You’ve probably heard that anxiety and depression are “brain disorders” that must be treated with psychotropic medication. That’s closer to a pharmacological marketing slogan than settled science. These conditions, along with ADHD and addiction, result from trauma, loss, psychosocial stressors and failed relationships. Even when there is a genetic proclivity to severe mental illness, such as bipolar disorder and schizophrenia, the environment plays a central part in triggering the disease.

Roland Kuhn, the Swiss psychiatrist who discovered one of the first antidepressants, imipramine, in 1956, later warned that many doctors would be incapable of using antidepressants properly “because they largely or entirely neglect the patient’s own experiences.” He was right. As a psychoanalyst, I often see patients who come to me after medication prescribed by psychiatrists—and even internists, who have no specialization in psychotropic drugs—has failed.

Doctors prescribe these medications as a quick fix. But the pills merely mask the patient’s emotional pain. Some medications come with serious side effects and are extremely difficult to quit. In 2020 the Food and Drug Administration issued a warning about a class of drug frequently prescribed for anxiety: “The current prescribing information for benzodiazepines does not provide adequate warnings about the serious risks and harms. . . . Physical dependence can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed.”

Medication can be a godsend in the right context. But it is risky and should be offered only after nonmedical options, such as psychoanalysis, have been exhausted. Why is therapy instead often a last resort for patients? In part because it is uncomfortable. Some patients temporarily become more symptomatic when they expose themselves to the origins of their pain. This temporary pain is necessary for long-term relief, but it’s easier to numb with pills.



Therapy is also expensive. Even if a patient does get a referral to a therapist, it will likely be a cognitive behavioral therapist who focuses on symptom relief rather than the underlying causes. The rise in CBT therapy came out of insurance companies’ demand for a short-term solution to the expensive problem of treating mental health. CBT has an important role to play in treating some obsessive disorders and post-traumatic stress disorder, and with patients who are extremely nonverbal and lack the capacity for deep introspection. But it’s being used as a go-to therapy for anxiety and depression, moving patients further from the root causes of the illness.

I was required to undergo therapeutic treatment as part of my training as a psychoanalyst. This is a critical part of training, so that practitioners don’t risk exposing patients to their own psychological conflicts. But medical schools don’t require it of psychiatrists, and many short-term therapy clinicians have never been in any kind of substantial mental-health treatment.

There are no shortcuts to treating mental illness. Insurance companies should be pressured into covering treatments that work. Patients have to be consumers and say no to medication as a first course of treatment unless their symptoms are severe. Doctors must acknowledge that medication can be risky and have severe iatrogenic effects. Medication should only be used for serious clinical conditions, or only after everything else has been tried and failed.

Ms. Komisar is a New York psychoanalyst and author of “Chicken Little the Sky Isn’t Falling: Raising Resilient Adolescents in the New Age of Anxiety.”

LINK: https://www.wsj.com/articles/m..._opin_pos_3#cxrecs_s

I hear women talk about it at work all the time so I had my wife ask her doctor what % of women are on some type of mood altering drug. She said 90% which is shocking to me and quite sad actually.

I know a couple of women who have been on the various drugs for 20, 30 years and more.

They're definitely addicts and take large amounts of painkillers on a daily basis.

One of them even told me how to convert a time release painkiller to a full on instant release for a better high.

I think a lot of women just want to get a free ride through life and be high most of the time, but that's just based on a lifetime of my obserations.

I also think that a lot of them were raised to believe that they were special and princesses and they came to believe that. Then when they went out in the real world, they discovered that they were special...just like everybody else. I think it crushed them mentally.

Bring a medical practitioner for over 30 years now one of the biggest problems in medicine ( started I think about 20 years ago) worsening every day, is the effort to essentially replace human contact and interaction with pharmacology and technology. I easily spend more time in front of a computer than I do in front of patients and much of that is dictated by organizations insurers and governmental mandates.
Sadly as a medical professional it has come down to a choice spend face to face time with patients actually caring for them or in front of a computer completing all the (for the most part nonsensical ) tasks required to make sure insurance companies pay for the things you want for patients, your organization gets paid for rendering services and you ensure you have sufficient documentation to “ cover you” in event of a lawsuit.
The idea of spending more actual time with patients as a way of addressing their problems is passively or actively discouraged.

Nurses I think have been especially hard hit by this. All the good basic nursing care they provided decades ago that actually benefitted patient outcomes like bed sore prevention, mobilization after surgery to prevent DVT ( blood clots) has been replaced with them sitting in front of computers checking boxes to more positively impact health system’s financials.

Pun intended- spending actual time with patients solving problems and managing illness what crazy talk

Watch FOX for an hour during prime time and count the number of pharma ads. There's a drug for everything today, and given how weak society as a whole has become, there's a growing patient base with hands outstretched for whatever drugs big pharma develops. The entire country is becoming a society of addicts.

Of the women I have dated, I would learn that many of them were on some sort of mental health meds. Mostly Anti-Depressants. Their doctors prescribed them like candy. Fun Fact for you boys who may not know this: Anti Depressants often interfere with female sexual response. So if you cant make your lady happy in the sack, it may not be you. Its the drugs.
I believe that our society needs way more long term, inpatient care facilities that can treat the seriously mentally ill. As a cop, I thought the short term "mental health holds" were a joke that just kicked sick people back out on the street with no real treatment. I feel a mental health hold should be for 30 days, with the hope of determining an effective intervention. And give our courts the power to order these holds, with a real review of the patient at the end of the 30 days.

quote:

Originally posted by YooperSigs:
Of the women I have dated, I would learn that many of them were on some sort of mental health meds. Mostly Anti-Depressants. Their doctors prescribed them like candy. Fun Fact for you boys who may not know this: Anti Depressants often interfere with female sexual response. So if you cant make your lady happy in the sack, it may not be you. Its the drugs.

Not just women. They often have similar side effects on men.

I had an ex-coworker who got put on anti-depressants because another coworker who was a close friend to him killed himself. He was so close that he and his daughter inherited a whole lot from the guy's will.

We met up years later and he told me he was on it for at least a couple of years but decided to stop. He felt like he was just a walking dead.

When I was depressed, I didn't want to see someone who would only prescribe me pills as I knew there was a reason I was depressed. If there is an actual external stimulus giving you pain, it's a bad strategy to just numb yourself to the pain. You need to do something about the external stimulus.

^^^ ALL SSRI's impede sexual function in both men and women, although it's more obvious in men.

Only Bupropion (Wellbutrin) and the very good but unjustly disregarded Nefazadone (Serzone), both of which are not SSRI's, don't generally have this issue.

SSRI's also cause weight gain. Mirtzapine (Remeron) which is like a shotgun to the neurotransmitters can cause a LOT of weight gain.

So we have women who feel depressed, getting medications that cause weight gain, which makes them feel worse about themselves, causing more depression, along with sexual dysfunction, on top of becoming increasingly unattractive to, and rejecting of, their husbands and boyfriends, which makes them feel more depressed...

Why are women depressed? That's a red pill thing.

But the short story is that women got sold a bill of goods that they would feel more life satisfaction from having careers instead of dedicating themselves to having families. And then they realized, work sucks and men do difficult, stressful, and painful jobs because they get paid for it. The things a man will endure to get paid a decent wage are legion. It ain't about job satisfaction or fulfilling your dreams - it's about getting paid and paying the bills and supporting your family.

THAT SAID:

My personal experience is that the right meds work and are essential when you need them. If you've never been down in the hole you can't climb out of, then you have no idea what it's like, therapists included. Never trivialize things you haven't experienced, and pray you never get down there, because it IS a living hell.

To make it worse, with managed care it's damn hard to find the right meds when you need them. You can and will likely go through hell to find out, and I did a long time ago. There is something in my family, a mix of things, part organic, part environmental, part Irish alcoholism, but it's taken three of mine at their own hand already, and recently a cousin lost touch with reality into schizophrenia and killed someone. He turned himself in to the police immediately, but he is still hearing the voices in his head. My aunt (his mom) is doing her best to help him.

Along the way I've saved a life or two, maybe three.

I had a really good doc for 20 years. He retired recently so I am in limbo until I get another. But he was the best and knew exactly what I needed when I needed it, and listened to me and let me guide my own treatment. "Only you know you as well as you do". And he was an M1 service rifle rifle competitor so he was cool. He was honest - SSRI's do not treat anxiety. The only thing that really works for anxiety are benzodiazepines, but they are addictive and you have to be disciplined when you use them. And yes, a lot of people abuse them, taking them whenever the "feel" they need them, rather than per prescribed schedule. They really work, and the right med and dose does "takes the edge off" in a very subtle way, without major side effects.

THE REALITY:

Talk therapy and Freudian method are great. In the movies, there is always a breakthrough where the patient finally understands the root of their problem and faces reality with the therapist. Then they get better with this new understanding.

Real life doesn't work that way. Knowing all the reasons exactly why, when, and how you are fucked in head, DOES NOT unfuck you in the head! It's great to know root causes, I know many of mine, but it doesn't fix anything. Changing long standing behaviors and manners of thinking takes effort, and that's where DBT and other methods are useful.

Getting medicated for depression is one of the most impactful things I’ve ever done in my life. It isn’t all snake oil and lazy doctors. There are certainly side effects, but my life is immeasurably improved by the head meds I take. No amount of exercise, therapy, human contact, or any other methods made a lick of difference, but when I eventually found the right medication for me, it saved my marriage and probably my life. You have to do what works for you, and for me the medication works. If it doesn’t help you, then no reason to take it, but that doesn’t mean it won’t help anyone.

- Bret

I was on therapy for years before MDs started trying drugs on me. I am VERY glad they did; from a completely disfunctional young man, I turned into a healthy adult.

Side effects? Dangers? Yes: they do exist, and should be taken seriously. But cases like mine are paradigmatic in the sense that, some times, only meds will do the job.

I believe the OP's point was not that such medications are always bad, but that they should never be a first resort.

quote:

Originally posted by ensigmatic:
I believe the OP's point was not that such medications are always bad, but that they should never be a first resort.

Never is big word.

The author is a psychoanalyst. She's resurrecting a debate that played out on the pages of psychiatric journals decades ago. What ultimately won that debate was the quickest results for the most people. Quickest, not longest lasting. The referees were (are) insurance companies. There is much to say about how we develop our knowledge base, what training looks like these days, and the changing roles of various players in mental health. To malign all psychotropic medications is not productive.

Daniel
Practicing psychiatrist

A complete and careful assessment should ALWAYS be the first step. This is not a fifteen minute assessment by an internist but a several session visit with a trained mental health professional. Psychotherpy and Psychoanalysis are two different things. Psychotropic drugs alone cannot fix complex psychological issues or trauma. Insurance companies like drugs because they are cheap. Older psychiatrists are trained in psychotherapy, most younger ones are not. All of our mental health problems are not due to some chemical imbalance.

Jesus, I must be one of the 10% of women not on any prescribed medications..
I do think it’s a bit strange how this twisted to women so quickly, and in what seems to be a negative way, esp since OP was general in his terms of who takes these meds.

Back to his point, I have had a (male) doc attempt to prescribe an SSRI to me when I went in for a physical and commented on SAD that seems to hit me in the latter stages of winter. ?? Knock me over with a feather. I was surprised, and to be frank, haven’t returned to that practitioner. So, yes, without any real consultation or further delving, he was quick to pull out the rx pad, instead of referring me on. YMMV.

quote:

Originally posted by ZSMICHAEL:
A complete and careful assessment should ALWAYS be the first step. This is not a fifteen minute assessment by an internist but a several session visit with a trained mental health professional.

Which is funny, because last year, I got referred to a psychiatrist when I told my doctor I was depressed. She understood the context (being diagnosed with a terminal condition), but given that I told her over Mychart and it was in writing, protocol dictated that she had to refer me anyway, lest lead mouthwash and liability, right?

I had a half hour Zoom appointment with a psychiatrist. I spent a few minutes talking about what was going on, and how it was affecting me. He asked me some questions, and then asked that my wife come into my office, whereupon he asked her questions for several minutes. When she left, he spent ten minutes telling me about lithium, and why he was going to prescribe it versus other, more modern medications. We ended the appointment early. We talked for twenty five minutes. At least ten of that was him telling me about litium. He diagnosed me as cyclothymic in fifteen minutes, and put me on mood stabilizers for it.

I did the lithium for a month, and we had a follow-up to see how I was tolerating the medication. It was also not a full half hour, and he mostly asked questions, then spent a good chunk of it explaining how he prescribes lots of people lithium, and they all get better for taking it. He said we'd give it another month, and if I had kept doing alright on it, we'd up my dose to about ten times what he had me on. I did that month, then I stopped taking the shit, and skipped the next appointment. When I asked my doctor about referring me to someone else for a second opinion, she said she could do that, but I needed to be aware that whoever she referred me to, my current psychiatrist would have to clear it with them and talk my case over. So, I'm not seeing anyone until I move.

I got zero value out of our short sessions. I took a mood stabilizer for a little over two months and saw and felt no change. In doing my own research, he diagnosed me with one of the rarer mood disorders that professors of psychology were saying took months worth of sessions to diagnose, and he did it in fifteen minutes. Trained mental health professionals can throw pills at you, too.

Since that time, I've spoken with, and listened to a lot of people who've gone through the shock of being told they're dying. I've put a lot of work into a program that works on my soul, and how I relate to the world and all living things in it. I'm ok with dying now. I'm not as depressed as I was. The mild mania I've dealt with in the past, I suspect is more part of my alcoholism than anything specifically in the DSM V. All-in-all, I'm feeling pretty good about life, and more balanced than I've ever been, and I didn't need to put any substance in my body to get here.

Put me in the camp that believes the pharma CO’s won’t be content until every one of us is on prescription meds.

quote:

Originally posted by sourdough44:
Put me in the camp that believes the pharma CO’s won’t be content until every one of us is on prescription meds.

And to accomplish that end, they have been caught handing out kickback payments quite often. That's the elephant in the room being ignored, Pharm is buying the Rx's by funding incentive payments.

Not to forget they provide the funds for the studies which generally agree with the stated intents they create for the drugs.

So, we have Pharm writing their own research to back their own approvals, their Execs rotating thru the .Gov agencies as the sign off for distribution, and their money going back to those who write the Rx's.

If this was insurance or stock there would be convictions and jail time, but for Pharma there is only profit. And not least of this is the concept that if they cured you, that would end their stream of payments treating your symptoms but not fixing it.

The game is rigged.

Medicare does publish how much money psychiatrists receive from Big Pharma. Some receive a tidy some, others none at all. Many physicians will no longer see the Pharma reps.

quote:

Originally posted by sourdough44:
Put me in the camp that believes the pharma CO’s won’t be content until every one of us is on prescription meds.

They better not hold their breath. I don't take prescription drugs except for extreme pain. I haven't taken one in probably 15 or 20 years.