tag:blogger.com,1999:blog-26666124.post7653650580807987419..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: For the Rest of Your Life -- Or Perhaps NotUnknownnoreply@blogger.comBlogger5125tag:blogger.com,1999:blog-26666124.post-52195804250746549322013-08-31T13:31:31.438-04:002013-08-31T13:31:31.438-04:00I second what Dinah just said. The situations of p...I second what Dinah just said. The situations of patients can be vastly different and complicated by myriad factors. For instance, what is the degree of mood disorder, anxiety, and physical factors? What age is the patient, is he using substances in some form that totally changes the risks, what is his social situation and support system, and what expectations are there from his own life goals and desires? <br /><br />A good working relationship between doctor and patient is very important. There are no cookbook answers. I know alcoholics who have achieved decades of stability and abstinence in spite of taking several milligrams of clonazepam every day, and adults whose depressive episodes led to years of disfunction, loss of job and relationships, and almost ended life, so that the danger of relapse is very great. And every clinician has had patients who, despite numerous inquiries and requests, completely hid parts of his life that were crucial to understanding and helping him.<br /><br />So I found the post thought provoking and worthwhile. jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-39938824266305512102013-08-31T13:30:38.250-04:002013-08-31T13:30:38.250-04:00When I went off psych meds, I looked up taper sche...When I went off psych meds, I looked up taper schedules on drug company websites, then I went a lot more slowly than listed. I had no reactions going off the meds, perhaps because I did it extremely slowly. I used a razor to slice pills into tiny fragments as needed by my schedule.<br /><br />Also when reading above, what strikes me is the word "diagnosis". I would guess that some of the diagnoses are wrong and some are right, and therefore you are looking at a mixed population in the study group. Maybe everyone labeled Bipolar is not bipolar. It is something to consider, anyway.<br /><br />Also, the above article seems to refute the concept that once a person has had a single episode of mental illness that they will forever be mentally ill. The majority of psychiatric community seems to think that a person can't have an episode of mental illness, but instead think.. once mentally ill...always mentally ill. If you had an episode of mental illness ten years ago, and no symptoms since, then you still ARE mentally ill and will ALWAYS be mentally ill. I think this belief is wrong, but this belief is now being codified into government registries of peoplle who have been hospitalized and into gun laws.<br /><br />Side-effects that patients experience are frequently discounted by psychiatrists, also. I notice that in the article, the only side-effect discussed is tardive dyskinesia. I experienced serious memory loss and difficulty in reasoning from psych meds and these side-effects are discounted as being unimportant or "nothing" by many psych professionals. It is not "nothing" to lose a significant percentage of cognitive functioning. In my case, nobody told me what any side effects might be. I was experiencing choking and near accidental swallowing of my tongue and problems keeping my legs still and I had no idea these were drug related changes. I thought at the time that somehow I had "forgotten" how to swallow my own saliva, and I kept trying to not be so clumsy. Eight years later, during a movie last Wednesday night, I almost was unable to breathe after I once again nearly choked on my tongue and saliva. There was no warning. I was not "doing" anything. Just sitting there, and suddenly I was choking. I never had that happen before psych meds, and it may seem like "nothing", but I got saliva in my lungs, and for a while was unable to draw a breath, and it was very scary. It was nothing to those who prescribed psych meds for me.Sunny CAhttps://www.blogger.com/profile/11451116932556227816noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-71373037601807133182013-08-31T11:12:33.043-04:002013-08-31T11:12:33.043-04:00There are clearly patients who can't go off an...There are clearly patients who can't go off antipsychotics and do well -- we know this because they don't care about the studies, stop their medicines, and get sick and hospitalized, over and over and over again. And there are clearly patients who stop their medicines or recover without ever taking them. The issue that gets raised is how do we figure out who will respond to what medications and how long they need them for at what dose. I've never seen it said anywhere, but I often tell patients "It takes more medicine to get someone well then to keep them well." (~ShrinkRapDinah, circa 1996, repeated over and over). <br /><br />Clinically, part of the issue is that those patients who stop their medicines and do well, don't come back, so we don't always see them. I have a few people who stop some/all of their medicines and do keep coming for therapy, so I don't believe everyone needs meds forver, the problem is one of RISK. So I agree with the tactic of trying to lower medications slowly and then going back up if problems occur. Problems can be not feeling well in any number of ways (often trouble sleeping) or the return of frank psychosis. The issue of RISK is one the patient has to decide -- if an episode of illness consists of sadness and sleeplessness, so be it. If an episode of illness consists of months of hearing voices, an inability to function, or an expensive and unpleasant hospitalization, many patients say "I want to stay on my meds, at these doses, and I don't want to take any risk of lowering them." My job is explain the risk (as I know it) not to live other peoples' lives for them. <br /><br />AA: Anti-psychiatry is all in the tone. I'm all in favor of questioning our assumptions, and these issues are not in any way unique to psychiatry. Think about that beloved food pyramid, hormone replacement therapy, and here's an article about the assumptions we've made for decades about salt consumption: http://www.kevinmd.com/blog/2013/07/salt-diet-high-blood-pressure-evidence.html<br />Is it really in the best interest of every cancer patient to offer them aggressive treatment? And how about our current vitamin D craze: someone please show me the evidence that exogenous vitamin D administration lowers the incidences of those disease states associated with low serum Vitamin D levels? I know, you'll look up that information as soon as you finish working on your lawsuit against the makers of the medicines that were supposed to strengthen your bones to decrease your risk of fracture, but instead disintegrated your jaw. Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-25234108779959841562013-08-31T07:19:24.568-04:002013-08-31T07:19:24.568-04:00PseudoK,
You might want to visit http://surviving...PseudoK,<br /><br />You might want to visit http://survivingantidepressants.org/ and look for tips on tapering various antipsychotics very slowly that you can share with your doctor. Don't be discouraged by the name of the site as many people have come there who are on antipsychotics including a newly appointed moderator who is helping his son get off of them who had had previously difficulty like you have.<br /><br />It is not beholden to any commercial interest and depends entirely on donations.<br /><br />Totally agree that difficulty in discontinuing a medication has nothing to do with whether someone needs it or not. Many people have sadly stayed on antidepressants for years due to what I feel is this misconception. And sadly, it looks like the same situation is occurring with antipsychotics.<br /><br />By the way Dinah, it sure sounds like Dr. Insel has been reading Robert Whitaker's book, Anatomy of an Epidemic. I guess that makes him anitpsychiatry. :)<br /><br />All jokes aside, it is great that this discussion is occurring. It is way overdue but better late than never.<br /><br />AAAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-35704314781964418212013-08-30T19:03:46.510-04:002013-08-30T19:03:46.510-04:00I had difficulty discontinuing an antipsychotic, a...I had difficulty discontinuing an antipsychotic, and although I'm back on it(for now), I don't see the difficulty in discontinuing as a sign that I need it. I see it as an indication that I had difficulty discontinuing it and may need to decrease it more gradually next time. (I should add that when it was discontinued, it was under my doctor's care and with his reluctant blessing. I didn't discontinue on my own).<br /><br />I support those who wish to take it for life, but I don't think that's the right decision for me. I think all of the metabolic risks of the drugs put my life in greater danger long term. For others, that may not be the case.<br /><br />PseudoKAnonymousnoreply@blogger.com