Anti-psychiatry movement thoughts?

zenman · Apr 30, 2014

I operate with integrity. All meds, psych or otherwise, can be harmful. Psych meds can also “remodel” the brain. Bipolar disorder might take on average, according to some studies, 10 years to diagnose. If someone comes in depressed and they can’t for example, identify having any hypomanic episodes, and you give them an antidepressant that throws them into a manic state, well perhaps you’ve done them a favor by now knowing how to treat them. I’ve had bipolar patients show up for years in a depressed state and that’s what they were treated for by many providers until one day you see them in a manic state. SI sparked by antidepressants usually occurs in teenagers, not adults. I only see adults by the way. This afternoon I saw a 25 yr old patient who still lives at home with parents, anxiety-ridden, and not able to be very functional. He has failed trails of antidepressants and was currently on BuSpar 15 mg daily prescribed by primary care. He’s leery about meds so I just prescribed BuSpar bid instead of once a day due to it’s short half-life. Primary care doc should have known that. Now, if he gets out of his parents house and becomes a more functional citizen how good is that? Those of us in psych have these moments everyday. That’s why I love going to work…plus I get to drive my beautiful Jeep.

PG2018 · May 3, 2014

I'm in the PMHNP program myself, and I believe there's quite a bit of validity to the anti-psych "movement." Read Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker. It's actually a very good book regardless of what one thinks about psychiatry. He references the studies used in his text although we all know anyone can tweak a study to fit their needs.

As zenman said, many psych drugs will ultimately "remodel," to use his word, the neurons -and ultimately the brain- to better accommodate the problem at hand rather than "curing" the problem. We're all aware that psych meds are replete with side effects, yet without side effects, there are no effects. I remember a case study starting out in school that came with an easy diagnosis, pregnant woman with GAD, and when asked what meds I would prescribe her, as others in the class rolled through their mental rolodex, I firmly stood by "nothing." The teachers and students were up in arms thinking I was harming our imaginary patient. Despite what studies say, I'm not at all open to prescribing psychotropics during pregnancy, and if I were to open up shop tomorrow I still wouldn't. Pregnancy is short term, and if it's that much of an issue she may go to therapy which even still there are conflicting reports of the efficacy of counseling on anxiety, lol. What is one to do?

think meds are handed out like M&Ms, and a more conservative approach needs to be followed in their use. Unfortunately, it's so hard to recruit a patient into psychotherapy, and I believe CBT has some terrific merits. They come in sad, hurt, agitated, or what have you and want a pill. They don't like what it does to them, and they demand a different pill. They stay on it, but feel that the side effects warrant a second pill and demand that.

Psychiatry wants to pill down every symptom and beat the psychopathology into the ground. Stephen Stahl advocates this in his books, and I love his books. However, I'm not presently comfortable with the idea of medicating their "disease" into submission. There are so many labels (diagnoses) for mental health disorders with new ones continuing undoubtedly on the horizon. We don't have consensus on what a diagnosis often is. Take schizoaffective disorder. I mean, what the heck is that?! Why isn't it a mood disorder with psychosis or schizophrenia with a comorbid mood disorder?

I'm not so much an outsider looking anymore, but I'm clearly not a psych provider yet. I'm sort of stuck in the window trying to crawl in. Mental health is beyond fascinating to me. I saw a guy the other day that said, "I just feel sad lately." He wanted a pill to feel happy. I asked him how the sadness was interfering with his daily activities, how it was functionally impairing him. His exact reply was, "I get everything done. I just feel sad." Is being sad bad? Is it something that warrants a pill when, for all intents and purposes, life (allowing that he was being truthful) was moving along reasonably well? What about the girl that said she was sad, had trouble concentrating, couldn't sleep at night, was prescribed antidepressants, and now she's on lithium because she became manic when she got off her SSRI? The whole field is, to me, a conundrum.

spaceinthesky · May 3, 2014

I was put on an anti-depressant as a depressed teen with two alcoholic parents and went manic. Then put on depakote, gained 40 pounds in a month and was even more depressed. For 2 years I went through a roller coaster of pharmaceuticals and inpatients. It wasn't until I stopped taking them all against everyone's wishes that I could go to college (I had been in all Honors/AP classes, I was smart just sensitive) and got into yoga, painting and them went on to work within the transformational community facilitating webinars with alternative therapists, shaman and herbalists (Stanislov Grof and Ram Dass were faves).

My younger brother went with heroin to deal. He's lovely, extremely smart and has always read physics and neuroscience for fun, and sensitive.

I was dead set against medications after what in hindsight feels like serving time. But when my brother would stop using, he would enter psychosis from the subconscious mind overwhelming him, as heroin had kept that at bay. Is he schizoid? No. But they want him to be on for life. I believe it can stunt you to never process what it was or get in touch with whatever lesson or thing to change or practice to help that depression or anxiety is pointing to. Transformation comes from a moment of catharsis, which even talk therapy doesn't necessarily do. But my brother could be dead if he didn't use that as a crutch. I'm thankful. It changed my mind. Sometimes we need help, but for some people that help can cause serious problems. And with the long term effects of those drugs I'd argue that help could cause serious problems for all but if it's necessary of course that outweighs.

I should still be on bipolar apparently because it's lifetime but I would never take them again! I am not manic without a stimulant. This has been the best 6 years. :) Even with painful things. That was the worst period of my life and I think our society is crazy, and if you're feeling that, then you're actually normal.

The biggest thing with the craziness is student loans for jobs that don't pay enough. Psych np pays and would let me into the field! I'd use that money to offer complementary yoga classes or something else for all my patients. And to be more honest. Like it sounds like you will be. You could also have adaptogenic herbs or other things to offer in conjunction. Anxiety meds or huffing essences. Or both! I guess it's just easier to take a pill, or cheaper. Who has money for super healthy diet and yoga classes? Usually not a psych patient on a bunch of serious meds, I'd imagine. Don't forget the streets or the struggle when you make it as a PMHNP!

Dont even get me started on ibogaine and ayahuasca for addictions instead of the 90% recidivism rate that is rehab. Dr Debra Marsh did some research off shore with a way better rate w ibogaine. I've seen miracles with the santo Daime church, only allowable bc a Rockefeller got caught w ayahuasca and hired awesome lawyers. When you love someone w addiction you just want them to get better.

I wish all future nps had experience taking some of these medications. They would probably not be so quick to give without a few questions and discussion of possibilities! :) or at least reminding people of ownership of it doesn't work for them. Blessings and thanks for writing back.

I think you'll make a great pmhnp. Kudos for standing your ground with the pregnant woman. The one I went to years ago actually asked me if I ever had trouble sleeping and did I ever see the butterfly commercial? Then whipped out her Lunesta stamp. She was always really happy prescribing more. You won't be that!

Gentleman_nurse, MSN · May 3, 2014

I don't think anyone who works in mental health profession doesn't want to do right by their patient. It's a very dysfunctional system. You're often limited by factors outside your control to make decisions based on 'the lesser of two evils'. An insurance company may give you fixed amount of therapy visits or may only pay medication but not talk therapy. You're forced to discharge a patient whose stability is questionable because several patients are in the ER waiting for bed.

zenman · May 4, 2014

Despite what studies say, I'm not at all open to prescribing psychotropics during pregnancy, and if I were to open up shop tomorrow I still wouldn't. Pregnancy is short term, and if it's that much of an issue she may go to therapy which even still there are conflicting reports of the efficacy of counseling on anxiety, lol. What is one to do?

I take most pregnant women off meds, especially during the first trimester. Problem is that when you say you'd never prescribe meds to a pregnant mother, that is when you'll get one who's psychotic or bipolar. Now, do you do the best you can to try to save two lives or do you risk the mother harming the fetus or cutting "out the little demon inside me" during a manic state?

zenman · May 4, 2014

I wish all future nps had experience taking some of these medications. They would probably not be so quick to give without a few questions and discussion of possibilities! or at least reminding people of ownership of it doesn't work for them. Blessings and thanks for writing back.

Problem with this is that everyone is different. Prozac may have side effects for one person and completely change another’s life for the better. That’s why I don’t take all the meds I prescribe. I have participated in Ayuhuasca ceremonies in the Amazon with Shipibo shamans and trained with Q'ero indians. I don't like yoga as many don't know how to teach it and as a result had a lot of yoga practitioners with hip and back problems when I was doing Zen Shiatsu. I teach medical qigong to Soldiers with chronic pain and even have to adapt that for some. I've seen people wind up in ICU from both acupuncture and "natural herbs." It certainly makes for an interesting time.

spaceinthesky · May 4, 2014

That's beautiful you teach to soldiers. I would like to work with that population.

I do agree it can help some people and love that. I guess for me it's more with kids in traumatic environments where the fear or depression makes sense... last year one of the nicest, smartest girls I was teaching went from depressed to episode of self harm after going on an antidepressant. After that she was in and out of school... I still wonder how she's doing.

I've participated in ceremonies too, originally seeking it out for my brother. Would love to in the rainforest. Maybe one day. I did yoga teacher training with a former chiropractor :) totally agree on that. Have heard wonderful things about qi gong but never tried.

spaceinthesky · May 4, 2014

Thank you for answering. It's good to hear about the people whose lives it's changed for the better. Id like to hear more about those! But I guess most of those people are on them and not "out" about it.

PG2018 · May 4, 2014

I guess I need a waiver that says I don't see preggnant patients.

PG2018 · May 4, 2014

I guess I need a waiver that says I don't see pregnant patients.

PG2018 · May 4, 2014

Pregnant*