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What You Need to Know Before Starting a Drug for a Mental Health Problem

cpuusage

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What You Need to Know Before Starting a Drug for a Mental Health Problem

What You Need to Know Before Starting a Drug for a Mental Health Problem - Mad In America

[Active Links/Videos in OP/Above Link]

By Joanna Moncrieff, MD
Foreign Correspondent February 3, 2015

In a belated new-year blog, I thought it would be useful to set out what I think someone needs to think about if they are considering taking a drug for a mental health problem, especially if they think they might end up taking the drug for a long time. These are the questions you might want to ask your doctor if you take a ‘drug-centred’ approach to the use of drugs in mental health.

1. What Immediate Effects Will the Drug Have?

We need to know how taking a drug for a short time is likely to affect our feelings, thoughts and behaviour. Data from animal studies and ‘human volunteer’ studies can establish how a particular drug changes ordinary behaviour, feelings and mental capacities, but unfortunately, for many sorts of drug, this sort of research remains scanty or unpublished. However, the internet provides increasing opportunities for people to record their experiences after taking prescribed medication (on sites like RxISK; AskAPatient). Although data from people with diagnosed mental health problems is often dismissed because it is difficult to disentangle the effects of the underlying problem from the effects of the drug, if it is considered carefully, it can provide useful insights. Further animal and volunteer studies are also necessary to clarify certain subtle and complex effects, however.

2. What Does the Drug do if You Take it for a Long Time?

As well as knowing what sort of changes occur after one or two doses of a drug, we need to know what happens to feelings and behaviour when the drug is consumed for the weeks, months and years that drugs are typically prescribed to humans with mental health problems. Since there are ethical, practical and financial limitations to the length of time volunteers or animals can be subjected to active drugs, we need to pay attention to other sources of information on what sort of mental and behavioural changes result when people take prescribed drugs for long periods of time. Drug monitoring programmes and other systems (including internet sites) that allow users to record what has happened to them while taking a drug are essential therefore to gathering information about what effects a drug can have when it is taken for long periods of time.

3. How Does the Drug Affect the Body as a Whole?

We need to know how the drug affects the body as a whole, in all its systems, including the brain and nerves, the heart, the digestive system, the reproductive system, other hormones etc. We need information on bodily effects that occur after short term use and long-term use. We need data on measures of physical disease and impairment such as cognitive function, hormone levels, cardiac function and metabolic efficiency, as well as data on how taking a drug for short or long periods influences death rates. Animal and volunteer studies are sometimes conducted to investigate particular, drug-induced effects, usually over the short-term. Again, however, we need to rely on recording effects that occur in people who are taking medication for diagnosed mental health problems in order to assess the impact of drugs on all bodily systems after long-term use.

4. What Happens When You Stop the Drug?

We need to know what happens when someone stops taking a drug they have been taking for a while. What sort of mental and physical effects occur after withdrawal? How long do the effects last for, and how do they relate to factors such as the duration of time the drug was taken for and the dose the drug was used at? How severe can they be, and can they persist for a long time? How can withdrawal effects be minimised?

5. How Will Taking the Drug Affect My Mental Health Problems?

We need information on how all these effects – the physical, mental and behavioural effects of different drugs over short and long periods – interact with the sorts of problems that people are seeking help for when they go to see a mental health practitioner. Does taking the drug reduce the intensity of distressing feelings, for example? Does it reduce unwanted behaviours like verbal and physical aggression? This is the point at which conventional randomised controlled trial (RCT) can be useful. RCTs can help establish whether a particular drug is superior to a similar intervention like a placebo tablet for particular problems or symptoms. Of course there are numerous difficulties in formulating the nature of mental health problems, and the ‘diagnoses’ we currently use are not necessarily helpful for pin-pointing the effects of prescribed drugs. Nevertheless, with simple problems like insomnia, for example, a trial can provide useful data on whether a drug is superior to a placebo, taking into account other influences like the ‘active placebo’ effect. Unfortunately most RCTs last only a few weeks, and none provide any data about whether the effects of a drug are sustained for months and years, or how they change over time with continued use of the drug.

6. How Will Taking the Drug Affect the Rest of My Life?

If we think we are likely to end up taking a drug for weeks, months or years, then it is essential that we know how the drug might affect all the various aspects of our life, from our ability to work or just read a book, to our emotional and sexual relationships. A drug may effectively wipe out symptoms by making someone sleep most of the time, for example, but this would obviously be a hindrance to getting to work or doing the shopping. Some RCTs provide a little information on global wellbeing or functioning, but again, we need to listen to the experiences of people who have taken prescription medications to understand the range of effects use of a particular drug might have on a person’s daily life.

7. Are There Alternative Ways of Achieving the Same Effects?

In some situations other measures, such as taking more exercise or relaxation techniques, might be able to produce the same effect as taking a drug with fewer complications. When, and if, we can establish that taking a drug is likely to provide some real, concrete benefits, we then need to compare the use of the drug with other methods of achieving the same result.

It is clear from setting out these considerations that the existing research base is completely inadequate. Your family doctor or psychiatrist is therefore most unlikely to have this knowledge at their finger-tips, because much of it does not exist. One of the most important implications of the drug centred model of psychiatric drug treatment is therefore that we need much more comprehensive scientific data about the drugs that we use for mental health problems. We should have had this data before we started on the sort of mass prescribing that has now become established, but it is not too late to provide a proper evidence base for future generations to make properly informed decisions. If we start asking the right questions, we might eventually persuade funders and scientists to do some more informative research, and to collate the wealth of existing information on the experiences of people who have already used these drugs.
* * * * *

This blog first appeared on JoannaMoncrieff.com

What you need to know before starting a drug for a mental health problem | Joanna Moncrieff
 
SarahD

SarahD

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These are all things we need to know and would like to know before starting a drug, and we can ask but as Joanna Moncrieff says no one knows the answers. The psychiatrist just gives you a spiel of how wonderful the drug is for YOU and how wonderfully it has helped other patients with similar problems. Maybe gives you a leaflet that lists a few side effects, not all by any means. Sometimes they lie to you about them (did to me). Then is unhappy when you don't want it.

The drugs affect every organ and part of the body. Many of the side effects are so serious and life limiting or even deadly that I don't know how they got approval. The casual disregard for the physical health of the mentally ill is breathtaking. (I think I mentioned before a positive review of clozapine which included the throwaway line "of course there will be some deaths". Unimportant, only mad people will die, so what?)

Yes I do know that they really help some people. But they work by suppressing brain function and damaging the brain. I have brain damage as a result. As JM says there needs to be much better research.

Sorry. Rant.
 

cpuusage

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Yes I do know that they really help some people. But they work by suppressing brain function and damaging the brain. I have brain damage as a result. As JM says there needs to be much better research.
i think there are far better ways of helping the majority of people, instead of primarily drugging them.

i'm not against a wise use of medication, & we obviously now have a very difficult situation where so many people are now drugged, & the primary system approach is based on drugging. i have also grown very tired of trying to argue for, raise awareness of & access alternatives. The majority of people appear to very much want, argue for, justify & defend the current pathology, label & drug system.

Half of me has & have to accept the realities of it all, for my own sanity - i half accept the official/orthodox psychiatric view, the diagnosis & need for the/dependency on the medication.

It's possible things could be different at some stage - with society, the system & my own circumstances. i would probably do things differently knowing what i know now - But the past has made me who i am, & we can't rewind time - it is what it is.

i think about the people new to all these areas - & those that are younger - i think they deserve better treatment & more informed choice.
 
SarahD

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Yes it is surprising how many people seem in favour of drugs, and seem to want to hold onto their diagnosis. At least in America many people have a therapist as well as psychiatrist, which is still less usual here. On other forums too people often rely overmuch on drugs and at the first problem the advice is to see the pdoc and get the meds "tweaked". I assume the drugs must be of help, unfortunately I have had very little benefit from them.

I hope at some point there will be awareness even among psychiatrists of how wrong the widespread prescribing of these dangerous drugs is, often forced on people too. Maybe one day there will be better and less harmful drug treatments and better therapies. (After reading about therapy for people with psychotic illness, which is now recommended, I just read a couple of articles saying in practice CBT not as effective as hoped for psychosis.)

Ah well the system is what it is.
 

cpuusage

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Yes it is surprising how many people seem in favour of drugs, and seem to want to hold onto their diagnosis.
i find it very hard at times to fully understand the popularity of the label & drug paradigm & willingness of so many people for the mass drugging of society, given what these areas entail.

I hope at some point there will be awareness even among psychiatrists of how wrong the widespread prescribing of these dangerous drugs is, often forced on people too. Maybe one day there will be better and less harmful drug treatments and better therapies. (After reading about therapy for people with psychotic illness, which is now recommended, I just read a couple of articles saying in practice CBT not as effective as hoped for psychosis.)

Ah well the system is what it is.
As frustrating as it is - we can't change the system.

There are alternative comprehensive psychosocial approaches for treating psychosis.

http://www.mentalhealthforum.net/forum/thread55346.html
 
SarahD

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Thanks - I read that thread. A lot of good information.
 

cpuusage

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Thanks - I read that thread. A lot of good information.
The thing that gets to me at times is that there are & always has been far more in depth, understanding, humane, compassionate & kind ways of helping & supporting people in psychosis/severe psychological/emotional distress.

i wouldn't exclude a potential wise use of medications in helping some people, & in cases i think it can help. But to have as a primary approach/system - Your mentally ill, slap on a label & drug everyone up - is insane.

To have a society/system that not only ignores & denies more comprehensive alternatives, but actively seeks to attack, suppress & block access to them - well - my location says it all to me - This planet is literally a Lunatic Asylum. i think it's ironic being considered, called & treated as mad.

http://www.mentalhealthforum.net/forum/thread101603.html

http://www.mentalhealthforum.net/forum/thread101538.html

http://www.mentalhealthforum.net/forum/thread101397.html

http://www.mentalhealthforum.net/forum/thread101657.html

http://www.mentalhealthforum.net/forum/thread100970.html

http://www.mentalhealthforum.net/forum/thread99596.html
 
F

firemonkee57

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I think psychiatric drugs can be helpful but (a) they are overhyped (b) pdocs need to be more proactive in informing patients of side effects/drugs desperately need to be made with better side effect profiles.
 
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