I am not a medical professional. This is simply my opinion based on personal experience and the experience of others at Psych Central and various other places. Do not mistake this for advice or medical opinion. It might be useful as a rough guide but is probably closer to an opinionated rant that is way too long.
I am not anti-drug. I think that meds provide tremendous help to those that really need them. I probably wouldn’t be here without them. I also think that they are misused by psychiatrists and unethically marketed by drug companies. It is a mess made by the pharmaceutical companies and doctors blindly throwing darts, and it is the patients who pay the price. It can be much worse than the affliction. I will also disclose that I am incredibly sensitive to psych meds which certainly informs my opinion.
People have been accustomed to taking a pill that solves a specific problem. They typically work well with no noticeable side effects. You get an infection; there is a pill that clears it up. You have a headache, over-the-counter drugs take care of it. These things almost always work well and predictably.
Psych meds are entirely different than what people normally experience with other types of prescription and over-the-counter meds. The two issues are that people react differently to the same drug at the same dosage, and they take a long time to start working. Yet, side effects can manifest in the first day or two. Some websites allow patients to solicit the experience of other people. They even allow them to review the drug as if it were a car or hair salon. This is a waste of time and dangerous. The sad fact is, and it pretty much invalidates most of this rant, there is no reliable way to tell if something will work until you try it. That something worked flawlessly for someone, or someone else nearly died from it is irrelevant to how well a third person will do.
There are genetic tests by various companies that claim that they can assist in helping the patient figure out what they will do better taking. I haven’t used it, and reports from patients make it seem just like the psych meds themselves. Hit or miss, but it may be a solution if you have trouble finding meds that work without any significant side effects. At least it is an attempt to inject science into psychiatry.
There have been so many psych meds I have taken over the past 21 years, that I can’t remember them all. Outside of anxiolytics, they either do not work well (or at all) or caused terrible side effects, or most commonly both.
I was not taking any psych meds from 2002-2010. I was pretty stable during this time. In late 2010, I crashed hard. It wasn’t really the depression, not directly, at least. I had severe anxiety, which wasn’t a problem before. It was the first time something new appeared since 1995. I thought they were heart attacks. I even walked into the VA ER and told them I was dying because I keep having heart attacks. Heart checked out fine. Early the following year, anxiety started feeding into my depression, and that was the big crash. I don’t remember a lot of this time as depression seems to be a memory thief.
I was on some anti-depressant medication that wasn’t working. It was suggested that I augment with risperidone. Risperidone is an antipsychotic with a lot of scary side effects. Mixing antidepressant medication with antipsychotics seems to be more and more common, and that is frightening. They are extremely dangerous meds, even newer ones. The so-called atypicals are just as bad as the older antipsychotics. The distinction between typical and atypical is mostly just marketing and tardive dyskinesia being rarer with the atypicals. Other than that, the side effect profiles are very similar. I wasn’t in any shape to argue or think critically, another hazard of psychiatry, so I agreed. It was a very low dosage. I lasted all of two days on it. I can’t adequately explain what it did; zombie mode is kind of accurate but doesn’t capture the suck. On day three, I felt if I took it one more time, it would kill me. It took two weeks for the side effects to clear out.
I started over again with a drug called venlafaxine, an SNRI antidepressant. It didn’t really work, so they kept increasing the dosage until I was at 150mg. It still didn’t work, so they augmented it with mirtazapine, a different kind of antidepressant medication. None really worked, except mirtazapine is great as a sleep aid, maybe too good.
I was also on Ativan, a benzodiazepine, like Valium. That didn’t work well because it has a short half-life and nasty anxiety rebound effects, so I switched to clonazepam. So, that is two antidepressants, one antipsychotic and anxiolytic, and other than reduced anxiety, better sleep, it didn’t touch my depression. I did gain about 30 pounds, so yay?
Around this time, I started to get tinnitus, my shrink attributed it to Venlafaxine. I tapered off it. It has been two and a half years since I have been off it, and I still have tinnitus.
Edit: Four years after writing this, the tinnitus is still here.
Since I was just on mirtazapine for depression and 15mg wasn’t working, it was increased to 30mg. Still worked well for sleep but didn’t touch my depression. It did, however, cause me to gain about 20 pounds in a month. I wanted to drop back down to 15mg, but he said 45mg might do better because the weight gain side effect is more prominent at 30. So I agreed. The good news is that I dropped the weight as quickly as I gained it. The bad news was that it caused restless legs which greatly interfered with the sleep properties and still did nothing for my depression. So he increased my anxiolytic to help deal with that. Yes, it can be a vicious cycle.
About 18 months ago, I started hearing voices and seeing things and getting paranoid. The immediate reaction of my doctor was to change my major depression diagnosis to major depressive disorder with psychotic features and put me on another antipsychotic. No tests, no evaluation of any kind was done. None of these things were more than mild distractions. I knew they weren’t real. Despite all of that, instant psychosis diagnosis.
I was hesitant because of the previous reaction to risperidone. One good thing about my shrink is that he does accept my input. He always lets me do research, a very rare trait in my experience. He suggested some scary ones that mess with cholesterol, blood sugar, and some are known for common and significant weight gain. All of which are non-starters for me, due to having diabetes and heart issues run in my family, as well as weight issues. He finally suggested ziprasidone, which he said is weight-neutral, and the other nasty side effects are rarer. He put me on a low dosage of 20mg twice a day.
Things started out okay, the psychotic symptoms were reduced, and it started my weight loss, where I dropped 50 pounds in 9 months without much effort. That was great! Well, it was dangerous also, but still great.
The problem was that I was wiped out in the afternoon and got a bad case of the shakes and needed to sleep it off. He removed the morning dose, which solved that problem. About six months into it, the paranoia and seeing things came back. Predictably, my shrink increased me to 40mg once a day. This caused different issues than the 20mg 2x a day, which is just weird. It is hard to describe but was something like disassociation.
The effects got bad enough that I dropped back down to 20mg which was painful for about a week because psych med withdrawals are no joke. It turned out that ziprasidone caused high prolactin in me, leading to dangerously low testosterone levels. This is what caused the extreme, no-effort weight loss.
I could go on for dozens of pages of all the problems I have had with psych meds but I will spare you for today. Like I said earlier, none of this means that you will have problems with these or other drugs or that they won’t be helpful. We do not metabolize these things the same way, so different reactions are the rule, not the exception. Many take these drugs without incident. Please do not use this as a reason to stop taking it or not even trying. I do think it is a decent cautionary tale. Be careful, educate yourself and note any negative or positive effects in a diary. If I had been paying closer attention, I might have been able to taper much earlier and avoid many problems. Try to learn about meds, side effect profiles and how much better they performed in trials against placebo, and if there are studies that test against multiple meds.
Doctors are seemingly uncaring about the pain of side effects and withdrawals. I have had shrinks ask why I want to get off meds, even with evidence that ziprasidone was causing significant harm. My shrink wanted me to take the risk of testosterone replacement therapy instead of just dropping the drug causing the problem. They will question why I am taking so long getting off something or prescribe me just enough to taper off on a schedule they think and no more. Maybe they should take Venlafaxine for a year and taper off quickly in med school.
You might be saying, “but that is dangerous”. That is exactly my point! Psych meds are dangerous and should be used only when it is needed and then very cautiously. Yet they are handed out freely and without knowing exactly what is causing your problem. Even in cases where it is situational depression, which might only last a month or three, you will likely get offered meds. It is pseudo-science and pure greed that is driving psychiatry. There should be better options. As much as I have been critical about shrinks, I would never accept psych meds from a primary doctor. Just like I would never accept other non-psychiatric treatments from a shrink.
The problem is that unless you find an underlying cause like hypothyroidism or have a significantly negative experience in your past, they can only guess what is causing your distress. To be fair, there is some research with fMRI’s. So there is some evidence that low serotonin and other neurotransmitters might be the cause of some depression. There are other ways of helping increase these things without the use of meds, like diet and exercise. Going for a short run will have a much more positive effect and more quickly than a pill ever will.
Mental illness is a very personal thing. Not everyone with the same diagnosis experiences it in the same ways. For example, some people feel sad while depressed, but I can honestly say that depression has never made me feel sad. I can be having a severe case of depression and still be able to laugh, some cannot. Psych meds are a one size fits all solution to a very personalized problem. Granted, they are more precise than OTC supplements that might not even contain the ingredients the label claims it has.
The worst thing about psychiatry is the pharmaceutical companies. They commonly advertise dangerous psych meds with narrow usage on national TV. This is but one and is the definition of insane, note the list of side effects. Antipsychotics are not an ‘ask your doctor if they are right for you’ kind of drug. Many of these drugs experience high dropout rates during studies due to many factors, including horrible side effects, yet they still get approved with suspect studies.
The FDA is supposed to be the watchdog of the pharmaceutical industry but more often than not the head of the agency is a former executive of a drug company, or not remotely qualified or have received substantial amounts of money from them. FDA often pushes dangerous drugs with little testing but this is hardly a psych-med only problem.
What is terrible about all this is that psych meds are important, and they can be necessary just to function. I know I might have angered some people who need these meds to get through the day. I am not saying to not take them. Stay on them until they are not needed. Yes, sometimes they are necessary for a lifetime. I currently am off psych meds, except a very low dosage of clonazepam, but I would not be here without them.