Friday, January 13, 2012

Reality Intervenes: The Case for Meds

Yesterday, in a piece entitled, We Can All Get Along, Can't We?, I wrote:

Psychiatry and its over-reliance on medications is experiencing a current self-inflicted lack of respect. This is occurring at the same time as Big Pharma is pulling out of the business of new psychiatric meds development. A new generation of psychiatrists pushing the same old meds serving up the same old explanations simply defies credibility.

Just so we're clear: In no way should this be interpreted as antipathy towards meds and those who prescribe them, much less those who take them, not to mention their family members and loved ones. As much as I may rail against the mindless overprescription of meds, I also realize there is a time and a place. Within hours of writing the above, I was served up a very strong reminder, three of them, actually.

First Reminder

Soon after posting my blog piece, I headed out the door and across town to check out this month’s International Bipolar Foundation lecture. The speaker was Maricela Estrada (pictured here), author of “Bipolar Girl: My Psychotic Self, a Memoir,” self-published in 2009. I arrived early and thus had a chance to have a one-on-one conversation with the author. Maricela is in her early 30s and works as a peer specialist for the Department of Mental Health in LA. She has an engaging manner and a delightfully bubbly personality, and in no time we were laughing and joking.

Maricela is no stranger to depression. She experienced her first episode as a school girl and has survived numerous suicide attempts, not to mention a drive-by shooting where a bullet whizzed past her head as she was lying in bed. The depressions continued through high school, but could not extinguish her irrepressible high spirits. She was very popular as a student, involved in activities, and elected prom queen.

Things fell apart soon after graduation. Mania, psychotic breaks, more suicide attempts, hospitalizations. During stable periods she managed to hold down various jobs and excel in college. But she would go off her meds and things would unravel. One time, in a car in a parking lot, she was convinced the world was ending. She heard a chorus of angels. She started screaming at people, and stripped off her blouse in order to be as naked as Adam and Eve. She was apprehended and handcuffed and put into a police car, breasts exposed.

In due course Maricela ended her denial and accepted the fact that she needed to stay on her meds. The meds were no picnic, and she had to struggle with weight gain and feeling like a zombie. In her talk she reported that she is now on a regimen she is happy with. In response to a question from the audience, she mentioned she loved her medication.

Thanks to her meds, she is in a position to say that.

Second Reminder

Just before Maricela was to speak, a woman I hadn’t seen in years walked into the lecture theater and took a seat next to me. Last time we talked, her husband, not on meds, had taken off and uprooted to another state. These kind of stories rarely have happy endings. Judy Eron’s “What Goes Up” recounts one such personal tragedy.

Fortunately for this woman, some 18 or so months later her husband eventually returned and got on lithium. Happy ending. Well, actually, there are no such things as endings so long as life goes on. For the two - thankfully - life goes on. So does their marriage.

Third Reminder

A few days ago, in response to an article on child bipolar, someone posted on mcmanweb:

Parents are being mislead by a multi billion-dollar a year child drugging industry that a diagnoses of "mental disorder" (ADHD, Bi-Polar, Social Anxiety Disorder) are medical diseases or illnesses. This is a fraud. No child has a brain scan, blood test, X-Ray or any evidence of physical abnormality to verify they are "ill" or "diseased." 

Yet psychiatrists continue to pound the public with misleading and fraudulent statements that these so called mental disorders are biochemical or neurological conditions. That is false. They are simply a list of behaviors that psychiatrists vote into existence and insert into their billing bible, the Diagnostic and Statistical Manual of Mental Disorders.

This has led to over 8 million children in the U.S. taking mind-altering psychiatric drugs.

This morning, I woke up to this response from Terea:

Mental disorders aren't something you have to "believe in" to be real. I once had my doubts about ADHD, but now that I have a 6 year old son with bipolar disorder and ADHD I know how important it is for these kids to receive an accurate and timely diagnosis. My son would stay up for nights on end, do dangerous and risky things, he couldn't function in school, he could barely talk, and even though he was frequently climbing walls he was a very unhappy little boy. 

Terea went on to say:

Now my son is taking Seroquel at night and Concerta during the day and life is so much better, not just for our family but for him as well. Grant can sleep, he is making friends, he is happy most of the time and not manic, and he is starting to read! In deciding whether to treat my child with "mind altering drugs" my choice was easy. It is absolutely apparent that Grant's quality of life is better now than it was before receiving treatment. If my child needed diabetes medicine I would make sure he got it, and the same goes for his bipolar meds. Finally, I look to my son's future and I know what happens when bipolar disorder is not treated. 

She wasn't through:

My dad committed suicide when I was a teenager and my brother has been on and off illegal drugs since his diagnosis in his late teens. I also have friends with bipolar disorder. You can't just ignore it and it will go away. With a 15% successful suicide rate untreated, self-medication, and all the other problems that arise when a mental disorder is unchecked, it is my responsibility as Grant's parent to do whatever I can to help him deal with his bipolar disorder...and not just ignore it.

Moral to this story

Well, it's rather obvious, isn't it?


Anonymous said...

Yeah, we'd all like not to have to take meds. They suck - even when they work. But they are definitely sometimes necessary. The "wouldn't you treat diabetes" is an appropriate argument - too bad some of these meds (seroquel for example) may make treatment for diabetes a necessity. It IS still a good analogy. This has been a difficult topic and I want to thank John for starting it up with the whole, easily twisted, ideas about Psychiatrists and big pharma pushing meds in spite of their efficacy. Sometimes they work and some of us need them, but you can't have blind faith in the profession or the medical model behind the drugs, or the drugs themselves.

Heather said...

I won't bash anyone who takes meds because they actually benefit from them and can manage the side effects so please don't bash me for *not* taking meds. It's not that I sit around and do nothing to manage my symptoms. I have done the heavy lifting in terms of major lifestyle changes and a metric ton of acceptance around the depth of my mood instability, all without the meds for 2 years running. Frankly, the average Joe or Jane on the street wouldn't know I was manic-depressive. Not taking meds does not equal not taking my illness seriously. I vote for room for each person to recover as he or she sees fit.
When I say they didn't work *for me* that can be as true as when the meds work for someone else.

John McManamy said...

Thanks, Anonymous. Your last sentence nails it.

John McManamy said...

Hey, Heather. You're definitely welcome here. We all support each other and the choices we make. And we all learn from each other. I've been writing so much stuff critical of psychiatry lately that it was high time for a reminder that meds can make a huge difference in people's lives.

Likewise, we need to hear people's stories about how they are leading successful lives meds-free or using low-dose strategies.

So, just to be clear: When I write about the virtues of heavy lifting with lifestyle and mindfulness etc I'm not bashing people on meds. When I write about people who choose to stay on meds, I'm not bashing those who choose to go off meds.

I was very grateful to listen to Maricela's story last night. Likewise, I am very grateful to hear from you. These are the kind of conversations we need to be having, so please feel free to keep posting.

gina said...

Nice job, John, as usual.

Anonymous said...

John is the torch bearer, leading us to healthier lives, educating us and allowing us to tell our stories.

He has been a Blessing to me for some years.

Hugs, M

Smitty said...

John you are doing again, what I wish I could do with my words.

Right now I work on taking that stand for my recovery on minimum drugs. When my faith fails, I now know to use the drugs as long as necessary.

Dawn said...

Blind faith in any profession or medication is inappropriate. My husband of 30 plus years was diagnosed with heart disease after his first heart attack at 46 years old. We went through 2 years of roller coaster pain while we waded through the medication side affects. His doctors weren't incompetent, his body simply responded dreadfully to traditional drugs.
Two years later I am diagnosed with bipolar 2 and have very similar experience with anti-depressants and other "recommended" therapies.

Four years later we are doing well on low dosages and healthy lifestyles. Neither of us like to take meds. Both are very glad the other one is happily with us.