Mental Illness Deniers Are as Dangerous as Climate Change Deniers

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Back in the mid-80’s, I was one of a few, fortunate psychiatrists in Massachusetts in charge of administering the just-released atypical antipsychotic medication clozapine. In our clinic, its use was still limited to a small number of carefully-selected patients with schizophrenia who had not responded to any of the conventional antipsychotic agents.

Harry was one of my first clozapine patients. He had been an inpatient for much of his adult life, and was widely thought to be a “lost cause.” For many years, Harry had been tormented by threatening “voices” urging him to harm either himself or others. He had become a shrunken wreck of a man, pacing the halls with a haunted look on his face, and confined to the inpatient unit with little hope of a normal life.

Clozapine changed all that for Harry. After a few months of treatment, the voices quieted down, and we were able to discharge Harry from the hospital and arrange for placement in a neighborhood residence. As I described in an earlier essay, Harry actually went on to earn his driver’s license.1

But, in the world of mental illness deniers, I was the deluded one. There is no such thing as schizophrenia, these critics claim. Mental illness itself is a “myth”, as famously (or infamously) argued by the late psychiatrist, Thomas Szasz. (Disclosure: Dr. Szasz was one of my teachers during residency). At most, the deniers claim, what psychiatrists call “mental illness” is nothing more than a socially-constructed label, or a misguided metaphor. According to mental illness deniers, the term “schizophrenia” does not identify a “real disease”, like cancer or coronary artery disease; rather, it is a term grounded in a mistaken theory of disease, based on an agenda of social control and coercion. Szasz argued, to his dying day, that only bodily disease is “real”. For him, a “diseased mind” was a contradiction in terms. Szasz argued that classifying thoughts, feelings, and behaviors as diseases was a category mistake, like classifying the whale as a fish.2

Szasz was a genial man, and a brilliant polemicist who still has many admirers among antipsychiatry groups and bloggers. But Szasz was flat out wrong regarding what should count as “disease.”3 When someone is suffering and incapacitated by a condition that destroys the ability to separate delusion from reality, that is real disease. When this person winds up lying dirty and disheveled in an alley way, hearing the Devil’s voice saying, “You don’t deserve to live,” that is real disease. When someone’s thoughts are tangled up in knots; when their emotions are blunted; when they think constantly of suicide, this is not the result of a metaphor or a myth. This is the reality of serious psychiatric illness, like schizophrenia.

To be sure, not all critics of psychiatry are “antipsychiatry.” Some are prominent psychiatrists themselves who rightly point to specific problems within the profession, such as over-prescription of some medications in certain settings, or the use of imprecise diagnostic criteria. In contrast, dyed-in-the wool antipsychiatry groups dismiss psychiatry as a fraud. They write off psychiatric diagnosis as nothing more than pathologizing “disapproved of behaviors” or “problems in living.” (Try telling that to someone like Harry, or to his anxious and beleaguered family). In a sense, mental illness deniers represent the flip-side of mental illness alarmists — people who, for example, see mass shootings, gun violence, and other violent acts as the product of mental illness, despite the fact that when psychiatric illness is adequately treated, it is very rarely associated with violence. Left untreated, however, serious psychiatric illness can increase the risk of violence; and, unfortunately, many people with untreated psychiatric illness wind up in the largest “mental health system” in the U.S. — our jails and prisons.

Both the deniers and the alarmists misconstrue the nature of psychiatric illness, and both do harm to people like Harry. The mental illness deniers erect barriers to the effective treatment of serious diseases like schizophrenia and bipolar disorder, and make it harder to persuade Congress to provide adequate funding for psychiatric research — after all, why should we fund research on a “myth”? The mental illness alarmists fuel social prejudice and job discrimination against those, like Harry, who suffer from severe psychiatric impairments. In my view, the mental illness deniers pose as much risk to the health of this country as climate change deniers.

To be sure, some people who post angry comments on antipsychiatry websites have had bad experiences with their own psychiatric care. Whether their accounts are entirely accurate or not, these people are understandably aggrieved by perceived mistreatment. Having worked in a variety of psychiatric settings over several decades — hospitals, nursing homes, outpatient clinics, and private practice — I have seen both excellent and poor psychiatric care, and everything in between. Certainly, there are legitimate reasons to confront psychiatry on its shortcomings. But this is a far cry from the outright denial of the reality of mental illness, and the blanket condemnation of psychiatry as a medical specialty. Like climate change deniers, mental illness deniers are doing a grave disservice to the health and wellbeing of their fellow citizens.

I have seen hundreds of people like Harry, suffering with psychiatric diseases as real as lung cancer or heart disease. And, with proper care and treatment, I have seen many of them recover their sanity, their lives, and their dignity.

Acknowledgment: Thanks to Dr. John Grohol for commenting on an earlier draft of this essay

For further Reading:

Insane Consequences: How the Mental Health Industry Fails the Mentally Ill by DJ Jaffe (Author), E. Fuller Torrey MD (Foreword)

Mental Illness Deniers Are as Dangerous as Climate Change Deniers

Footnotes:

  1. Pies, R. (2009, May 4). A Guy, a Car: Beyond Schizophrenia. The New York Times. Retrieved from: https://www.nytimes.com/2009/05/05/health/05case.html []
  2. Szasz, T.S. (1998). “Thomas Szasz’s Summary Statement and Manifesto.” Retrieved from: https://selfdefinition.org/psychology/articles/thomas-szasz-summary-statement-and-manifesto.htm []
  3. Earley, P. (2018). Psychology Today Article Debunks Claims By Antipsychiatrists: “Easily refuted by scientific evidence.” Retrieved from http://www.peteearley.com/2018/09/07/psychology-today-article-debunks-claims-by-antipsychiatrists-easily-refuted-by-scientific-evidence/ []

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Medications That Can Cause Depression

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There is nothing more frustrating than when the cure is part of the problem. Because depression is prevalent in patients with physical disorders like cancer, stroke, and heart disease, medications often interact with each other, complicating treatment. To appropriately manage depression, you and your physician need to evaluate all medications involved and make sure they aren’t cancelling each other out.

A review in the journal Dialogues in Clinical Neuroscience a while back highlighted certain medications that can cause depression. The following are medications to watch out for.

Medications to Treat Seizures and Parkinson’s Disease

Many anticonvulsants have been linked with depression, but three medications — barbiturates, vigabatrin, and topiramate — are especially guilty. Because they work on the GABA neurotransmitter system, they tend to produce fatigue, sedation, and depressed moods. Other anticonvulsants, including tiagabine, zonisamide, levetiracetam, and felbamate have been associated in placebo-controlled trials with depressive symptoms in patients. Patients at high risk for depression should be monitored closely when prescribed barbiturates, vigabatrin, or topiramate. When treating Parkinson’s disease, caution should be taken when using levodopa or amantadine, as they may increase depressive symptoms.

Medications to Treat Migraines

In migraine patients at risk for depression, topiramate and flunarizine should be avoided when possible. A better option is acute treatment with serotonin agonists and prophylactic treatment with TCAs, as those medications could simultaneously address symptoms of both depression and migraine headaches.

Certain headache medications like Excedrin that list caffeine as an ingredient can also worsen anxiety.

Heart Medications

The link between blood pressure medications and depression has been well established. By affecting the central nervous system, methyldopa, clonidine, and reserpine may aggravate or even cause depression. Beta-blockers like atenolol and propranolol may also have depression side effects.

Although low cholesterol has been associated with depression and suicide, there is no clear link between depression and lipid-lowering agents.

Antibiotic and Cold Medications

Although most antibiotics used to treat infections are unlikely to cause depression, there have been some cases in which they induce symptoms. Anti-infective agents, such as cycloserine, ethionamide, metronidazole, and quinolones, have been linked to depression.

Over-the-counter cold medications like Sudafed that contain the decongestant pseudo-ephedrine can contribute to anxiety.

Antidepressants and Anti-Anxiety Medication

Sometimes medications to treat depression and anxiety can have a reverse effect, especially in the first few weeks of treatment. There have been reports of Lexapro, for example, worsening anxiety, however it usually subsides after the first few weeks. Anecdotal evidence suggests that Wellbutrin may also cause anxiety.

Cancer Medications

Approximately 10 to 25 percent of cancer patients develop significant depressive symptoms, however, given that so many medications are involved in treating cancer, it can been difficult to pinpoint the culprits. Vinca alkaloids (vincristine and vinblastine) inhibit the release of dopamine-ß-hyroxylase, and have been linked to irritability and depression. The cancer drugs procarbazine, cycloserine, and tamoxifen are also considered to induce depression.

One report cited depression in 16 percent of carmustine-treated patients, and 23 percent in those receiving busulfan when employed as part of the treatment for stem cell transplants. The antimetabolites pemetrexed and fludarabine have been reported to cause mood disturbances. Some hormonal agents to treat breast cancer have also been associated with depression, including tamoxifen and anastrozole. Finally, taxane drugs such as paclitaxel and docetaxel have been linked to depression.

Oral Contraceptives and Infertility Medications

Oral contraceptive medications have long been associated with depression. In a study published in the British Medical Journal, of the group of women taking oral contraceptives, 6.6 percent were more severely depressed than the control group. GnRH agonists (such as leuprolide and goserelin) can have depression side-effects in some people. In one study, 22 percent of leuprolide-treated patients and 54 percent of goserelin-treated patients suffered from significant depressive symptoms. Clomiphene citrate, a selective estrogen receptor modulator used to induce ovulation, has also been associated with depressed mood.

Medications That Can Cause Depression

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Should Mental Health Determine Pain Treatment Options?

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Patients with a mental health condition might have a hard time accessing opioids for pain relief, while patients with unexplained pain are often referred to psychiatric care, which does little to alleviate their symptoms. Finding treatment can be frustrating and humiliating.

Four years ago, Dez Nelson’s pain management clinic demanded that she complete a visit with a psychologist. Nelson was surprised, since she had no history of mental illness, but she didn’t feel that she could push back on the request.

“Of course I said okay — I didn’t want to lose my treatment,” Nelson told The Fix. “I was not happy about it, but I did it.”

Nelson, 38, went to the appointment and had a mixed experience with the psychologist. She hasn’t been back since and the pain clinic hasn’t asked her to visit a psychologist again. Still, Nelson said that the experience highlighted — yet again — the discrimination pain patients face.

“It was a condition of my continued care,” she said. “It seemed like they’re bringing it up in a beneficial light, as part of a multi-pronged approach to pain care. But I don’t think [mental health treatment] should be forced on a patient who doesn’t think they need it.”

Chronic pain and mental illness are among the most stigmatized conditions in modern medicine. The conditions frequently intersect and change the way that patients are cared for and treated. Patients who have a mental illness might have a hard time accessing opioids for pain relief, while patients with unexplained pain are often referred to psychiatric care, which does little to alleviate their physical symptoms. At the same time, research suggests there is a strong connection between mental health and pain: depression can cause painful physical symptoms, while living with chronic pain can cause people to become depressed.

All of this makes treating chronic pain and mental illness complex and frustrating for doctors and patients alike.

A Mental Health Diagnosis Affects the Way Your Doctor Treats You

Elizabeth* is a professor in her mid-thirties who had undiagnosed Lyme disease for eight years. Her Lyme contributed to the development of an autoimmune disease that has led to widespread inflammatory and nerve pain throughout her body. Elizabeth also has bipolar disorder. Despite the fact that she has been stable on medication for a decade, her mental health diagnosis complicates her pain treatment.

“Doctors’ demeanor changes when I tell them my medications. When I say I have bipolar disorder, it’s a whole different ballpark. To them that’s clearly a risk factor and red flag for drug abuse,” Elizabeth said.

Opioids are one of the few treatments Elizabeth has found that works to alleviate her pain. But she also takes benzodiazepines on an as-needed basis to control her anxiety (usually once a week). Even though Elizabeth is well aware of the risk of combining the two medications and knows better than to take the two pills together, doctors refuse to prescribe both. They don’t seem to trust her not to abuse them.

“I could tell them that I wouldn’t take them together. But that’s not a valid choice,” Elizabeth said.

While doctors were extremely cautious about this drug interaction, they didn’t focus on another drug-related risk: medications that are used to treat nerve pain can cause adverse reactions in patients with bipolar disorder. No one warned Elizabeth of this danger, and she ended up being hospitalized for psychosis after a long stretch of stability.

“The doctors didn’t talk about it because it’s just a side effect, not a liability concern,” she said.

On the flip-side, Elizabeth has experienced psychiatric providers who were skeptical of her pain diagnosis.

“They wrote in my chart that I had a delusion that I had Lyme disease,” she said…

Find out more about the complications of treating pain in patients with mental illness, the dangers of confusing one’s body with one’s psyche, and the “time bomb” of untreated pain in the original article Should Your Mental Health Determine How Your Pain Is Treated? at The Fix.

Should Mental Health Determine Pain Treatment Options?

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Emotional Numbness and Depression: Will It Go Away?

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Even as we don’t like pain, it is a reminder that we are alive and have a steady pulse. Worse than heartbreak or rage can be the sensation of numbness, when you lose access to your feelings and can’t feel the sadness of an important loss or the aggravations that used to make you scream. Emotional numbness is a common, yet not talked about, symptom of depression.

In an informational video, Will This Numbness Go Away?, J. Raymond DePaulo, Jr., M.D., co-director of the Johns Hopkins Mood Disorders Center, describes emotional numbness and helps people to distinguish between the numbness caused by depression and that from medication side-effects. He also assures anyone experiencing it, that it WILL go away.

I don’t feel anything.

“Numbness is not the most talked about experience or the most prominent experience of a depressed patient,” DePaulo says, “but there is a small group of patients for whom their first concern is that they don’t feel anything.”

Writer Phil Eli could be included in that group. He wasn’t prepared for the way his depression stole his sex drive and attention span. Nor was he ready for the overwhelming fatigue that made it difficult for him to stay on task. However, he was most surprised by his inability to feel anything. In his piece “Sometimes Depression Means Not Feeling Anything at All” he writes:

Nothing about hearing the word “depression” prepared me for having a moment of eye contact with my two-year-old niece that I knew ought to melt my heart—but didn’t. Or for sitting at a funeral for a friend, surrounded by sobs and sniffles, and wondering, with a mix of guilt and alarm, why I wasn’t feeling more.

During my recent depression spell, I experienced this kind of numbness for weeks. Political news that would have previously enraged me left me cold. Music had little effect beyond stirring memories of how it used to make me feel. Jokes were unfunny. Books were uninteresting. Food was unappetizing. I felt, as Phillip Lopate wrote in his uncannily accurate poem “Numbness,” “precisely nothing.”

Is it my medication?

To further confuse matters, numbness can also be a side-effect of certain medications.

“It is true that there are medications and a particular group of antidepressants that can cause a very similar numbness,” explains DePaulo. “It’s important to distinguish that and know if it’s a side effect of medication. The Selective Serotonin Reuptake Inhibitors at higher doses can cause this.”

A 2015 study published in the journal Sociology found that emotional numbness was among the dominating experiences of antidepressant use among young adults, and a 2014 study published in the journal Elsevier cited that 60 percent of the participants who had taken antidepressants within the past five years experienced some emotional numbness.

That said, it can be tempting for people to assign blame on the medication when it is due to the depression, itself, especially in the initial weeks and months of treatment.

Will it go away?

Regardless of the cause, people want to know if and when numbness will go away. DePaulo asserts, “If the treatment is sufficiently helpful, it will go away.” However, he explains that it may not be the first thing to improve. The progression of recovery usually starts with a person looking better to other people and talking more and being response. “They may still feel awful on the inside,” he explains, “but usually those feelings go away later in the course of treatment.”

And if the numbing is caused by a medication? “We have to figure that out,” says DePaulo. “We may try reducing the dose of medication — if the medication seems to be otherwise working — or may attempt to change medications.”

Either way, though, DePaulo says, it should go away. “That is our job.”

The good-bad news is that ALL your feelings will return.

Emotional Numbness and Depression: Will It Go Away?

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8 Reasons Why Your Depression May Not Be Getting Better

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You’ve been to four psychiatrists and tried over a dozen medication combinations. You still wake up with that dreadful knot in your stomach and wonder if you will ever feel better.

Some people enjoy a straight path to remission. They get diagnosed. They get a prescription. They feel better. Others’ road to recovery isn’t so linear. It’s full of winding bends and dead-ends. Sometimes it’s entirely blocked. By what? Here are a few impediments to treatment to consider if your symptoms aren’t improving.

1. The Wrong Care

Take it from the Goldilocks of mental health. I worked with six physicians and tried 23 medication combinations before I found the right psychiatrist who has kept me (relatively) well for the last 13 years. If you have a complex disorder like I do, you can’t afford to work with the wrong doctor. I would highly recommend that you schedule a consultation with a mood disorders center at a teaching hospital near you. The National Network of Depression Centers lists 22 Centers of Excellence located across the country. Start there.

2. The Wrong Diagnosis

According to the Johns Hopkins Depression & Anxiety Bulletin, the average patient with bipolar disorder takes approximately 10 years to receive the proper diagnosis. TEN YEARS. About 56 percent are first diagnosed incorrectly with major depressive disorder, leading to treatment with antidepressants alone, which can sometimes trigger mania.

In a study published in the Archives of General Psychiatry, only 40 percent of participants were receiving appropriate medication. It’s pretty simple: if you’re not diagnosed correctly, you won’t get the proper treatment.

3. Non-adherence to Medication

According to Kay Redfield Jamison, Ph.D., Professor of Psychiatry at Johns Hopkins University and author of An Unquiet Mind, “The major clinical problem in treating bipolar illness is not that we lack effective medications. It is that bipolar patients do not take these medications.” Approximately 40 to 45 percent of bipolar patients do not take their medications as prescribed. I’m guessing the numbers for other mood disorders are about that high. The primary reasons for non-adherence are living alone and substance abuse.

Before you make any major changes in your treatment plan, ask yourself if you are taking your meds as prescribed.

4. Underlying Medical Conditions

The physical and emotional toll of chronic illness can muddy the progress of treatment from a mood disorder. Some conditions like Parkinson’s disease or a stroke alter brain chemistry. Others like arthritis or diabetes impact sleep, appetite, and functionality. Certain conditions like hypothyroidism, low blood sugar, vitamin D deficiency, and dehydration feel like depression. To further complicate matters, some medications to treat chronic conditions interfere with psych meds.

Sometimes you need to work with an internist or primary care physician to address the underlying condition in tandem with a mental health professional.

5. Substance Abuse and Addiction

According to the National Institute on Drug Abuse (NIDA), people who are addicted to drugs are approximately twice as likely to have mood and anxiety disorders and vice versa. About 20 percent of Americans with an anxiety or mood disorder, such as depression, also have a substance abuse disorder, and about 20 percent of those with a substance abuse problem also have an anxiety or mood disorder.

The depression-addiction link is both strong and detrimental because one condition often complicates and worsens the other. Some drugs and substances interfere with the absorption of psych meds, preventing proper treatment.

6. Lack of Sleep

In a Johns Hopkins survey, 80 percent of people experiencing symptoms of depression also suffered from sleeplessness. The more severe the depression, the more likely the person will have sleep problems. The reverse is also true. Chronic insomnia creates a risk for developing depression and other mood disorders, including anxiety, and interferes with treatment. In persons with bipolar disorder, inadequate sleep can trigger a manic episode and mood cycling.

Sleep is critical to healing. When we rest, the brain forms new pathways that promote emotional resilience.

7. Unresolved Trauma

One theory of depression suggests that any major disruption early in life, like trauma, abuse, or neglect, may contribute to permanent changes in the brain. According to psychiatric geneticist James Potash, M.D., stress can trigger a cascade of steroid hormones that likely alters the hippocampus and leads to depression.

Trauma partly explains why one-third of people with depression don’t respond to antidepressants. In a study recently published in Scientific Reports, researchers uncovered three subtypes of depression. Patients with increased functional connectivity between different brain regions who had also experienced childhood trauma were categorized with a subtype of depression that was unresponsive to selective serotonin reuptake inhibitors like Zoloft and Prozac. Sometimes, then, intensive psychotherapy needs to happen alongside medical treatment in order to reach remission.

8. Lack of Support

A review of studies published in General Hospital Psychiatry assessed the link between peer support and depression and found that peer support helped reduce symptoms of depression. In another study published by Preventive Medicine, teens who had social support were significantly less likely to become depressed after experiencing work or financial stress in early adulthood than those without support. Depression was identified among conditions affected by loneliness in a paper published in the American Journal of Public Health. Persons without a support network may not heal as quickly or as completely as those with one.

8 Reasons Why Your Depression May Not Be Getting Better

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What Do I Do When My Antidepressant Stops Working?

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Approximately 25 percent of patients with major depressive disorder (MDD) experience a recurrent depressive episode while on an adequate maintenance dose of antidepressant medications, according to a 2014 metanalysis published in Innovations in Clinical Neuroscience. The clinical term for this medication poop-out or antidepressant tolerance is antidepressant treatment (ADT) tachyphylaxis. While psychiatrists and neuroscientists don’t know exactly why this happens, it could be due to a tolerance effect from chronic exposure to a medication.

I address this topic because I have experienced antidepressant poop-outs myself, but also because I often hear this concern from persons in my depression communities: What do I do when my antidepressant stops working?

The following strategies are a blend of clinical suggestions from the metanalysis mentioned above and other medical reports I’ve read, as well as my own insights on recovering from a relapse.

1. Consider all reasons for your relapse.

It’s logical to blame the return of your depressive symptoms on the ineffectiveness of a drug; however, I would also consider all other potential reasons for a relapse. Are you in the midst of any life changes? Are your hormones in flux (perimenopause or menopause)? Are you experiencing loss of any kind? Are you under increased stress?Did you just start therapy or any kind of introspective exercise? I say this because I experienced a relapse recently when I starting intensive psychotherapy. While I am confident it will lead to long-term emotional resiliency, our initial sessions triggered all kinds of anxiety and sadness. I was tempted initially to blame the crying and emotional outbursts on ineffective medication, but soon realized that my pills had nothing to do with the pain.

Watch out especially for increased levels of stress, which will commonly drive symptoms.

2. Rule out other medical conditions.

Another medical condition can complicate your response to medications or contribute to a worsening mood. Some conditions that are associated with depression include: vitamin D deficiency, hypothyroidism, low blood sugar, dehydration, diabetes, dementia, hypertension, low testosterone, sleep apnea, asthma, arthritis, Parkinson’s disease, heart disease, stroke, and multiple sclerosis. Get a thorough check up with a primary care physician to rule out any underlying condition.

Make sure to test for a MTHFR gene mutation, how you process folate, which can definitely affect antidepressant results. If you experience any elevation of mood with your symptoms of depression, be sure to discuss those with your doctor. More than half of people with bipolar disorder are misdiagnosed as clinically depressed and don’t receive the proper treatment they need, including a mood stabilizer.

3. Take your medication as prescribed.

Before I list some of the clinical suggestions, it’s worth mentioning that many people don’t take their medication as prescribed. I would like to plead innocent here, however, I acknowledge that there are too many evenings when I forget to take my pills.

ccording to a 2016 review in the World Journal of Psychiatry, about half of the patients diagnosed with bipolar disorder become non-adherent during long-term treatment, a rate similar to other chronic illnesses. Some psychiatrists assert that the real problem isn’t so much the effectiveness of medications as much as it is getting patients to take medications as prescribed. Before switching up your medication, ask yourself: Am I really taking my meds as prescribed?

4. Increase the current antidepressant dose.

Increasing the dose of an antidepressant is a logical next course of action if you and your doctor determine that your relapse has more to do with a medication poop-out than anything else. Many patients take too little medication for too short period of time to achieve a response that can last. In a 2002 review in Psychotherapy and Psychosomatic, doubling the dose of Prozac (fluoxetine) from 20 to 40mg daily was effective in 57 percent of patients, and doubling the 90mg from once weekly to twice weekly was effective in 72 percent of patients.

5. Experiment with a drug holiday or lowering the antidepressant dose.

Since some medication poop outs are a result of a tolerance built up from chronic exposure, the metanalysis recommends a drug holiday among its strategies for tachyphylaxis, however this needs to be done very carefully and under close observation. In some patients where the symptoms are severe, this is not a feasible option. The length is of a drug holiday varies, however the minimum interval required to restore receptor sensitivity is typically three to four weeks. This all seems counterintuitive, however, in some studies, like the one by Byrne and Rothschild published in Clinical Journal of Psychology, decreasing the dosage of an antidepressant led to positive results.

6. Change your drug.

Your doctor might want to switch medications, either to another drug in the same class or to another class. You may need to try several medications to find one that works for you, according to the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Study, the largest and longest study ever conducted to evaluate depression funded by the National Institute of Mental Health (NIMH).

If the first choice of medication does not provide adequate symptom relief, switching to a new drug is effective about 25 percent of the time. It might make sense to introduce a drug that has an entirely different mechanism of action in order to regain the response blunted by the drug tolerance of the one you’re on.

The transition between meds needs to be handled carefully. Typically it’s better to introduce the new drug while tapering off the old, not to quit it abruptly.

7. Add an augmentation drug.

According to the STAR*D study, only one in three patients in the first sequence of monotherapy (that is, taking one drug) achieved remission. Meta-analyses of antidepressant trials of nonchronic patients with major depressive disorder report remission rates of 30 to 45 percent on monotherapy alone. Augmentation drugs considered include dopaminergic agonists (i.e. bupropion), tricyclic antidepressants, buspirone, mood stabilizers (lithium and lamotrigine), antipsychotic medications, SAMe or methylfolate, and thyroid supplementation. According to STAR*D, adding a new drug while continuing to take the first medication is effective in about one-third of people.

8. Try psychotherapy.

According to a 2013 Canadian Psychology Association report, mild to moderate depression can respond to psychotherapy alone, without medication. They found that psychotherapy is as effective as medication in treating some kinds of depression and is more effective than medication in preventing relapse in some cases.

Also, for some patients, the combination of psychotherapy and medication was more beneficial than either treatment on its own. According to a study published in the Archives of General Psychiatry, adding cognitive therapy to medication for bipolar disorder reduced relapse rates. This study examined 103 patients with bipolar 1 disorder who, despite taking a mood stabilizer, experienced frequent relapses. During a 12-month period, the group receiving cognitive therapy had significantly fewer bipolar episodes and reported less mood symptoms on the monthly mood questionnaires. They also had less fluctuation in manic symptoms.

It’s normal to panic in the days and weeks your symptoms return; however, as you can see, there are many options to pursue. If the first approach doesn’t work, try another. Persevere until you achieve full remission and feel like yourself again. It will happen. Trust me on that.

What Do I Do When My Antidepressant Stops Working?

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