“Psychiatric Medications Have Led to Dramatic Improvements in Mental Health Outcomes” (Big Lie No. 2)

In continuing my discussion of Robert Whitaker’s Anatomy of an Epidemic from my last post, I begin with the results of a study on the use of anti-psychotic medication for treating schizophrenia; it is one of many such studies discussed by Whitaker which report very similar outcomes.  This study was funded by the National Institute of Mental Health (NIMH) and conducted at NIMH’s clinical research facility in Bethesda, Maryland.  According to Whitaker:

“[T]hose treated without drugs were discharged sooner that the drug-treated patients, and only 35 percent of the non-medicated group relapsed within a year after discharge, compared to 45 percent of the medicated group.  The off-drug patients also suffered less from depression, blunted emotions, and retarded movements.”  The investigators reported that, over the long term, the medicated patients were “less able to cope with subsequent life stresses.”

Study after study shows that, in the short term, anti-psychotics do reduce unrealistic thinking, anxiety, suspiciousness and auditory hallucinations, but in the long-term, they make those continuing on medication much more prone to relapse and re-hospitalization than non-medicated patients or patients given a placebo.   “Schizophrenic patients discharged on medications were returning to psychiatric emergency rooms in such droves that hospital staff dubbed it the ‘revolving door syndrome.’  Even when patients reliably took their medications, relapse was common, and researchers observed that ‘relapse is greater in severity during drug administration than when no drugs were given.'”

In other words, schizophrenic patients who received no medication had much better long-term results than those treated with anti-psychotic drugs.  This jibes with both (1) a historical comparison between long-term outcomes for schizophrenic patients prior and subsequent to the introduction of anti-psychotics; and (2) a comparison between long-term outcomes for schizophrenics treated with anti-psychotics in the developed world versus those in poor countries treated without them (much better).  Study after study bears this out.

In short-term usage, psychiatric medications for psychotic disorders have value in stabilizing patients and reducing the severity of their symptoms, but long-term usage makes those people more prone to relapse and “may prolong the social dependency of many discharged patients.”   And here is the tricky part:  If patients are withdrawn from their medications, they do poorly, then do better once they have been put back on those drugs.  For this reason, it appears to be proof that the drugs “work”; but do they only “work” in the sense that they ameliorate a problem created by placing the patient on those very drugs in the first place?  In study after study, it is patients given no medication whatsoever who have the best outcomes.

Whitaker goes on to conduct a similar outcomes analysis for benzodiazepines, with similar results:  patients with no exposure to those drugs do best.  It is his discussion of the Selective Serotonin Reuptake Inhibitors (SSRIs), however — the class of drugs widely used today for the treatment of depression — which I found the most disturbing.  Study after study undertaken during the late 1990s-early 2000s showed that SSRIs were no more effective than placebos for the treatment of depression.   You’ve probably heard about these studies already, from Newsweek or the mainstream media.  They tell only half the story.

As he did with his analysis of the effects of anti-psychotics and benzodiazepines, Whitaker turns to comparisons between (1) the outcomes for patients given anti-depressants (including the earlier tricyclics) and (2) the outcomes for those who received no medication.  Here are the results of three (among many) studies he discusses.

In a Dutch study, 76% of those not treated with an antidepressant recovered and never relapsed, compared to 50 percent of those prescribed a drug in that class.

In a 1997 study from a large inner-city facility in England, scientists reported that 95% of the depressed patients who had never received medication saw their symptoms decrease by 62% during a period of six months, while those treated with anti-depressants saw only a 33% reduction in symptoms.

At the University of Calgary, one researcher accessed the Canadian health database and analyzed the five-year outcomes for 9,508 depressed patients.  He found that those on anti-depressants were depressed for an average of 19 weeks per year vs. only 11 for the non-medicated patients.

Every study reports the same finding:  exposure to anti-depressants leads to a worse long-term prognosis.  An international study by the World Health Organization found that of the “740 people identified as depressed, … it was the 484 who weren’t exposed to psychotropic medications … that had the best outcomes.  They enjoyed much better ‘general health’ at the end of one year, their depressive symptoms were much milder, and a lower percentage were judged to still be ‘mentally ill.’  The group that suffered most from ‘continued depression’ were the patients treated with an antidepressant.”

The conclusion is inescapable:  even if SSRIs have any short-term benefit (debatable), their continued use makes you worse.  It’s difficult for patients who have already been medicated to understand this.  As I’ll discuss in my next post, exposure to anti-depressants alters your neural synapses, introducing an imbalance that wasn’t there before; withdraw the drug and the patient seems to do much worse, then “recovers” once returned to the drug or another one in the same class.  It may appear as if the medication is working, when in fact, it’s only treating a disorder that the drug itself created.

Since the introduction of Prozac in 1987, the rates of disabling mental illness in this country have skyrocketed.  In fact, contrary to what we have been led to believe, we currently have a mental health crisis of epidemic proportions.  “Today, major depressive disorder is the leading cause of disability in the United States for people aged fifteen to forty-four.  … [N]early nine million adults are now disabled, to some extent by this condition.”  Whitaker believes that it is the prolonged use of anti-depressants that has led to this epidemic; I find the data and his argument entirely persuasive.

To make matters worse, there are the side effects.  Long-term use of SSRIs causes “sexual dysfunction, suppression of REM sleep, muscle tics, fatigue, emotional blunting, and apathy … [and] is associated with memory impairment, problem-solving difficulties, loss of creativity, and learning deficiencies.”  These impairments to cognitive function are quite common and are a contributing factor to the rise in disability due to depression.

Finding Your Own Way:

Are you reading this book yet?  I’m doing my best to give you a flavor for the mass of statistical analysis and studies Whitaker presents, but the book will of course be much more powerful and persuasive.

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44 Responses to “Psychiatric Medications Have Led to Dramatic Improvements in Mental Health Outcomes” (Big Lie No. 2)

  1. Liz Sparkes says:

    I haven’t read this book yet (thanks for flagging it up btw), hovever I have long been interested in UK research following 3 treatment plans for clinically depressed patients and comparing outcomes. Patients have been divided into 3 groups, psychotropic medication, placebo and moderate exercise. Consistently exercise is showing the speediest recovery and with far better relapse stats. And yet in the UK medication is free of charge (NHS) , whilst access to gyms, swimming pools etc needs to be paid for. Also there is no support provided to help motivate patients to access this valuable “therapy” in the first place.

    Unfortunately I don’t think it is just the pharma companies who have a vested interest in maintaining these myths, I also believe the majority of us still prefer the “pill for every ill” … it is just so much easier to take a tablet than to take responsibility and stand up to the plate, finding the courage to enter therapy, or the energy to commit to an exercise regime (or preferably both!) ….. the longing for a quick fix is part of the human condition….. even in therapeutic circles the rise in popularity of Brief Focused therapies supports this trend.

    Put all this together and my fear is that not much will change in Western treatment planning, despite what research shows.

    • Joseph Burgo, Ph.D. says:

      Liz, I completely agree. It does seem to be the human condition to look for easy ways out, and taking a pill is so much easier (in fantasy) than taking personal responsibility. The difficulty in expressing this is that people hear it as harsh judgment. It’s difficult to help them recognize that they have a longing for an easy answer without making them feel ashamed about it.

      • Liz Sparkes says:

        Absolutely! Also, physicians can be seen by their patients as “not caring” or “understanding” if they are simply advised to go for a good walk ever day.. it can smack of “just pull your socks up, matey”, which is why I believe some form of counselling needs to be available too.

        Another thought, the issue of shame is another reason for “you have a chemical imbalance” being so seductive.. at last something that can help alleviate the stigma so many people experience with mental health problems.. for so long they have felt ashamed, then a “life line” was thrown so they could say “see? It’s just an physical illness like any other.. like diabetes for example! It just happens to affect my thinking/feeling/behaving…”… if research constantly now shows this not to be the case, as you say it is absolutely vital that care is taken in how that message is broadcast.

        Myself, I find the judicial use of humour a great way to make “bitter pills” a little easier to swallow… :)

        Great blog as usual Jo, you always help me think.

        • Joseph Burgo, Ph.D. says:

          I didn’t get into the issue of shame, either, because I wanted to be as factual as possible about this book without addressing the many reasons why these drugs are so popular. But yes, I think the shift from “mental illness” to “medical syndrome” alleviates a great deal of shame.

  2. littlelizzy says:

    I was wondering if medication in combination with therapy works, cause I’m taking an anti-depressive and a anti-psycotic besides my weekly therapy. I use it for my depression and dealing with stress wich I have from mood swings. I’m a borderliner with autism and ADHD so was wondering if the meds would help me or make things worse.

    Btw I love you’re blog I’m on twitter and clicking the links you post there every day

    Little lizzy

    • Joseph Burgo, Ph.D. says:

      The real concern is how long you’ve been taking them. None of these drugs is suitable for long-term usage; they have their value in stabilizing psychotic disorders or helping people with severe depression get back on their feet, but beyond six months, the complications from side-effects are extremely serious. One of the interesting results of all those studies was that patients who had taken these drugs were LESS capable of coping with later stresses in their lives, so if that’s the reason why you’re taking meds, you might want to reconsider. I know it must be hard for you, but long-term usage of these drugs can lead to brain damage, irreversible motor tics and other nasty problems.

      I’m glad you’re reading my blog!

      • Farah says:

        As someone who recently had a psychotic episode and was pregnant at the same time, I would have rather preferred to have been told about exercise options then have had to take medications as I am now obese as a result. And no the weight gain is not because of my pregnancy, because this was my fourth and I knew from the previous pregnancies that if I ate right I would not put on that much weight. In addition, I have feel by telling people you are on medication you are more likely to be viewed in a shameful manner than by telling people you had an episode and will get better by some good exercise. Moreover, having had to take the medication put my child at risk and this may have caused my premature labour. Having said this, any suggestions for what forms of exercise I should do to lose these 40lbs that I have gained as a result of this medication?

        • Joseph Burgo, Ph.D. says:

          I understand about the weight gain — it’s very common with these kinds of medication. As far as exercise is concerned, I would think that any type of cardio workout that elevates your heartbeat long enough to stimulate endorpins would be helpful. I suspect it’s not the kind as much as it is the intensity.

  3. Leigh Ann says:

    This post is full of the pseudo-science, anti-medication fervor that is not just misleading, it is downright irresponsible and dangerous. I hope people who need antidepressants balance “information” like this with the truth that the scientific community accepts.

    • Joseph Burgo, Ph.D. says:

      I don’t usually approve comments like this one because they’re so out of keeping with the tone of respect and intellectual curiosity shown by visitors to this site, but you need to see what passes for a “thoughtful” rebuttal in the debate over psychiatric medications. I posted a three-part review of a well-researched work that performed a meta-analysis on many many studies about the outcomes for patients on psychiatric medications; I cited the results of many of those studies, including ones from our own National Institute of Mental Health and the American Psychiatric Association. This visitor subsequently accuses me of publishing “pseudo-science” and accuses me of professional misconduct, without citing a single scientific reference to even one study, or actually rebutting any of my points.

      From other sites where I visit and occasionally comment, I’m accustomed to this kind of reaction. Usually these are people who have personal experience with anti-depressants and other meds and fervently believe these drugs have been of use. This is often true: for some people, psychiatric medication saves their lives. Unfortunately, they confuse the short-term benefits with the longer-term habituation and withdrawal issues associated with these drugs. I’m sure many of you know people who swear by their meds; just remember that anecdotal evidence is not the same as a broad-based scientific study with control groups and long-term follow-up for participants.

      I think the answer is simple. For those of you truly concerned, inform yourself. Read the books and studies and make up your own mind. Don’t take my word for it and certainly don’t believe critics who throw around labels like “pseudo-science” and “anti-medication fervor” in lieu of offering scientific support for their own position.

    • Joseph Burgo, Ph.D. says:

      For those of you are interested in learning about how the pharmaceutical industry has manipulated the scientific data supporting the benefits of psychiatric drugs, you might want to read this article from Huffington Post. He also has some useful suggestions on modifications in diet and exercise, though he doesn’t acknowledge that depression has psychological *meaning*.

  4. Soull Purple says:

    Incredibly interesting… iv always known that these drugs do not work, as is written, they create a problem and then offer the solution by treating it with the very drugs that caused it and not addressing depression on any clear level at all.

    I find your posts incredibly interesting, and continue to read. Thank you :0)

    Love from England – UK.

  5. Amanda says:

    Joe,
    I guess that this hot topic will remain hot for a long time still. There is no denying that the pharma industry is very influential and in particular, on the medical profession. The medical insurance industry also plays a huge role. I’m a South African psychologist and most of our medical insurance (we call them medical aids) will pay for a-depro’s but not not more than 4-6 session of psychotherapy. Then, it seems the only way to stabilise a client is to elicit the help of a-d’s – if the client is willing.
    We find ourselves between the proverbial rock and hard place.
    My own personal thoughts about it: and/both instead of either/or. Life’s too short to be depressed forever! :-)
    Keep up the good work, great blog.

    • Joseph Burgo, Ph.D. says:

      I think you’re in agreement with Dr. Bob Dick’s comment. I really do believe that anti-depressants have their place; it’s just the indiscriminate prescribing and the marketing push by Big Pharma that get to me.

      • Amanda says:

        Yes, it is a frustration. I haven’t read the book yet, but I have this general caution about reading books: if you start out with a mindset to prove/disprove something, you will find proof for you hypothesis in research, no matter what research says. It takes a very specific methodology to get to unbiased results and many medical studies are quite flawed in terms of generalisability. (busy with doctorate by dissertation and learning all about methodologies – so pardon me if I say what is obvious to others – it wasn’t obvious to me until recently). While its frustrating, I have found that clients who went the a-d route because it was too painful to process all the underlying gunk, end up coming back because a-d’s are not able to deal with these issues on long-term basis. What is your experience?

        • Joseph Burgo, Ph.D. says:

          My experience has been the same as yours. I find that many people come for psychodynamic psychotherapy only when they’re tried everything else.

  6. john says:

    Thanks Joseph, your exactly right there when you say stay sick on the poison,s and the oppression and alienation that goes hand in hand with the forcing down the throats of the victims made to take the poisons. I will add a statistic to what your saying also, here,s a real beauty too saying exactly what your saying, and going on exactly that, we asked mental health to give us the opportunity to come away from the poison and if we get worse we can always go back to the poison and they wont let us try, or prove we can be OK off the forced poison, I wonder why! ? im pretty sure we know why, some of us do anyway.
    >>>>>>People with schizophrenia not taking antipsychotics more likely to recover,
    states researchJune 13, 2007by Angela HussainPeople diagnosed with schizophrenia
    who are not on antipsychotics are more likely to experience recovery than those
    taking the medication, according to an American study.Over 15 years,
    schizophrenia patients not on antipsychotics showed more periods of recovery
    than those taking antipsychotics, states a research paper in last month’s
    Journal of Nervous and Mental Disease. Researchers reported that, after 10
    years, 79% of patients on antipsychotics were psychotic, whereas 23% of those
    not on medication were psychotic. After 15 years, 65 per cent of patients on
    antipsychotics were psychotic, whereas only 28% of those not on medication were
    psychotic.The study’s authors – Martin Harrow and Thomas Jobe of the department
    of psychiatry at the University of Illinois in Chicago – concluded that “not all
    schizophrenia patients need to use antipsychotic medications
    continuously throughout their lives.”They stated that certain patient
    characteristics – such as a “favorable personality” – helped those not on
    medication to experience recovery.The study was on 145 patients – 64 diagnosed
    with schizophrenia, and a control of 81 patients who had another psychotic
    diagnosis, such as paranoid disorder.The research was part-funded by America’s
    National Institute of Mental Health.>>>>>>>>>>>> there ya go more proof, John

  7. ron says:

    i was a happy go lucky get back up guy when knocked down, always laughing and able to easy to be around, after years of taking antidepressants, and other meds that the doctors insisted i must take, in 1994, after my relapse and being admitted to the hospital, the psych doctors implicated the drugs in causing the stressers, but it seems like it permantly altered me, because after being off them for some 17 yrs, i still find my self not being able to enjoy life to the extent i was before the years of use on them,

  8. I read this article, which I thought was interesting, and I just HAD TO take notes as there are a few interesting points I want to touch on, if you will.

    Many people, both doctors and their patients, forget that prescription drugs are NOT the only answer for treatment of almost ANY type of mental illness. Pills can alter one’s state, but what is important as well is therapy. DBT therapy, talk therapy, Equine therapy… whatever. Patients need to LEARN how to control their illness to the best of their powers. I know this post dealt with schizophrenia, but it’s the same, in a way, as Borderline Personality Order (my illness). Wow– popping pills is easy, but it’s not going to “cure” BPD sufferers OR Schizophrenics. These individuals have to participate in some other type of therapy (based on their symptoms and illness{es} in general) so they can organize their thoughts and pick up skills and different ways of thinking that will allow the patient to live a much more productive and satisfying life as well as not being totally dependent on pills. Pills can also give the patient a “false sense of security”. A patient might think that if they take their medications like they are supposed to, that they WILL get better. This happens at times, BUT medicine can only do so much.

    One thing with prescribed medications is that there are almost ALWAYS some sort of side effect. It could be something small such as ‘having dry mouth’, but it could also be something much more serious, such a suicidal ideations. This is one reason why that patients need to be medicated “with care” and that for treatment, doctors CANNOT be solely dependent on medication. Moreover, other types of complimentary therapy is needed.

    If doctors were able to use different types of non-drug therapies on their patients, not only would patients actually be dealing with their problems and learning skills, many times, a patient’s drug regimen can be reduce some. For Schizophrenia it could be a little different, but concerning my “specialty”, BPD, this is what I’ve been told by my own psych.

  9. Genita says:

    This has been such a heartfelt subject for me. i have been in and out of the hospitals fighting with the doctors to don’t inject any medications in my body and i have been forced time and time again. I have memory loss probably brain damage from the on going torment of refusing and they stick it to me anyway they can. I HATE PILLS ALWAYS HAVE ALWAYS WILL… It is very downright degrading that my voice has not been heard over my own wellbeing. i have been in and out of the hospital several times on nuermous medications and have experience ever known side effect that has been mentioned just to find out that i wasnt crazy to begin with how crucial this reality i live in that i have been subjected to another form of slavery!!!!!!!!!!

    • Joseph Burgo, Ph.D. says:

      This is truly awful. But I do think that there is a growing skepticism about psychiatric medications in our culture today; you might have an easier time now finding someone who will listen to you and respect your wishes. Just keep looking around.

  10. john says:

    Id just like to say that the Leigh Ann response sounds like the typical standard psychiatrist response, that says, shut up and take your medication, you don’t know what your talking about, but i do. Totally disregarding the pain and despair the victim is reporting and feels from their abuse called care.

  11. Tim Reynolds says:

    I listened to my psychiatrist as well 12 years ago was put on my fair share of meds trazadone..seraquel clonazapame to name a few.found out I was put on them for my apperent schizofrenia was taken off all meds 1 year ago after being told I don’t have the disease.On home care because I can’t wash myself..clean my house have proper meals.Was working 35 hours a week now 3 days a week home care and go to a day support for the brain injured and then you get assholes who say it safe.

  12. Christa Stolz says:

    I’m from Romania. I had a psychosis some 3 years ago. The psychiatrist never recognized it as such but prescribed me Solian 400 on account of having depression. So I took the medicine 6 days. Than I reduced to 200 for two months. After two months I took only 100 or 50 mg. I’m not on any medicine now (5 months). I am nevertheless concerned I might have a relapse. Do you think that after taking 2 years of (low dosis) of Solian my brain was messed up? I don’t think I have schizophrenia, my psychosis was short, I never was admitted or anything. I have a great job, I’m happy but I worry.

    • Joseph Burgo, Ph.D. says:

      I would think that a low dose of the drug for a couple of years wouldn’t do lasting damage. It’s great you’ve gone off meds now; have you thought about revisiting any of this with a psychotherapist?

  13. Rwema says:

    Hi Dr. Joseph, this is my second year on schizophrenic medication. To tell the truth, when I ask my doctor what my diagnosis was, he tells me that I had a pyschotic episode, nothing much, nothing less. But I am shocked but Whitaker findings. After being put on these medications, I suffered from mild depression and refused to take medicines for depression. And now i think that the schizo meds may be causing my depression. So is it to late to stop altogether these medications for schizo? Or they have already messed up my brain? Thanks for sharing this truth

    • Joseph Burgo, Ph.D. says:

      I’m not sure which meds you’re on, but some of the typical drugs for schizophrenia have debilitating side effects after long-term usage. You should be fine if it has only been a couple of years. Make sure you discontinue under some kind of medical or psychotherapy supervision as there may be some withdrawal symptoms and you may need help.

  14. Rwema says:

    Thank you for your insights. I am initially on Geodon 140 mg. When I research the long-term side effects, I only see the short term side effects. Could you tell me more about those debilitating long-term side effects? Also, is it possible to have any other thing, be it psychotherapy or other medical intervention, that can replace the use of Geodon? I would very much like to use that alternative rather than altering the natural mechanism of my brain. I appreciate the service you are doing to people like me.

    • Joseph Burgo, Ph.D. says:

      Among the more serious long-term side-effects are: neuroleptic malignant syndrome and tardive dyskinisia. You can read more about the adverse side-effects of Geodon here.

  15. Mr Tony Austin says:

    Dr Joseph, i wish i had your suggestions before i started my phsychatric medication about 3 years before .Actually i just had a mild depression and i was compelled to take a-d’s by my parents.Then i had tabs-Nexito10 and then later reduced to 5 mg and i stopped the medicines having a total course of 18 months.i start to over eat due to the side effect of medication and i became fatty.but due to the use of medicines at the end of the course my overall health started to detiorate..it affected my digestive health and some some probs related to urination..above all it affected my overall health and happiness..
    Now i am mentally stable and ok… i want to regain my health and happiness as of earlier
    I kindly request your valuable suggestions regarding overcoming the ill effects of post medication….

    • Joseph Burgo, Ph.D. says:

      Tony, I’m not a medical doctor so I can’t speak with authority about the best course of action, but as I understand it, your body returns to “normal” over time once the drugs are withdrawn. I doubt that you’ve suffered any permanent neurological damage. Most likely what you need to do is what most of us need to do: eat well, get regular exercise and try to lead an all-around healthy lifestyle. Mild depressions are a normal part of life; as a society, we’ve become very intolerant of them, however, and instead of just living through them, we (and the doctors) expect there should be a pill to get rid of them.

  16. dhurba says:

    i took lexapro the medication for depression for 5 years but it did nothing good rather than making it worse. i always believed it would make me better one day but instead my beliefs were shattered. i did exercise, ate healthy and even did relaxation but at the end of the day the i feel like taking medication was the worst thing that i ever did. i am so frustrated and my brain is so fucked up, i am only 27 years old, i feel so hopeless. i was much better person before i started taking medication. i had few episodes of anxiety then but now i suffer from panick attacks and so many problems the list will go on.. doesnt physcian have some responsibility that they prescribe medication just because they have to follow some fucked up procedure. when i first went to see a doctor they asked me what would i like to do, take medication or do therapy or both. how the hell in this world do i know whats good for me. anybody in this world would think that doing both would be a good idea. its the doctor who could have suggested me to do therapy. i was so young only 20 years old with so much energy and life full of dreams. i went to college with hope that medication will solve my problem with anxiety and the rest i will take care of myself. i graduated with a biology degree and premed with a hope to become a doctor but i am back to the same point where i started and even worse except i have a degree .
    for anyone who feels like taking medication for depression and anxiety, from my personal experience i strongly recommend not to do so. go for a therapy but hell no for medication. exercise regularly, keep journal, eat healthy and share your story with people who care the most . it might seem like a long way but trust me u will be in a much better shape than a medication…

    • Joseph Burgo, Ph.D. says:

      I’m sorry to hear about your experience but I’m glad you shared it here; more people suffering from depression need to near these stories from someone like you who has “been there.”

  17. michael says:

    I don’t care what they say when they find the right combo of anti-pycoit and anti-depressates(i am not the best speller in the world). Along with therapy and workingout(like 30 to 45 minutes of having your heart rate up at 114 to 130) heavy exercise.Three times a week. You more then likey are going to have less of a in and out clinic experience. overall take the meds with excercise. Ask your doctor all these things first.

    • Joseph Burgo, Ph.D. says:

      I agree about the great value of physical exercise. Plenty of studies have proven its value in alleviating depression.

  18. Mike says:

    Well my son refuses to take any meds and is getting worse and worse (dx as prodromal for psychosis). I see meds as the only hope to keep him going full spy/sz. So, we need to understand psych meds as matter of perspective. With the luxury of stability/funcationality and med compliance, yes patients might do better with lower or no dose, but from the crisis persective, nothing else offers any hope at all.

    • Joseph Burgo, Ph.D. says:

      As I’ve said many times before, I do believe that meds have their short-term uses, especially in stabilizing someone in crisis.

  19. Savvy B says:

    I am new to your website and find incredibly informative and thoughtful. I was diagnosed with depression 6.5 yrs ago, which was 1 year following the death of my husband. During this entire time, I have been treated with weekly psychotherapay sessions with a psychiatrist and for the first 3 years I resisted the meds but and when I felt I had tried everything I could and yet couldn’t get myself back to “feeling that joy for life” as I believe I used to, I finally caved in and accepted that I needed to give the meds a try, which I did for the next 3 years, as follows: Cymbalta 60 mg daily for 1 year – and the intial few weeks were the worst – but I persisted through the settling of the side effects on the basis that I saw the immediate potential benefits (in particular almost full elimination of the PHYSICAL symptoms of anxiety, although the psychological symptoms were most definitly there in full force – which created a complete mind-body disconnect) . Unfortunately, I went from not sleeping at all the first few days (although I was ‘functional’, which speaks loudly to the inappopriate impact these meds have on your brain) to eventually sleeping too much … and although that was a welcome change at first, I finally decided I couldn’t tolerate the oversleeping (as I wasn’t able to get to all I needed to do to get my life back on track) and at the 1 year mark I began to wean down to 30 mg by taking 60mg/30mg on alternate days. Since the noticable (deteriorating) mood change and what appeared to be a return of the depressive and anxiety symptoms frightened me so much, I thought I’d take it real slow and weaned down to 30 mg daily over the course of 3-4 months. I continued with that for about another year and then weaned down to 30 mg on alternate days, until I finally weaned off completely by the end of the third year. At each stage of the change in dose, I would notice a slight increase in and return of depressive and anxiety symptoms. I took the approach that what the meds were doing for me I now had to learn to do for myself. However, it hasn’t worked entirely (dare I say, YET). My psychiatrist considers me to have had only a ‘partial response’ to the medication treatment and immediately upon weaning off began discussions about another drug treatment. Even before educating myself as much as I have recently I was of the opion that if I’m not given a chance to adjust and learn to cope, I’ll forever need the meds. When I’ve advocated for myself (or perhaps literally PLEADED with my psychiatrist) to give me a chance, I just get the blank stare and silent treatment. Albeit I haven’t had the courage yet to ask if or to what degree he agrees/disagrees with my approach … although, I suppose the blank stare and silent treatment may say something about that – I’m not sure. Hence, my question, I don’t think I should have to PLEAD to have my views heard and/or respected … AND, at the very least, if a doctor disagrees, I think it’s only reasonable that he/she state his/her opinion and recommendation CLEARLY. I’d be interested in feedback about this situation and whether my expectations are reasonable or not. I’m getting the impression from what I’ve read online (at other sites and your blog) that it may be a no win situation with psychiatrists – they just all fall back on meds … is this the take away message? And if so, then it seems I may have wasted my time with weekly psychotherapy sessions with a psychiatrist who seems convinced I should me on meds? I almost get the impression that he thought once I tried them I’d happily oblige if the first try didn’t work. Any thoughts are most welcome. Thanks!

    • Joseph Burgo, Ph.D. says:

      I’m afraid your conclusions are correct, although there are a very few psychiatrists who don’t believe in meds. As you know, the “chemical imbalance” theory has so saturated our culture, and in particular the medical profession, that it has become unquestionable dogma. It sounds to me as if you’d do better to find a different mental health professional, maybe a non-M.D. You can ask questions up front: you can find someone who has a bias against using psychiatric medication. If you let me know where you live, I might be able to help.

  20. lisa says:

    Dr.burgo-thank you for referring the books by Whittier and Bregger. I am very angry about the effects and damage done by my meds which will take me over a year to come off of after 15 years.
    I only wish that your blogs would have been available then. I broke away from the original psychopharmacologist and am insisting that my new Dr. help me to do this. My only fear is that when completely off my meds I will still have the side effects I have now. I feel like a child screaming to find the real me. I know that my writing, thoughts and feelings are not what I would have written years ago-but these blogs give me hope from you and your responses
    from a thoughtful audience. I await the arrival of your book. profound appreciation

  21. Cameron says:

    Fuck, I’m on 20 mg Prozac and my doctor told me not to come off it until the new year. I’m not sure whether to come off it or not now.

  22. Simon Arvidsson says:

    What about those thas didn’t get any meds, did they get any other treatment?

  23. Kathy says:

    I think you have a lot of brilliant discussions and help here, about the psychological causes of mood disorders and that you sound like a wonderful therapist. Your conclusions regarding pharmaceuticals take in research against use only. I just looked at an article today out of Japan that supported meds overwhelmingly over placebo for maintaining stability for major depression (Kamijima et all). I have read other articles that are just as well supported that take a more moderated viewpoint. E.G. you make the claim that antidepressant use should ONLY be used for very short term use above. I know this is a popular stance in the anti med folks due to studies of meds failing to work after some time for certain folks, but I have seen nothing to show that this is overwhelmingly the case for most people. I have read more compelling discussions about possible reasons for this but a discussion of all of those discussions is beyond the scope of a blog posting.
    I have struggled with major depressive disorder for 25 years that struck me in my teens. The times I have been most in danger of suicide, I.e. times of withdrawing from society, paranoid, sleepless, to worse and worse and worse symptoms including delusional thinking have ONLY been cured by taking medication, therapy only helps to control acting out on the symptoms (and doesn’t really help after a certain point where you lose touch with reality). Now, I’ve been off meds for many time blocks and those times are the worst in my life to look back on. I’ve been able to work, go to school, strengthen healthy relationships in a consistent manner only during the on meds time blocks. Each time I go off of medication, I am ok for a bit before I start mentally disintegrating slowly over time. In comparison, my cousin never takes meds and she has hidden herself completely from life for the same 25 years, hides herself away, doesn’t have a job or any non family relationships and she has had a lot of therapy. Shes made her suffering work for her over time but she’s always in pain, irritable, and everything is hard for her. Therapy has helped me tremendously with my psychological issues but doesn’t help with the physical brain decompensation periods. (And I meditate, eat well, go to sleep regularly, and exercise I have tried self-discipline as a cure but it’s not a cure). I hate taking meds and no one in their “right mind” would choose to take them, you are right, they are terrifying and have side effects. Perhaps what you mean to say is more moderated…people with psychological depression, mild depression, and situational depression may benefit much more from working through their pain than from taking meds. I know that this was and is true with my psychological depression and event caused depression; going through the loss and pain is necessary to get to the other side with new growth and a deepened understanding.
    I think the reason you may have some angry responses is because you insult people with mental illness who take medication by claiming people are weak if the take medication but are somehow tougher if they go without. Or at least only take it for a few months. I’ve almost reached suicide by trying to be so tough, and sadly others I’ve known have not been so fortunate but have actually committed suicide. I take medication long term and work with a great doctor long term as well as a sensitive and gentle nurse practitioner. I have been strong by facing my demons in therapy and I am also courageous in taking medication because without them I function at a fraction of my capacity for my family and to give back to the world and for myself. It’s not easy to do, and it takes courage. And it’s a distinctly separate courage than that of the courage to go through therapy.

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