It's incredibly frustrating seeing people who acknowledge they have no specialized knowledge in a field make sweeping statements about it, encouraging psuedo-scientific beliefs about psychiatry (which is, make no mistake about it, more of an 'art' than a science, but so was the beginning of many now-scientific fields). Nobody tries to tell a cancer patient how to treat their cancer, yet so many people feel obliged to opine about mental illness.
What this article is discussing is the (unquantified) subset of people who experience serious side-effects from anti-psychotics. The key takeaway from the article:
> “For some people, remaining on medication long-term might impede a full return to wellness,” Insel wrote. “For others, discontinuing medication can be disastrous.”
> The problem is that we do not know who is in which group.
> Some people can learn to talk themselves down from delusional thoughts. And some people might choose hearing voices over being 30 pounds overweight and tired all of the time. The point is that this is not a choice I should be making for my patients; it is a choice I need to make with them.
Of course, if somebody is having a psychotic break or mentally unstable, you can't even begin to have that conversation about their available options because they will be unable to focus or make rational choices. You pretty much need to start with the medication, then work from there to figure out which group they're in, and adapt their treatment accordingly (i.e. stick with meds or drop them but help them learn how to manage it).
I found the article to be a long-winded way of saying "psychiatrists ought to seriously consider dose reduction in their treatment regime", which is something that I doubt anybody would argue against. The devil is in the details (for some people, dose reductions can be incredibly dangerous), and the article does not delve into what a sensible strategy would look like.
Oh I wish that was true. My gf had cancer and every crackpot we knew was advising on nonsense causes and treatments.
6. Have any preclinical (laboratory or animal) studies been conducted using Cannabis or cannabinoids? Preclinical studies of cannabinoids have investigated the following activities:
Antitumor activity
Studies in mice and rats have shown that cannabinoids may inhibit tumor growth by causing cell death, blocking cell growth, and blocking the development of blood vessels needed by tumors to grow. Laboratory and animal studies have shown that cannabinoids may be able to kill cancer cells while protecting normal cells. A study in mice showed that cannabinoids may protect against inflammation of the colon and may have potential in reducing the risk of colon cancer, and possibly in its treatment. A laboratory study of delta-9-THC in hepatocellular carcinoma (liver cancer) cells showed that it damaged or killed the cancer cells. The same study of delta-9-THC in mouse models of liver cancer showed that it had antitumor effects. Delta-9-THC has been shown to cause these effects by acting on molecules that may also be found in non-small cell lung cancer cells and breast cancer cells. A laboratory study of cannabidiol in estrogen receptor positive and estrogen receptor negative breast cancer cells showed that it caused cancer cell death while having little effect on normal breast cells. A laboratory study of cannabidiol in human glioma cells showed that when given along with chemotherapy, cannabidiol may make chemotherapy more effective and increase cancer cell death without harming normal cells.
Stimulating appetite
Many animal studies have shown that delta-9-THC and other cannabinoids stimulate appetite and can increase food intake.
Pain relief
Cannabinoid receptors (molecules that bind cannabinoids) have been studied in the brain, spinal cord, and nerve endings throughout the body to understand their roles in pain relief. Cannabinoids have been studied for anti-inflammatory effects that may play a role in pain relief.
So it's not like the marijuana people are entirely making it up - cannabis definitely helps with pain relief and appetite (serious issues during cancer treatment), and may help with treating cancer directly.
[0] http://www.cancer.gov/cancertopics/pdq/cam/cannabis/patient/...
Sorry to make light of this.
As far as I know, almost all people taking medications for serious mental illness suffer serious side effects from them, that's just a fact. I am not trying to convince anyone to stop taking medication, some people might really be even worse off without them, I am just saying that it is a very difficult decision for a good doctor whether to put someone on psychiatric drugs or not, and whether to keep somebody on them. I speak from my personal observations of close family and friends who had mental health issues and were put on drugs, and from reading summaries of current research e.g.:
http://en.wikipedia.org/wiki/Antipsychotic
Antipsychotics are associated with a range of side effects. It is well-recognized that many people stop taking them (around two-thirds even in controlled drug trials) due in part to adverse effects.
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In people with schizophrenia less than half (41%) showed any therapeutic response to an atypical antipsychotic, compared to 24% on placebo, there is a decline in treatment response over time, and potentially a biases in the literature in favor of these medication.
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If you have another opinion, I would love to hear where does it come from, do you have any kind of evidence that would counter what I said?
EVERY drug can cause side effects. and it seems that drugs meant for treating severe conditions, also have the most severe side effects. e.g. take a look at cancer medication. these meds are for a very serious condition, and simultaneously come with some of the worst side effects i know of. but the thing is, they can help. they can save lives. the same is true for psychiatric medication. psychiatric conditions often show drastic mortality rates (25%-50% of people diagnosed with bipolar disorder attempt suicide at least once, with of course many succeeding[1]). and there are plenty of other such disorders with very high mortality rates.
In people with schizophrenia less than half (41%) showed any therapeutic response to an atypical antipsychotic, compared to 24% on placebo..
numbers like these may seem low, but looked at alongside the mortality rates of many psychiatric disorders, these numbers can save A LOT of lives.
Even though I am a strong advocate of individual liberty, and I think that except in the most extreme cases people should have the right to choose their treatment, a cursory browsing of wikipedia suggests that there is strong evidence for the effectiveness of antipsyichotic medication.
He isn't "quite simply wrong", by your own point. It could just as easily be the case that the severely mentally ill only couldn't live because of their interactions with "non-ill" people as it could be the case that severely mentally ill people would up and off themselves en masse by virtue of their 'illness' alone. The only life a severe schizophrenic can't live (for example) is one in a society which demands non-schizophrenic behavior, else death/shunning/exile/whatever. I here note that in order to determine that someone is mentally "ill", a defining criteria for diagnosis is being diagnosed by someone confirmed to be not ill.
This back-pedaling is where you begin to lose steam.
> Nobody tries to tell a cancer patient how to treat their cancer, yet so many people feel obliged to opine about mental illness.
Including the psychiatrists who admit to 'more art than science.'
>You pretty much need to start with the medication, then work from there to figure out which group they're in, and adapt their treatment accordingly (i.e. stick with meds or drop them but help them learn how to manage it).
Sounds essentially like just guessing.
Now let's look at your first statement.
>While I'm sure you mean no harm, you are - quite simply - wrong.
While I'm sure psychiatrists mean no harm, that doesn't mean they're right.
That's exactly that—a layman's impression. Realistically this is very complex to evaluate. Personally, when I took my antipsychotic, I thought clearer. I stopped because there were physical side effects, but I still miss it.
As always, exercise caution when adopting new medication, and evaluate early and often whether it helps you address your needs.
However, I can't think of anything more harmful than denying patients medication that actually might help them. People have strong feelings about psychiatric drugs, and even more so when it's hard to quantifiably evaluate the beneficial effects. Add in that depression and anxiety have a practically infinite number of causes. The result is that it's very difficult to evaluate medications for a given patient without trying it, and there are a large number of failures before finding good medication.
i had a psychotic break last year, really bad. i was put on intensive medications, which made it easier to fit into normal every day interaction, but also made me tired, depressed and, ultimately, more psychotic. all of the times i've experienced psychosis, it's been a defensive mechanism that my mind uses to explain why i'm feeling so shitty - so taking medicine that is exhausting, makes me gain weight and have trouble focusing just made the problem worse.
the meds stopped the immediately frighting and bizzare imagines my mind presented to me, but they didn't go away - they just changed into longer term, ultimately more frighting images that still scared me, but in a way that was more conducive to my behaving in a way that everybody else expected. i would believe i was trapped inside something like the matrix, where everything i did on the inside had intense consequences for people outside my reality; failing to wash my hands after using the restroom would cause millions to die far away. one of the 'rules' the psychosis imposed on me was that i could never talk about what i was struggling with because that would break the matrix and cause even worse problems.
it's pretty easy to see in retrospect that it was entirely metaphorical; the 'matrix' stands for the world of social convention, and small risks that add up over time (i.e. not washing hands or brushing teeth) were presented as catastrophic nightmares in order to make sure i focused on resolving them.
over the course of the past year i've slowly reduced the usage of these psychotropic medications - with approval from my psychiatrist - and with increased amounts of energy and happiness, i no longer have as much of the psychosis.
the issue i can see with all of this is that treatment for mental health issues requires love, patience and careful attention from a lot of people over a long time; if you ask me, our society does not want to give that to people for fear of being taken advantage by some unscrupulous people who would feign mental illness to get out of work.
i don't know what a solution would be, but i agree with you - these meds do more to help everybody else than the patients themselves.
I would not condemn anti-psychotic medication just because
1. we do not understand the brain and thus are not able to design more sophisticated methods to treat this terrible decease
2. many patients suffer from terrible side effects.
Thanks to some new generation anti-psychotic drugs (e.g. Risperidol, Abilify, etc) many a person who has the misfortune to suffer from psychosis can return to their daily live - and by this I mean that the person can do more then just 'function'. Of course, his ability to do so depends on the severity of psychosis and dosis of medication. I know a person who learned to live with his psychosis and has greatly improved his quality of life in the recent two years.. to such a degree that he may complete his (ambitious) studies and get a job. Medication was one of the key factors for his well being, other were a long series of psychologic treatments and support from his surrounding.
It also true that in societies where the access to anti-psychotic drugs is restricted (e.g. lack of a pharmaceutical industry) a completely different development of the person is observed, not necessarily in a negative way. However, the nature of psychosis is deeply connected with genetic (hard) and enviromental (soft) factors, such as family, society, experience as a child, etc - so no actual comparison can be made between those patient groups.
Right now, there is no solution to this phenomenon of brain disfunction, and research has a long way to go to understand the structural changes in the brain of psychotic persons during their beginning adolescence and possible treatment.
At the end, stigmatization of psychosis should be avoided, as should be any general magic recipe - every patient is a single case who deserves the best treatment and support from his family and friends.
Allow me to disagree.
We do not need to understand how the brain works in order to be able to find treatments for all the different mental deceases.
Its all trials and errors, hypothesis -> testing -> result, again and again and again until a final conclusion!
I have spend a lot of years researching the brain, the black box which everyone wants to understand but no-one has any clue about it and more specifically Alzheimer's disease (not in a pharmaceutical company but in academia).
From my experience, we don't need to understand how something works if we know what is the most likely outcome for a given input.
I was lucky enough to test different types of drugs, their long term and short term effects, how useful they are and of course what effects have in behaviour etc. From every single study I could put a piece of puzzle right there and be able to see a clearer picture of what's going on, make hypothesis, tests hypotheses, have controls, tests controls etc. I obviously have no clue how the brain works but for those things I checked I know:
Given an input -> Brain -> I get an particular output most likely*
From that (and of course many control studies), I could trust that this drugs will most likely give me the predicted output. And that's how research is done..Is not always correct but based on that, we managed to be where we are, to have drugs for diseases which in the past killed us and step by step we can move forward and it would be wrong to doubt how much improvement has been done so far by the research community.
I am not suggesting you to trust anti-psychotic, just suggesting you that in my personal opinion, is wrong not trusting a drug (which you of course are well aware for advantages/ disadvantages) just because you don't know how brain works...Many other drugs which are for simple diseases actually affect your brain in many similar ways as anti-psychotics.
of course you are right: we do possess very advanced tools, starting from the actual design of drugs that target certain receptors selectively, medical trials, production and quality control. What I meant by "we do not understand the brain and thus are not able to design more sophisticated methods to treat this terrible decease" was the fact that most of the time, we are treating symptoms, for we are not sure what the actual causes are.
It is great what we can do, but (IMHO) pharmaconeurology still has a long way to go.
The actual process of choosing a drug for a patient is somewhat black voodoo magic: If A does not work/has bad side effects, B is prescibed, etc.
And of course, due to the nature of our organism, it is impossible (?) that a pharaceulogically active compound has just one system effect/side effect e.g "Aspirin".
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On a side note: could you PM me in which field you are active as an entrepreneur? My email is in my account description.
Cheers!
The brain is something of a black box, and it is extraordinarily complex. We have a complex understanding of it - which isn't enough to understand it fully, but it's better than 'very basic'. The characterisation of our understanding as being so simple doesn't do either the brain or the researchers any justice at all, and makes us lean towards it 'being okay' to be helpless in the face of its complexity. It is, without a doubt, the most complex field in the human experience by far.
all the treatment often seems to do is to alleviate the most visible of the external symptoms, causing several new problems in the process, or simply making the patient apathetic
Some patients generally do okay with medication, others have transient episodes during which the medication helps throughout. Not every patient is on a rollercoaster to hell. If the argument "well, you can't save everyone, so don't try anything" really had any merit, there wouldn't be any Emergency Departments in hospitals.
And yes, that's a dilemma.