Wednesday, August 13, 2008

Meddy-Go-Round: multiple 'trials' of meds cuz they ain't workin

I hate to hear people tell me stories of being lead by some physician to get on psychiatric meds for some behavioral or emotional problem, when the problem truly ought to be addressed with therapy. There are a lot of conditions and problems out there, in my opinion, where therapy should be first line of treatment. Largely due to efficacy, and due to the lack of bad side effects, and the range of good side effects of decent therapy.

But, for a couple reasons, getting started on pills is preferred over doing the good, hard work of therapy. Some other time, I will blog about the three main reasons why, tragically, we end up on pills instead of in the therapist’s office. MedsVsTherapy, and too often, meds wins.

So, what happens when you get put, inappropriately on meds?

Well, you have just jumped on the Meddy-Go-Round. You probably will not enjoy the ride. However, like some merry-go-rounds, this is difficult to get off.

The term “meddy-go-round” popped into my head one day, as I was thinking about this common problem. It seems to fit the problem really well. I remember the days when I was a wee lad. Binghamton, New York was the home of the merry-go-round. As a kid, my family would travel over to this happy land of shoe factories and merry-go-rounds, and spend some time visiting my grandparents. The coolest thing was when we kids could get loose of the adults and head down to a nearby park, where it seems they were always running a classic merry-go-round. We would just wait for the next turn, get on, and ride. When it was done, get on another bejeweled horse, and you are riding again. Over and over.

When you go to the doc’s office for some problem: a kid is noncompliant, you are depressed, you can’t sleep, you have stage fright, whatever – well, the old saying about the hammer and the nail applies. So, the doc provides an answer for you, and writes out the prescription. Maybe you are unsure, but you give it a try.

Well, maybe the meds work for a while. Maybe they don’t work at all. Or maybe the side effects are so bothersome that you would rather go back to your familiar problem. But no. when you go to the doc, you hear one of three things: raise the dose, switch to another med, or “augment” with another med. You have now jumped on for your second go-round on the meddy-go-round.

When this new regimen of pills fails to solve your problems, you go back to the doc. The doc asks: how is your depression? Still glum? Well, let’s try another. You start to wonder, “when are we gonna start talking about my problems?” But the doc is firmly in control, socially speaking. You are on the doc’s meddy-go-round.

And so it goes. The next trip on the meddy-go-round. The doc has you try another prescription. Or raises the dose. Or augments.

Tragically, as this goes on, you get into believing that your problem will be solved by pills, because surely the doc would not keep trying you on one prescription after another unless the doc was really sure. You buy into this idea that multiple trips on the meddy-go-round are necessary to find the right pill, or right combination of pills. Maybe. But, maybe not. However, how often do people hear the 'maybe not' from their doc?

Here is a variation in the trips upon the meddy-go-round. Antidepressants are commonly prescribed for depressive type problems, and a range of other things. Well, the problem here is that for many people, the antidepressants actually do have an effect for a brief, shining moment. The mood lifts. The world again has color. You have found a solution.

But then, it happens: the magic wears off. After about five months, the pills no longer work. Maybe four months. Maybe six. But that fleeting period of normalcy really convinces you that pills are the solution. So, you get on the meddy-go-round for yet another trip.

This happens, in my opinion, because the antideprssants, the SSRIs, do have an effect on your mind, as do other drugs including alcohol. And, like other drugs including alcohol, at first your brain, and body, are naïve to the effects of the SSRI. They have their impact.

But with time, the body adjusts – the body does not like foreign substances upsetting the balance. So, the brain recalibrates itself back, as close as it can, to normalcy in the face of this foreign, upsetting substance. You get tolerance. Just like with alcohol.

No one ever talks about this phenomenon. It is simply noted, and dismissed with the comment that it was close, but not quite the correct pills. Onto the next bottle of pills. The next trip on the meddy-go-round.

Tragically, the change in the brain as it compensates to the influence of this foreign substance causes withdrawal problems in some people when they go to quit the pills. There is a lot of talk on the web now about the difficulties getting off of SSRIs. Especially Paxil, but others also. This is just evidence that, like alcohol, your brain has adjusted itself to get back to normal in the context of constant foreign substance.

Ask yourself: how much BETTER are you on the meds? Are you where you hoped to be when you sought treatment? Like so many people, are you still having your same problems AND taking meds? Does that make sense? Think about it, and start searching the web. Start reading up on non-pharmacological treatments for what ails ya. Maybe you will be able to finally get off the meddy-go-round. You will catch a lot of difficulty from the physician, but it might just be a good move.

Sure, this short-term response is good for getting someone out of a depression. Often, therapists note how it is great for getting someone into the range of functioning where they can get engaged in decent therapy. And, pills work for some people. But all too often, they simply don’t but somehow you get caught on this meddy-go-round, trip after trip.

Same thing for kids and behavior problems. Well, these pills did not make junior start to complete his homework and start to talk to me in a decent tone. So, let’s try some other pills. Folks, let’s get real. There is no pill that makes a kid talk to you respectfully, stop listening to angst-ridden music, stop stealing your smokes, and start completing homework. No pills will achieve that. Maybe it is time to think about getting off the meddy-go-round.

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