Most of us know that every individual reacts differently to every different psych med, but sometimes we forget to say that they help some people sometmes, at least in the short term, Here's one way to say that without diluting our message..
These raw data from an FDA clinical trial of Paxil use in teens shows a wide range of individual variation among the people in the test. Each line and, dot represents an individual kid. They show a wide range of individual reactions to the drug.
(This Study 329 is controversial. It has been called fraudulent. The principal investigator, Dr. Martin Keller, resigned his position at Brown University June 30, without explanation. There is some pressure in the research community to have the study formally retracted. I kept the data in this story because the scientist who interpreted it for me challenges the study's conclusions.)
To make sense of this, I had to call on a scientist who shares my values.
According to Corinna West, who has an advanced degree in pharmaceutical chemistry, the trial showed some people do much better on Paxil, and some do much worse. It's a miracle for some people, and a dangerous trap for others, she says.
Eleven kids became suicidal on Paxil, only two on placebo, Corinna said. And the study does not show what happened to people after the trial, or after discontinuing medication.
The risk of relapse after anti-depressant medication discontinuation was higher than the risk of relapse after remission on placebo, according to a study published in.Frontiers in Psychiatry, July 7, 2011, Corinna said.
Study 329 does not say what happened to the people after the study: what was their relapse rate; did they have trouble getting off the drug, and how much of the good outcomes were really placebo effects, Corinna says.
“People need to know they’re up for a lottery with odds less than placebo,” she says. "People are right to be concerned about the safety of anti-depressants."
But a completely honest discussion of whether an individual should take them should also say they might help.
Discussions and advocacy regarding medication should be nuanced, not black-and-white, Robert Whitaker says in this video. .
I corresponded recently with a combat veteran, who permitted me to post, this summary of our nuanced discussion.
He said he is still experiencing serious emotional difficulty several years after seeing his friends killed in a war. He said a popular SSRI anti-depressant helped him when he was overseas, and he has a prescription for it now – but he’s afraid to take it.
When he left the military, and returned to the States, he decided to become an “educated consumer.” He has trouble sleeping, nightmares, periiods of rage, depression, and suicidal thoughts. He says his family is supportive, but those relationships become strained sometimes. Yet, he’s afraid to fill his prescription and go back on medication.
He found so many Empowermement movement Facebook pages and websites that say taking meds is bad that he doesn’t know what to do
I told him not to let strangers tell him how to take care of himself. All but the most strident, ideological critics of psych meds know that every individual reacts differently to every different treatment. If a particular drug helped him before, it might again, BUT:..
- It would not solve his problems, make him well or keep him well. Chances are, the best he can hope for from the drug is enough relief from his symptoms to allow him to bring other treatments and resources to the problem that can make him well and keep him well. I suggested he continue individual psychotherapy and support groups with other veterans.
- I suggested he also follow a non-medical wellness and recovery plan, and recommended Mary Ellen Copeland’s Wellness and Recovery Action Plan (WRAP), which I’ve been using myself, and teaching, since 1997,
- I suggested he take vacations from the drug every so often: withdraw gradually under supervision, and see how well he does without it, or with less. "Take as little as you need, not as much as you can stand," I said.
- I suggested he Include people in his circle of supporters from outside the mental health world. I said, "Talk about, and do things you enjoy, that take your mind off your mind." I sent him my phone number and said it would be an honor to talk to him about anything, not an imposition.
- I shared some insights I got from reading When Johnny and Jane Come Marching Home by Paula Joan Caplan of Harvard. We should get away from the term Post-Traumatic Stress Disorder (PTSD), and stop treating troubled vets in medical facilities, she says.
"A lasting emotional reaction:to the horror of war is not a disease or disorder," Dr. Caplan says. It's a normal, human reaction to horrible, abnormal experience. Calling it PTSD puts the blame for the suffering on the sufferer, not the war that caused the suffering, Making people go to medical facilities for treatment reinforces the message that they/re sick..
For years, anti-medication talk created a barrier between me and some national leaders in the Empowerment movement, whom I admired so much for so many other things. What
they said about medication did not account for my experience, or that of many people I knew, who had good outcomes and no obvious, life-limiting side effects.
When I asked seemingly outspoken medication critics, including David Oaks of Mindfreedom International, if they’re against medication, they almost always said, “Oh, no! I just mean….” And they finished that sentence with something I agreed with completely.
- In 2009, Judi Chamberlin, told me in an interview, “I’m not against medication. If medicine is helping you, you should take it. I just think it should be offered as one of many options, not the only option." I completely agree.
- When I asked Dr. Dan Fisher the same question, he said, “Is that what people think? I PRESCRIBE medication at a clinic one day a week!”
- Corinna West of Wellness Wordworks says she’s not against medication. She’s FOR full disclosure and truly informed consent. I completely agree
I think alternative treatments should be tried before psych meds, not as an afterthought or footnote to a treatment plan. Maybe it will minimize dosage, or psych meds will never become necessary at all.
I disagree with Scientologists, who say all psych meds are bad for everybody all the time, and claim they have a home cure that makes psych meds unnecessary. Irresponsible claims like that might tempt people, like my best friend David Hilton, who ultimately took his own life, to go off meds the wrong way. Too many people hate to take these medicines for a million good, and not-so-good, reasons. Applying anti-medication ideologies to individuals can do serious harm.
And I HATE to think of my new friend, the combat veteran, afraid of a treatment that might help him, because a stranger on Facebook told him medicine is bad.
Getting Well, Staying Well, Making Systems Well: A long-time journalist and advocate of recovery-oriented services, Ken Braiterman writes about overcoming adversity, and adverse systems of care.