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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Simcha on January 26, 2003, at 18:30:26
Folks,
Currently here is my mix:
40mg. Celexa
200mg. WellbutrinSR
600mg. Neurontin at nightAccording to two separate psychiatric opinions I will never be able to be off of medication. In fact the second pdoc said that it would be unethical for any doctor to take me off of medication given my case history and family history.
That being said, I have come to an acceptance of this in my life. I'm stable and my mood has been stable for a year now since I've found a good mix of meds for Major Depressive Disorder.
I have increasingly heard the opposition to medications. Most of these zealots seem to have similar themes. Here are the themes I've noticed:
1. The meds are too new to know what the long term side effects are.
2. Doctors medicate rather than deal with the "real" underlying issues a patient might have.
3. HMOs find it cheaper to prescribe meds rather than pay for extensive psychotherapy.
4. It is a stab in the dark as to which med will work for which patient having whatever problem.
5. Diagnosis is still a very inexact science concerning mental illness so it is irresponsible to treat an illness with medication when we aren't certain of the diagnosis.
I'd like to address how I've come to address these in my life.
1. "The meds are too new to know what the long term side effects are." Well, in my case life was not much worth living before medication. I was definitely handicapped by Major Depressive Disorder to the extent that my life was fast becoming unlivable. So, the question for me is should I medicate and face the possibility that it might shorten my life and that the shortened life might be worth living? - OR - Should I not medicate so that I might live a long and miserable life? For me this is a no-brainer.
2. "Doctors medicate rather than deal with the "real" underlying issues a patient might have." Personally I underwent ten years of psychotherapy before I consented to taking medication. I was extremely anti-medication as were most of the therapist I was seeing. They did give me many tools that have helped to make life more liveable. However, my life continued to deteriorate as a patient of psychotherapy. Finally it became so bad that a therapist suggested that I see a doctor to start medications. I resisted yet things were so bad that I consented. Since then my life has improved immeasurably. For the first time in my life I wake up in the mornings wanting to be alive. This tells me that the real UNDERLYING issue is a medical problem that REQUIRES medication.
3. "HMOs find it cheaper to prescribe meds rather than pay for extensive psychotherapy." Yes, this is true. I agree that HMOs have been very cheap with all people in regards to quality care. Yet I do have a defense to this one. THE MEDICATION ACTUALLY WORKS IN A GREAT NUMBER OF CASES. While I do agree that psychotherapy in conjunttion with medication is my best bet for having a life worth living, the HMO push to medicate is based in real scientific terms. THE MEDS CAN WORK.
4. "It is a stab in the dark as to which med will work for which patient having whatever problem." Granted, as with all new medical sciences sometimes the solutions are very experimental and we don't understand exactly how the solutions work. The simple fact is that in a lot of cases medication works. Yes, it might take a few, or more than a few, trials before something works. The promise that something might work is a definite reason to try in my book. Remember, that for me, premedicated life was just not worth living. Granted, sometimes medication does not work. We don't completely understand why. This is no reason to deprive people for whom medication works the opportunity to have lives worth living.
5. "Diagnosis is still a very inexact science concerning mental illness so it is irresponsible to treat an illness with medication when we aren't certain of the diagnosis." I would argue that it is irresponsible to ignore the suffering of a patient just because we don't completely understand the diagnosis and how the medication works. Basically, for me it all comes down to the maxim that life was not worth living without medication. While I know there are risks because the science is not exact yet and the drugs have not been tested over the long-term, I would not go back to the way things were before medication.
Well, I hope this generates some discussion as to the ethical concerns of medicating or not medicating. I hope that this is appropriate for this board....
Simcha
Posted by viridis on January 26, 2003, at 19:46:48
In reply to Bias Against Drugs -- How Do You Cope? -- Long, posted by Simcha on January 26, 2003, at 18:30:26
Your approach strikes me as very rational and well-thought-out. Your response to the anti-med camp is very similar to mine, although I generally don't spend too long arguing with those people -- the hard-core ones are going to believe what they want to, no matter what you say. Most have never experienced serious depression or other mental illness, so can't relate.
I often point out that taking long-term medication for mental illness is no different from taking insulin therapy for diabetes, blood pressure meds, etc. And, of course, few of the anti-psychiatric med crowd would refuse to take these kinds of meds if their doctor recommended it, even if the long-term risks weren't completely known, etc.
Mental illness takes a huge toll on your physical health; the most obvious risk is suicide, but even if you're not suicidal, chronic anxiety, depression, etc. wears on your immune system, prevents you from eating well, exercising, etc., and reduces the quality of life drastically. So, I'm with you -- I'd rather take meds long-term and enjoy life than be miserable (and probably live a shorter life anyway). Given the choice, I do prefer to take drugs that have a track record of safety, and I'm lucky that I do well primarily on low-dose benzos and stimulants. But I'll also try the newer ones if I think they'll help (e.g., I'll soon try Strattera).
As for "underlying problems": I've had plenty of therapy of various kinds, and I don't dismiss it altogether. I think that, especially for people who have had traumatic experiences, been abused, etc., it can be very helpful to work through this. But even in these cases, meds are usually required too, because the experiences really have changed the way the brain works.
One of my last therapists tried very hard to pinpoint some event early in life that "caused" all of my problems with anxiety and depression. Unfortunately (mostly for her) we really couldn't come up with anything, and I got fed up with her insistence that there must have been something that I wasn't remembering. It got kind of silly. Cognitive therapy was somewhat more useful, in that it actually addressed counterproductive thinking patterns. But most of the therapists I've seen have wound up telling me that I seem quite rational and really need appropriate medications. The meds (once I finally found the right ones) rapidly improved my life vastly more than years of therapy could, so I'm sticking with them.
I do think that the stigma of mental problems has decreased dramatically. When I first took Prozac about 12 years ago, it was kind of a "closet" thing. I gradually discovered that several people I knew were taking ADs, benzos, etc., but it was almost like a secret society. Now, I and many friends and colleagues talk openly about meds, share tips, and frankly, I'm not concerned about what other people think. When I run into the anti-med types, I politely tell them my rationale (very similar to yours) and if they continue to lecture me, I simply tell them they have no idea what they're talking about, and it's not really any of their business anyway, any more than I would advise them on what meds to take (or not take) for their arthritis, migraines, and so on.
Posted by Tabitha on January 28, 2003, at 3:45:12
In reply to Bias Against Drugs -- How Do You Cope? -- Long, posted by Simcha on January 26, 2003, at 18:30:26
Those are some good arguments. Sadly many people won't listen to good arguments. The prejudice against meds defies logic for lots of folks. Personally I think it's just the terror of admitting we're not always in control of our minds. Better to hang onto an irrational belief than accept that.
This is the end of the thread.
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