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Questions you might want to consider before relying (or continuing to rely) on any psychiatric medication

Posted Jul 30 2010 12:00am

What follows is a handout I designed to give to people to help them think through whether they really want to try psychiatric medications.  Imagine how mental health treatment might be different if these questions were routinely considered by everyone before psychiatric drugs were prescribed!

Questions you might want to consider before relying (or continuing to rely) on any psychiatric medication

As with any potentially life-altering choice, it is important that decisions about psychiatric medications be made in a thoughtful manner, which requires looking at all sides of the issue.  But because billions of dollars are spent to promote psychiatric medications, because the time available to medical providers who meet with you is often limited, and because the possible advantages of medications are often easier to understand than the disadvantages, there is a risk that people may end up on medications without a full understanding of possible hazards associated with taking medication.  This handout assumes you have already heard about the possible benefits of using medication, and it focuses on addressing the “other side,” or some of the possible reasons you might want to decline to use medication.

I am not a doctor, so I am not providing medical advice in this handout.  But I am passing along to you concerns I have heard about medications, so that you can, if you choose, decide to seek out more information and make up your own mind about what to believe. 

Have you considered the possibility that even if the medication is effective in helping reduce your mental or emotional problem in the short term, that it may cause this problem to become worse in the long term?  There exists quite a bit of evidence for example suggesting that anti-anxiety, antidepressant, mood stabilizing, and antipsychotic medications, despite seeming to help in the beginning, are likely to make problems worse in the long term. [i]

Are you taking the medication because you are hoping it will correct a “biochemical imbalance?”  You should be aware that there is no convincing evidence of, or tests for, any “biochemical imbalance” in people diagnosed with any mental disorder, but there is lots of evidence that psychiatric medications create abnormal states in the brain, which you may or may not experience as helpful, and which may have long term consequences you haven’t anticipated.

Have you considered the possibility that the medication may make it much more difficult to make progress in therapy?  While medications are generally used in an attempt to make distressing feelings or thoughts “go away” or fade in intensity, therapy takes a different direction, instead helping people learn how to understand themselves and their past experience better, and how to relate differently to feelings and thoughts so that new life patterns emerge.  It can be difficult or impossible to learn new ways of understanding or relating to experience that has been “numbed out” by medications.

Have you looked carefully into all the possible “side effects” including side effects that may be permanent, persisting even after you quit taking the medication?  Psychiatric medications can cause a number of possibly permanent effects.  These range from (to give just a sample) possibly permanent sexual dysfunction, or even bipolar disorder possibly caused by SSRI antidepressants, to permanent movement disorders, diabetes, heart problems, brain changes or damage, or even (weirdly) breast growth in boys caused by antipsychotics.   You can find out about many common possible side effects by reading literature available from your pharmacist, but you should be aware that medications may also cause other effects not yet documented in such literature. 

Have you become informed about the possibility you may experience withdrawal reactions when you attempt to discontinue the medication, and about what these may look like?  All classes of psychiatric medications can cause withdrawal reactions, they are quite common, and for some people make it almost impossible to discontinue the medications.  If you don’t know about these possible withdrawal effects, you may conclude that problems that occur when you try quitting the medications are proof you need to stay on medications forever.  Many people find though that if they taper off very slowly, then these problems can be minimized.

Have you considered that once you start taking the medication, you will have to be evaluating the medication’s effectiveness while being under the influence of the medication?  So for example if the medication makes your thinking foggy or your emotions apathetic, that fogginess and/or apathy may make it difficult for you to notice that the medication is causing a problem.

Are you informed about how problems with medications sometimes lead to people taking even more medications?  For example, medications meant to solve a problem will for some people make that problem worse, which may be mistaken for a need for more medication.  Or a medication may cause a new problem to emerge, which may not be recognized as a side effect, and may lead to a perceived need for new kinds of medication on top of that already being used.

Are you fully informed about all of the possible alternatives to medication, about all of the other possible ways your problem might be resolved?  You should be aware that for all the major mental disorders, studies have found significant numbers of people who fully recover without using medications.

If any of these questions concern you, it makes sense to seek more information, which you might find by having conversations with your licensed medical practitioner and/or by seeking out information by yourself. [ii]   I will also be happy to talk with you in more detail about what I know about any of these concerns.

[i]   The book “ Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America ” by Robert Whitaker goes into detail about evidence that most all of the psychiatric medications tend to worsen mental health problems in the long term.  You can also find a summary of the arguments and detail on the sources at http://bit.ly/bWchcz

[ii] A good source of balanced information about psychiatric medications is the book “ A Straight Talking Introduction to Psychiatric Drugs ” by psychiatrist Joanna Moncrieff. 

One source of information about reducing or getting off medications is http://www.comingoff.com/

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