5 ms·

My layman's impression is that the current generation of drugs for serious psychiatric diseases does more to help family and society in general to live with the

by stiff 13y ago

My layman's impression is that the current generation of drugs for serious psychiatric diseases does more to help family and society in general to live with the patient, than to help the patient itself. Our understanding of the brain is still very basic, so, even with the best intentions of the doctors, all the treatment often seems to do is to alleviate the most visible of the external symptoms, causing several new problems in the process, or simply making the patient apathetic, "solving" the problem for everyone but the patient. The dilemma described in the article is all the more difficult given that suicide is so common in many of those diseases, and not administering drugs (or using the wrong ones) might, on the other hand, cost the patient their life.

bayesianhorse 13y ago
Schizophrenic patients do suffer, both from the symptoms themselves as well as from the consequences on their life and relationships. And yes, that's a dilemma.
MarkPNeyer 13y ago
this is absolutely correct. i had a psychotic break last year, really bad. i was put on intensive medications, which made it easier to fit into normal every day interaction, but also made me tired, depressed and, ultimately, more psychotic. all of the times i've experienced psychosis, it's been a defensive mechanism that my mind uses to explain why i'm feeling so shitty - so taking medicine that is exhausting, makes me gain weight and have trouble focusing just made the problem worse. the meds stopped the immediately frighting and bizzare imagines my mind presented to me, but they didn't go away - they just changed into longer term, ultimately more frighting images that still scared me, but in a way that was more conducive to my behaving in a way that everybody else expected. i would believe i was trapped inside something like the matrix, where everything i did on the inside had intense consequences for people outside my reality; failing to wash my hands after using the restroom would cause millions to die far away. one of the 'rules' the psychosis imposed on me was that i could never talk about what i was struggling with because that would break the matrix and cause even worse problems. it's pretty easy to see in retrospect that it was entirely metaphorical; the 'matrix' stands for the world of social convention, and small risks that add up over time (i.e. not washing hands or brushing teeth) were presented as catastrophic nightmares in order to make sure i focused on resolving them. over the course of the past year i've slowly reduced the usage of these psychotropic medications - with approval from my psychiatrist - and with increased amounts of energy and happiness, i no longer have as much of the psychosis. the issue i can see with all of this is that treatment for mental health issues requires love, patience and careful attention from a lot of people over a long time; if you ask me, our society does not want to give that to people for fear of being taken advantage by some unscrupulous people who would feign mental illness to get out of work. i don't know what a solution would be, but i agree with you - these meds do more to help everybody else than the patients themselves.
- wuschel 13y ago
  I am sorry for you and wish you the very best. I would not condemn anti-psychotic medication just because 1. we do not understand the brain and thus are not able to design more sophisticated methods to treat this terrible decease 2. many patients suffer from terrible side effects. Thanks to some new generation anti-psychotic drugs (e.g. Risperidol, Abilify, etc) many a person who has the misfortune to suffer from psychosis can return to their daily live - and by this I mean that the person can do more then just 'function'. Of course, his ability to do so depends on the severity of psychosis and dosis of medication. I know a person who learned to live with his psychosis and has greatly improved his quality of life in the recent two years.. to such a degree that he may complete his (ambitious) studies and get a job. Medication was one of the key factors for his well being, other were a long series of psychologic treatments and support from his surrounding. It also true that in societies where the access to anti-psychotic drugs is restricted (e.g. lack of a pharmaceutical industry) a completely different development of the person is observed, not necessarily in a negative way. However, the nature of psychosis is deeply connected with genetic (hard) and enviromental (soft) factors, such as family, society, experience as a child, etc - so no actual comparison can be made between those patient groups. Right now, there is no solution to this phenomenon of brain disfunction, and research has a long way to go to understand the structural changes in the brain of psychotic persons during their beginning adolescence and possible treatment. At the end, stigmatization of psychosis should be avoided, as should be any general magic recipe - every patient is a single case who deserves the best treatment and support from his family and friends.
  - Maria1987 13y ago
    Just a short note on the "we do not understand the brain and thus are not able to design more sophisticated methods to treat this terrible decease" Allow me to disagree. We do not need to understand how the brain works in order to be able to find treatments for all the different mental deceases. Its all trials and errors, hypothesis -> testing -> result, again and again and again until a final conclusion! I have spend a lot of years researching the brain, the black box which everyone wants to understand but no-one has any clue about it and more specifically Alzheimer's disease (not in a pharmaceutical company but in academia). From my experience, we don't need to understand how something works if we know what is the most likely outcome for a given input. I was lucky enough to test different types of drugs, their long term and short term effects, how useful they are and of course what effects have in behaviour etc. From every single study I could put a piece of puzzle right there and be able to see a clearer picture of what's going on, make hypothesis, tests hypotheses, have controls, tests controls etc. I obviously have no clue how the brain works but for those things I checked I know: Given an input -> Brain -> I get an particular output most likely* From that (and of course many control studies), I could trust that this drugs will most likely give me the predicted output. And that's how research is done..Is not always correct but based on that, we managed to be where we are, to have drugs for diseases which in the past killed us and step by step we can move forward and it would be wrong to doubt how much improvement has been done so far by the research community. I am not suggesting you to trust anti-psychotic, just suggesting you that in my personal opinion, is wrong not trusting a drug (which you of course are well aware for advantages/ disadvantages) just because you don't know how brain works...Many other drugs which are for simple diseases actually affect your brain in many similar ways as anti-psychotics.
duaneb 13y ago
> My layman's impression is that the current generation of drugs for serious psychiatric diseases does more to help family and society in general to live with the patient, than to help the patient itself That's exactly that—a layman's impression. Realistically this is very complex to evaluate. Personally, when I took my antipsychotic, I thought clearer. I stopped because there were physical side effects, but I still miss it. As always, exercise caution when adopting new medication, and evaluate early and often whether it helps you address your needs. However, I can't think of anything more harmful than denying patients medication that actually might help them. People have strong feelings about psychiatric drugs, and even more so when it's hard to quantifiably evaluate the beneficial effects. Add in that depression and anxiety have a practically infinite number of causes. The result is that it's very difficult to evaluate medications for a given patient without trying it, and there are a large number of failures before finding good medication.
loceng 13y ago
One thing to note with many, if not all (?), SSRIs (unsure about other classifications of brain-chemistry altering drugs) lead to a higher rate of suicide than placebo. I won't go into more depth than that. There are lots of assumptions as to why that occurs, though it sounds like a better for more individuals if you do it without medication and create an environment that fosters recovery and healing over time. Unfortunately our societal structures, and pressures they put on families, etc. doesn't generally allow for this. Not yet, anyway.
- ctdonath 13y ago
  The drugs work. Missing a couple days is very easy - and the consequences very severe. From what I've encountered several times, I'm surprised nobody is seriously & publicly discussing the very serious problem of missed doses, as likely the root of much of the associated violence.
  - loceng 13y ago
    The controlled studies they do, that determined the increased rate of suicide, is in a very controlled environment - where no one would have missed their doses. If you get angry and feel violent because of missing doses, perhaps it would be valuable to explore the underlying anger - see what it's associated with and perhaps learn skills to calm and cope with it, in case you miss a dose again, etc..
    - ctdonath 13y ago
      You haven't seen what I have up close and personal about missed doses. I'm not questioning your controlled studies, just observing something related from up-close-and-personal experience: missed doses can FUCK YOU UP ... I'm not talking explorable anger issues, I'm talking your anger processing unit suffers an electrical storm.
ryanjshaw 13y ago
While I'm sure you mean no harm, you are - quite simply - wrong. There are plenty of people who live lives they would never be able to live without medication, and without many of the harmful side-effects being discussed. It's incredibly frustrating seeing people who acknowledge they have no specialized knowledge in a field make sweeping statements about it, encouraging psuedo-scientific beliefs about psychiatry (which is, make no mistake about it, more of an 'art' than a science, but so was the beginning of many now-scientific fields). Nobody tries to tell a cancer patient how to treat their cancer, yet so many people feel obliged to opine about mental illness. What this article is discussing is the (unquantified) subset of people who experience serious side-effects from anti-psychotics. The key takeaway from the article: > “For some people, remaining on medication long-term might impede a full return to wellness,” Insel wrote. “For others, discontinuing medication can be disastrous.” > The problem is that we do not know who is in which group. > Some people can learn to talk themselves down from delusional thoughts. And some people might choose hearing voices over being 30 pounds overweight and tired all of the time. The point is that this is not a choice I should be making for my patients; it is a choice I need to make with them. Of course, if somebody is having a psychotic break or mentally unstable, you can't even begin to have that conversation about their available options because they will be unable to focus or make rational choices. You pretty much need to start with the medication, then work from there to figure out which group they're in, and adapt their treatment accordingly (i.e. stick with meds or drop them but help them learn how to manage it). I found the article to be a long-winded way of saying "psychiatrists ought to seriously consider dose reduction in their treatment regime", which is something that I doubt anybody would argue against. The devil is in the details (for some people, dose reductions can be incredibly dangerous), and the article does not delve into what a sensible strategy would look like.
- stevoski 13y ago
  > Nobody tries to tell a cancer patient how to treat their cancer, Oh I wish that was true. My gf had cancer and every crackpot we knew was advising on nonsense causes and treatments.
  - ubercore 13y ago
vacri 13y ago
I would add my voice to cautioning against such sweeping generalisations. Saying "I'm a layman... our understanding of the brain is very basic" doesn't really follow. The brain is something of a black box, and it is extraordinarily complex. We have a complex understanding of it - which isn't enough to understand it fully, but it's better than 'very basic'. The characterisation of our understanding as being so simple doesn't do either the brain or the researchers any justice at all, and makes us lean towards it 'being okay' to be helpless in the face of its complexity. It is, without a doubt, the most complex field in the human experience by far. all the treatment often seems to do is to alleviate the most visible of the external symptoms, causing several new problems in the process, or simply making the patient apathetic Some patients generally do okay with medication, others have transient episodes during which the medication helps throughout. Not every patient is on a rollercoaster to hell. If the argument "well, you can't save everyone, so don't try anything" really had any merit, there wouldn't be any Emergency Departments in hospitals.

by stiff 13y ago

bayesianhorse 13y ago

Schizophrenic patients do suffer, both from the symptoms themselves as well as from the consequences on their life and relationships. And yes, that's a dilemma.

MarkPNeyer 13y ago

this is absolutely correct. i had a psychotic break last year, really bad. i was put on intensive medications, which made it easier to fit into normal every day interaction, but also made me tired, depressed and, ultimately, more psychotic. all of the times i've experienced psychosis, it's been a defensive mechanism that my mind uses to explain why i'm feeling so shitty - so taking medicine that is exhausting, makes me gain weight and have trouble focusing just made the problem worse. the meds stopped the immediately frighting and bizzare imagines my mind presented to me, but they didn't go away - they just changed into longer term, ultimately more frighting images that still scared me, but in a way that was more conducive to my behaving in a way that everybody else expected. i would believe i was trapped inside something like the matrix, where everything i did on the inside had intense consequences for people outside my reality; failing to wash my hands after using the restroom would cause millions to die far away. one of the 'rules' the psychosis imposed on me was that i could never talk about what i was struggling with because that would break the matrix and cause even worse problems. it's pretty easy to see in retrospect that it was entirely metaphorical; the 'matrix' stands for the world of social convention, and small risks that add up over time (i.e. not washing hands or brushing teeth) were presented as catastrophic nightmares in order to make sure i focused on resolving them. over the course of the past year i've slowly reduced the usage of these psychotropic medications - with approval from my psychiatrist - and with increased amounts of energy and happiness, i no longer have as much of the psychosis. the issue i can see with all of this is that treatment for mental health issues requires love, patience and careful attention from a lot of people over a long time; if you ask me, our society does not want to give that to people for fear of being taken advantage by some unscrupulous people who would feign mental illness to get out of work. i don't know what a solution would be, but i agree with you - these meds do more to help everybody else than the patients themselves.

wuschel 13y ago
I am sorry for you and wish you the very best. I would not condemn anti-psychotic medication just because 1. we do not understand the brain and thus are not able to design more sophisticated methods to treat this terrible decease 2. many patients suffer from terrible side effects. Thanks to some new generation anti-psychotic drugs (e.g. Risperidol, Abilify, etc) many a person who has the misfortune to suffer from psychosis can return to their daily live - and by this I mean that the person can do more then just 'function'. Of course, his ability to do so depends on the severity of psychosis and dosis of medication. I know a person who learned to live with his psychosis and has greatly improved his quality of life in the recent two years.. to such a degree that he may complete his (ambitious) studies and get a job. Medication was one of the key factors for his well being, other were a long series of psychologic treatments and support from his surrounding. It also true that in societies where the access to anti-psychotic drugs is restricted (e.g. lack of a pharmaceutical industry) a completely different development of the person is observed, not necessarily in a negative way. However, the nature of psychosis is deeply connected with genetic (hard) and enviromental (soft) factors, such as family, society, experience as a child, etc - so no actual comparison can be made between those patient groups. Right now, there is no solution to this phenomenon of brain disfunction, and research has a long way to go to understand the structural changes in the brain of psychotic persons during their beginning adolescence and possible treatment. At the end, stigmatization of psychosis should be avoided, as should be any general magic recipe - every patient is a single case who deserves the best treatment and support from his family and friends.
- Maria1987 13y ago
  Just a short note on the "we do not understand the brain and thus are not able to design more sophisticated methods to treat this terrible decease" Allow me to disagree. We do not need to understand how the brain works in order to be able to find treatments for all the different mental deceases. Its all trials and errors, hypothesis -> testing -> result, again and again and again until a final conclusion! I have spend a lot of years researching the brain, the black box which everyone wants to understand but no-one has any clue about it and more specifically Alzheimer's disease (not in a pharmaceutical company but in academia). From my experience, we don't need to understand how something works if we know what is the most likely outcome for a given input. I was lucky enough to test different types of drugs, their long term and short term effects, how useful they are and of course what effects have in behaviour etc. From every single study I could put a piece of puzzle right there and be able to see a clearer picture of what's going on, make hypothesis, tests hypotheses, have controls, tests controls etc. I obviously have no clue how the brain works but for those things I checked I know: Given an input -> Brain -> I get an particular output most likely* From that (and of course many control studies), I could trust that this drugs will most likely give me the predicted output. And that's how research is done..Is not always correct but based on that, we managed to be where we are, to have drugs for diseases which in the past killed us and step by step we can move forward and it would be wrong to doubt how much improvement has been done so far by the research community. I am not suggesting you to trust anti-psychotic, just suggesting you that in my personal opinion, is wrong not trusting a drug (which you of course are well aware for advantages/ disadvantages) just because you don't know how brain works...Many other drugs which are for simple diseases actually affect your brain in many similar ways as anti-psychotics.

duaneb 13y ago

> My layman's impression is that the current generation of drugs for serious psychiatric diseases does more to help family and society in general to live with the patient, than to help the patient itself That's exactly that—a layman's impression. Realistically this is very complex to evaluate. Personally, when I took my antipsychotic, I thought clearer. I stopped because there were physical side effects, but I still miss it. As always, exercise caution when adopting new medication, and evaluate early and often whether it helps you address your needs. However, I can't think of anything more harmful than denying patients medication that actually might help them. People have strong feelings about psychiatric drugs, and even more so when it's hard to quantifiably evaluate the beneficial effects. Add in that depression and anxiety have a practically infinite number of causes. The result is that it's very difficult to evaluate medications for a given patient without trying it, and there are a large number of failures before finding good medication.

loceng 13y ago

One thing to note with many, if not all (?), SSRIs (unsure about other classifications of brain-chemistry altering drugs) lead to a higher rate of suicide than placebo. I won't go into more depth than that. There are lots of assumptions as to why that occurs, though it sounds like a better for more individuals if you do it without medication and create an environment that fosters recovery and healing over time. Unfortunately our societal structures, and pressures they put on families, etc. doesn't generally allow for this. Not yet, anyway.

ctdonath 13y ago
The drugs work. Missing a couple days is very easy - and the consequences very severe. From what I've encountered several times, I'm surprised nobody is seriously & publicly discussing the very serious problem of missed doses, as likely the root of much of the associated violence.
- loceng 13y ago
  The controlled studies they do, that determined the increased rate of suicide, is in a very controlled environment - where no one would have missed their doses. If you get angry and feel violent because of missing doses, perhaps it would be valuable to explore the underlying anger - see what it's associated with and perhaps learn skills to calm and cope with it, in case you miss a dose again, etc..
  - ctdonath 13y ago
    You haven't seen what I have up close and personal about missed doses. I'm not questioning your controlled studies, just observing something related from up-close-and-personal experience: missed doses can FUCK YOU UP ... I'm not talking explorable anger issues, I'm talking your anger processing unit suffers an electrical storm.

ryanjshaw 13y ago

While I'm sure you mean no harm, you are - quite simply - wrong. There are plenty of people who live lives they would never be able to live without medication, and without many of the harmful side-effects being discussed. It's incredibly frustrating seeing people who acknowledge they have no specialized knowledge in a field make sweeping statements about it, encouraging psuedo-scientific beliefs about psychiatry (which is, make no mistake about it, more of an 'art' than a science, but so was the beginning of many now-scientific fields). Nobody tries to tell a cancer patient how to treat their cancer, yet so many people feel obliged to opine about mental illness. What this article is discussing is the (unquantified) subset of people who experience serious side-effects from anti-psychotics. The key takeaway from the article: > “For some people, remaining on medication long-term might impede a full return to wellness,” Insel wrote. “For others, discontinuing medication can be disastrous.” > The problem is that we do not know who is in which group. > Some people can learn to talk themselves down from delusional thoughts. And some people might choose hearing voices over being 30 pounds overweight and tired all of the time. The point is that this is not a choice I should be making for my patients; it is a choice I need to make with them. Of course, if somebody is having a psychotic break or mentally unstable, you can't even begin to have that conversation about their available options because they will be unable to focus or make rational choices. You pretty much need to start with the medication, then work from there to figure out which group they're in, and adapt their treatment accordingly (i.e. stick with meds or drop them but help them learn how to manage it). I found the article to be a long-winded way of saying "psychiatrists ought to seriously consider dose reduction in their treatment regime", which is something that I doubt anybody would argue against. The devil is in the details (for some people, dose reductions can be incredibly dangerous), and the article does not delve into what a sensible strategy would look like.

stevoski 13y ago
> Nobody tries to tell a cancer patient how to treat their cancer, Oh I wish that was true. My gf had cancer and every crackpot we knew was advising on nonsense causes and treatments.
- ubercore 13y ago

vacri 13y ago

I would add my voice to cautioning against such sweeping generalisations. Saying "I'm a layman... our understanding of the brain is very basic" doesn't really follow. The brain is something of a black box, and it is extraordinarily complex. We have a complex understanding of it - which isn't enough to understand it fully, but it's better than 'very basic'. The characterisation of our understanding as being so simple doesn't do either the brain or the researchers any justice at all, and makes us lean towards it 'being okay' to be helpless in the face of its complexity. It is, without a doubt, the most complex field in the human experience by far. all the treatment often seems to do is to alleviate the most visible of the external symptoms, causing several new problems in the process, or simply making the patient apathetic Some patients generally do okay with medication, others have transient episodes during which the medication helps throughout. Not every patient is on a rollercoaster to hell. If the argument "well, you can't save everyone, so don't try anything" really had any merit, there wouldn't be any Emergency Departments in hospitals.