Congratulations on the New York Times article!!!

I cannot possibly, possibly disagree more with your commenter Mr. Morgan about the lack of need for medication for serious mental illness.

He says we can live “meaningful” lives without lithium or other similar drugs for bipolar disorder, or anti-psychotics for schizophrenia. All these drugs have profound side effects, yes — I’ve experienced many of them personally.

But his definition of “meaningful” without drugs seems, by his own literature, to indicate some sort of assisted living facility, with the help of health aides and family. And as Kent (no fan of medication) pointed out, the influence of family, so critical to a patient’s recovery, is often profoundly negative due to stigma and past relationship difficulties.

Lithium (and Lamictal) are what allow me to live independently, period. And a non-independent life — when the treatments to assure otherwise exist — hardly seems “meaningful” to me. In fact, Dr. Kevorkian would seem an appealing option. (And I refer to the infamous death doctor from Michigan in full knowledge I am a consumer myself and am in an audience of consumers.)

I am also deeply disturbed that worry many of your posters, not just Mr. Morgan, unthinkingly accept Charles Barber’s “medication is bad” line, primarily based on his own personal life. Barber’s diagnosis was OCD, a profoundly different disease from unipolar depression, let alone bipolar disorder and schizophrenia. And it strikes me he has unfairly projected his OCD experience, harrowing though it was, onto a spectrum of diseases he has no knowledge of.

His tossed-off, profoundly insincere in tone, “Well, I guess you need medicine for serious mental health conditions” goes begging to be ignored. And if that in fact is his intention, how does that make Barber different from, say, Tom Cruise?

PS — If we no longer, like Tom Cruise, stipulate that depression is a medical condition (as if our docs don’t prescribe therapy, exercise and diet, just like heart doctors don’t just prescribe blood pressure and cholesterol medicine and be done with it), doesn’t that just make us plain old “crazy” (or Liz, as you would say, “mad”) again? And put us right back at square one in the stigma battle — with a self-inflicted wound, no less?

Sandy,
I’m so sorry to hear what you’re going through. And glad to hear your daughter is responding well to the lithium. I think part of the confusion you’re experiencing is that meds are oversold. For the few people for whom they work well, they are a godsend. But the fact is, they really only seem (to many of us) to work well for only a few. And many of the newer drugs, especially, work well for a while and then poop out.

But the ads and mainstream press, combined with remarks I hear in general conversation, would have me believe that psych drugs are mental health penicillin. Not so. And, just as some people are allergic to penicillin, some people find the side effects of psych drugs (about which we are typically NOT informed by our doctors) intolerable or simply too dangerous.

So we go off them. And yes, we often feel betrayed, which tends to make a body angry and no doubt lends a sharp edge to our conversation.

When someone cannot take penicillin, no one blames them. But if you refuse psych meds, anything that happens after that is your fault. It’s a blame game and many of us who are actually getting better outside the system know it well. Part of the problem is that, unlike people allergic to penicillin, we’re not sporting rashes; our risk-benefit analysis often involves factors invisible to others. Part of the problem is the *massive* amounts of money at stake. And a large part of the problem is the continuing stigma of mental illness–once you have that label slapped on you, you lose your voice, you lose all credibility. That makes me angry and definitely lends a sharp edge to *my* conversation at times.

In the end, my feeling is if the drugs were all that helpful and benign, people wouldn’t be going off them wholesale. And I’m tired of people being blamed for everything that happens to them because “he/she went off his/her meds”–as if the meds are a Big Cure. If they were nearly as big a cure as they’re oversold to be, we’d have wiped out mental illness.

Sandy, you know your daughter best. Listen to her, listen to your guts. Do your best to tease out what’s her depression and what’s the normal insanity of adolescence in a basically crazy culture. I hope she continues to respond to treatment, no matter what that is. Keep reading, keep thinking.

Best wishes,
Sherry

The example that Joe cites of 80% of the patients at one particular community mental health center being offered nothing but medication is probably fairly representative of public mental health treatment throughout the entire United States. Alternative treatments that have worked well in years gone by have been defunded because of the belief in the halls of power that only biologically based treatment can work.

I think there is an inherent hypocrisy in the medical model as it is applied to mental health treatment in that diagnoses of non-infectious diseases almost never are considered as justification for forcing treatment on someone in any other field of medicine. Even in regards to life-threatening diseases, like cancer for example, people aren’t forced to have treatment if they don’t want it. I believe that many of the people suffering from mental health-related problems who refuse treatment do so not because they are unaware that they have problems, but just because the treatment options available to them are so limited and bad – there is probably no other area of modern medicine where the treatment is so likely to be worse than the malady.

That online petition linked to in a previous comment is asking only that drug company TV ads be required to include a toll-free phone number and web address where people can report side effects or other problems with the drugs they take. It is not to stop anyone from taking drugs that might help them, but just so that more information can be gathered on what side effects can occur. If it doesn’t get the needed 50,000 signatures by the deadline, I guess that idea will probably just die.

Personally I can relate a lot to the statements by Charles Barber about relationships making a difference – in ways that are both good and bad. I see a lot of relevance in his statement: “Recovering patients will tell you that they get better (and get worse) under the influence of and in connection to other people” – particularly in regards to family relationships. I have found that the influence of some family members can be so consistently negative that the best thing to do is to just avoid as much as possible having anything to do with them, while the influence of other family members can be very positive and a great aid to mental health.

As for parity, I for one, would be able to swallow that terrible taste in my mouth after I learn that my daughter’s therapy sessions AND her med managment appointments would be covered after 30 visits. It sickens me that the insurance companies can legislate my familiy’s health care. It is hard enough to deal with the hardships of mental illness but the entire insurance system is broke and I feel so angry about the struggle to get the insurance to cover her medical appointments. I wouldn’t feel so badly about the therapy capitation, but they limit visits with her psychiatrist for her medication checks! They would never legislate that for diabetes, AIDS or cancer.

Joe’s comments about 80% of patients at community mental health centers getting medication only are a sad commentary. It would be a disaster if cut-and-dry pill prescriptions became the only recourse for mental illness – I had one health plan where medication management was the only function allowed for psychiatrists. We can’t allow that.

On the other hand, the medical model is getting abuse it doesn’t deserve. It’s not only about drugs and brain chemistry. It encourages – and health insurance often pays for – therapy and a wide range of treatments besides medication – when it’s properly incorporated into a comprehensive health plan. While the drug companies do promote the neurotransmitter- amine myth, as Peter Kramer calls it, as if it were truth, the research on brain chemistry is much more complicated and offers the best evidence for looking beyond the commercial nonsense of pills curing mood disorders.

We can’t get to be anti-science because the drug companies are corrupting both the forms of treatment and research itself. We need to fight for reforms to control the influence of money in health the way we fight for reforms (OK, usually in vain!) to control the influence of money on the electoral process. And we need to fight for parity in the way health insurance pays for treatment of mental illness, provided parity doesn’t mean pills only. Liz, I think you’ve got the right balance of caution and commitment to action in your piece. Thanks for highlighting this issue.

John D

At one of our community mental health centers of the approximately 2,500 patients receiving outpatient treatment 2,000 (80%) find treatment in its entirety is only medication. This is a far cry from the comprehensive, recovery & wellness based care so frequently represented. Where medication is but one tool and increasingly a tool whose long claimed benefits are increasingly suspect and detriments were only recently disclosed, we have every reason to be concerned about how this potential mental health “victory” will play out.

It will be interesting to see if the number of individuals on SSI and/or SSD by virtue of a mental illness continues its rapid increase. After all, parity by reducing economic barriers allows for early identification and treatment. This is supposed to result in better outcomes. If it doesn’t we should remember that this parity legislation doesn’t apply to those on Medicare and/or Medicaid.

Dysfunctional systems repeatedly look to the promise rather then the reality which follows.

I was diagnosed with a range of issues two years ago; major depression, attention deficit disorder, and non-respiratory sleep apnea. I still suffer severe insomnia. For the last 18 months I’ve been taking Wellbutrin XL, Adderall XR, and different formulations of Zolpidem as needed.

While I have no doubt the medications have helped me, I have also found that the addition of marriage counseling and individual psychotherapy has made a significant difference in my life. I do not believe the medication alone would have resulted in the improvements in my mood and mental state. Psychotherapy has definitely been an important part of my improvement as well.

I teach in the University of California system, and one of my courses is an introductory physiological psychology class; I am keenly aware of the power of our biology on our behavior. Yet, as Konrad Lorenz most cleverly showed, we are not simply products of our physiology. The environment we live in also has powerful effects on us, and as we are by definition social animals, I don’t see how those in the mental health profession can deny the effect that social relationships and support have on our mental well-being.

Paul D. Thiem, PhD

But it occurs to me that you may be on to yet another way that parity makes sense.

Because the drug companies aren’t just overselling us on antidepresseants — they’re overselling us on just about everything, from drugs that lower our cholesterol without necessarily having any effect on our actual heart risks to drugs that treat symptoms the ads are there to help us recognize.

Those clinical guidelines for depression — especially exercise and watchful waiting — probably work just as well for things like irritable bowel and a host of other physical ailments Americans spend millions trying to cure.

No, talking and listening probably won’t cure cancer, any more than therapy alone will cure schizophrenia.

But what could they hurt?

Mental health care is about a lot more than the few antidepressants from that antipsych meta-analysis that were turned into a straw man. The medical model does include CBT, supported housing, and more holistic care – at least in other countries.

Here is a link regarding a petition for drug ads to place a 1-800 number in there ad to report side effects of medications to the FDA.

They need 50,000 signatures by the end of the month!

https://secure.consumersunion.org/site/SPageServer?pagename=Rx_Drug_Ads_Petition&JServSessionIdr005=bpc74k92e1.app46a