“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.
The suicide of comedian Robin Williams this week has left us reeling. Whenever someone so successful takes his own life, we’re reminded that mental illness doesn’t discriminate. Even celebrities aren’t immune to its ravages. In fact, being rich and famous may even heighten a sense of despair for someone who seems to have it all.
On TV, in the newspapers, and online, commentators, journalists, and the general public are speculating about what led to Williams’ final expression of hopelessness. Almost certainly, they are wrong. Even those of us in the mental health profession can’t always say what pushes a person over the edge. And we definitely can’t draw any conclusions about the inner torment of someone we know only from his public persona.
Even so, ignorance hasn’t stopped many from weighing in with their opinions, as a Facebook post I saw this morning highlighted. It said,”Pharmaceutical companies are evil.”
I don’t even know where to begin. Is the poster suggesting Williams was taking psychotropic meds, which led to his death? Is she alluding to the Black Box warnings on some antidepressants about the potential side-effect of increased suicidal ideation (usually among teens and young adults)? The only thing we know for sure is that whatever treatment Williams was receiving, it failed.
I doubt similar accusations would be lobbed at Big Pharma if someone with uncontrolled hypertension were to die of a heart attack.
Misconceptions about medications used to treat depression unfortunately keep many people who could benefit from psychopharmacology from taking full advantage of the range of options available to them. I don’t know if Robin Williams was on antidepressants. But he was in and out of therapeutic programs over the years, both for depression and for alcohol and drug abuse. He suffered from a mental illness, and it ultimately killed him.
Let’s stop all the commentary by self-proclaimed experts and simply mourn the loss of a beloved entertainer who brought happiness to millions but couldn’t find it for himself.
I know everyone’s been giving you a hard time lately for saying in your recent E! interview that 9-5 moms have it easier than you movie stars because “when you have an office job . . .it’s routine and, you know, you can do all the stuff in the morning and then you come home in the evening.” You think your life is so much harder because “when you’re shooting a movie, they’re like, ‘We need you to go to Wisconsin for two weeks,’ and then you work 14 hours a day and that part of it is very difficult. I think to have a regular job and be a mom is not as, of course there are challenges, but it’s not like being on set.”
Like working mom Mackenzie Dawson, who skewered you in her NY Post “Open Letter to Gwyneth,” I found your comments utterly out of touch with life outside the rarified bubble of Planet Hollywood. You might as well have said, “Like, let them eat cake.”
But after I picked up my jaw off the floor, I switched to professional mode and tried to see things from your perspective. And I realized you’ve taught us all a very important lesson.
When you’re unhappy, it’s easy to imagine how much better your life would be if only you were [fill in the blank] . . . single, married, younger, older, thinner, prettier, richer, or—hard as it might be for most of us to believe—poorer and more ordinary. Your fantasy of what life as an office worker would be like should remind us that when we think the grass would be greener, we haven’t got a clue.
I can’t, of course, surmise your mental condition just by reading the statement you made on your website Goop about your split with husband Chris Martin. But no matter how you try to spin it—by calling it “conscious uncoupling” instead of divorce, say—ending a 10-year marriage and working out the logistics of coparenting when you have young kids can’t be easy, even for a celebrity.
So, Gwyneth, here’s my unsolicited advice to you: find yourself a good cognitive-behavioral therapist to help you challenge your distorted thinking. And, while you’re at it, you might consider hiring a new publicist.
Lynne S. Gots, PhD
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.