The Challenge of Going Off Psychiatric Drugs

The Challenge of Going Off Psychiatric Drugs
newyorker.com

This term, "prescription cascade", should be lesson #1 at medical school. It's the natural result of an incomplete diagnosis, and is present in every medical field.

> At the hospital, where she stayed for two weeks, she was put on a new combination of pills: Lamictal, a mood stabilizer; Lexapro, an antidepressant; and Seroquel, an antipsychotic that she was told to use as a sleep aid.

(emphasis added)

These descriptions -- mood stabilizer, antidepressant, antipsychotic -- are just marketing terms that don't actually describe the actual function of the drug. These marketing terms are most useful for tricking medical professionals into prescribing these products.

'Antibiotic' is the prototypical name for a class of drug that does what it describes: acts against bacteria.

> She saw her drugs as precision instruments that could eliminate her suffering, as soon as she and Dr. Roth found the right combination. “I medicated myself as though I were a finely calibrated machine, the most delicate error potentially throwing me off,” she later wrote.

I think this attitude is probably common for all the smart people who find themselves medicated into a downward spiral.

> “It is tempting to add a second drug just for the sake of ‘doing something,’ ” a 2004 paper in Current Medicinal Chemistry warns.

This is the trap the mental health system has fallen into: the professionals want to help. The drug industry has FDA-approved drugs for the various diagnosises.

Joel on Software said a re-write is something that shouldn't be done. But what other choice does the mental health industry have? Their system doesn't work. The modern industry is based on the flawed chemical imbalance theory of mental illness.

Little bits of progress have been made, in spite of the inertia to treat misunderstood behavioral problems with patent medicines. I have to conclude this comment before I can finish the article, so I'll link to my recent comment on the submission on the Szasz's book, the myth of mental illness: https://news.ycombinator.com/item?id=19243417

edit: shortened my first quote from the linked article

Same for antidepressants - often the same drugs (especially SSRIs) are both antidepressants and anxiolytics, but both labels are useful descriptions of the meds' common effects. Antidepressants in particular happen to be fantastically idiosyncratic drugs, but on average they do what they say on the label.

Part of the problem is that, due to the ill-understood nature of the brain, good psychiatrists need to know strange drug interactions and ill-studied minority reactions in order to serve the full range of their patients. This edges on art rather than science, which is always a recipe for cognitive biases to gain control.

It is like her doctors tried to medicate away an epiphany. Realizing that "the glittering balls and designer clothing has no real underlying substance" and being depressed that one's life is limited to such things, is not a cause for medication.

It sounds like she was struggling to be happy in a situation in which she was never going to find happiness.

Finding purpose, the thing she said was missing so early on, seems to ultimately be what helped her. Her reason to get up every day is that she can now help others, instead of live just for herself.

Some people look inward, they want to be the best dressed at the party, have a good career, and overall be successful in life. If that brings them happiness, then good for them! They have found what makes their life fulfilling. But different people need other forms of fulfillment, be it an artist completing their latest work, or someone who wants to have a daily positive impact on the world around them.

Medication cannot make people happy. (Well at least not the legal drugs, and the illegal ones won't work long term!) They can only create the possibility for happiness for those who need some extra help.

But, doctors need to do a better job of discovering if that extra help is just needed, or if the road their patient is going down is not going to lead to happiness no matter what is written on the prescription pad.