Friday, April 29, 2016

Saying No to Antidepressants

Saying No to Antidepressants

I wrote this blog for the many women who tell me that they feel pressured to take meds. They feel pathologized by the diagnosis, like a scarlet letter D, their new name. They come to me because they know I will work with them to make real changes that are at the heart of their symptoms.
But they still have loved ones who don’t understand. So here’s my list of the top reasons – logical, intelligent, evidence-based – to say no to antidepressants.
Easy does it
As physicians, we take an oath – “first do no harm” – but then we get lured by the seeming simplicity of a one-pill-for-one-ill model. In fact, it makes no sense to take powerful psychiatric drugs as a first line treatment. In fact, I’d go further and say that it’s irresponsible. There’s peer-reviewed research that implicates lifestyle choices in depression and upholds medical meditation and other powerful mind-body techniques as more effective than drugs. More women are saying that they’d rather start by taking a hard look at diet, nutrition status, and their personal care regimen.
So how about devoting one month to a lifestyle overhaul and taking it as seriously as others might take a doctor’s order? Because you’re worth it.
Pharmaceuticals are dangerous
Drugs are potent and dangerous, and there’s no doubt that Americans are taking too many of them. It’s called iatrogenic drug dependence and it definitely includes psychotropic medication. Don’t roll your eyes. I’m not talking about some kind of conspiracy in which malevolent people sit in a room and plot to harm people. I’m talking about the way the world works. It’s an alignment of politics, profits, and incentives. We have a system that richly rewards people who prioritize commercial applications for drug research. Simple solutions that can’t be patented won’t get the time of day. New drugs are fast tracked through the approval process too quickly and risks are ignored – short and long-term. A lot of what we need to know about these medications is locked in a drug company’s file drawer cabinet.  What’s been unearthed by those file-drawer studies is that psychiatric meds result in worse long-term outcomes than no treatment at all.
If you’re not signing up to be reflexively medicated as a cog in the pharmaceutical wheel, that’s smart medicine.
How can a happy pill be so miserable?
There’s not a lot of happiness coming from these pills. Take a few minutes to scan the side effects of commonly prescribed antidepressants and you may have trouble lifting your jaw off the ground. The following are acknowledged and documented reactions to antidepressant medication.
Common side effects include:
  • agitation, shakiness, anxiety
  • flu-like symptoms
  • indigestion and stomach aches
  • diarrhea or constipation
  • loss of appetite
  • dizziness, disorientation, confusion
  • insomnia or sleepiness
  • headaches
  • low sex drive, erectile dysfunction, difficulties achieving orgasm
  • weight gain
  • excessive sweating
  • heart rhythm problems
  • muscle twitching or pain
  • shivering
Patients are almost always told to hang in there because the above problems generally improve with time. And if they don’t resolve, doctors start tweaking… they’ll adjust the dose or add a second and a third medication. What they typically won’t tell you is that things can go very, very badly. There are other, much more severe reactions, that include suicidal thoughts, a desire to harm self or others, seizures, and psychosis. The scary part is that we don’t know how to predict if you may be one of these cases. It is literally Russian Roulette, sometimes in as little as 1-2 doses.
If you’re wondering how this is possible, I’m right there with you. Part of the challenge of working with women who take meds for any reason is that I’m unable to distinguish between symptoms and side effects. It becomes a tangled web of bodily imbalance.
They are worse than ineffective
Being a “good patient” may make you a patient for life. Consider these research findings, which I outline in A Mind of Your Own:
  • There is no validated science that supports a neurochemical explanation for mental illness, including depression.
  • The placebo effect – a complex physiologic process based on our beliefs about treatment – is responsible for what we think is helping about these meds.
  • Medications acting on these chemical systems force the body to adapt.
  • These adaptations are likely responsible for the inferior long-term health outcomes of the medicated versus the unmedicated (who presented with the same symptoms).
  • It’s quite possible that these drugs fail over time because they induce compensatory adaptations that end up creating the opposite of what the medication originally intended and this worsening of the illness may not be reversible (even after stopping the medication).
In other words, attempting to medicate away your symptoms may:
  • Not help at all
  • Make you sicker
  • Engender new diagnoses requiring more treatment, which produces additional, unintended side effects
  • Rob you of the opportunity to understand why you were symptomatic in the first place.
There simply isn’t a good case to be made for their effectiveness. In fact, there is no case. It’s what leads patients to my door, because they are asking, isn’t there a better way?
Ever try to stop?
Here’s another dirty little secret in psychiatry. Starting meds is easy. Stopping? Not so much. It’s like riding in a hot air balloon. Going up was a piece of cake but it doesn’t occur to most people that the trip down can be a very bumpy ride
Patients are told that reduction schedules vary based on the drug, the dose, the duration, and previous symptoms. It sounds scientific enough. But the truth is that coming off antidepressants can be a horror show. Most people don’t understand that these drugs are habit forming so withdrawal can be excruciating and feel intensely… shameful. Add to the med mayhem that many doctors aren’t taught how to taper and the available guidance isn’t very helpful. Harvard Medical School says: “There are no hard and fast rules for getting off antidepressants… some can taper off… in a matter of weeks, while others may take months.” I would even add years to that statement. What this should tell you is: A) they don’t really know, and B) it might not go so well.
Numbed to life?
When life deals you some tough news, realize that you are having a human experience. You are meant to work through it. What you’re not meant to do is to suppress consciousness and anesthetize the mind. Are you sure that you want to pathologize your pain with labels and diagnoses, and take pills to suppress consciousness? That’s precisely what antidepressants do. Imagine feeling… nothing. No sadness, no happiness, no pain, no anger, no love. There’s something worse than feeling bad and that’s saying no to what life has brought to your path.
You can choose a different narrative. You’re not broken.
You’re intelligent… life is intelligent and purposeful and we forget that growth and evolution comes through suffering. In fact, when my patients heal off of meds, all sorts of wild things happen – they adopt babies, get divorced, move to Europe – things that were sitting dormant, needing expression.
Humans have evolved over millennia to interact with our environment with deep wisdom. There’s a good reason why you’re feeling bad and you deserve the time and support to figure it out. Antidepressants don’t work the way you think they do. They are a tempting fairy tale… a miracle-in-a-capsule that will magically transport you back to yourself. But there isn’t a single study that supports this myth, that it’s possible for the mind to be effectively rewired by a one size fits all, synthetic, chemical concoction. And in view of their risks, you deserve to try every single safer alternative first. It’s time to empower yourself with A Mind of Your 
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KELLY BROGAN, MD
Kelly Brogan, M.D. is a Manhattan-based holistic women’s health psychiatrist, author of the book, A Mind of Your Own, and co-editor of the landmark textbook, Integrative Therapies for Depression. She completed her psychiatric training and fellowship at NYU Medical Center after graduating from Cornell University Medical College, and has a B.S. from MIT in Systems Neuroscience. She is board certified in psychiatry, psychosomatic medicine, and integrative holistic medicine, and is specialized in a root-cause resolution approach to psychiatric syndromes and symptoms. View full bio

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