“Many People Taking Antidepressants Discover They Cannot Quit”
Does this headline concern you? If you read the accompanying article in the New York Times and you’re on medication for anxiety or depression, you might feel alarmed. And if you’ve decided to start a medication regimen, you might even change your mind.
The article reflects a bias many people still harbor towards mental health issues and medication: you should be able to deal with your problems by force of will; if you can’t just get on with it, you’re weak. As the Times article suggests, “Daily pill-popping leaves them doubting their own resilience…” Pill-popping? Seriously?
No medication is completely benign. Yet few would question taking drugs commonly prescribed for high blood pressure, seizures, muscle cramps, and infections, many of which can have discontinuation side effects. Clearly, a double standard applies to the pharmacological treatment of psychiatric conditions..
The writer acknowledges that “many, perhaps most, people stop the medications without significant trouble,” but then goes on to relate the personal anecdotes of a handful of individuals who attributed “all the symptoms of withdrawal,” including increased anxiety and insomnia, to medication discontinuation. He neglects to point out one of the most common reasons for deciding to go back on medications for anxiety and depression after trying to come off them: a resurgence of the symptoms being treated.
It’s true, as the article points out, that primary care physicians write the vast majority of prescriptions for antidepressant and antianxiety medications. Follow-up is not as rigorous as it should be, and office visits are typically too short for an adequate assessment of mood changes and side effects. But it’s very misleading to assume, as the writer does, that “a useless [my emphasis] prescription may be continued for years—or a lifetime” because “improvement…is based on the passage of time or placebo effect.”
I’m not in the pocket of Big Pharma. I can’t prescribe medication. I don’t get a kickback from my psychiatrist colleagues for referring patients to them. When someone in my practice expresses a preference for trying cognitive-behavioral therapy without medication, I’m more than happy to oblige—with the understanding that we’ll revisit the decision at a later date if the therapy yields less-than-optimal results.
I believe in helping people find the maximally effective treatment for them. If that means recommending a trial of medication, I’ll suggest a referral to a psychiatrist who can address their concerns fully, monitor them regularly, and work with me to provide the best care.
Medication isn’t a magic bullet. But it can be a powerful tool. Making any health care decision should involve weighing the costs and benefits–with the help of professional guidance and not anecdotal horror stories–to determine the course of treatment.
I’ve been meditating daily for over three years, half of that time with the popular app, Headspace. But recently,thrown off by jet lag following a trip to the West Coast, I unaccountably forgot to meditate one day and broke my streak.
I was upset by my lapse and tried, as any good CBT practitioner would, to challenge my all-or-nothing thinking. One day out of over a thousand is no big deal. Less than a drop in the bucket. It didn’t negate my progress.
But Headspace didn’t see it that way. It reset my stats back to Day 1. Even more aggravating, it started sending me motivational messages like: “A 3-day run streak is a great start to your practice! Next stop 5!” And, after 5 days: “Nice job. This is precisely how you build a solid meditation practice. Think you can make it 10?” At 10 days, they told me: “Your consistency is outstanding. You’re starting to build a lasting, healthy habit.” And today, 15 days into my new streak, I got: “Great work. Maybe everything changes except your commitment to meditation.”
I decided I needed to say something. Here’s an excerpt from the email I wrote to Headspace:
I had over 450 consecutive days of Headspace under my belt until a few weeks ago, when travel to the West Coast threw me off schedule and I somehow forgot to meditate one day. I was upset to have broken my “streak,” but I tried to practice what I preach to the many perfectionists I work with by forgiving myself for the brief, and ultimately insignificant, lapse.
But Headspace is making it harder for me to let go of my mistake! It reset my progress back to zero and is giving me motivational messages after three, five, ten, fifteen days of consecutive practice to tell me I’m on my way to a solid practice and a commitment to meditation. I suppose I could use those statements as a mindfulness exercise, treating them as if they were just random thoughts of my own creation, but coming from the “experts,” they are not at all helpful.
I have continued to use the app but now am having second thoughts. I’m not sure whether such a quantitative, competitive (albeit only with myself) approach is really how I want to frame my meditation practice. And I certainly will be less enthusiastic in recommending it to my perfectionistic patients.
You might want to pass this feedback onto your software engineers to see if there could be a way turning off the streak function, or sending out messages of self-compassion to those who’ve accrued a lot of hours but miss a day here and there.
I’ll let you know what they say.
OCD is like an opportunistic pathogen, invading hosts with weakened immune systems. So it’s not surprising to see it thrive and spread when daily news reports stoke uncertainty and fear in those who are vulnerable.
The recent spate of revelations about sexual misconduct among the rich and famous, along with controversial reports in the last few years of a campus rape crisis, have brought a new demographic into my practice: young men in their twenties who worry about committing or having committed a sexual transgression.
Some of these men have been accused—and all exonerated—of inappropriate touching, nonconsensual or consensual but inappropriate sex with colleagues, students, or classmates; others live in fear of having a casual sexual encounter from their past surface and become fodder for an accusation.
OCD is having a field day.
As reporter Emily Yoffe chillingly details in a series of articles in The Atlantic , Obama-era federal directives governing the handling of sexual-assault allegations have prompted universities to craft vague and overarching definitions of sexual assault designed to protect the (mostly) female victims while stripping the accused of their right to due process. The Kafkaesque scenarios Yoffe describes—such as a third party accusation in which a friend reported her roommate’s boyfriend as an abuser and the alleged victim, refuting the claim, was told she was in denial– create the perfect medium for OCD to flourish.
Let me be perfectly clear. I am in no way minimizing the trauma experienced by assault victims. I believe charges of rape on college campuses should be taken very seriously. They should be investigated thoroughly and, if the evidence points to a crime, prosecuted in a court of law. And I am not excusing the predatory behavior of the Harvey Weinsteins who have abused their power to intimidate and sexually exploit women.
But the men with OCD I see in my practice are not predators or rapists. In fact, most share two thinking patterns common in people with OCD: an excessive sense of responsibility and a highly developed sense of morality. They worry about causing harm and about being bad people even though, in the paradoxical way of OCD, they’re actually good people with a strong—perhaps even excessively rigid—moral compass.
So, no, I don’t secretly question if they might have done what they’ve been accused of or fear being accused of, just as I know with a reasonable degree of certainty that the people with OCD who confess to me their fears of being pedophiles are not a danger to children.
As with all OCD worries, however, facts and probability do little to assuage anxiety. So the challenge is to acknowledge the possibility of a dreaded occurrence—such as a false accusation–while not letting fear get in the way of living.
While it’s hard to push back, I can recommend a few guidelines to follow if you’re consumed by worries of being unjustly accused of sexual assault.
Shakespeare said, “Misery acquaints a man with strange bedfellows.” Resist the temptation to lie down with OCD.
This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.