistics that are very misleading.

This has caused many people to be kept on meds for years when they shouldn't have been which obviously needlessly increased the risk of side effects.

AA

PS - Because so many people have not been helped by their doctors regarding withdrawal issues, they have gone to this board for support.

http://survivingantidepressants.org/index.php?/index

It depends on donations and is not linked to any organization. Commercial links are forbidden.

Anonymous said...

Dinah--I'm sure you get informed consent, but I'm curious--what do you tell people about the diagnosis and the meds? Do you tell them they have a chemical imbalance? A brain illness? Do you tell them the meds will correct their chemical imbalance?

I adamantly refused to take meds after a psychiatrist rather casually diagnosed me with bipolar disorder and told me I'd have to take meds for the rest of my life, when I had a serious adverse effect from an SSRI. I think I suffered more than necessary as a result of this, because a short course of meds probably would have helped ameliorate the adverse effect. But I just wasn't going to take the meds from a doctor who dismissively gave me a clearly erroneous diagnosis, and subsequently refused to reconsider it, and who refused to treat me unless I agreed in advance to stay on the meds once on them.

If the doctor had something along the lines of "well, you've clearly had a bad reaction to an SSRI; we're not sure why some people have that reaction. But we have meds that may help you get over the adverse effects of the SSRI more quickly. We can try them for the short term, and if you like, we can discuss the long term later," that would have been both truthful and helpful.

I guess my objection to meds is that they're often sold to patients as something they're not--magic pills that correct a chemical imbalance. And I object to patients being told, in effect, you have a brain disease and you must depend on these meds (and a doctor to prescribe them) for your sanity forever. Get used to it. There is a broad range of treatment options that don't seem to be discussed.

There's an interesting editorial in the journal Molecular Psychiatry that just came out called "Advances in Depression Research: 2011.
http://www.nature.com/mp/journal/v16/n7/index.html

Second red header as you scroll down the page.

It really brings home how little is known and how far there is to go with regard to a scientific understanding of depression. And how truly primitive current meds are in treating the possible biological causes and mechanism underlying depression.

Sarebear said...

A small-ish bone to pick with you, Duane, out of the many that I want to, is, you're saying the second someone becomes a senior, bam, that's it, no more meds? HOW ABSOLUTELY CONDESCENING OF YOU! I'm thinking I turn 65, or 50, or 55, some places define "senior" differently, and BAM no more meds, cause apparently I'm a population easily taken advantage of and incapable of making informed decisions for myself (some seniors are not capable, some are as hale and hearty as many of the rest of us, with a little more wear, but with still-sharp minds).

Don't just write off a whole category of adults as being incapable as children of making informed decisions for themselves. If you had said the mentally impaired elderly, I'd not be protesting like this, although I still feel they should be consulted (depending on degree of impairment). It's like you are saying those who can't make informed consent shouldn't get any treatment at all, well, traditional treatment with medications, lest we risk possibly "forcing" such a decision on them when they can't make it for themselves. And who are YOU to know that they wouldn't choose it, if they could? You might argue back, who is the DOCTOR to choose it for them, not knowing if the patient WOULDn't choose it? THIS is where family comes in, the people who are to make medical decisions for their family who have become incapable; do you deny their ability to know their family well enough to make an informed decision? Yes, some families aren't so close but then in that case the family may be specifically excluded from having any medical proxy rights (if that's the term, and if the elderly in question did all those trusts and things to set out who makes decisions for them and who doesn't.)

Yeah, I kind of got off into territory that I know will bother you there, with the incapable elderly having family making decisions for them, but originally I just wanted to object to you lumping all seniors as incapable, seemingly.

My dad will be seventy-five, shortly, and he is EXTREMELY capable. I would fight like a pit bull against anyone who would take away his right to decide his own treatment, medications or not.

Anonymous said...

The link to the Molecular Psychiatry editorial didn't copy correctly, trying again:

http://www.nature.com/mp/journal/v16/n7/index.html

Duane Sherry, M.S. said...

Sarebear,

I was not referring to an older person who is in a position to make health care decisions.

I was referring to what is taking place in nursing homes, where patients are given antipsychotics out the gazzoo... drugged down, so the staff have an easier time of things. And it's happening.

Also, I was not referring to someone who has been on them for years, and who is now older.

I was referring to taking advantage of older people, some of whom have dementia, depression, etc, and could benefit from non-drug approaches that are rarely considered in such places as nursing homes.

It looks like I've become the person people love to hate on this blog...

That's okay. I'm okay with that, as long as the facts are presented. And most of them aren't pretty.

Duane

Sarebear said...

I don't hate you, it's just that you said "not seniors". That was a pretty broad brush, and now you've defined it more specifically. Whether or not I agree with your assessment of what is going on is another matter, or to what degree it goes on, but I don't see any reason for me to discuss that; just saying I'm on a different page, and there we are.

Dinah said...
This comment has been removed by the author.
Duane Sherry, M.S. said...

Dinah,

You're so "nice" and "fun"...
Until someone challenges you.

You had a question from one of the readers, about 'informed consent'...Why don't you answer it?

Also, there was deep concern expressed by other readers on this post... not just me.

I challenge you.
And I challenge you right where it hurts, with the facts... with the truth, and it hurts like hell, doesn't it?

I'm curious to find out what you think informed consent consists of...

Duane

Duane Sherry, M.S. said...

Dinah,

And what of the article by Marcia Angell, M.D?

You made no comment.

I guess Dr. Angell just doesn't understand all the inner-workings of neurotransmission to the level that Dinah Miller understands...

Ha!

It seems to me that there's more than a few people on to the myth of the chemical cure.

Duane

Dinah said...

Duane,
If I was that troubled or "hurt" or unable to deal with challenges, I wouldn't be blogging and inviting others to freely comment....for years, and I certainly wouldn't be allowing open, unmoderated comments.

I read the Marcia Angell article briefly. She's a bright woman, and I didn't find her article to be terribly controversial...with one exception, the statement:
"Like most other psychiatrists, Carlat treats his patients only with drugs, not talk therapy,"

You seem to pick certain people to believe, and others not to believe. I'm still perplexed at why you're here.

Informed consent: if you want to know how I think psychiatry should be practiced, read my book.
I'm sure I don't inform people of what you think I should inform them, but alas, the internet is there and people can find whatever they want. I certainly don't discourage anyone from Googling. I suppose if you think children and seniors shouldn't be allowed to have meds, then you'd assume all patients are incapable of their own research?

No "Thank You" for putting links to your sites on our main site or giving you your very own special place on Shrink Rap???
: )

Anonymous said...

Dinah said in response to Duane,

"You seem to pick certain people to believe, and others not to believe."

And you don't?

Do you read anything that challenges the traditional view of psychiatry? Have you read Anatomy of an Epidemic by Robert Whitaker who is not anti meds but doesn't share psychiatry's view that they work in a majority of cases.

By the way, he has spoken to several psychiatry groups so I am not sure why psychiatry professionals on this blog find folks like Duane threatening.

As far as you having experience as a psychiatrist, how would you taper patients off of psych meds who were having trouble doing it your way?

AA

jesse said...

Duane, I wrote four paragraphs above making a number of points and you simply responded with "We disagree." With what? One thing I have noticed is that often there are comments that are negative about "medication" without being specific.

I wrote "Do [medications] routinely do more harm than good? No, unless they are not being used correctly." Is this what you disagreed with?



Medications help some people and not others. True for antipsychotics, true for antibiotics.

Anonymous said...

Hi Jesse,

You addressed this comment to Duane:

You wrote "Do [medications] routinely do more harm than good? No, unless they are not being used correctly." Is this what you disagreed with?

I hope you don't mind my intrusion but I am puzzled by this comment.

What do you mean when you say that med don't cause harm unless they are not used correctly? Many people take meds exactly as prescribed by their physician and suffer greatly. This happens even when the physician prescribed the med under reasonable circumstances.

AA

jesse said...

AA, "correctly" means prescribed correctly, by a doctor who is carefully considering the benefit versus side effect potential, and who is working with the patient to achieve the best result. The doctor is not only open to feedback but has developed a rapport with the patient so that the patient feels comfortable discussing options, side effects, and so on. It's a two way street. This can be a tall order. Moviedoc could comment on how difficult even for a doctor thoroughly knowledgeable about medications.

The doctor also needs to know alternative treatments, not necessarily as an expert on each but so as to be aware of the limits of what he can offer and when referrals to others would be helpful.

One difficult decision to make is when to taper down or discontinue (slowly and carefully) medications when the chance of a relapse exists. We cannot predict the future, but every psychiatrist I know has had patients who go off their medications and after a year or two have a relapse that may destroy all of what they have built up. Making it harder to recover and increasing the chance of future relapses. This is what Dinah was talking about.

Anonymous said...

I would love for Duane to set up his own blog. I disagree with almost everything he says and would love to debate him, counter every argument he makes -- but Shrink Rap just isn't the right forum for that.

So, Duane, how about it? You up for some real debate on your own turf? I'll even take you and AA on in debate at the same time -- bring it on!

RH

jesse said...

P.S. AA, I didn't say "meds do not cause harm." I said "'Do they routinely cause more harm than good?' No, unless..." So by saying routinely I do acknowledge that meds can cause harm even when used most carefully. That is true of near everything!

We always have to weigh the risk of any option against the risk of not doing that thing.

Duane Sherry, M.S. said...

Jesse,

IMO, using drugs "correctly" would involve telling a patient that there is no evidence of a "chemical imbalance", and that the drugs do not correct any such "chemical imbalance."

It would also entail explaining to the patient that the drugs can provide relief of symptoms, but can be physiologically addictive, and many take quite some time to taper-off, once placed on.

The "risk/benefit" analysis you speak of is IMO, a "risk/symptom relief" benefit. Not a medical benefit in the sense of helping "cure" or even "heal" for that matter.

Your ideas seem to come right out of the conventional model. A model that has been a failure.

Dinah,

I pass on the "separate" ... "special?" place for links. You make it appear as though I've placed the same links, again-and-again... There have been a few that I've used more than once, others only once. One of the reasons that I place these links is because they are ones that help people learn "where to start"...

I'm not a doctor, nor have I ever claimed to be. But I do have a master's degree in counseling, and have spent most of my adult life working closely with people with severe disabilities.... Also, I have spent about 9,000 hours of study on the subjects often discussed on this blog.

My life experience working with people in Safe Harbor (both the patient-side as a site moderator, and the professional-side, with integrative psychiatry) has taught me a lot.

Do I know everything?
Not even close.
But, in some ways, it provides an advantage to look at this stuff through the eyes of a "freshman".


No.

I'm not too interested in having links placed on a particular place on the blog.

If that means that you toss me off the group, so be it.

Duane

Duane Sherry, M.S. said...

Dinah,

Also, I'm doing my best to limit the number of comments (along with redundant links)....

But it can be hard when people comment back to what I've put up, such is the case with this post, where both you and Jesse asked for clarification.

I would like to clarify my comment about psychiatric drugs not being for kids.

IMO, there was lots of political pressure from groups like NAMI to get a couple of these drugs approved for kids, and I think it's fair to say they should not have been approved.

The others are written "off label"... So not only are seniors in nursing centers being taken advantage of, so are children... some very young.

I think there is some room for debate on whether teenagers might benefit with symptom-manangement, but it's time the government provided much-needed oversight.

My views are expressed in the comment section of Dr. Balt's blog (scroll down to the bottom area of the comment on his post) -

http://thoughtbroadcast.com/2011/06/08/i-want-a-dsm-wiki/#comments

Duane

Anonymous said...

Hi Jesse,

Unfortunately, many people have not had the benefit of doctors who carefully considered what they had to say about medications.

The common complaint is that they were deteriorating big time and the psychiatrist insisted that they stay on meds.

As far as your point about patients going off of meds and relapsing, once again, I think you are confusing withdrawal symptoms with a relapse, particularly if the patient has been tapered too quickly.

In my opinion, psychiatry really needs to revisit this as in my opinion, those relapse statistics are very misleading and keep people on meds needlessly.

Also, you might want to contact, Dr. Carlotta Belaise, who is doing research on prolonged withdrawal cases. See this thread on the surviving antidepressants withdrawal board.

http://tinyurl.com/3zuaxo9

By the way, I am curious as to how you define a slow taper? On the surviving antidepressants board, people are advised to taper at 10% of current dose every 4 to 6 weeks.

In some cases, people might have to go even more slowly.

AA

Duane Sherry, M.S. said...

AA (aka, Anonymous).

I agree.

So does Peter Breggin, M.D. -

"All psychiatric drugs have the potential to cause withdrawal reactions, including the antidepressants, stimulants, tranquilizers, antipsychotic drugs, and “mood stabilizers” such as lithium. When the individual’s condition grows markedly worse within days or weeks of stopping the psychiatric drug, this is almost always due to a withdrawal reaction. However, misinformed doctors and misled parents, teachers, and patients think this is evidence that the individual “needs” the drug even more when what the patient really needs is time to overcome the drug’s contrary effects on the brain and body."

The ten percent rule.
Slower if needed.
LOTS slower in some cases, especially with benzodiazapines.

Thanks for the comment, AA.

Duane

Anonymous said...

Duane--I'm the Anonymous who posed the questions about informed consent. My questions were rhetorical and only intended as food for thought. I didn't really expect any response and I don't fault Dinah for not responding.

I'm someone who's had some bad experience with psychiatry, but I don't fault every psychiatrist or condemn the entire profession. The doctors who run this blog are providing an open forum for discussion among all kinds of viewpoints.

You're clearly a passionate advocate, but the dialectic requires civility. I ask you, as someone who is sympathetic to some of your views, please tone down the hostility.

Thank you.

Roy said...

This so-called 10% rule makes a lot of sense. In response to a change in the brains stew (meds, trauma, chronic stress, etc), it generally takes neurons a couple weeks to fully generate new or recycle old protein machinery. See my post from today about this.

Sarebear said...

Constantly posting a variety of links smacks of advertising, whether it's advertising your own point of view or whatever. If your comment can express your point of view well enough without having to frequently attach a bunch of links, this feels like spam.

I hope that if you violate the rules they've set up for you in this post (and I believe it was going above and beyond to even give you 'any' space to advertise your varieties of links) I do hope they delete such posts in the future; they almost have to, since it's been said that will only be allowed in this thread, with single links back to this thread when you have new links.

I don't come here to read spam. And that, I think, is why Dinah is saying what she did (um, sorry for the mind-reading, Dinah lol!)

Sarebear said...

That's "if your comment CAN'T express your own point of view well enough . . . ."

Anonymous said...

Duane wrote: "The "risk/benefit" analysis you speak of is IMO, a "risk/symptom relief" benefit. Not a medical benefit in the sense of helping "cure" or even "heal.."

Okay Duane, it's nice that you have a Master's degree. I have two of them. They still don't qualify me to speak about medicine except with respect to my own experiences as either a patient or someone working in the system. As for your comment above, I will speak about my own experience and say that while I have mostly not had a great time with meds, not one doctor has ever said or implied that they were a cure. The most I have ever heard is that they could control symptoms and if I was lucky, delay time to relapse. Believe me, I have seen enough doctors that I find it tough to believe there are very many touting the meds as a cure.

Anon
(insert string of letter to signify completion of three degrees and please add up the number of years in the labor force as well as the experience of bringing up the heir and the few spares we have)

Altostrata said...

Dinah, let me point out that you only continue to see your satisfied customers. The customers who decide that you're going in the wrong direction with their therapy, or that you're outright clueless, leave your practice.

Patients very, very seldom let a doctor know that he or she has injured them. They are so shocked and appalled by the betrayal of trust, you'll never hear from them again.

Thus, any psychiatrist's subjective experiences are not only colored by his or her desire to see his or her contribution to the universe in the best possible light, but by sampling error that favors that prejudgment.

May I also point out that pharmaceutical advertising on TV is driving customers to you who are already primed to think you will work magic with drugs. Pharma propaganda in general has predisposed them to be eager for treatment. Cognitive dissonance will prevent a patient so invested in realistically evaluating the cost-benefit of drug treatment, even if she or he experiences deleterious side effects.

So, yes, the patients who stick with you like you and seem to get well.

Alison Cummins said...

The problem with all these tapering anecdotes is that we have no idea what they mean.

The problem with the hypothesis that there is no such thing as chronic mental illness, no such thing as a relapse and that all problems are caused by meds is that it is non-falsifiable by anecdote.

Sought treatment for a mental illness and are now better? Of course, you would have been better anyway! Mental illness is not chronic/ doesn't exist!

Sought treatment for a mental illness and are not better? Of course, the meds are making you sick!

Was taking meds, didn't like them, went off and are now feeling even worse? Of course, you didn't taper the meds fast enough!

Was taking meds, didn't like them, tapered off over ten months and are now feeling even worse? Of course, you didn't taper the meds fast enough! Alternatively, Of course, meds/tapering cause permanent damage!

Was taking meds, didn't like them, tapered off over ten months and are now doing ok? Of course, you never had a mental illness in the first place!

There is no single anecdote that cannot be interpreted to be in accordance with this hypothesis. Anecdotes prove nothing. Controlled studies and analyses of the TOTALITY of the evidence are required to tease apart relapse and discontinuation syndrome.

One line of evidence that goes against the hypothesis that what appears to be chronic mental illness is in fact caused by meds is that chronic mental illness existed before meds were invented.

Anonymous said...

I absolutely don't need people like Duane spouting off their theories and making me feel as though I'm somehow violating my child's individual rights by even considering a trial of psych meds for her. I beat myself up enough about this without his help. It is not a decision I am taking lightly. I've been avoiding it at all costs. We've seen doctors, specialists, and therapists. We've tried different behavior plans, reward systems, etc. We've tried natural supplements. Ultimately her symptoms are worsening.

I hate the idea of medicating her. I don't like taking psych meds myself and quite frankly refuse to take them a great deal of the time. I firmly believe that medication options for children are even more dismal. However, we're at a place where I am more and more concerned for her safety. I don't want to medicate her but I have agreed to see yet another specialist and at least listen to the options with an open mind. If medication could even POSSIBLY make her happier, healthier, or even just safer then I feel as a parent I at least need to consider a trial period.

To make a broad statement that children shouldn't receive psych meds is upsetting to hear. I impose enough guilt on myself, I don't need to hear it from others. But really we're at the end of our proverbial rope and I don't know what else to do for her.

Sarebear said...

It's a parent's decision to make the best choice they can medically for their child(ren). This includes medication, and, Duane, even includes psychiatric medication, although I know you doubt the validity of psychiatry as a medical profession, and feel no child should be on psychiatric meds.

In the real world, there are real people, and real children, with real problems that don't fit into your black and white thinking, Duane. I'm sorry if this offends you, but psychiatry IS a medical specialty and they ARE doctors and most do their best by their patients, at least most try to. There are always bad apples.

Parents of children with real, complex problems, do not need MORE guilt foisted on them by people insisting that they aren't even seeing a valid medical doctor, let alone that they shouldn't be considering psych meds for their kid. If the situation should warrant considering meds for the kid, THAT is between the medical professional (ie, DOCTOR, ie, PSYCHIATRIST) and the parent(s) of the child.

Not for other people to judge. Yes, go out there and raise awareness of how some people think children are overmedicated (for all I know, they are, but that doesn't erase the cases where medication is needed). But don't throw the baby out with the bathwater and insist that NOT ONE CHILD EVER should get medicinal help for problems that aren't responding to every other treatment they try.

I don't believe, Duane, that anything I said here will sway you. But if I let that keep me from posting, people like Anon above me will not receive the support they need.

Anonymous said...

Anonymous,

Not to sound like I am defending Duane but here is how I see the situation with medication and children.

Too many kids are being put on medications for what I call "life issues." In my opinion, that is a very legitimate concern.

But in my opinion, the problem with legislating against allowing meds for kids is then you end up preventing folks like your kid from getting it who really need it.

By the way, I encountered a similar issue on a Yahoo Groups email list in which people suggested that psych meds be completely banned. I said hmm, what about people who are tapering off of meds, then what?
When they came back with what I felt was some nonsensical response, I unsubscribed from the list.

Anyway, I have alot of sympathy for your situation with your child due to feeling like I was at the end of my rope regarding insomnia when I was tapering off of psych meds.

A slow withdrawal greatly helped me get off of 4 meds but unfortunately, it didn't help much with insomnia. I was desperate and if I could have found a psychiatrist who I thought understood withdrawal and sleep issues and prescribed medication in a responsible fashion, I would have taken it in a heartbeat.

This was even though I was trying to get off of medication permanently. But as we all know , lack of sleep isn't a good thing either.

Unfortunately, a person like that was way out of area which obviously didn't do me any good.
He didn't know anyone in my area that he could recommend.

Fortunately, I was able to fight through it even though it was a rough ride.

AA

Duane Sherry said...

Anonymous,

A master's degree simply means I remain a "freshman" in the eyes of academia and medicine. In fact, I think I mentioned that in the comment that "I don't know everything."

Sarebear.

I've been reading your comments.
I've been listening, and have "heard" what you've had to say.

The brain -

I'm not sure any of us... including psychiatrists know much about the human brain.

IMO, it is, has been, and will likely always be a scientific phenomenon, a spiritual mystery.

No other comment.

Duane

Anonymous said...

Duane,

A Master's degree means you are freshman in the eyes of academia and medicine? I think that first year of your Bachelor's degree is the Freshman year. I know lots of PhD peeps who can talk your ear off about one very narrow topic and lots of M.D. types who cannot string a sentence together.
A degree means nothing in isolation. Some degrees mean nothing when they are bought or "earned" at dubious institutions.
There is no degree that is worth a darn if the holder cannot think critically and manage to hold two opposing views in his or her mind without having to resort to some camp at either end of the spectrum for relief of pressure between the earlobes.

Discover and Recover said...

Anonymous,

On the subject of "freshmen."

I know a professor who used to tell students, "If you're learning everyday, and willing to keep learning, you'll always be a freshman in life."

I don't claim to be a Dr. Breggin, but I do find it fascinating that he was able to help several people walk out of psychiatric wards during his freshman year of college, and I think it would be fair to say that he makes a strong case for "love" being the greatest healer.

One woman in the ward was silent... Not a word to anyone, until he started to visit... He would sit on the floor with them, and talk... and just listen. She never talked with anyone before he arrived... Soon, she started to talk, when Breggin started to leave... The word she used? "Stay."

IMO, two advanced degrees that would help on the subject of psychiatry would be an MBA and an advanced degree in political science.

IMO, this is aboug clever, unethical marketing, and political control.

As far as the comment about earlobes...

IMO, having a moral compass is a good thing for anyone who works with people who are in crisis, suffering emotionally or otherwise.

Not everything in life is black and white. Some things are.

And we didn't end up in the spot we're in because of a lack of political correctness.

We find ourselves in the position now of needing good people who begin to do the right thing.

Political correctness is not my strong card.

So what?

Duane

Sarebear said...

Duane, I really can't comprehend the thought that psychiatry, its medications, and all the other issues involved in it, are black and white. It's FAR too complex.

I'll agree to disagree with you here, but wanted to state what I thought of what you said (though I was assuming it was about your most vehement positions, those being about what I say above.)

Sara

wv = tapea taper if your're from Boston

Discover and Recover said...

Anonymous Parent,

A holistic approach is not a 'one-size-fits-all approach.

Some parents find benefit for their kids with Orthomolecular Medicine, but others with Enviromental Medicine, Functional Medicine, Naturpathic, or Cranial Osteopathy, and a host of others.

It's not always about adding supplements... Sometimes it's about eliminating culprits from a diet. There can be food allergies, poor intestinal absorption (Natasha Campbell-McBride, M.D)... lots of things at play.

Sometimes, it's stress-related. There is Neurofeeback, along with other forms of relaxation that can be helpful as well.

It was not my intent to add to any guilt you're feeling.

I hope you find some things that help your daughter live a happy and meaningful life.

Duane

yobluemama said...

This post is the first I have read and I must say it is humorous how much effort the blog's author put into what is a pitiful attempt at appearing respectful towards a person who challenges the drugging of humans with psychiatric drugs. It is humorous to me because the practice of prescribing drugs which are tolerated by a much smaller number of people than would recommend their broad use; yet psychiatrists are continuing to defend the practice...

The one thing I note about the writer of this post in her response about "Informed Consent" she acknowledges that what she and Duane would consider to be sufficient information to share with a patient differs. I am just a mother who has been misinformed and/or outright lied to by every single psychiatrist who has treated my now brain damaged adult son. I urge you to consider if a patient who experiences dependence, obesity, diabetes, akasthisia, tardive dyskinisia, or any other iatrogenic illness as a result of taking drugs you prescribe, would believe you had fully informed them?It seems to me, that if psychiatrists follow the Ethics Guidelines for Informed Consent, or the Nuremberg Code; they would not be forced to defend themselves, or the profession.

It seems to me, "The lady doth protest too much"

yobluemama said...

CATIE Trial
RESULTS
Overall, 74 percent of patients discontinued the study medication before 18 months (1061 of the 1432 patients who received at least one dose): 64 percent of those assigned to olanzapine, 75 percent of those assigned to perphenazine, 82 percent of those assigned to quetiapine, 74 percent of those assigned to risperidone, and 79 percent of those assigned to ziprasidone. The time to the discontinuation of treatment for any cause was significantly longer in the olanzapine group than in the quetiapine (P<0.001) or risperidone (P=0.002) group, but not in the perphenazine (P=0.021) or ziprasidone (P=0.028) group. The times to discontinuation because of intolerable side effects were similar among the groups, but the rates differed (P=0.04); olanzapine was associated with more discontinuation for weight gain or metabolic effects, and perphenazine was associated with more discontinuation for extrapyramidal effects.
The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons."

http://yakimavalleysystemsofcare.blogspot.com/2011/06/results-from-two-nimh-studies-teoss-and.html

The SSRI antidepressants and neuroleptic, "antpsychotic" drugs were inefficacious for the majority of the people who took them in Drug Trials...why are they so widely used?

I sympathize with any parent who is struggling to help a child---the parent who blames Duane for causing them to feel guilt---no one can make you feel guilty. As a parent who trusted and believed that I was being given accurate information, I feel guilty that I trusted the psychiatrists who misinformed me...This is a guilt that is misplaced, and it is due to the massive betrayal of trust that being misled by "medical professionals." What I really feel is BETRAYED and outraged that psychiatrists develop "treatment protocols" and "practice parameters" based on subjective opinions and agreement among themselves to follow a particular course for a particular diagnosis, e.g. consensus; It is not scientific or acceptable; given the results of the drug trials, and the harm done to patients. Treatment recommendations should be based on the evidence; not marketing strategies, and a "consensus of professional OPINIONS!!" Does anyone really doubt that psychiatric drugs would be used a whole hell of a lot less if psychiatry was practiced ethically and honestly by more of it's practitioners? Who believes psychiatric drugs would be so widely prescribed if the prescribing were based on trial outcomes, and truly INFORMED Consent?

It is criminal to mislead or lie to a patient or a parent---if a psychiatrist does not openly share the fact that dependence, debilitating iatrogenic illnesses, and death are possibilities when taking antidepressants or neuroleptic drugs; they are not sharing very pertinent information! The patient is not informed. I was not informed of these risks and the damage to my son is profound: he is dependent on the drugs which caused him cognitive and physical disabilities and will, likely cause him to die young...

Anonymous said...

Dinah,

One of Duane's friends has written about you at :

http://bipolarsoupkitchen-stephany.blogspot.com/2011/06/discover-and-recover-blog-author-duane.html#links

Stephany said...

ref the comment above mine, yes Dinah and Roy have both left comments on my blog post re Duane Sherry's 'space' here.

Readers can view the post here, and for the record, I am a parent who blogs about transparency in pharma, doctors, COI, etc. I am a parent of an adult child now disabled and unable to function as a typical 20 something would as a result of being mis dx bipolar age 11 and drugged to the eyeballs as a result. The label has since been removed (by doctors)and my hope for quality of life for her is my daily mantra so to speak.

I appreciate Duane's story as it is similar to my own, as parents of children harmed by psych meds.

herb said...

I was lead to this blog as from time to time I read Stephany’s site with specific interest as to the wellness of her daughter and some of the comments rendered therein.

By way of background my spouse and I are approaching our 50th anniversary and of those many years we were confronted about 36 years by my spouse’s diagnosis of MDD. Through all these years I have not only been her lover and spouse, I have been her very caring, effective and vocal support person and health care advocate.

I have seen many changes take place as it relates to psychiatry and the care of patients and more specifically as it relates to my spouse. I can understand and respect the positions of Mr. Sherry, Stephany and others but then again I also can do without what I read as their incessant dogma. I can also respect and understand the difficult position of many of my spouse’s attending physicians who while caring for her have always tried their best, one way or another, to obtain some degree of wellness and stability over her very devastating illness without rendering any assurances or having answers to my numerous questions.

There is no doubt, in my opinion; there is an important need for disclosure in all of the medical fields and especially psychiatry. This is not to preclude that any criminal acts have been perpetrated and while Senator Grassley investigations may have uncovered the questionable and inappropriateness of a number of relationships and to the best of my knowledge I have not read of any criminal indictments.

I would have posted these comments to Stephany’s blog if not for the fact, in my opinion, she has felt challenged by my questioning her actions and unresponsiveness through the years by asking why would a parent give a drug to a child for bedwetting and why would a parent not be knowledgeable of the drug being administered to the child and its potential side-effects. Why would a parent standby while seeing her daughter gain 100 lbs. from a drug without interceding and/or modulating the therapy whether or not the potential side-effect was known; this amongst a number of questions I would have liked an answer to without need for personal attacks.

Having stated the aforementioned brings me back to my all-important and very long-held position of advocating the need for patient and/or support person education while encouraging hope and persistence. As it pertains to psychiatry I am for the least invasive therapies to be considered first such as diet and exercise, talk therapies and its various disciplines, holistic approaches etc., etc. and if need be medications and other therapies conjunctively and/or standalone etc. When one has exhausted various treatments without beneficial results and as my spouse’s psychiatrist has stated, “What other alternative(s) would you suggest?”

As a spouse, parent and grandparent I don’t necessarily first look to medications for a resolve knowing as I do that even aspirin has the potential to kill and as it relates to psychiatry and in my spouse’s case history we exhausted most all of the former approaches over some 4 decades without any reasonable efficacious result. Most all the practitioners of psychiatry attending to my spouse’s care have been responsive to her needs and me.

With some 5 decades under our belt of having to work with and collaborate with neurological and psychological professionals in her care I can state we have been most fortunate. I can also state with their assistance my spouse has been almost continuously depression free these past 12 years. We no longer have needed to discuss depression.

It is my opinion as a support person that those challenged by these horrific illnesses need the professionals to have available all potentially beneficial therapy options along with patient understanding and knowledge that there are no guarantees of efficacy and the potential for serious side-effects.

Warmly,
Herb
vnsdepression@gmail.com
http://www.vnstherapy-herb.blogspot.com