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Anti-Depressants - Is the cure worse than the illness? (Part 2 of 2)

Married to antidepressant meds

The author has a wonderful quote on taking meds:

an unexpected relationship will become permanent

He uses this quote (from a fortune cookie) as an analogy to taking meds. He suggests that many people are encouraged to take meds as a temporary measure not realising that for some they will need to be on antidepressants for the rest of their life – either because the illness is too severe or because the withdrawal symptoms of stopping are too painful.

Dr Karp likens the relationship with meds to a marriage:
This process of becoming committed to drugs can be seen as having four stages: desperation, experimentation, engagement and marriage.

I'm not sure I like the analogy, unless you were to describe it is an arranged marriage - for many taking meds is not something they willingly choose.

I can see where he is coming from but I believe the process of becoming wedded to medication is more like that of grieving. Elisabeth Kubler-Ross has defined the five stages of grieving as:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
I think many depressed people move back and forth between the first four phases before finally reaching acceptance. At that point they acknowledge that they have a psychiatric illness and that medications are a necessary part of the recovery.

For some people acceptance never comes. Instead they form an uneasy alliance with the meds and their health professionals but in their mind it is a temporary arrangement. Even after 15 or 20 years in medications there are many people who long to give them up and fight or question on a regular basis the need for antidepressants.

Doctors encourage patients to take meds likening the antidepressants to treatments for diabetes or headaches. However there is one critical difference - antidepressants are mind altering substances.

In my experience with doctors they are all reading from the same script. They all want you to believe that antidepressants are better than the alternative. I’m not convinced that is always the case. From my own personal experience the side-effects of meds often outweigh the benefits.

Do the drugs really work?

The author points out many of these drugs are relatively new. While they have been tested and found safe this is only within the parameters of their testing. If a drug has only been around for 10 years there is no way to know what it’s long term effect may be on someone who needs to take that med for another 50 years.

For many the improvement from antidepressants is only slightly greater than the placebo effect. According to one study of SSRI antidepressants:
Approximately 80% of the response to medication was duplicated in placebo control groups, and the mean difference between drug and placebo was approximately 2 points on the 17-item (50-point) and 21-item (62-point) Hamilton Depression Scale.

There were many patients interviewed in the book who had little or no relief from the prescribed antidepressants. They also disliked being labelled as someone with a mental illness and found it difficult to tell friends, colleagues and new acquaintances about their diagnosis and the need to take pills.

Dr Karp shines the light on unethical pharmaceutical practises such as:
“commissioning multiple studies to assess a drug’s effectiveness and then reporting only on the research most flattering to their product
“failing to systematically ask study respondents about certain side effects
“Limiting drug trials to short periods of time

He also states that:
rarely does the antidepressant medication far exceed the placebo in effectiveness, and sometimes subjects in the control group actually report greater symptom relief

It makes you wonder why doctors prescribe antidepressants! In reality, I think antidepressants are helpful for many people with depression and anxiety, but for those that don't find them helpful doctors would be wise to stop experimenting and forcing drugs on treatment resistant individuals and focus instead on therapy, cognitive behavioural techniques, positive psychology and lifestyle changes.

What about the side-effects?

Side-effects vary according to the individual biochemistry of the individual taking meds. As we've seen in Part 1, the patient's trust in their doctor is a factor in the efficacy of the meds as well as their attitude towards taking meds for depression.

One of the most contentious risks is the possible increased risk of suicide in children and teens. The US FDA became so concerned about the risk of youth suicide among those taking antidepressants that they asked for a blackbox warning on all antidepressant meds. You can read an analysis of the black box warning issue here

According to the manufacturers of Prozac, the meds may increase the risk of suicidal ideation in children and teens. They also state that there are benefits and risks in using antidepressants.

What are possible side effects of PROZAC?
  • Some people experience side effects like nausea, difficulty sleeping, drowsiness, anxiety, nervousness, weakness, loss of appetite, tremors, dry mouth, sweating, decreased sex drive, impotence, or yawning. Most of these tend to go away within a few weeks of starting treatment and, in most cases, aren't serious enough to cause people to stop taking PROZAC.

  • PROZAC can cause changes in sexual desire or satisfaction.

  • Do not drive a car or operate dangerous machinery until you know what effects PROZAC may have on you.
  • Contact your doctor or healthcare professional if you get a rash or hives, or other side effects that concern you while taking PROZAC.

While the manufacturers state that ongoing drowsiness and loss of sex drive is relatively uncommon, Dr Karp found in his interviews that the majority of patients experienced these side-effects.

Please don't stop taking your meds without medical supervision

The jury is still out on the effectiveness of antidepressants compared with the placebo effect, and for many the side-effects of meds make them unpalatable. However, the placebo effect does show an improvement, and some patients have found antidepressants a lifeline for depression and anxiety. The results were less clear in the interviews with bipolar patients, possibly due to the fact that many bipolar are prescribed a mix of antidpressants and antipsychotics or mood stabilisers.

If you have any doubts that your meds are working effectively, please see your health professional to fully discuss your options. Sometimes switching to another antidepressant can bring about radical improvements. You may also like to consider therapy and lifestyle changes.

I look forward to your feedback.

Part 2 of our review of Is It Me or My Meds?: Living with Antidepressants by David A. Karp

You can read part 1 here

Anti-Depressants - Is the cure worse than the illness? (Part 1 of 2)

This is the sort of book you wish your doctor would read.

It looks holistically at depression considering the biomedical model (i.e. there is something wrong with your body and in particular your brain) as well as psychosocial factors, lifestyle changes and other environmental influences. Is It Me or My Meds is penned by David Karp, who has long term depression and anxiety. He interviewed 50 people (including teens) with major depression and manic depression to gauge their attitudes about taking antidepressants and dealing with depression and the stigma around it.

Why people take antidepressants

Commonly accepted wisdom is that depression is caused by a biochemical balance in the brain which can be helped by taking antidepressants. Not everyone accepts this hypothesis. Some believe that depression and other mental illnesses can be fixed through meditation, counselling or other types of therapy, dietary changes, exercise or sheer willpower.

According to an anonymous academic who blogs here
Please. There may well be brain issues in people with various “mental illnesses,” but this whole ‘chemical imbalance’ thing is 95% marketing, 5% science. Find a serious scientist who will step up to the mic (sic) and tell us about the definitive chemical imbalance that causes bipolar, schizophrenia, or much of anything else in the mental disorder world.

While there were many people that resisted medication there were some who welcomed it with relief. Many patients were anxious for anything that might grant them some relief from unrelenting feelings of sadness, worthlessness and at times suicidal ideation.

Individuals reported varying degrees of success with antidepressants. For some, taking medications were a lifesaver that enabled them to feel more confident, overcome feelings of hopelessness and get on with life. However large numbers of people reported dissatisfaction with the side-effects of meds, failure of the meds to work effectively, gained only short-term relief from antidepressants or felt ostracised by being labelled as someone who needed to take psychotropic medications.

There were several patients who refused to take meds, or found themselves hopeful that they would one day be able to wean themselves off antidepressants. Overall, the majority of patients interviewed did not like taking meds for depression, bipolar or anxiety.

This attitude is also reflected in the attitude of the author, who has tried unsuccessfully to withdraw from taking antidepressants and antianxiolytic meds.

The people interviewed referred to searching for identity and not knowing whether the self on drugs is the ‘normal’ person or the one off drugs. Many felt pressure to conform to society’s expectation of normalcy.

The book includes a quote from Francis Fukuyama:
There is a disconcerting symmetry between Prozac and Ritalin. The former is prescribed for depressed women lacking in self-esteem; it gives them more of the alpha-le feelings that comes with high serotonin levels.
Ritalin on the other hand, is prescribed largely for young bots who do not want to sit still in class because nature never designed them to behave that way.

How your relationship with your doctor affects you

It was also evident throughout the book that the relationship of the individual to their health professional made a substantial difference. In situations where the individual felt that the health professional listened to their needs and offered trustworthy advice, patients were more likely to take meds and more likely to have success with them.

In this respect the placebo effect of medications was influenced not only by the knowledge that they were taking meds for their depression but also by their trust in the Health Professional prescribing the meds.

Part 1 of our review of Is It Me or My Meds?: Living with Antidepressants by David A. Karp
You can read Part 2 here

Weight loss: I can make you thin

Can your thoughts make you thin?

According to TV hypnotist Paul McKenna the answer is yes. I have watched his TV program “I can change your life” and I have to admit I was impressed. He took a man with hysterical blindness and helped him improve his sight. Later in the show his diagnosis was revised – it turned out the problem was physiological not psychological! The experts were at a loss to explain how the hypnotist had been able to improve a physiological condition.

McKenna also helped a lifelong sugar-holic with diabetes overcome sugar cravings. In the face of temptation that would make even a saint reach for a Toblerone she remained strong. Naturally I rushed out and purchased Paul McKenna’s books and tapes.

He makes a bold claim in his #1 Bestseller ‘I can make you thin’ which includes a free weight loss CD. According to his book you should:

“Forget about dieting. For ever. Diets are no more than training courses in how to get fat and feel like a failure.”
McKenna blames obsessive dieting, emotional eating and faulty programming (or your thoughts) for excess weight and claims a greater than 70% success rate with his program. I decided to put his claims to the test.

He is convinced that if you follow his four golden dietary rules and listen to his CD that you will lose weight. His book includes a large number of testimonials from successful weight loss participants. Some had used the book and CD but it appeared that the majority had the advantage of one-on-one consultations with the magical hypnotist Paul McKenna.

McKenna’s rules for weight loss

  1. Eat when you are hungry
  2. Eat what you want, not what you think you should
  3. Eat consciously and enjoy every mouthful
  4. When you think you are full, stop eating

If only life were so easy. The rules are great but not everyone will be able to implement them. This is where the CD comes in. It includes visualisation and hypnosis geared towards changing your programming.

I’ve listened to the CD a few times but unfortunately I am not susceptible to hypnosis so I can’t tell you whether I noticed any change in my thinking patterns. Nor am I skilled in visualisation. However I did think that the affirmations and statements of positive intent on the CD were likely to be helpful.

The book ends with craving buster techniques including tapping (Thought Field Therapy). There are a lot of positive testimonials from people who have used TFT or EFT techniques - unfortunately I'm not one of them - but it's worth a try.

I asked a friend to trial the CD. She has been overweight for a long time and was very keen to try McKenna’s CD and book. She has been listening to the CD for nearly three weeks and feels that there has been no significant change in her thinking patterns. However, she still believes the book is a good investment. She liked the CD and the book which she found to be very encouraging. She is optimistic that the improvements in her self-confidence and dietary habits will take place if she perseveres.

Click here for help with emotional eating