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kottke.org posts about mental health

One woman’s story of self-discovery through psychotropic withdrawl

posted by Chrysanthe Tenentes   Apr 08, 2019

In this week’s New Yorker, Rachel Aviv looks at why it’s so hard to go off psychiatric drugs, and why they may often be overprescribed. She tells the story of Laura Delano, a descendant of Franklin Delano Roosevelt from Greenwich, CT.

Laura received a bipolar diagnosis as a teen and was medicated for several conditions and a cascade of associated symptoms. She assumed her depression was due to a chemical imbalance being corrected by the cocktail of psychotropic drugs used longterm. Her decades-long cycle through different drugs, diagnoses, and symptoms show an under-discussed side of psychopharmacology.

Dorian Deshauer, a psychiatrist and historian at the University of Toronto, has written that the chemical-imbalance theory, popularized in the eighties and nineties, “created the perception that the long term, even life-long use of psychiatric drugs made sense as a logical step.” But psychiatric drugs are brought to market in clinical trials that typically last less than twelve weeks. Few studies follow patients who take the medications for more than a year. Allen Frances, an emeritus professor of psychiatry at Duke, who chaired the task force for the fourth edition of the DSM, in 1994, told me that the field has neglected questions about how to take patients off drugs—a practice known as “de-prescribing.” He said that “de-prescribing requires a great deal more skill, time, commitment, and knowledge of the patient than prescribing does.” He emphasizes what he called a “cruel paradox: there’s a large population on the severe end of the spectrum who really need the medicine” and either don’t have access to treatment or avoid it because it is stigmatized in their community. At the same time, many others are “being overprescribed and then stay on the medications for years.” There are almost no studies on how or when to go off psychiatric medications, a situation that has created what he calls a “national public-health experiment.”

Aviv makes an apt observation about our culture and willingness to confront mental health:

Overprescribing isn’t always due to negligence; it may also be that pills are the only form of help that some people are willing to accept.

But back to Laura. In 2010, after years of cycling through diagnoses (most recently borderline personality disorder), psychiatrists, pharmacologists, and prescriptions, she came across what would turn out to be a life-altering discovery in a bookstore.

On the table of new releases was “Anatomy of an Epidemic,” by Robert Whitaker, whose cover had a drawing of a person’s head labelled with the names of several medications that she’d taken. The book tries to make sense of the fact that, as psychopharmacology has become more sophisticated and accessible, the number of Americans disabled by mental illness has risen. Whitaker argues that psychiatric medications, taken in heavy doses over the course of a lifetime, may be turning some episodic disorders into chronic disabilities. (The book has been praised for presenting a hypothesis of potential importance, and criticized for overstating evidence and adopting a crusading tone.)

Not only did this alter the course of Laura’s treatment, but her life’s work as well. Last year, she helped launched the online resource the Withdrawal Project after years of both informal and formal counseling of others.

But what’s next for our brain health? Some health experts say probiotics and our microbiome should not be ignored.