Archives for February, 2012
Some new findings about disparities in the way young adults of different races use mental health services have been troubling me since I first read about them last week. Whites who received "psychological or emotional counseling" as teenagers were more likely to be in treatment as young adults compared to their age peers who didn't receive counseling, a study in Psychological Services found. But for black young adults, the findings were reversed: Having received counseling as teens made them less likely to receive services as adults.
I borrowed the title for today's post from Is It Me Or My Meds?, a very interesting book by the sociologist David Karp that examines how people taking antidepressants understand the drugs' impact on different aspects of their identity. I keep coming back to this question with regard to a new medication I'm taking and some rather unpleasant and difficult-to-place cognitive effects I've been experiencing. Karp's book asks the question broadly, invoking it in big, existential ways and also with regard to smaller, more prosaic topics such as side effects. This second point is actually more fraught than it might seem: It can be amazingly difficult to tell drug side effects from psychiatric symptoms, something I've been reminded of lately as I've had my meds adjusted. My whole medication regimen has been in flux lately, because, as I think I mentioned in a previous post, I'm trying to get my migraines under control and the drugs used to treat migraines can interact with those used to treat anxiety and depression. Lately, I've been feeling anxious, jumpy, and have been having trouble concentrating. But it took me a while to even think to tie this to my medications. Given how long I've been taking meds (more than a decade), and the fact that I've written a book about the complicated and unexpected effects of psychiatric medications, you'd think I'd know better. But it just goes to show that one is inclined to think one's moods are organic or innate. It takes a bit before you think to ask if it's the drugs you're taking.
I stayed up late the last few nights reading Jeffrey Eugenides' The Marriage Plot, engrossed in large part by the subplot involving Leonard Bankhead, who suffers from bipolar disorder and what might be called a typically complicated relationship with both his manic phases and his medication. The book is set in the early 1980s, which gives Leonard few viable options for pharmaceutical treatment. Now doctors often prescribe anticonvulsants such as Tegretol and Depakote, and atypical antipsychotics, but back then lithium was more or less the only choice. Leonard began to experience depressions early in high school but wasn't diagnosed or treated until his freshman year of college, when he began taking a low dose of lithium apparently without incident. But as college graduation nears, he begins to chafe at the idea of taking the medication at all, which sets him on a terrible merry-go-round of breakdowns, high doses to get him back on track, side effects from the high doses and then rebellions against the side effects, followed by more breakdowns.
In the ever-fraught public discussion of kids and psychiatric medication, the proper role of school administrators and teachers often comes up. What teachers should or shouldn't say to parents about medication treatment for their students is an understandably touchy subject. Many parents are wary of being told to medicate their child because an overwhelmed teacher "can't deal" or because medication would be cheaper than providing special services. Teachers and administrators, though, are are in their own bind. They may have opinions about what would be best for the kid - going on a drug for the first time, adjusting a dosage, trying a new out-of-school therapy - but they are also wary of meddling. The subject is so delicate that at one point about a decade ago, a number of states even passed resolutions seeking to ban teachers from mentioning medications to parents. Ten years later, the landscape has shifted a little, partly because of the demographics of the teacher workforce. Many of today's young teachers were yesterday's medicated kids.
This reader's story about her experience with medication seems especially timely, given the recent analysis of studies analyzing suicidal ideation and antidepressants. She says she experienced such suicidal thoughts in the initial weeks of treatment, but that the thoughts passed. For patients, especially young people, who do experience this kind of suicidal ideation after beginning an antidepressant, it is usually early in the course of treatment. The reader, who didn't want to use her name, doesn't elaborate on her response to this suicidal ideation, or whether a doctor told her to expect it. However, if she'd be willing to take questions in the comments section, I, for one, would be very curious to hear more about how she interpreted these thoughts, whether they scared her, whether she was able to brush them off because she knew they were "drug-induced," etc. I'd also like to hear why she was so resistant to taking meds in the first place and whether there was going on in her life that was particularly stressful and that she thinks helped set off her depression at that particular time. Her initial resistance is interesting to me, because it seemed to surface again during the time she she either forgot to take her medications or decided to go off it and concluded that she "deserved" her misery. From interviews I've conducted and research I've done, that seems a very common attitude in others, especially in depressives. I don't think it's necessarily unique to being young, but I would be curious to hear readers' thoughts about why this mindset is so persistent. Incidentally, on the topic of suicidal ideation, I'd like to point readers to a very thoughtful critique of the Archives of General Psychiatry study by Dr. David Healy, a psychopharmacologist and one of the most prominent and earliest crusaders seeking to draw attention to the link between antidepressants and suicidal behaviors and thoughts. I'm not sure I understand everything he says in the column, but it's an interesting read, nonetheless. And now, the reader's account of her experience with meds, in her own words. I invite further personal stories about medication, in any format you like and on any aspect of your experience - don't feel bound by the prompts I gave. Email me at kaitlin.b.barnett [at] gmail.com. Try to include your diagnoses and what medications you took.
A new, important study published in the prestigious Archives of General Psychiatry found that antidepressants decrease the risk of suicidal thoughts and behavior in adults and have no effect on the risk in children. This is big news, since in 2004 the FDA slapped a black box warning on antidepressants, cautioning that they could cause suicidal tendencies in people under 18. In 2007, the agency extended that warning to young adults under age 25. I've read the study and news accounts about it, including PsychCentral's, but I'm still left with a lingering question. Perhaps some astute readers who know more about statistics than I can weigh in. Based on the studies findings, can we conclude that there is really no association between antidepressant use and the risk of suicidal thoughts and behaviors in kids? Or did the kids who grew more suicidal while taking antidepressants and the kids who got less suicidal taking the medications just cancel each other out?
Many people - most, I would venture to say - don't have simple, uncomplicated relationships with their medication. One reader who has generously shared her story of taking medication demonstrates how conflicted one can be about long-term drug treatment, and yet how one can feel unready or unable to end it. Among many interesting issues Kristy touches on, I'm struck by how little the doctor explained to her at the outset. In interviewing other young people who began medication as children or teens, I have found this substantially complicates their relationship with medication, often creating confusion, resentment and a lack of commitment to long-term treatment. Their reaction is understandable. Would you want to continue taking a drug if you didn't perceive a major positive change, and if you received very little feedback and guidance from the adults in your life as to what to expect and how to interpret what you experienced?
Trying to get one's medication regimen just right proves an ongoing challenge for many people. Over the years, I've learned that if you need to change something about your meds, it's best to alter just once thing at a time. Tweak too many things at once and neither you nor your doctor will be able to tell which new drug, altered dosage, or medication interaction is to blame. I say this, but I still regularly ignore my own advice. Suffering from a migraine today, I did it again, demonstrating just how difficult it is to practice good self care, even when you've had years of experience.