The Challenge of Going Off Psychiatric Drugs
newyorker.com
newyorker.com
A few years in, I found a psychiatrist who was willing to experiment and we discovered that the two meds above helped tremendously with the insomnia. I was then getting a solid eight hours most nights. There were side effects but they were much better than suffering with the insomnia was.
Now, after a decade, the insomnia seems to be completely gone. Knowing that I have medications available to me that can help me get to sleep is enough that I think I don't actually need the medications any more. So I'm very slowly going off of them. Klonopin first. There are, as far as I know, no guidelines for how to do this. I tried cold turkey, but the side effects from that were fairly severe. So I started tapering. I'm now down to half my original dose. If things go well, within four months I'll be off the Klonopin for good, and then I'll start on the Remeron.
These medications are not easy to stop taking.
Honest question: Have you ever considered that your insomnia was psychosomatic and, through your doctors involvement in for-profit sales of pharmaceuticals, socially re-inforced?
In my case, I see my psychiatrist once a quarter for fifteen minutes. Klonopin and Remeron are two of the cheapest drugs there are. My meds cost me less than $40 a year. I don't think anyone is making a lot of money off of me.
Cognitive Behavioral Therapy or biofeedback, which are two alternatives that were presented to me, would have been far more expensive.
You may take the view that you can always take them, but circumstances change (your doctor may no longer be allowed/feel comfortable prescribing for a long time - this happened with opiods) or you may not be able to get access with them for other reasons.
The drugs will most likely stop working or rapidly increase in side effects after very long term use, it's generally just a matter of time.
I would strongly recommend you get a plan to taper if possible and look into alternatives. Many think the benzodiazepine withdrawal is as bad if not worse than opioid (plus it can be lethal).
I guess I'm just agreeing with you from a philosophical point of view.
For what's its worth for anyone (including OP) reading this, I found success in studying philosophy as a poor man's CBT especially Existentialism. I think an argument could be made that these two things are the same thing but represented slightly different language and with slightly different goals.
I tried CBT, and it didn't work. Admittedly I only tried it once. There are lots of different flavors of CBT for insomnia, and maybe if I had tried harder I could have found one that did work. The problem is finding a doctor who knows about it and will work with you, especially if you don't live in a big city.
Benzodiazepines are worrisome drugs, but I have to admit that for my insomnia, they were almost magic. Once we got the dose right it went away almost literally overnight. But then, as the OP illustrates, doctors aren't necessarily helpful in getting back off them.
Truth!! I had to discover this for myself as well, and I'm continuing to figure it out as I go (currently lost about 50lbs in a 150lbs weight loss journey).
I'm sorry if I came across as judgemental, nor do I want to diminish your accomplishment. As someone on both sides of these drugs, it is no easy feat to make this big of a change. Kudos!!!
It sounds like the medication has done its job in that it has given you relief to get some sanity back and to focus on other options.
Once you have insomnia for a few weeks it tends to be self-reinforcing. I didn't get adequate medical care during the first few weeks, when it was acute, so it became chronic. I tried, but the doctor wrote me a half-strength prescription for Ambien, and that was all. It didn't work.
But the thing with insomnia is that it is self-reinforcing. You get conditioned to lying in bed awake, and that's what your brain then expects to do when you go to bed. And then you get anxious about it, which makes it worse. Once you have it, removing the original cause doesn't solve the problem.
In my defense, I worked under these conditions for five years before it became an issue.
There's various schedules on how to do it, here's a good starting point: https://www.aafp.org/afp/2017/1101/p606.html
My personal rule is to never be taking benzos for more than 3 days in a row, to avoid being in a dangerous withdrawal situation.
I did not know this could have been life threatening. That's... comforting...
[1] https://qz.com/677980/opioids-arent-the-most-dangerous-drug-...
[2] https://en.wikipedia.org/wiki/Benzodiazepine_withdrawal_synd...
Doctors are often ignorant of the need to taper benzos over a long-term period, and not rapidly. Some might see you coming to them with a problem quitting an often abused drug as a sign that you need to be taken off of it as soon as possible. Sometimes instantly.
Of course you should always let your doctor know when you're taking less medication than you're prescribed. I suggest consulting with a specialist before trying to quit with a GP or your run-of-the-mill psychiatrist.
I ended up moving my prescriptions to my GP and managing the tapers myself, because the doctors don't really know how to do it.
I've had a lot of complaints about various psychiatrists, but one constant even among the worst has been that they were always very, very cautious about the need to taper and the possible risks involved.
My partner started taking sertraline (Zoloft) for depression, and started grinding their teeth at night. Their dentist asked if they'd started taking any new medicine lately, and was like "oh yeah that'll do that."
My partner's psychiatrist literally did not believe that the medication could cause this - despite it being right there on WebMD, not exactly secret knowledge.
Currently looking for a new psychiatrist.
That happens in every field. It’s just shitty when you’re depending your health on them instead of a deadline.
It makes you look a bit dorky but it's better than not sleeping (or mania).
The product used in the study (and the one that I've seen work) is:
Uvex Skyper Blue Light Blocking Computer Glasses with SCT-Orange Lens (S1933X)
Before, my eyes were super heavy and aching by the end of the day, and now they feel as though only an hour of screen time has passed. Thing is if I take them off while working/looking at any screen without a blue light filter, they start aching within 10 minutes :/
https://willhall.net/comingoffmeds/
I consider it the bible.
Being on such meds may work, keeping the patient stable. Nobody mentions that when a couple doses are missed, the result can be a week of anger & angst as resumed medication balances back out again - living hell not just for the patient, but for those around.
Weaning off such meds is difficult, reducing doses by literally counting out & down individual granules of medicine daily.
Easy to get on. Nightmare to get off.
I think the reason its under-discussed is that there is a collective group-think which functions as overwhelming (to the individual) reinforcement: "there is no other way available to solve this problem than the mass sale and consumption of pharmaceuticals".
The moment someone proposes a non-pharmaceutical (read: profitable) solution to many of these ills, they are shut down by the group-think. This is under-discussed, imho, because in the context of social/peer pressure to conform to a very Western normative (consumerism), individual responsibility is shut down.
EDIT: and the downvotes demonstrate my point, because "everyone knows pharmaceuticals are the only solution" ...
I think there are very definitely market forces at work, keeping people in the mindset that pharmaceuticals are the only 'real' effective solution to their ills - when so, so many other alternatives are available. I don't doubt that chemicals can make peoples lives happier - I see it all the time.
What I resist, however, is the notion that individuals should subjugate themselves to collective will just because everyone says pharmaceuticals are the way. Maybe strengthening ones resistance to groupthink and collective-derived thought processes is also an effective way to strengthen ones mental health .. alas, this point of view is too often overwhelmed by the very mob it serves to service, however ...
What I'm getting from this is you have a specific agenda against "group think and collective-derived thought processes" and are being purposefully vague, as demonstrated with "...".
What is your alternative? You seem to have one in mind.
Case in point: The West's mental health addiction problem. It isn't getting better because of pharmaceutical treatment: its getting worse.
My only point is, don't just blindly accept pharmaceutical dependence without at least considering the alternatives. Pharmaceutical addiction is no benign thing - addiction and dependency is a key factor in the profit motives of the military-industrial-pharmaceutical complex. Before you fall for their traps, be sure you've considered the alternative.
Accepting ones own personal responsibility is a requirement for a healthy mental condition; leaving the responsibility for ones mental health to other agencies and denying ones own agency - well, this is the very definition of mentally un-well.
Educate yourself before you fall into this scenario, is what I'm saying. Sure, if you're so mentally un-well that you can't care for yourself, you're going to need help - but too many times, that help turns to betrayal when one problem (mental illness) gets supplanted with another (pharmaceutical addiction).
There are no silver bullets to mental illness - not even the ones that come in a nicely packaged pill container.
We do not have the handle on mental illness that we think we do.
So no, just assuming "because everyone else is doing it" is not a good enough reason, imho, to put oneself in the position of addiction to pharmaceutical products. Take personal responsibility, and consider the alternatives before one becomes pharmaceutically dependent in order to maintain a 'healthy life'. This is a mine-field, and is by no means a settled issue in our current culture.
Agreed!!
> I just want there to be an awareness that all therapies aren't created equal, and people could be lead some bad places depending on how poorly educated they become. After all, people still use alcohol to cope with mental health. Who knows what ridiculous notions someone could come up with given enough ingenuity and misinformation?
Unfortunately in my experience, the level of education doesn't help. I've known medical doctors that know exactly the risks involved yet still make poor choices because they haven't resolved the underlying issues. Medical doctors can be good at treating other people, but very bad at "treating" themselves and family.
So the best answer I can come up with is, who cares if someone wants to use alcohol (or heroine, etc.) to get relief as long as it's not causing anyone else physical or mental harm, recognition by that individual that its a crutch therefore temporary, and a focus in resolving the real issues.
And that's really why you need a medical doctor taking the edge off your symptoms and therapist who helps you deal with the underlying issues themselves. Medicating and go is a terrible, terrible idea.
Do you mean a over reliance on antidepressants for treatment?
You meant American, because in the UK the front-line treatment for depression or anxiety is a talking therapy, coupled with social prescribing (which to be fair has variable availability), and then medication if indicated.
OP talks about a long term prescription for clonazepam, and current advice is that long term benzo use must be avoided.
It's the front-line treatment for mild depression and mild-to-moderate anxiety, because of the poor evidence for the efficacy of antidepressant medicines for patients with less severe illness. SSRIs and talking therapies are recommended equally for moderate or severe depression and severe anxiety, because the evidence suggests that they are equally effective.
NICE guidance states that benzodiazepines should not be prescribed for more than two weeks, because of diminishing efficacy and the risk of dependence.
SSRIs are cheaper and more convenient than psychotherapy, which should not be underestimated. The NHS certainly can't afford to offer psychotherapy to everyone who could benefit and many Americans don't have adequate insurance coverage. Getting psychotherapy outside of office hours can often be a significant challenge, which is a total dealbreaker for many people. I would certainly like to see greater use of psychotherapy (particularly for people with chronic and/or severe disorders), but there's nothing innately wrong with the widespread use of a safe and effective class of drugs. There just isn't any evidence to suggest that SSRIs are inferior to psychotherapy, although it may be the case that some patients who do not benefit from SSRIs would benefit from psychotherapy (and vice-versa).
https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#ste...
https://www.nice.org.uk/guidance/cg113/chapter/1-Guidance#st...
I was prescribed Lexapro a few months ago, and while I don't have any plans to go off of it in the immediate future, I did have an encounter with unexpectedly discontinuing it a couple of months ago. I was planning on getting my prescription filled on a Friday, but forgot. I realized this at 12:30pm on Saturday, after the pharmacy had closed. I went without Lexapro for three days: Saturday, Sunday, and Monday (it was a holiday). During that time I lost a significant portion of my hearing of all things; things sounded muffled, as if I had pressure built up in my ears and needed to pop them, but I could easily pop them and it didn't improve. I was also very irritable and had "brain fog", but that wasn't unexpected and was manageable.
Tuesday my pharmacist said that he'd never heard of anyone complaining about hearing issues discontinuing Lexapro and to let him know if it didn't clear up. About three hours after taking it again, I noticed I was able to hear better, and by the next morning I was back to normal.
The best sources of data are your historical responses and those of your family members, and even then, it's really unreliable.
Historically, I have had extremely few side effects from any medication, cold turkey (unintentionally, except for v. small doses of v. safe meds) or tapered off, and I have unfortunately had occasion to try a large spread of psychopharmacology.
Some of those medications either did nothing for me from their primary/intended effect set, while they were extremely effective for family members - not just limited to psychiatric medications, but they do have a great deal of variability in response compared to some.
Some medications that work on me but have no obvious secondary effects than sometimes mild sedation (opioids) do nothing for some of my immediate family (positive or negative) or are extremely powerful on others.
Some medications that leave me with no positive or negative emotional responses to anything are extremely effective for some immediate family members and even worse for others.
Some medications that are strongly sedating for some of my family members (antihistamines) have never done anything useful for me.
Some medications (both in the ??RI classes and a couple of atypical ones) that are helpful or neutral for me induce manic or depressive episodes in family members.
This is a hard problem, and it's going to take a good amount of work and better data curation (e.g. not asking a patient what they took for how long and how well it worked by word of mouth as a primary source) before we get any better at guessing.
Nausea, tremors, memory loss--these are just the basics. Throw in anhedonia and loss of desire for good measure, and long after you've stopped the medications too.
The options as I see them are either: be miserable, and probably just die, or: be not miserable, but sabotaged and unable to actually enjoy your newfound life. This usually just leads to a cycle of starting and stopping medications, desperately trying to have a happy yet functional life that is worth living.
The first month of antidepressants is hell, since you're compounding depression or anxiety with the nausea of the onset symptoms. Risk of suicide increases considerably in that first month or so.
There's some recent research that due to the onset effects, the surveys of the patient's well being at the 8 week and 12 week marks are inaccurate or even useless, since it's really hard to objectively measure your state of mind compared to before you started.
It is like her doctors tried to medicate away an epiphany. Realizing that "the glittering balls and designer clothing has no real underlying substance" and being depressed that one's life is limited to such things, is not a cause for medication.
It sounds like she was struggling to be happy in a situation in which she was never going to find happiness.
Finding purpose, the thing she said was missing so early on, seems to ultimately be what helped her. Her reason to get up every day is that she can now help others, instead of live just for herself.
Some people look inward, they want to be the best dressed at the party, have a good career, and overall be successful in life. If that brings them happiness, then good for them! They have found what makes their life fulfilling. But different people need other forms of fulfillment, be it an artist completing their latest work, or someone who wants to have a daily positive impact on the world around them.
Medication cannot make people happy. (Well at least not the legal drugs, and the illegal ones won't work long term!) They can only create the possibility for happiness for those who need some extra help.
But, doctors need to do a better job of discovering if that extra help is just needed, or if the road their patient is going down is not going to lead to happiness no matter what is written on the prescription pad.
But heck, look at the diagnostic criteria for Bi-Polar,
> The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
That line about "marked impairment in occupational functioning" is a common theme in the DSM. (Hypomania has a lower threshhold, but still involves risk to self) If someone is able to live their life, hold down a job, isn't a risk to themselves / others, then they should be directed to a psychologist or therapist.
Bloody hell, the DSM says this, again and again and again.
In the must be met criteria for ADHD:
> There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
Major depressive disorder, again, with this requirement:
> Cause significant distress or severely impact social, occupational or other important life areas
The diagnostic criteria is pretty on point.
But even so, misdiagnosis is possible. If someone comes in and says that they hate their job and their spouse is abusive, the correct solution is a lawyer / career training (probably in that order?), not a pill!
If someone comes in and says "my life has no meaning", maybe it isn't anhedonia, maybe the activities in their life legitimately aren't of interest to them!
We all feel social pressure to fit in with the culture we grow up with. The great thing about America is, if we don't fit in with that culture, plenty of other culture's abound! But first people have to realize that they can leave the culture they are familiar with if it isn't bringing them happiness.
We all know that one engineer who decided to be become a brick layer, and who is now super happy! Heck one of my friends and old co-workers went from being a preacher to coder!
We all need to realize that laying bricks is just as fulfilling and meaningful as writing code[1] and not being judgmental about people's choice to leave one career behind and go into another.
My masseuse used to be in the corporate world.
One of the best Chocolatiers[2] alive used to work at Microsoft.
Parents, if you kids aren't happy living the upper class lifestyle that you dreamed of when you were working your way up the ladder, then support them doing something else! Tell them that they don't have to live up to your dreams, or fit into the societal image of perfection created by the culture one is surrounded by.
[1] Possibly more so, the bricks are going to outlive 99.9% of code that is ever written, and will likely be appreciated by far more people.
[2] I've traveled to quite a few countries and found her equal, but none that surpass. http://bruggechocolates.com/
This is one area where I think the ADHD community has pulled ahead, good doctors will, when someone starts a new treatment, do weekly check-ins[1] with how one's quality of life is going across multiple metrics. Mood, self image, social life, and work/school performance.
The fact this isn't done for all forms of psychiatric treatment is shocking and sad.
From a non-medical perspective, Cognitive Behavioral Therapy is good in that it tries to help people find fulfillment, or at least come to peace with themself.
[1] Proper ADHD treatment is supposed to be provided by a psychiatrist and psychologist working in tandem and communicating with each other. Unfortunately the % of times this is actually done is most certainly way under 1%. Not even going to get into the insurance issues around this...
She was by no means stable before the medication. In fact - Bipolar, if the hypomanic/manic states hit at the right time, could be a huge help with school. I'm not saying it's in any way right, I'm saying there are broad criteria for getting on medication, and there's no DSM criteria for when she should be coming off.
Also, that story somehow reminds me of someone I know who really is bipolar, she looked somewhat normal until she went completely bonkers, burning down most of her stuff at home, etc... It is serious. She now takes mood stabilizers (lithium) and lives a healthy life. So don't dismiss psychiatry.
At those points the cycle is the problem and needs to be broken.
Frankly I think MD's shouldn't be allowed to prescribe psychiatric drugs period.
These weren't quack diagnoses either. We both saw traditional gastroenterologists, in different states, several years apart, both of us seeking treatment for different things. My diagnosis was confirmed with blood and endoscopy, as well as a follow-up DNA test to make sure I had the right mutation that makes it possible for celiac to arise.
But it can allow one to find happiness. Depression is a chemical imbalance, and not everyone can overcome it on their own - especially if left untreated for extended lengths of time. The medicine helps people get back into balance, so they can start to work on their happiness again, whatever that may be.
> They can only create the possibility for happiness for those who need some extra help.
That is literally drug company marketing propaganda.
There are phase 3 randomized controlled trials that prove differently.
Your statement is completely anecdotal and carries no weight without the references.
P.S. My statement wasn't an anecdote.(I think you're using that word incorrectly)
(Also no one is taking effexor to get high!)
An SNRI isn't going to make people feel happy or joyous. It may lift the fog of depression and allow one to feel happiness, but it doesn't create it on its own.
Joy in a pill, without long term side effects, doesn't yet exist.
Well if removing pain isn't happiness. It was for me. At least I don't think any more of how killing yourself is only a problem because of the people that will stay alive and suffer because of your suicide.
My comment was "without references...", ie. facts or research, it would make it anecdotal.
As others commented, "lack of depressive symptoms" is very different from happiness. That's what "numbness" is.
I don't see you asking other people to reference the stuff they're coming out with.
I'm not trying to be the "reference" police, I glanced at the first page or so of comments and this is what stood out to me as being against the multitudes of information/research that I've read.
It seems poor form to reject someone else's point by saying "studies say otherwise!" and not provide the studies.
Additionally, there are few longitudinal studies that show antidepressants as being effective and reasonably side effect free.
Worse, neuroleptics leave the majority of long term users with lifelong tics, tremors, rigidity, and other Parkinson’s style symptoms.
But yeah, there’s a study showing they make people happy with a slightly better efficacy than placebo.
Playing with fire has its risks. Listen to the burned ones, it’s more complicated than a whitepaper.
The issue with SSRIs for people who are bipolar is that it can trigger a manic episode.
In the end, I opened up the plastic casing of the pill, which turned out to contain a few dozen grains. Over the course of 2-3 weeks, I took a few grains less every day, until I was completely done with them. I don't know if you're allowed to do that, maybe there is no guarantee that every grain contains the same amount of medication? I'm not a fan of tampering with medication, but I didn't feel like I had a choice.
There are entire fields of material science dedicated to this problem. Generally, if a single pill is metered into smaller doses, resources went into ensuring that each dose is metered accurately. The grain form was probably for absorption or time-release.
This term, "prescription cascade", should be lesson #1 at medical school. It's the natural result of an incomplete diagnosis, and is present in every medical field.
> At the hospital, where she stayed for two weeks, she was put on a new combination of pills: Lamictal, a mood stabilizer; Lexapro, an antidepressant; and Seroquel, an antipsychotic that she was told to use as a sleep aid.
(emphasis added)
These descriptions -- mood stabilizer, antidepressant, antipsychotic -- are just marketing terms that don't actually describe the actual function of the drug. These marketing terms are most useful for tricking medical professionals into prescribing these products.
'Antibiotic' is the prototypical name for a class of drug that does what it describes: acts against bacteria.
> She saw her drugs as precision instruments that could eliminate her suffering, as soon as she and Dr. Roth found the right combination. “I medicated myself as though I were a finely calibrated machine, the most delicate error potentially throwing me off,” she later wrote.
I think this attitude is probably common for all the smart people who find themselves medicated into a downward spiral.
> “It is tempting to add a second drug just for the sake of ‘doing something,’ ” a 2004 paper in Current Medicinal Chemistry warns.
This is the trap the mental health system has fallen into: the professionals want to help. The drug industry has FDA-approved drugs for the various diagnosises.
Joel on Software said a re-write is something that shouldn't be done. But what other choice does the mental health industry have? Their system doesn't work. The modern industry is based on the flawed chemical imbalance theory of mental illness.
Little bits of progress have been made, in spite of the inertia to treat misunderstood behavioral problems with patent medicines. I have to conclude this comment before I can finish the article, so I'll link to my recent comment on the submission on the Szasz's book, the myth of mental illness: https://news.ycombinator.com/item?id=19243417
edit: shortened my first quote from the linked article
Same for antidepressants - often the same drugs (especially SSRIs) are both antidepressants and anxiolytics, but both labels are useful descriptions of the meds' common effects. Antidepressants in particular happen to be fantastically idiosyncratic drugs, but on average they do what they say on the label.
Part of the problem is that, due to the ill-understood nature of the brain, good psychiatrists need to know strange drug interactions and ill-studied minority reactions in order to serve the full range of their patients. This edges on art rather than science, which is always a recipe for cognitive biases to gain control.
> due to the ill-understood nature of the brain,
I think this is exactly the problem. We have a bunch of drugs that seem to work, and we think we know how and why they work, but we're not able to directly measure the problem in those terms. If someone has a bacterial infection, we can culture it and prescribe the correct antibiotic. If someone has a mental health condition, we almost always have to consider the way that it's presenting and make an educated guess as to which drug is going to be effective. It's not at all uncommon for that first guess to be incorrect, which leads to either iteration or a "cascade" depending on the practitioner.
The medication that stopped him from hearing voices pre ECT/episode started again after ECT. After a year, the Psychiatrist is still trying to find the right combination of medication to stop it - they've (I think) more than tripled his current dosage of lithium along with others that I'm not aware of but it's unpredictable how much time the medication change actually takes effect, could be anywhere from 2 weeks to 2 months.
I don't know where I was going with this, just sad to see him like this.
If he's ordered to submit to involuntary mental health treatment, you can probably request judicial review on his behalf. This would be to let the court know that your friend was doing better before the ECT treatment, and that you are concerned that some of his problems are now caused by the treatment itself.
Edit: I commented on lithium a few weeks ago: https://news.ycombinator.com/item?id=19299137
How can I, advocate on my friend's behalf against a Psychiatrist who has been working with him for years when I have no expertise in the field? Do I trust that his Psychiatrist has already thought the same thing?
Maybe I can leak some info to him (like those articles) so he can think for himself and talk to his Psychiatrist about it.
Technically he was doing better pre-ECT, but stress got to him and when comparing to when he had his episode (lasted a while before deciding on ECT), technically he's doing better post-ECT than during that phase.
I'll take a look at that thread, thanks
> but stress got to him and when comparing to when he had his episode
Stress is the major factor in most of these conditions. My recent comment about the Quakers and their asylums [0] is relevant: most of their patients got better with nothing more than 4 meals a day and the expectation that they could recover if given appropriate support.
Malnourishment is the other major factor. My friend's involuntary treatment provider eventually did a genetic test that found she can't turn folic acid into folate. Getting supplemental folate has made a big difference for her misdiagnosed "mental" condition. B-vitamins... eggs... more coconut oil, less vegetable oil... fewer grains, more fruit (juice, apples, etc).
I am skeptical of tcj_phx's advocacy of resistance to lithium. It's a very effective drug with horrific side effects, and it seems to have worked pre-ECT. It sounds like the psych involved is aware of the safe limits for lithium, as hitting the maximum safe dosage for one drug is usually what (in my experience) causes psychiatrists to start mixing different meds. (Which comes with its own problems, since as side effects multiply they get harder to understand.)
They gave me the heavy anti-psychosis meds too (I can't remember the name) and it did nothing for him either.. But yes, he's taking so much medication I can't imagine trying to map out all the potential side-effects of any combination.
This is the most harmful idea in psychiatry and it's pure marketing bullshit -- everyone knows it, but they still sell this to people.
Here's hoping you don't have serious mental health problems in the future.
EDIT: By far the biggest part in me getting better was moving on to a different way of life. Basically, changing the set and setting. Which I think is underrated by the professionals described in this article, hence the problem:
Treating the symptoms, not their source.
I went from enjoying a good night's sleep to completely dependant on it just to function.
The only way to describe it was that I became "psychologically fragile" such as if things didn't go exactly according to expectations I would be in a state of panic and fear. It was horrible.
I decided then to go cold turkey (no one told me otherwise) and it was hell! I thought I would die or lose my mind. To say nothing of the electric shock sensations that were constant and the feeling that my skin was buzzing. After a couple months I felt like myself again and my mental fortitude had returned. I will never take another.
For me the benzo class of meds are way more dangerous than helpful.
I had suffered a reaction to an antibiotic, it is now documented by case studies, FDA, and EMA. I still have some side effects years after last dosage. I have seen maybe 30 docs over the years, ONLY ONE agreed that my symptoms appear to be a direct reaction to that medication. Few refused I even after I showed that information. Said "it doesn't really matter at this point"....
Imagine this: You know arrays start at 0 in C#/Java even though you don't program but you saw a meme online. Now, you want to have an application developed. During the first conversation with a dev he says, ah "no problem we can use arrays and those start 1".......This has been my experience, the amount of doctors that just are ignorant, relying on knowledge from 80's when they attended school is saddening. Entering the medical system has been eye opening for me, I feel that developers could do a better job treating people with just google (obviously surgery is different, I am talking mainly about prescriptions)
Drug companies like to sell drugs like soda companies like to sell soda.
The conflict of interest is so awful that sometimes I wonder if we should ban for-profit drug companies.
Personally my anxiety/depression when it flares up is virtually always a direct result of poor diet/lack of sleep which compounds itself into lack of energy and lack of exercise. Once you find something that works, hold onto it for dear life because you need to use your good times to build good habits.
With any medical decision one of the important questions to ask is "What happens if we do nothing? What happens if we just watch and wait?" This isn't just for mental health. Whatever it is you should ask your doctor that question.
Then you have to balance the risk of side effects and discontinuation against not doing anything.
If you want evidence-based advice from a credible source you can read the NICE guidance: https://pathways.nice.org.uk/pathways/depression
And here: https://www.nice.org.uk/guidance/cg90
Personally - I liked venlafaxine for the first two years but one of the side effects was hard to live with. I was on a high dose for years, and coming off it was rough for two weeks. I'm currently on Mirtazipine which doesn't feel liek it's working, and causes me to feel hungry all the time, but I'm not dead so maybe it is working. I think I would have preferred a more active "off-boarding", although I can understand why in my case people were reluctant to take me off a med that appears to keep me alive. I had low-intensity IAPT (a UK talking therapy thing) which was not good, and I had high intensity IAPT (one to one, face to face with an experienced therapist using CBT for 14 weeks) which was considerably better. Cognitive Behavioural Therapy has a good evidence base and is effective for about 60% of the people who do it (although those numbers are tricky).
EDIT: I forgot to mention that whatever you do I hope things pick up, and good luck!!
With this I don’t want to disparage her personal odyssey or that of people suffering from psychiatric difficulties, but the framing of this article is unfortunate. Very much
Fast forward a couple years and I'm realizing that medications aren't the answer for me. So what do my doctors do? They try to push yet another pill or three down my throat. Finally I'd had enough of it and told them I didn't want to take anything anymore. Their idea of a tapering plan from over 2 years of medications was a week and a half. They were sure to tell me that if I stopped treatment I wouldn't be given any more refills and one doctor condemned me for even showing up to my appointment with the intention of discontinuing medications. He said I was wasting everyones time.
Anyway, I figured sure, I got this. I can get myself off these meds. I was very wrong. I made it about two weeks before withdrawals really kicked into overdrive. Dizzy, brain zaps, tinnitus, profuse sweating all hours of the day, insomnia, numbness in my face and arms, racing heart, involuntary muscle spasms... I started stuttering and couldn't force my body to stop twitching and shaking. My mind was completely fogged over and at times I couldn't even articulate words to talk to someone. It was a state of being in a perpetual panic attack multiplied by 100. After I thought I was actually going to die I setup an emergency appointment to try and get a prescription refill and a longer tapering plan only my doctors wouldn't have it. They flat out refused treatment and told me to go to the ER if I thought things were getting that bad. I was floored. Here this doctor got me physically addicted to powerful mind altering medications over the course of a couple years and now that I want out they treated me like a drug addict and dismissed me.
In the end I sourced some darknet meds and very slowly tapered myself down. To this day I'm still not even close to being back to normal, whatever that is. I get random panic attacks out of the blue on a daily basis. Sometimes the left side of my body will go numb. Other times I'll just start sweating while my heart beats like I just finished running a marathon. The ringing in my ears is horrible. I'm now extremely sensitive to stimulants of any kind (no more caffeine, meh) so I've had to make some significant changes to my diet.
The good news is I've been 100% off any medications for two months now and I'm finally getting to where I can get more than four consecutive hours of sleep several days a week (so much better than zero sleep every day). I feel as though being able to enjoy coffee, sugary drinks, and having the ability to actually sleep an entire night has been permanently removed from my life now.
At any rate, if there's anything anyone should get from all this rambling, it's that you should exercise extreme caution with pill pushing doctors. They have the ability to drag you into your worst nightmare of existence and leave you high & dry when you want the ride to stop.
Wow. Just wow. That's very unfortunate that you had to go through that. That seems beyond malpractice and if its not, it should be. I don't want to dox anyone but those doctors should be avoided...probably by everyone...
(I have a pet theory that some psych meds "de-integrate" the left and right hemispheres of the brain)
Dr. said I was crazy and it had nothing to do with the meds. Sent me for MRI for that and the "brain zaps".
Eventually the left side numb thing went away.
Good luck and wish you well!
I could believe it. Could you explain more?
At the end of the day I had to issue a sort of ultimatum: I was going to discontinue those drugs with or without their assistance, but recognized the risks of doing so and would prefer to do it with their oversight. I did it "against medical advise, but with medical supervision".
Years later I asked for and was once again prescribed Lexapro, but at a lower dosage and for a different issue. Apparently it was either Abilify or the combination of the two that caused my issues before.
Coconut oil, niacin/niacinamide (vitamin B-3), and other pro-metabolic interventions help get at the actual causes behind the diagnosis.
Coconut oil is helpful because it can be directly metabolized by the cells, whereas longer saturated fats have to be ... processed somehow before they can be used for energy (I forget the exact name of the step). Coconut oil is also helpful for alcohol cravings.
Cortisol deficiency is now associated with psychosis [0]. This is one of the manifestations of the metabolic problem at the root of the behavioral symptom (psychosis).
[0] https://psychcentral.com/news/2016/06/04/low-morning-cortiso...
Sometimes metabolic problems are caused or amplified by emotional stress.
Question:
Cortisol is a stress hormone, how can a deficiency cause psychosis?
My earlier comment about the reason some people find alcohol to be so seductive: https://news.ycombinator.com/item?id=14085230
> I avoid coconut oil because of the fats, but I will change it now!
If you're avoiding sugar too, try salted orange juice. This is a good source of sugar and potassium. If your OJ isn't very sweet you can add a spoonful of sugar.
> I already noticed probiotic foods make me much happier.
Good observation. Less-desirable intestinal microorganisms create endotoxin, which have to be detoxified by the liver.
> Cortisol is a stress hormone, how can a deficiency cause psychosis?
Cortisol tells the body to get more sugar into circulation. Cortisol levels are highest in the morning, when it's been the longest since the last meal. Cortisol is released when blood sugar gets low, or when a person might suddenly need a jolt of sugar to respond to a threatening situation.
My current understanding is that when a person runs low on fuel (sugar), their body will compensate by putting its most fuel-hungry organ (the brain) into hibernation: "psychosis".
Alcoholics train their nervous system to run on alcohol. People who become psychotic from alcohol withdrawal need help avoiding alcohol, and retraining their nerves to run on sugar. (Edit: alcoholic psychosis is some combination of inflammation, insulin resistance and fuel deprivation.)
See link above, and search my comment history for 'alcohol'.
Edit: So I guess what are you refuting, coconut oil or the metabolic aspect?
> You can't cure psychosis with fucking coconut oil.
The person I responded to said in a later comment that his psychosis was related to alcohol use. This being the case, coconut oil is an appropriate treatment to help keep his alcohol use under control.
> PLease stop peddling this dangerous advice.
People like HN user clydethefrog (above) and my girlfriend (my comment history) are hurt by the mental health industry's standard of care. Someone probably told clydethefrog that he has now has a chronic condition and that he'll have to be on "antipsychotics" for the rest of his life to keep from becoming psychotic again.
One case study acknowledges the possibility that people who made themselves psychotic through alcohol withdrawal can be made delusional with Abilify [1]. The actual experience of patients is that maintenance antipsychotics makes their condition worse [2].
I think in the very near future the mental health system will have no choice but to listen to the resistance's complaints.
[1] https://europepmc.org/abstract/med/26502575 - "At first, we regarded all the symptoms as alcoholic hallucinosis, by a clinical standpoint, in spite of no auditory hallucination in this case. However, taking the overall clinical course into consideration, withdrawal syndrome could have been affected by some factors. One of the possibilities is that delusion might have been induced by aripiprazole." (emphasis added)
My mother eventually found one that works and is absolutely necessary for her to live a normal life.
Lamictal and Seroquel can cause an often permanent condition called tardive dyskinesia[1]. Basically the dopamine receptors tend to permanent up scale leading to sleep disorders. This is fairly unique compared to most Psychiatric drugs out there.
[1]: http://www.onlinelawyersource.com/tardive-dyskinesia/seroque...
[1] https://www.ehealthme.com/ds/lamictal/tardive-dyskinesia/
If you're curious about this, Stahl's Essential Psychopharmacology textbook goes into detail about this and is written in a way that some idiot (me) on HN can grok it.
True at typical low dosages.
I have been on Seroquel at very high dosages for sleep and the doctor gave me the explanation above. I have after multiple attempts failed to taper off of it. I have even tried liquid. I will definitely check out the book. The key issue being that the receptor up scale permanently.
The problem is when the sadness becomes the crippling kind that prevents you from acting to change the situation that's making you sad to begin with. It can be helpful, I think, to take anti-depressants long enough for you to be able to enact positive change in your life.
My wife was taking anti-depressants as she finished up college, then she went traveling, met me while we were both backpacking, we got married, have two kids. She weaned off the anti-depressants while we were engaged. She gets transitory anxiety attacks every once in a while, but she's told me she's never had a relapse of depression. I think she was just bored and lonely and stressed in college -- a temporary situation.
This is all just my personal opinion, i'm not a psychiatrist.
Depression is sort of different than generic sadness as it DOES NOT drive you to improve your situation, due to the severe hopelessness it causes. It's the massive problem with depression, and why medication can be so helpful. Depression can cause you to stop functioning, even at your situationally reduced level, essentially fucking you over even worse.
As you show, it was an external event that kicked your wife out of her rut. Sometimes that required kick is helped by medication
I experienced depression as symptom of a deeper "illness" of the brain that needs to be cured with psychotherapy. If it wasn't for that I'd still make the same mistakes again and again that made me depressed in the first place.
Meanwhile I expect to be on my anti-anxiety medication for my life, as my brain chemistry is not going to fix itself.
Think of it like Ibuprofen. It's there to help you manage pain, but it won't fix things.
It can "numb" the feelings, like pain meds (as others have said).
Major Depressive Disorder is a specific disease that's commonly called "depression", and I have no idea what the long-term treatments look like there.
Depression is usually a cycle, I'm too tired to go to class, ends up failing classes, great now I'm a useless human, fails more classes, becomes too tired to do anything I normally enjoy, can't focus on homework, becomes more depressed, socializing causes too much anxiety to make friends, etc. This was me last year.
The hope is that with the correct combination of medications you'll manage to "break" this loop. You can start to focus again, maybe complete some homework. You have enough energy to get yourself to class. Your grades improve, you don't self-loath as much, your life improves, you make supportive friends.
Once you have your life back in your control you can consider discontinuing your medication. You might go off it and be fine, now that you were able to focus on your stresses in life and how to handle them, you may find you don't have any issues without your medication. Or everything becomes worse again and you have to stay on it.
To be honest, modern psychiatry is kinda a crapshoot and nobody knows 100% for sure how antidepressants work, why some people don't respond at all to prozac but do to cymbalta, etc. There's a lot of research involving your diet, your gut bacteria's health, your immune system's effect on mood, etc. All of these will be a factor.