Thursday, April 25, 2019

Comments by madcat

Showing 11 of 11 comments.

  • ANY intervention has the potential for unwanted effects. Yoga and meditation can have significant adverse effects, especially in the setting of post-traumatic conditions, where they can lead to de-repression of traumatic memories and subsequent destabilisation and crisis (even if there is no previously acknowledged trauma history).

  • Yours is a truly unenviable position to be in. To know what the better option is but only be able to offer it on a limited basis, with the risk of making the situation worse by raising hope in these young adults and then having it eroded by financial and bureaucratic constraints. No matter that it is a false economy in the longer term (not to mention incredibly destructive to individuals) to manage the problems arising from trauma and abuse through drugging, hospitalisation and detention.

    I know from personal experience what it is like to come off long term psychiatric medication and have to deal with a long and horrible withdrawal followed by emotional dysregulation and then to have to deal, unmedicated, with the underlying traumas that led to the “mental illness”, while repeatedly facing criticism of my decision to discontinue drugs and pressure to recommence them because I am now perceived as a difficult, time-consuming and risky patient. From working with a good therapist I understand and appreciate the healing power of a safe and supportive relationship and of being heard, but it is a very slow process, and there are big risks of retraumatisation if this level of support is not available for as long as is needed – it has the potential to simply repeat a life-long pattern of loss and betrayal. I am a middle-aged professional with the necessary personal and financial resources to make this option work for me, and I still struggle immensely. I can only imagine how much more difficult it is for those who do not have these resources.

  • One of the things for which I am most grateful to my psychiatrist is his keeping me out of the hospital system, particularly as it has become clearer to me that my problem is not “depression” but complex trauma (including but not limited to sexual assault by a psychiatric nurse).

    The risks for women in a psychiatric inpatient setting in the state in Australia where I live are considerably worse than 1 in 3. A 2013 report (linked below) on sexual victimisation alone showed that the rates of sexual harassment were around 67%, and sexual assault around 45%. I am not sure how much the situation has improved since then, but anyone who has been following the news in the last few years cannot help but be be aware that Australia has (or should have) an appalling reputation with regard to its treatment of detainees of all sorts – in prisons, immigration detention and as involuntary psychiatric patients.

    http://www.abc.net.au/reslib/201305/r1115028_13591277.pdf

  • Great article. I can really identify with some of the things you have said. It makes me so, so grateful to my therapist/psychiatrist for having kept me away from most of harms of institutionalised psychiatry despite a number of suicidal crises, particularly as one of my sexual assaults was by a psychiatric nurse (not someone with whom I had a professional relationship, but he was a mentor and volunteer leader and someone I’d turned to for advice and friendship; the assault was something I only recently revealed to my therapist).

  • I agree that withdrawal is horrendous and the after-effects prolonged.

    

I was on citalopram for around 12 years and made the decision to withdraw from it around 18 months ago. I’d made two previous attempts to withdraw but could not tolerate the process and went back to the original dosage of 20mg. With this more recent attempt I went more slowly, over about 8 months and using an equivalent dose of escitalopram liquid once it became impractical to use fractions of tablets. Every time I dropped the dose I would have a week or two of marked physical and mental withdrawal symptoms including transient suicidal thoughts, which would gradually settle. By the time I reached 20% of the original dose the physical symptoms were not much of a problem, but the mental symptoms were more marked. I found the Surviving Antidepressants online site very useful for both information and support, and I really wish I’d read Will Hall’s “Harm Reduction Guide” BEFORE I commenced withdrawal – I’d have been much better prepared.

    After ceasing the drug completely, over the course of a couple of months I developed a rebound episode of suicidal depression, with much more severe anxiety than I’d had prior to being on the drug. Despite being under psychiatric supervision during this whole process, I came under considerable pressure from my GP – after minimal examination and with no discussion whatsoever with my treating psychiatrist (who is also my therapist, and with whose care I was very satisfied) – both to reinstate the drug and to get a second opinion from an extremely biologically focussed psychiatrist (senior academic, head of a private ECT unit, author of an ECT textbook, a director of the organisation that writes the prescribing guidelines most commonly used by GP’s) – on the premise that my “mood swings” were due to possible bipolar disorder. In addition to being pretty annoyed with her for deciding to intervene at all at this point, given that she had been blithely writing prescriptions for citalopram for the previous 8 years without ever questioning the need for long term medication, and without actually having read my history (eg she was unaware that I’d previously taken an overdose of this drug – unwisely provided in the form of free samples by the GP before her – but that’s a whole other story), I realised that her referral had the potential for a really bad outcome for me.

    It was highly likely that the second psychiatrist’s opinion would be that the rebound depression was a sign that I should be on lifelong antidepressant therapy. Plus if I were foolish enough to admit to the symptoms I’d had early on in treatment with citalopram – very mild behavioural activation and euphoria, barely more than my “normal” but quite a contrast to the unmedicated state of a week prior – at a stretch he could probably also make a bipolar spectrum diagnosis. My job requires a high level of concentration and dexterity, so any of the drug treatments commonly used for this condition would be a disaster. As a health professional myself, there was also the risk that if I disagreed with any aspect of the diagnosis or proposed management that pressure could be applied including via my professional registration board (this may sound like mere paranoia on my part, but the psychiatrist in question was noted in a number of online reviews to be somewhat of a bully, and recent events in my hometown of Melbourne have demonstrated fairly conclusively the potential for abuses of power by psychiatrists). So I simply walked away from that, refusing the referral and firing my GP.

    

In the 6-7 months since I recovered from the depressive episode I’ve had significant ongoing problems with both anxiety and emotional dysregulation. These are slowly improving with a combination of time, therapy, exercise and mindfulness meditation but it’s all had a major impact on my quality of life. The irony is the realisation (in the course of therapy and a lot of reading) that my recurrent “depression” has a lot more to do with multiple traumatic life experiences than genetics or biology but that I had swallowed hook, line and sinker the conventional biomedical model I had been taught. It all makes me very angry.

  • I agree totally. As I said in my comment, meditation can be hazardous, especially in particular symptom-meditation style combinations. I know this from personal experience as well. Nothing like a silent retreat with plenty of unfocussed meditation when you’re already feeling suicidal to really send you over the edge. In teaching or recommending meditation for any sort of mental health problem, you need to know what you’re doing. It’s not a panacea.

  • I think it is important to note that this study used a focussed attention style of meditation. There are some styles of meditation such as open awareness meditation (aka objectless meditation) which can exacerbate rumination and make depressive symptoms worse, and can be particularly hazardous if the depressed person has significant suicidal ideation. I found the explanation of helpful and unhelpful meditation practices on the wildmind Buddhist Meditation site (meditation and depression section) was quite a good overview of this topic.

  • Always good to read about other people’s experience. I’m in the medical field so I can really identify with the difficulties of speaking out. I’m currently withdrawing from AD very slowly after 10+ years on them, and have found the survivingantidepressants site very helpful. I also can’t speak highly enough of using a form of the drug which makes it easy to taper the dose. I switched from citalopram tablets to the equivalent dose (about half) of escitalopram liquid specifically to taper the dose, because I’ve had horrendous problems trying to withdraw several times previously on the tablets. I’m down to 10% of my original dose, with a fair way to go yet due to percentage tapering.

    My psychiatrist is very supportive, but I’m meeting surprising resistance from my GP, who is reluctant to accept that my symptoms are withdrawal and is trying to convince me that I should increase the dose again or at the very least not go off them while I’m dealing with some other (non-depression) issues with a psychologist. As you say, there is never a good time to go off AD, but I’d have thought that doing it while being closely monitored by a professional who can actually teach you non-drug strategies to manage symptoms as they occur has to be about the best plan there is.

    I’ve avoided supplements for 2 reasons – one being that anything which has a genuine effect has the potential for side effects and withdrawal effects, and I have had enough problems with one drug and its interactions; and secondly, I hate having to take stuff every day – I’m not so much an ideological objector to artificial vitamin/mineral/other supplements as lazy.

    The AD have caused quite a few problems which have only been recognised in retrospect as side effects rather than illness effects (which is why I was continued on the drugs for so many years), including worsening depression, mental agitation, suicidal thoughts of an unusual and violent nature, and a suicide attempt (which, obviously, I survived). One thing I’ve noted is that it can be quite difficult using personal stories as evidence for illness vs AD side effects because many people are firmly in either the biological-model-pro-drug camp or the big-pharma-conspiracy-anti-drug camp and will tend to give anecdotal accounts which are rather biased toward their own point of view. One group of people that seem to give a very unbiased account of these side effects as they are occurring are those who are new to the drugs, experiencing symptoms with no preconception that they might be side effects and asking for advice on internet forums. These seem to give a very clear picture that the agitation-weird thoughts-suicidal obsession-suicide group of symptoms are a drug-induced effect which is more common in younger patients but which can most definitely occur in the over 30’s (a group to which I belong and which drug companies still don’t recognise in the black box warnings).