Wednesday, September 18, 2019

Comments by 2C922C1932D64

Showing 9 of 9 comments.

  • There might be another reason for that, too, Fiachra. People with different genetic heritage have a different risk of allelic variations, which affect drug metabolism (I am referring to the CYP450 system here). For example, I have no 2d6, so I get paranoid on cannabis, got serotonin syndrome on mdma, and didn’t sleep for days when I used to take street drugs. This is because I wasn’t metabolising the drugs out of my system effectively, and they would build up to toxic levels.

    In psychiatry, this translates to a much higher incidence of adverse drug reactions in people who don’t have a full complement of genes in the CYP system (there could well be other systems involved too, but I don’t know about them) who are prescribed psych drugs. Maybe this leads to a higher rate of diagnosis of ‘mental illness’, which are actually adverse drug reactions, be it to psych or street drugs.

    Unfortunately (and bizarrely, considering how important it is), psychiatrists do not know about pharmacogenetics (the relationship between drugs and genes). However, doctors who aren’t psychiatrists know about it somewhat. For example, that you shouldn’t eat lots of brocolli or grapefuit if you’re taking statins, because the brocolli and grapefruit inhibit the liver enzymes that are responsible for metabolising the statins. It’s the same with psych drugs; giving an ‘antidepressant’ or ‘antipsychotic’ to a poor metaboliser will result in a much higher chance of an ADR. As will giving one of these drugs to an older person, or a very stressed person, or a person on birth control, or on other drugs… some substances inhibit, and some induce…and knowing what substance does what, and what enzymes are available for metabolism is a basic and crucial question to answer if you’re going to force drugs on people (obviously I wish they wouldn’t, but they do)…

    I am still struggling to understand why psychiatrists are so illogical, unscientific, and incurious…

  • I had a similar response… I am sort of relieved that At Last, a psychiatrist has experienced what so many of us know from the inside, and now understands that his medical training is unnacountable, b*s* (although Dr Horowitz was more diplomatic than that). But I’m feeling pretty tetchy, too.

    It’s well known, by, like, everyone that if you withdraw suddenly from many drugs, you get withdrawal syndromes. Why would it be such a stretch for the 0.5% of the supposedly brightest members of our population to understand that a drug that alters neurochemistry (in unexplained and poorly understood ways) would not have the potential for dramatic withdrawal reactions if suddenly withdrawn? It’s not like the body says, ok, this is a nasty street drug, so we’re up for withdrawal syndrome, but this is a nice pharmaceutical, so we’ll just reset ourselves quietly without a fuss. I mean, that sounds stupid, and yet something like that must be the thinking process…

  • Out, you have touched on an important point: For some (often completely unsuspecting) people, meditation can lead to various levels of decompensation, which is a field of research currently attracting a lot of interest (Dr Willoughby Britton at Brown University has published in this area). And you also make an excellent point: No self is not for everyone, and it’s hard to control how far into that shift you go as a meditation practitioner (most people do not even realise that from an Eastern perspective, that is the entire point of the endeavour)…

  • Bippyone, you make a great point about the drugs having a place. I sometimes (ok, very occasionally) find clients who do much better with drugs than without them, and I like to be reminded of this, lest I get too one-sided.

    If advocacy can get the public and the medical profession educated to the point that it is widely understood that the drugs can have significant side effects and a possible nasty withdrawal syndrome (& potentially the need for compounded medicine), then drugs may take their rightful place as a possible treatment, and not a mainstay…

  • Thank you for this blistering article and all the work you are doing on behalf of the truth, and patients’ rights.

    My recent experience: Three months ago: Taking my teenaged son to get a GP mental health plan because he wanted to see a therapist (not my idea! but he felt strongly that he needed help outside the family). Within 5 minutes of doing a checklist depression inventory (the K10), the GP announced that he had a chemical imbalance and he needed to go on antidepressants. My son relayed this information, knowing that I would never agree, and anxiously asked if the doctor could “make” him take the drugs. I changed GP’s so he wouldn’t have to go through this again when the mental health plan needed to be ‘renewed’ a couple of months later.

    The second GP said “Your K10 scores are no better! You are really unwell! You are going to have to go on antidepressants to sort this out! This is unacceptable!” It took me an hour to calm my son down (he was by now quite convinced that he was fundamentally broken), and (again) go through the research with him, discussing that the chemical imbalance theory is an unproven hypothesis, and that these drugs have a withdrawal syndrome, and side effects, and they were only trialled for 6-8 weeks, and not on paediatric populations blah blah blah, and that both his parents have metabolising issues (I am a poor metaboliser, and he will have half of my genes), which means there is a higher likelihood of him having metabolising issues.

    Then he was in the horrible situation of having to navigate two different sets of beliefs (his collective doctors’ the ‘experts’), over mine, (I am a psychiatric mental health worker with lived experience of the negative impact of carelessly prescribed psych drugs in family members and clients). (Note, I did not force my beliefs on him, but he knows I will not pay for antidepressants so he can get over school bullying and the impact of his father leaving the family).

    All this to say that I agree with Niall that GPs should not be prescribing antidepressants. And as for my experience (as a patient advocate) with psychiatrists… man, they are (often- not always) plumb crazy… (shakes head in wonder)… I mean Donald Trump crazy…