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Thinking about psychiatric drugs: Their limits

Psychiatric drug limits

When we hit difficult times we have grown to expect antidepressants and other mental health medications. Sadly, for many people the initial hope of an instant cure soon turns to disappointment as the side-effects take effect (like excessive weight gain, lethargy, disturbed sleep, memory loss, sexual problems, intense restlessness, feeling panicky, or simply feeling 'out of it' and detached from life).

Whilst some people say that they find their mental health drugs helpful, there are others who find the adverse effects just too much. Worryingly, scientists are not fully aware of the long-term consequences of these drugs on the brain and other parts of the body. That there are very serious risks and limitations is beyond doubt.

So, what do psychiatric drugs do?

If you are new to these drugs (and/or are concerned about someone you care about who is wondering whether or not to begin using them) you will no doubt want to know what they can or cannot do. So, what do psychiatric drugs do?

To some extent, depending on the drug, they may sedate or have a calming effect; they may have a stimulant and/or an energising effect; and/or they may create a measure of detachment from painful and/or unwanted thoughts and emotions. That may all sound well and good, but in reality it isn’t that simple. For a start, people differ considerably in how they respond to the same drug – so, for example, a drug that calms one person may make somebody else agitated and hyper. Thus prescribing a drug to a person can be a rather hit and miss affair. The psychiatrist Dr Carlat puts it like this: "The fact is that psychopharmacology is primarily trial and error, a kind of muddling through different candidate medications."4

Furthermore, as over time our bodies become tolerant to the drug, the expected benefits may be reduced or even lead to the opposite effect - the so-called paradoxical effects - so instead of reducing the intensity of hallucinations, for example, the drugs may actually cause a worsening of what might be referred to as psychotic reactions.

Help or hindrance?

For many people mental health medications just don't live up to their expectations - in reality there are no simple and quick chemical cures to alleviate or resolve life's problems. These drugs come at a cost, a cost to our health and well-being, in that the very faculties that we most need when in a crisis situation are often impaired by these drugs. To begin to face (and have a chance of resolving) the problems of life that we encounter, we need to be able to focus, to think clearly and to engage directly with those issues.

  For many people mental health medications just don't live up to their expectations
- in reality there are no simple and quick chemical cures to alleviate or resolve
life's problems. These drugs come at a cost, a cost to our health and well-being,
in that the very faculties that we most need when in a crisis situation are often
impaired by these drugs.

 

But mental health drugs can so often impair memory, learning, concentration and the ability to be decisive and engage with problems and obstacles along life’s way; perhaps making it more difficult for people to face and resolve crises, hold down a job, sustain relationships, and/or care for a family.

The drugs can be disabling and disfiguring too

Particularly with the antipsychotics, over time (and sometimes quite suddenly) people can develop what will be perceived by others as odd facial grimaces, tongue movements, twitches, jerking body movements and even arms flailing uncontrollably – all as a direct result of the drugs – these are not signs of a so-called “mental illness”, as some would put it. Added to this there can be shuffling steps, uncontrollable drooling (soaking the pillow and hair at night - e.g. with clozapine), and a marked slowness of thought and indecisiveness. The ability to read social cues and respect another person’s personal space may well be markedly hindered too.

Blurred vision (an ill-effect of various drugs, including antipsychotics, antidepressants and anticholinergics) is not uncommon and can make everyday tasks that many people take for granted, like reading a newspaper or watching TV, difficult or impossible. With drug-induced reduced concentration and impaired cognitive ability the simple pleasure of getting lost in the world of a novel can be denied. Being emotionally detached (again, through the drugs) can be difficult, as can the inability to experience a full range of human emotions. In addition, it is not unusual for these drugs to lower and even remove libido and create various sexual dysfunctions too. It’s not surprising people often inadvertently opt for a more sheltered, shallow and routine existence – existing rather than embracing life with all its challenges and rewards.

This website supports the freedom to choose (including to take or not to take
these drugs) and the right to be fairly informed of the limitations, risks and
alternatives.

Before you tell someone that they should go on an "antipsychotic" please read on...

Drugs like the so-called antipsychotics do not have the more pleasurable effects that someone might experience with some street drugs. In fact, taking them can be a nightmare and it is no surprise that so many people stop taking them. Dr Gwen Jones-Edwards, a Welsh psychiatrist, agreed to take one small dose of an antipsychotic drug as part of a clinical experiment. For anyone considering going on these drugs (or recommending them to someone else) I strongly recommend a careful reading of her account of her experience that describes troubling and distressing effects that lasted around 3 months. It is available here. Other doctors who participated in that study also had traumatic reactions, including Dr Phil Thomas. The published journal write-up is available here.

  My experience wasn't that the drug caused apathy, rather that the side-effects
were so distressing that one's concentration was entirely taken up by it. It is a cruel
drug, because the effects keep on coming back in waves, leading one to believe
that they have disappeared only to return - with all their personality-destroying
power. I was reduced to a nervous wreck. Dr Gwen Jones-Edwards, Psychiatrist

Trapped in a medication web

Gwen (mentioned above) was prescribed other mental health medications to try to combat the side-effects of the drug given to her. This is usual practise in psychiatry - to try to compensate for extreme reactions - doses get raised and other drugs are added. It is thus far too easy to get trapped in a medication web.

You can imagine how this spirals. A person may be prescribed an antidepressant. Antidepressants can cause anxiety thus leading to the need for a drug like Valium. Bizarrely, antidepressants can lead to depression. Then an antipsychotic may be prescribed as an adjunctive treatment of depression. Antipsychotics commonly cause depression, so it may be decided that we need an antidepressant. As antipsychotics often create movement disorders an anticholinergic drug (or a benzodiazepine) may be prescribed to suppress these. And then a benzodiazepine such as Xanax could (as many antidepressants can do) lead to violence. Psychiatric drug warningAntipsychotic drugs are used to try and restrict violence (including in prisons), but their use has been associated with a rise in violence (in prisons). Antidepressants may lead to mania and then a “mood stabiliser” is prescribed. Mood stabilisers are often anti-epilepsy drugs. Sadly, most psychiatric drugs lower the seizure threshold and so increase the chance of seizures. A child may be prescribed Ritalin, but then be given a sleeping tablet as Ritalin can cause insomnia. And so it goes on. Medication madness!

If you are already on these drugs please note the cautionary advice by clicking the WARNING image above. This warns about the dangers of changing medication doses (and stopping), cautions against sudden drug withdrawal and discusses the need to work closely with a physician you trust.

The drugs are tested for efficacy, not for effectiveness - there's a world of difference

As drugs are tested in somewhat artificial circumstances - Randomised Controlled Trials (RCTs) - they may not be as effective as we might hope when used in everyday life. Not only are the trials usually around just 6-8 weeks, but clinical situations aren’t necessarily typical of how the drugs are used in non-clinical settings and when used for much longer periods (often years). In trials the drugs are typically measured for efficacy (meeting the preset outcomes of the RCT) rather than what benefits the patient in the real world (quality of life and not simply a reduction in symptoms) over a longer period of time, which is effectiveness. In fact, "many of the situations that people are in when they seek psychiatric intervention are unlikely to be helped by the range of effects that current drugs are known to cause. Some problems may be exacerbated by the drugs". 1

Mental health drugs are not really specific treatments

Doctors may place such confidence in these drugs that people fail to realise that they, at best, only reduce symptoms: they are not cures. In fact, they are not really specific treatments that act in a “disease-specific way”1.  Antipsychotics are not just prescribed for "psychosis", but prescribed for depression, also for so-called bipolar disorder, and to control and sedate (sometimes referred to as the “chemical straightjacket” or "chemical cosh") patients and/or prisoners. They used to be called "Major Tranquilizers" - perhaps a more apt name for them. In fact, in their early days they were hailed as chemical lobotomisers, having a similar effect on the brain as the surgical lobotomy. In a similar way, drugs for anxiety (anti-anxiety drugs or anxiolytics) used to be termed "Minor Tranquilizers" - again, rebranded but the same drugs.

The fact that the newer antidepressants (following on from the launch of Prozac in 1988) have been cleverly branded as Selective Serotonin Inhibitors (SSRIs) makes them sound like the chemical equivalent of keyhole surgery; in reality, this is far from true [see here].  In fact, antidepressants are prescribed for a whole host of personal concerns, including anxiety, obsessive behaviour, eating disorders, post-traumatic stress and chronic pain. Professor Valenstein rightly concludes: "There is much that is illusory and misleading about the claims of increased specificity for the newer psychiatric drugs"5.

The prescribing of mental health drugs is not a precise science

The prescription of psychiatric drugs is in many ways made in ignorance. Treatments tend to focus on just a few neurotransmitters (chemical messengers) within the brain, but in truth there are over sixty neurotransmitters and the drug action on the function of the brain and the nervous system is little understood “because most of the molecules in a very complex organ like the brain remain unknown 6.” Any talk of targeting dopamine or serotonin, for example, is grossly misleading in that modifications to one neurotransmitter have a chain reaction across the brain and beyond. And as we have seen here, serotonin receptors exist right across the body – in the gut, in the blood, and some scientists speculate that “every neuron in the brain may be contacted by a serotonin fibre”. 7

Drug category names (anti-depressant, anti-psychotic etc) are really product branding

In truth, the category names (such as antipsychotic, mood stabiliser) have little meaning. Antipsychotics aren’t really drugs that specifically correct psychosis. They have global effects across the whole of the body (affecting moods, hormones, movement, thinking, memory etc). Research indicates that antidepressants are, for example, much more effective at lowering libido than they are at lifting depression. And then we have so-called “mood stabilisers” too. These tend to be sedatives that have been used over the years to try and reduce the occurrence and/or intensity of seizures, but have been re-branded more recently as “mood stabilisers”.  I quote Dr Joanna Moncrieff: “No drugs have been shown to normalise or smooth out moods, and all drugs prescribed as mood stabilisers are sedative drugs…These drugs suppress mental and physical activity and probably reduce people’s emotional responses to their environment, in a similar way to neuroleptics.”2

These drugs have serious limitations and are rough tools not specific cures

If and when a doctor is prescribing these drugs – it is important to bear in mind that they have many different effects, some desirable and others undesirable – and, as we have seen, the category names are merely branding terms rather than accurate indicators of what they do. There’s a well known advert here in the UK for a particular brand of wood treatments: “It does what it says on the tin.” With these mental health drugs, they don’t necessarily do as the name suggests. In saying this, I am not claiming that they never have beneficial effects: “Benzodiazepines [drugs such as Valium] reduce physical and mental tension. Stimulants increase energy. Anticholinergics can be euphoriant. Antipsychotics tranquilize”3 – and these effects may be welcomed by the patient. That said, these drugs have serious limitations and are rough tools not specific cures. As Dr Thomas Insel, a key proponent of bio-medical psychiatry concedes here: "For too many people, antipsychotics and antidepressants are not effective, and even when they are helpful, they reduce symptoms without eliciting recovery.”

Studies highlight these limitations, as we read here: “It is now widely admitted that at least 25% of patients do not show any significant clinical improvement with [neuroleptic/antipsychotic] treatment. A recent comparison of two of the newer neuroleptic drugs, risperidone and olanzapine, found that 46% and 56% of patients, respectively, did not respond after four months of treatment (Robinson et al. 2006) 1.”

If these drugs were simply ineffective we would have less to fear. But as we have seen, they can create more problems than they solve: antidepressants can lead to depression and mania, drugs like Valium (intended to calm) can make people extremely anxious and panicky, and, according to Dr Healy (here), "there is a real case today that many of the antipsychotics or mood stabilizers being given cause the psychoses they are supposed to treat or mood swings they are supposed to stabilize." 

Can psychiatric drugs be helpful? To a point. There is however a big BUT here. They may be helpful in some ways, but, they do come with a whole host of unpleasant side-effects, can aggravate the problems they are supposed to help remedy, create new problems, can impede natural recovery, and are seriously risky too, especially when used for long periods. We look at the risks here.

References - Bibliography - Further reading

1 Moncrieff, J. (2008) The Myth of the Chemical Cure. UK: Palgrave MacMillan

2 Moncrieff, J. (2009) A Straight Talking Introduction to Psychiatric Drugs. UK: PCCS Books Ltd

3 Healy, D. et al 2012 Data Based Medicine Position Paper: Antidepressants for Takers (RxISK). Full article

4 Carlat, D. (2010) Unhinged: The Trouble with Psychiatry - A Doctor's Revelations about a Profession in Crisis. New York: Free press

5 Valenstein, E.S. (1998) Blaming the Brain: The Truth About Drugs and Mental Health. New York: The Free Press.

6 Cooper et al. (2003) The Biological Basis of Neuropharmacology. UK: Oxford University Press. (p. 40)

7 Jackson, G. (2005) Rethinking Psychiatric Drugs. USA: Anchor House. (p. 77)

   
       
 
     
 
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