Friday, January 27, 2023

Comments by fran sans

Showing 13 of 13 comments.

  • Hola Piston, I am afraid I can’t give you a precise replay;
    I think this is not the better space or place to answer personal or particular issues.

    Firstly I would need to have some knowledge about you ( I don´t know you, I don’t know what happened to you, why and when did you started to take psychiatric drugs, if they have been or still are helpful, which of them do you consider helpful or harmful, do you think you need any of them, how are you doing nowdays, what familial or social support do you have, have you previous experience in trying to reduce the medication…)
    I think the first step would be to have a good supportive and safe network and a trustful relationship with your health professionals (doctors, nurses, family doctors…).

    Having said that, and from a theoretical point of view, I have to admitt that it seems to me you are on too many drugs and that those tremors could be a neurological side effect of one or more of your medications (achatisia, tardive dyskinesia, parkinsonism or chronic dystonia).
    It seems there is not evidence to support the prescription of two antipsychotics (altough this is common practice), and in the case that this were a temporary option, I don`t consider the combination of ariprazole+risperidone the best option. May be if you could stop one of them this would help with the tremors. On the other hand, I tend to use akineton (biperideno) just for acute dystonias, not as a long term treatmente, because the cognitive disfunction it can cause among other anticholinergic side effects.
    Another point would be to check accurately any pharmacological interactions with other drugs of common use, like statins for reducing cholesterol or omeprazol for gastric protection. Another very easy option to try to minimize metabolic interactions, would be to shift rivotril (clonazepam) to lorazepam, that does not interfere with the liver metabolism. Finally, I don`t know why you are taking duloxetine, but like any other antidepressant, it should not be prescribed for long periods, and it has an important risk to produce withdrawal symptoms. Another posibility would be to have a pharmacogenetic test done (Amplichip or others ) to know if you have a metabolic deficiency that makes the medication less effetive or gives you serious side effects.
    I have checked the metabolic interactions of your treatment and it seems a priory that the metabolic liver path 2D6 is saturated, which means that some drugs are interacting with others and this could affect the efficacy of your treatment.
    I am sorry for all this technical talking, but in summary my advice would be: try just one antipsychotic (if still necessary), stop Akineton (biperiden), try to discontinue antidepressants if you are not feeling depressed and shift clonazepam (rivotril) to lorazepam.
    Of course this is only a theoretical hypotesis and you have to keep in mind the serious risk of relaps or withdrawal symptoms, so, again, please, get in contact with your psychiatrist to discuss all these issues.

    Best wishes

    Fran Sans

  • Sotoleon,
    Thanks to you for exposing so well the sad situation of mental health in most places of Spain and probably many other countries.
    I think that we as health professionals, have been captured by the spell and promises of biological and pharmacological psychiatry and modernist talking therapies, and we have lost the most powerfull healing skills we had: ourselves and our human relationship.

    Un abrazo
    Fran Sans

  • Dear Bonnie, of course there is a lot of different issues involved in drug withdrawal (family support, religious believes, physical excersise…) and I totally agree that a good nutrition is fundamental, altough sadly specific counselling in this matter is not ussually available…
    Hopefully in the future nutritional assessements and treatments will be part of the standarized approach to drug withdrawal programmmes.
    Thank for your support and best wishes

    Fran Sans

  • Aliveagain,
    Thank you so much for your kind and encouraging words and for sharing your own experience.
    I totally agree with your points.
    Hopefully, initatives like that of the International Institute for Psychiatric Drug Withdrawal (IIPDW), with the knowledge and wisdom of first hand expertices, will help all of us to provide a better support.
    Users, survivors, insiders, first hand expertices experiences are essential to improve mental health care.
    Best wishes

    FRan Sans

  • Dear Rosalee, thank you so much for your kind and supporting words. These are the sort of things that guide and give meaning to my work.
    I can find information and knowledge from books, papers, and other colleagues, but real wisdom…this I just can learn thanks to the generosity of the persons that every day share with me their expertice and strenght to fight and survive mental suffering. I want to express my gratitude to all of them.
    Best wishes

  • Dear Dr Maviglia,
    thank you very much for your comments and interesting questions.
    First of all I would like to clarify that I am not a resaercher, nor an academic, just a down to earth general psychiatrist, trying to do my best with the 15 minutes per patient schedule I am given; and this is not properly a resarch paper but a sort of naturalistic narrative where I try to explain my personal and local experience.
    I am aware this can pose more questions than the answers I have, but somehow that was one of my purposes.
    Regarding the persons that refused to participate, some of them felt fine on their medication and did not questioned that they could do as well with less or no medication at all. Others, although did suffer from persistent symptoms, did not think it was a failure of the treatment but of themselfs: they have been told that their disease was severe and resistant to treatments, but they should continue for ever even though the lack of efficiency. In other cases the families and carers were afraid to try any change…
    Of course there are a lot of people for whom drugs have been or are still the best option to alleviate their mental suffering, and they have all my respect; but in my opinion, the dominant narrative of standard psychiatry (biological and reductionist) can be very invalidating and frustrating for people; they are told that they suffer from a brain condition and the main treatment are very specific psychiatric drugs (magic bullets).
    As Joanna Moncrieff proposes, this “disease centered model” has not been proved, but it has gained the status of truth for professionals and patients. So, who would stop a medication that can correct the disorder, like insuline or anibiotics do? This medicalized cosmovision internalize the mental suffering and puts the responsability on the individual, minimazing the importance of social, economic and political context. From a “drug centered model”, we could use pharmacological treatments to alleviate symptoms, like painkillers or tranquilizers do, but it would be much easier to understand them just as a temporary remedy, not a necessary and ever lasting treatment.
    As for the admissions due to relapse or withdrawal symptoms, I just can say that the number of admissions ahs remained steady during these 3 years; may be in the future the group of people that has been able to minimize or stop their medication will function better and will need less care and hospital admissions, but this is at present just speculation. In the work of Wunderink (2013), the group on the reduction arm had less relapses and better functioning but that was obvious after 3 years and very clear at 7 years follow up. Similar results have been found in other experiences like Soteria or Open Dialogue. In my experience, it is too soon to evidence clear benefits for the patients, apart from the satisfaction to have participated in their decision making process. I think in my case the key point has been to facilitate a colaborative and participative approach to the withdrawal process.
    Finally, regarding the coordination and peer support with other profesionals, families and carers, I have to admit that sometimes it has not been easy, specially with some of the psychiatrists of my own service; but I have been very lucky to have the support of mental health nurses, psycologists, family doctors, social workers and carers. May be the key is that I work very close to the community; actually my consultation room is placed in the same building that the primary care center, and that makes easy the contact, collaboration and coordination with them.
    I hope this has clarified in part some of your questions.
    Kind regards,
    Fran Sans

  • Dear Fiachra,
    may be being considered a “dangerous man” is a honour after all…something is being done that puts at risk the stablishment
    I guess the drug discontinuation process can be very different for each person, and in your case a very hard one. The point is that no one knows beforehand how it will run this withdrawal journey…
    The most honest thing we can do is admit that we do not know a lot of things, explain the risks and try to help people for their best, avoiding unnecesary harm.
    Petter Bregging would say that a warm human relationship is the best we can offer as health professionals.

    Best wishes

    Fran Sans

  • I agree that there should be more options for helping people in mental distress.
    Professional help, included psychiatric drugs, can help some people but so can do many other approaches and I think honest information about prons and cons is the only way to help people to make their best choice.
    And of course, zero tolerance for coertion.
    Best wishes
    Fran Sans

  • Dear Sylvain,
    thank you for your nice comments and smart suggestions.
    Of course I would like to have more objective measures to support the results, mainly in terms of functionality and cognitive recovery, but this has been a small and first step. Hopefully in the future, with the collaboration of more coleagues, the proyect will be more ambitious.
    At present, I count with the most valuable subjective data, the opinion and narrative of the people involved.
    As for the tests, I do offer physical health check up regularly that include blood test for metabolic syndrome and of course the serum levels of drugs (clozapine, lithium, valproic acid…) when necessary.
    Thank you again for your inspiring comments
    Fran Sans