Dear Bob:
Saw a young man recently, early 30s, who wanted help withdrawing from benzodiazepines.
He had been on escalating doses of Xanax for two years. The Xanax had been prescribed for panic attacks that began after he was placed on Wellbutrin. The Wellbutrin had been prescribed when he became depressed while on high doses of narcotic pain medicine. And the narcotics had been prescribed starting four years previously after he injured his back at work.
He had no psychiatric history prior to the back injury. For four years now, he has been cycled through drug after drug by well-meaning primary care physicians. It’s easy to see in retrospect that each drug was treating, at least in part, the side effect of another drug, as he built up a tolerance to each until he reached a maximum dose.
And here’s the thing: he’s on all of these drugs, and he still has back pain . . . but it’s worse now. He still has depression, but worse. He still has panic atacks, but worse.
He can’t hold a job, he can’t engage in his marriage, he can’t function in his life. He’s addicted and he knows it. Getting worse with polypharmaacy, not better.
I started seeing him when he had reached the end of his rope. Luckily, he has enough residual self-awareness and inner resources to recognize that he was headed down a dead-end street. He didn’t like that ending, so he sought me out to change the script, so to speak. He and I have got a plan, and we’ve started to decrease doses and stop medications one at a time, doing our best to replace the drugs’ effects with healthy habits and support systems. I have high hopes that he will do well.
Yet it is stunning and dismaying how frequently this occurs. In this whole chain of events, none of the principal actors–doctors and patient–are unscrupulous or looking to have a bad outcome. They’re just people, trying to do their best, but with the limited horizon afforded by a deeply flawed system.
Are there bad guys here? I don’t know. Maybe some fat cats sitting in corporate offices of Big Pharma somewhere. Maybe some academic psychiatrists who take money to promote misinformation and misdirection. But I don’t know any of those types. I just know people like my patient and like myself who are trying to sweat it out in the clinics everyday and make sense of the tangled mess of science, economics, ethics, and human behavior that’s been handed us.
System failure is what this is. Starts at the top. Starts where the money is. Filters down to the rest of us, and in the name of healing, causes so much unnecessary harm.
Maybe it’s time to get a new system.
Mark
Editor’s note: These letters are selected from an exchange that Dr. Foster and Robert Whitaker have had since he read Anatomy of an Epidemic. They describe his interactions with his patients, and his changing thoughts about the prescribing of psychiatric medications. In all of these letters, the specific patient situations he describes are real, but all identifying characteristics have been changed, or permission has been given, in order to protect patient privacy.
