My friend told me that she wants to stop taking her anti-anxiety medication.
“It’s important for me to get off of it. I want to try really, really hard to eliminate it from my life.”
Bear in mind that this is a woman who has suffered from crippling anxiety for many years, to the point that she wasn’t even leaving the house. Countless therapy sessions did nothing. Yoga, meditation, acupuncture, exercise, vitamins, you name it. Nothing, nada. She was a complete mess until she met her good friend, Mr. Paxil. And then she was much better. At least to the point that we could have this conversation in a bar and not simply through text messaging while she sat alone in her bedroom.
Knowing this about her led me to get on my soapbox about her desire to stop her medicine, to the point that I was told by the bartender to either lower my voice or leave. Apparently I can scream all I want when the Yankees lose – and believe me, I do – but I have to use my Indoor Voice when discussing matters of health.
Before being scolded, I listed for her several valid reasons that physicians and patients will stop a reasonably successful medication regimen:
1) Side effects: sometimes the benefits of the drug are simply offset by the cons that come with it. Most of my patients tell me that many side effects go away after a few weeks, but whether it be significant weight gain, loss of libido, dry mouth, dizziness, etc., some people decide that the gains are simply not enough to warrant continuing the medicine. An extension of this would be when a patient’s mental health medicines are contraindicated due to a physical issue such as pregnancy.
2) The issues or circumstances that led to medical intervention have been resolved: some patients need medication as a temporary band-aid to simply take the edge off or alleviate symptoms on a short-term basis. I have plenty of clients who have panic attacks that are so agonizing that medicine gives them an almost-required relief. They then go to therapy, learn the skills to control the panic and then make a conscious choice that they feel better equipped to deal with the issue. At that point the drug is often removed. Another example would occur when a patient loses a loved one and, for whatever reason, is unable to get out of bed in the morning or function throughout the day. Anti-depressants are often prescribed to help the patient get to work and manage their daily tasks until they gain some control over their grief.
3) Cost: while most of my clients have some type of health insurance and can get at least generic versions of medication at a reasonable cost, this is not true for everyone. Some patients simply do not have the funds needed to get the drugs that will help them. And unless they have a doctor who will provide them will samples on an indefinite basis, some people simply can’t access what will help them.
4) Dependency: certain medicines such as Ambien or Klonopin have habit-forming properties and are often used only on a short-term basis. Some patients need to stop taking these drugs after a period of time due to the risks involved.
“I’ve known you forever and none of those apply to you,” I said. “So tell me the reason.”
“I don’t like the idea of needing it,” she said. “It’s like, I’m weak if I have to take the pill.”
I’ve heard this innumerable times from clients, friends and even Dr. Pete. I almost always say the same thing in response.
“So if you were diabetic would you bat an eyelash at taking Glucophage?”
My friend sighed, knowing where this was going, fully prepared to humor me. “No, doctor of sorts.”
“And would you even consider your own intestinal fortitude if you needed Zocor for high cholesterol?”
This time she rolled her eyes. “No, I would not, you pedantic dick.”
“So it’s fine for you to have problems with your kidneys or heart. In fact, I’ll bet any organ gets a free pass as long as it’s not the brain. Where did you even get this idea?” I asked.
“Come on,” she said. “You know the stigma. You talk about it all the time on that stupid blog of yours. It’s just the way society looks at this type of thing.”
Of course she’s right and, while the stigma has weakened over the years, it still exists. Many people (most of whom probably don’t read this site) feel the same way as my friend: the brain is the sole organ that you are supposed to have full control over. Unfortunately it doesn’t work that way in real life. The reality is that she doesn’t have control over it and needs the medicine.
“You’re actually being very judgmental to both yourself and everyone else who needs these drugs,” I said. “So what’s going to happen? You’ll stop the Paxil, become a screaming ball of anxiety again, and be ‘strong’ because of it?”
She threw back a bit of some pineapple-scented drink. “I don’t know, maybe. I suppose I could get lucky and the anxiety could go into spontaneous remission.”
“After all these years, I doubt it. How about, as an alternative, you remain a happier person with the medicine instead of being a martyr?” I suggested.
“Or,” she countered, “how about you go fuck yourself?” To solidify her request she stabbed me in the arm with a paper umbrella from her drink.
Although I think she agreed with me on an intellectual level, her gut was still telling her that ‘mental health medicine = weakness.’ And this is the case for so many people who rely on the drugs. The point that needs to be drilled home is that, ironically, a weak person is the one who will not admit that she needs help. Strength is the ability to say “I can’t do this alone, it’s not working.” You can’t allow your mind to wrap around the notion that it’s a good idea to remove an agent that has improved your life immeasurably, only to return to a previously miserable state. And all for the sake of falsely claiming strength.
Are some people in the world over-medicated? Yes. Do some people use it as a ‘quick fix,’ a way to not have to address their problems? Of course. Could our society strive toward a less biochemically-altered state? Absolutely. But none of this is applicable to my stabby friend who never did apologize for her assault on me. This is a psychological battle for her. She has to resolve the fact that there is likely something going on in her skull that needs to be addressed through modern medicine.
I don’t know as of yet what my friend is going to do. We saw the violence she is capable of when her medicine is keeping her reasonably calm, so I’m pretty sure she could kill me if she goes back to her former self. That in and of itself should make the decision an easy one, but we’ll see.
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Another reason for quitting medication is curiosity about a life without medication, which you touched on briefly. Periods of long stability have a way of making you wonder whether or not you were really “that bad”. It’s the dim hope that whatever was wrong “back then” is now no longer a part of your life, and now you would be able to possibly handle life without the benefits of medication. With that possibility out there, you become curious about what life would be like without the addition of the meds. I feel that at its crux it’s really a hope that the diagnosis was a mistake, and the symptoms just temporary (even if they have gone on for many years).
I’ve fallen into this trap myself: “I’m not really sick, I was just stressed/overwhelmed/young/suffering the effects of bad Chinese food, and I don’t need these drugs any more because those things have changed.” In most cases for me, the only thing that really changed was the use of medication, but I refused to admit that at the time.
Also, watch out for those pineapple drinks, Rob. Maybe they just make your friend that much more stabby.
“doctor of sorts” .. I love that!
I live in a very nutritionally phobic aware community where taking one ibuprofen is akin to putting nasty toxins into the body. So psychiatric meds are seen as evil. It’s one complaint I hear frequently and work toward countering. Or trying to keep it in perspective, is a better way of putting it.
Great topic, Dr. Rob.
After struggling with depression for most of my life, it got to the point (due to a culmination of events) that I finally decided to get medicated. A prescription and therapy with a psychiatrist likely saved my life.
I was on the Rx for over a year, but then I moved to a different state and lost my health insurance. So I decided to see if I “really needed it.” I made it about 1 year before I, once again, got the point where I decided that the meds were not an option. I told my husband (who also suffers from depression), “I thought I was better than that [than needing meds].” He said, “No, we’re not.” It’s not a choice for me, it’s a necessity. And I’m okay with that. I’ve been able to start the Rx again because I make so little money I get it for free from the drug co., which is a huge blessing.
Like you said, there are certain circumstances when someone might need to be medicated for only a short period of time. But for those of us that don’t have that option, we should be okay with admitting that, too. I’d rather “need” a pill than be dead.
or you could sneak into her flat, and switch her meds for placebos and see what happens, then write a book and get rich.
I never thought of treating the brain as another organ… like your friend, I feel think this a weakness, to be overwhelmed by my emotions even controlled by them at times.
Also, I don’t think it’s just with these medications that people stop taking them. One thing they drill into us in pharmacy school is that once people start to feel better, they want to stop taking the pills. Or they just stop taking them for their own reasons. I think its very difficult to be a patient, I can’t blame them.
Help me understand, Dr. Rob. What’s the difference between the patient you describe under scenario 2 (someone experiencing acute exacerbations which require temporary pharmacological control) and someone who is using the medication as an inappropriate “quick fix?”
Dr. Rob: If a client has an onset of panic attacks or depression that incapacitates them (i.e., can’t get out of the house and therefore reisks losing her job), most psychiatrists wouldn’t see this as a “quick fix,” especially if the client begins to address the problem in therapy after they’ve been pulled out of the abyss. By contrast, many psychiatrists complain that they have patients who come to them at the slightest negative emotion. They can’t feel frustrated at work, their spouses are annoying, they don’t want to EVER feel sad. These patients are usually denied medicine or simply placated with it and need to be working through this stuff. They treat the medicine as a Magic Bullet, the cure-all of everything wrong in life.
I celebrated my birthday yesterday, made possible in part by Celexa! Great post – thank you Dr. Rob!!
Good stuff Rob. So why’d she stab you? You should have made out instead…but whatev.
Some people need meds for the rest of their lives. It’s not weakness, it just is. I hope she finds strength in something.
I sympathize with the woman. Not that I want to get off of any medicines, but the whole anxiety thing.
I could probably super use some paxil.
Meds definitely saved my life, but I made the decision going into the treatment that I would work to change my patterns of thought/lifestyle that were getting me into trouble in the first place. It wasn’t easy AT ALL, but definitely worth it to turn your brain into your best friend rather than your worst enemy. I’ve been off them for a year and a half now and still feel great!! But it also brings me comfort knowing that if I ever fall into depression again, there’s something that can bring me out of it rather quickly. I believe in alternative therapies, but it’s true that drugs help you get back on your feet quickly – which is sometimes essential for survival.
It’s so easy to perpetuate damaging thought patterns yet so hard to break them. I don’t view anyone who has to go on medication as weak – life doesn’t really afford us the luxury of shrinking away from it while we “fix” our brains.
I wish everyone the same luck that I had!
Dr. Rob,
Thank you for such an informative and truthful post. As a methadone recovery advocate, something that as you may be aware tends to cross the boundaries between pharmacology and mental health; this is an all too common issue amongst patients and Doctors alike.
I tagged your post (and blog) with full authorship credits to you to some of our message boards. The feedback I received was grateful; as so many of our patients encounter Doctors who themselves push patients off a much needed stabilizing medication like methadone. It was a relief to so many of our patients and advocates to hear the words coming out of a Doctor’s mouth.
Thank you again; may there be more professionals like you in the world. Feel free to check out some of the responses at the following links:
http://www.readybb.com/nama_wespeakmethadone/viewtopic.php?t=9290
http://www.readybb.com/watchdog/viewtopic.php?t=10595
Sincerely,
Lindsay Miller
ARM – Advocates for Recovery through Medicine
NAMA
“Come on,” she said. “You know the stigma. You talk about it all the time on that stupid blog of yours. It’s just the way society looks at this type of thing.”
wtf, I hope you Chinese wrist burned her for that shit
Good topic. One thing to add to the “side effect” topic are the long-term and often irreversible changes that can happen on some of the more potent psychotropics.
I’ve used the diabetes example, but pts often say, “I know that I need [the meds], but it still makes me look crazy.”
btw, Sanofi-Aventis would argue that Ambien is in fact non-habit forming, but we all know it is just semantics.
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Well, the piece is in reality the freshest on this noteworthy topic. I fit in with your conclusions and will thirstily look forward to your upcoming updates.
Yet another example of how Ph.D’s need to remove themselves and walk around for a bit. You think you would have learned by now that there is no one fix for everyone and to promote one way over the other to your “friend” is just plain wrong. If she wants to experiment then why not try to be a good friend and provide a safe back up to it? Perhaps she would be fine, bu then again she may not. To limit her options just because “most of the time you have seen it not work is letting the 1 percentile fall through the cracks. How did you become so smart without making mistakes? Let her make hers.
I’ll bet that if Lady Xanax instead of Mr. Paxil was the medication in question here this blog would’ve been a lot different.
@Kevin: you are right, a one-size-fits-all model is a horrible approach to mental health. However, why would someone return to a previously attempted and failed model when success has been achieved? Especially when every other failed attempt has been covered as well? Unless it’s for one of the reasons delineated above, they wouldn’t unless it was associated with pride, strength, or stigma, and these are poor reasons.
You are clearly anti-medication, and that is your choice, but to advocate someone remove something that is clearly beneficial simply to “let her make mistakes” is being not only a poor shrink, but a bad friend as well.
@Brandon: No doubt, see # 4 reason above.
In general terms, medication isn’t the answer, but this woman seems like an exception. Sorry you got stabbed.
I am sorry if I came off harsh and even more sorry if I branded myself as anti-medication. I know many people that benefit from it and I have been on paxil in the past. My suggestion is not to let your friend try something that would be dangerous and have her deal with it, it was to let her try and for you(or others) to help her deal with it. If she goes off it and is fine then great, but if she goes of the meds and then is a mess again that is an important growth point of life for her that she needs to to deal with to further her understanding of life.
I simply fail to understand why people like to think of their brain as something separate from ‘themselves’. The brain is the person, and this stigma upon medication is an active barrier to progress and survival. I just don’t understand why someone would prefer changing outside environment over direct chemical intervention. Either way, you are correcting the conduction of neurotransmitters to an established norm, assuming the medication is successful.
I spent years in the cycle of going on meds/going off meds. I felt so strongly that I needed to be able to go without medication, I couldn’t even really articulate why but it was a strong drive.
Unfortunately, the event that ended that cycle was my own son nearly being taken by depression. Within six weeks my beloved child was so sad, so lost and I could almost see the chemical storm in his brain. We got him into therapy three weeks into it and had him seen by a pediatric psychiatrist during the sixth week. Two weeks on the meds and he was nearly back to his old self. He goes to therapy when he feels he need help or a “tune-up”, he takes the medication daily.
It was terrifying. It was also a cold bucket of water to the face…I need these meds. In with all the good things my DNA passed onto my son, it included this glitch. My attitude towards medication changed completely. My son is not weak, he is not broken and neither am I. We are simply two people with a problem who are lucky enough to be living in a time where help if available and with the means to procure it.
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Plain and simple.. People don’t have mental issues because there is a lack of “Prozac” in their brain..
Prescription medications may help with a few symptoms but the problem that they are address are still there. Medications have never been intended to “cure” but rather generate revenue by the patient being forced to take a medication for life.
This also comes at the cost of countless side effects. Sure you may not been feeling the effects of an emotional disorder.. But have you prepared yourself for that kidney transplant your going to need in a few years because of the medication side effects?
And guess what? Your going to pay for that too or die..
Look for alternatives to “prescription medications”. Hospitals, doctors, pharmaceutical companies don’t make any money from “healthy” people.
Its not in their best interested to make you well.
Greed rules all.. And your foolish to think it don’t rule your health-care professionals too.
I did what your friend wanted to so. I stopped. It was harsh. It was a process to get through the “not withdrawal” symptoms. And i realized a few things afterwards.An afterwards that was months and months to get to with strange reactions. I had been living a half life. I hadn’t dated in years. I hadn’t missed it. I had let relationships go shallow – and not noticed. I worked a job that was my whole life – and didn’t mind. I wasn’t me at all. But I held my job and smiled and moved along so nobody else minded. Sometimes it was fine. Mostly it was not bad. There were high points but looking back, it was not very deep.
I’m super glad I stopped taking (the last one was effexor). Am i solid now? Meh. I have depression and anxiety, but i will in any case. Nothing works forever. Bodies like to equate to their own idea of equallibrium. Hence the need to change prescriptions over time. Rather than bandaid it, i’m attempting to find a way to live with who I am. I don’t think any prescription answer should be forever without a life threatening (dire and immediate) reason. It’s like saying to use a crutch forever without physical therapy.
According to my shrink, the anti-depressant won’t be doing miracles. It is a 50-50, meaning that you’ll do 50% of the job and the A.D. will do the other 50%. It basically gives the individual a chance to work on his issues…. That’s probably why psychotherapy is needed even when the individual is on meds.
My life without the meds was shallow, since I spent too much time focusing on my mood, and I had no room for anything else. I feel that I’m finally waking up, a bit too painful because I lost all of my teen years and a bit of my 20’s (I’m in my early twenties) but it’s something. I was tired of living like a zombie.
I guess everyone has a different response to treatment.
@ All the World’s a Stage
Huh. Where I live, in the U.S., doctors are almost never allowed to force patients to take medications. I’ve never known a single person in my life who was forced by a doctor to take a medication. (Though I have known many people, including myself, who have been forced to take medications by the negative consequences of illness and/or death if a medical condition is bad enough. It’s too bad that we get sick. But we do.)
Me, I tried an antidepressant once that didn’t help, and all I had to do to go off it was …. well, go off it. I tapered off it as recommended over about two weeks and that was that. My doctor was all for my discontinuing the stuff, as it wasn’t helping, and she wanted to help me — an attitude really not unknown or even rare among doctors; you seem to have known only sociopathic ones with mysterious powers of compulsion not normally found among humans. I have never met such but would love to, if only to see how it’s done.
The good news is that wise and humanity-loving people over the millenia have labored and have had some success at developing things that allow others to be less sick, to recover entirely, to live rather than die. That is medicine, a thing not known in nature until humanity grew clever enough to look after itself better than Nature, which being a theoretical idea looks after nothing. Some natural processes and conditions and things do — those medicine seeks to bolster — others harm and kill us, and those are medicine’s enemy.
I would have died last weekend, in fact, if it weren’t for antibiotics, which we invented and which are not manufactured by the body and are thoroughly unnatural to it. I would be dead for exactly that reason, in fact; doctors had to introduce those artificial substances into me and disrupt the course of nature, which in this case was my body losing a battle with a bacterial infection of a major organ system. Yes, the infection was not caused by my body lacking antibiotics, it was caused by bacteria. So??? That has nothing at all to do with the fact that antibiotics were so necessary, I would be dead had I not been given them. If you think I should be dead, because unnatural medications are worse than the disease and death they can allay or stop, I disagree. And not terribly respectfully; if that were the case, you obviously would not respect me enough to think it acceptable that I lived, when that was at the cost of doctors doing more of those unnatural things they do.
Choose the ravages of natural disease and dysfunction for yourself, if you want, but know that others have a perfect right to choose healing; and that that seems infinitely the saner and unquestionably the good and benevolent course. You are very quick to tell others to suffer for your ideology; suffer yourself for it if you wish. Let others free themselves of senseless pain. Why that idea disturbs you so, I do not know; it is unnatural for a human being to wish humanity to suffer on principle, and even sociopaths usually know better than to admit it, if they feel that way.
News flash: Suffering is not a good thing. However natural. It may be unavoidable, but that is the best one can say of it. Well, and that it can teach people like you not to hold others’ suffering so light; but that is a completely circular argument — better if neither of you suffer more than you need, as far as I’m concerned. We will all suffer enough; as I write this, children have died for lack of clean water. That is natural; it is an evil of nature. That you would give such things a free hand speaks worse of you than the medical establishment, by far.
As for depression not being caused by a lack of Prozac in the brain — well, of course it’s not; humanity invented Prozac to selectively inhibit the reuptake of serotonin. That was clever of us. Medicine is clever. It is unnatural — when the course of nature is that a person suffer, grow ever more ill, and perhaps die unnecessarily, we can prevent that. I say that’s a good thing. Of course, I just got out of the hospital, and am alive to type this only because that malefic medical monster of your imagining took time off from the service of evil to diagnose me with an appendix that was about to explode — quite naturally; it would have if unnatural measures had not been taken to stop it, and I filled with unnatural substances like IV antibiotics, anesthesia, stitches, etc., not to mention –temporarily — a surgeon’s fingers wielding a scalpel. And bless her forever for it. I am alive; the course of indifferent, mindless nature would have killed me, but human beings sometimes look out for each other. And most differ from you in not objecting.
And if these helpers are paid for their work — well, should only useless work with no redeeming social value pay? That would greatly increase the number of people employed doing useless, socially unredeemed things, while utterly discouraging those who would like to work at more worthwhile things, but cannot do so if they cannot both work at such a job and keep fed.
Sue says:
“I would have died last weekend, in fact, if it weren’t for antibiotics, which we invented and which are not manufactured by the body and are thoroughly unnatural to it.”
Kind of like food. I will die if I don’t eat food.
And antibiotics weren’t invented. They were discovered because they are mold.
Of course, many people would not have died over the years if they had just eaten the right mold when they needed to, instead of food.
What’s the moral of this story?
People aren’t good at figuring out what to eat and need doctors to point them in the right direction.
So, doctors are like farmers and nutritionists all rolled into one.
Except they farm mold.
And the mold kills things.
So maybe doctors are more like gun farmers.
They grow biological weapons that you then eat.
Annie says:
“My life without the meds was shallow, since I spent too much time focusing on my mood, and I had no room for anything else. I feel that I’m finally waking up, a bit too painful because I lost all of my teen years and a bit of my 20’s (I’m in my early twenties) but it’s something. I was tired of living like a zombie.
I guess everyone has a different response to treatment.”
So meds are kind of like the opposite of law school.
When you go to law school and then work in a law firm, you spend all of your time focusing on billable hours and don’t have any room for anything else.
Do you have an Axis I diagnosis Annie?
Hey, Rob based on your experience, wouldn’t it be a good idea to include “lawyer” as an Axis I diagnosis for the DSM-V? I’m thinking that you have to somehow combine the signs and symptoms for ODD, OCD, dysthemia, and anxiety disorder, NOS. Maybe throw in cyclothemial, too.
That’s my psychological thought for the day.
I honestly don´t know if you are making fun of me, but yes, I do have an Axis I diagnosis….
I should add that it would be the opposite of business school as well.
No, I’m not making fun of you. I was making fun of lawyers, though.
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