Archives for Anti-anxiety Drugs
How closely does a writer's work mimic her life experiences? It's a perennial question made all the more irresistible as it pertains to Lena Dunham, the 26-year-old creator of one of TV's most talked-about shows, and her recently-revealed history of Obsessive-Compulsive Disorder. In the first season of HBO's Girls, Dunham stirred up debate by, among other things, repeatedly revealing her less-than-perfect body while playing the show's main character, Hannah Horvath. What got people talking as the second season progressed, though, was how serious the show seemed to be getting, especially with its depiction of Hannah coping with a resurgence of her OCD symptoms. Critics, fans, mental illness activists and patients have largely praised the Girls' depiction of OCD, which they've hailed as convincing and nuanced, but agonizing to watch. One hollywood.com writer and self-described former OCD patient called it "some of the darkest, most difficult material with which Girls has wrestled to date," lauding the show for avoiding the temptation to turn OCD into a mere joke. The fact that Dunham revealed in a March cover story for Rolling Stone that she's struggled with OCD since childhood - and taken medication for it on and off - gave the topic more buzz. (I discussed what she revealed-and what she didn't-here). In a HBO behind-the-scenes look at one of the episodes, Dunham disclosed a little more about the connection between her experience and the show's representation of Hannah's OCD - though she didn't go into specifics. For those looking for a more direct comparison, here's a look about what Dunham has said about her own experiences with OCD symptoms and treatment - and how they compare to Hannah's.
Lena Dunham, the 26-year-old force behind HBO's popular and much-discussed show Girls, hasn't grown famous through discretion. Part of the cringe-inducing delight of watching Girls is hearing Hannah say things and do things she knows she shouldn't. And part of what's refreshing about Dunham herself are her irreverent, indecorous comments and self-revelations, whether on Twitter, New Yorker essays, or interviews. So I was especially curious to hear what Dunham had to say about her obsessive-compulsive disorder and medication use in a just-released Rolling Stone cover story. Especially since it was titled Girl on Top: How Lena Dunham Turned a Life of Anxiety, Bad Sex, and Countless Psychiatric Meds into the Funniest Show on TV.
I've argued before that declaring American kids and teens to be "overmedicated" is something of a cop-out. How can people say what constitutes overmedication when they can't - or won't - specify what would constitute an acceptable number or percentage of kids taking psychiatric meds? Still, I do care about the numbers, because they can give us clues as to which kids and how many are getting appropriate treatment for emotional and behavioral problems. A recent and widely publicized study by researchers from The National Institute of Mental Health provides data on some -but not all - key measurements of youth medication use. Its main finding: Just one in seven teens with a diagnosable psychiatric conditions have recently taken medications to treat it.
Most psychiatric drugs bear some version of the warning: "Do not drink alcoholic beverages when taking this medication." In reality, though, many people taking psych meds drink anyway. They have various reasons: not wanting to curtail their fun, not putting much stock in the warnings, or simply thinking it's easier to take a proffered drink than explain why they're turning it down. Doctors oftentimes don't bother to talk to patients about potential dangers. Or they tell patients not to drink, but don't explain why. To make matters worse, because of a lack of studies on the subject, patients inclined to do their own research will have a hard time just how risky it is to drink while taking various kinds of psychiatric medications (I've written elsewhere about this troubling lack of evidence). A widely publicized study that came out last month in the journal Neurology underscores the problem. The findings, which pooled data from 16 studies, showed that people taking SSRI antidepressants like Zoloft or Celexa were 40 percent more likely to suffer a type of stroke caused by bleeding in the brain and 50 percent more likely to suffer any bleeding in the skull.
A recent article in USA Today about the challenges of dealing with ADHD at college suggested students keep their conditions - and their prescriptions - secret from their peers. The reason? Abuse of stimulant medications like Adderall and Ritalin is rampant on college campuses, where the medications are used as "study drugs" and also to provide a boost of energy during long nights of drinking and partying. As a result, students with such prescriptions can find themselves under intense pressure to share or sell their pills. But when students keep their meds a secret from peers, does anyone actually benefit?
People who take psychiatric medications long-term are no strangers to stigma, or the threat of it. We perennially face, for example, the question of whether it's worth risking others' judgment and the potential negative repercussions of disclosing our conditions -- and the fact that we take medication for them. But you can commit to taking medications long-term and still perpetuate or further the stigma associated with meds. And I don't just mean that in the sense of keeping your medication regimen secret. Most of us do so in another way altogether that we're largely unaware of. The fact is, most people have some kind of internal barometer when it comes to medications - which ones they are willing to take, and which ones they're not.
This weekend a mother published a New York Times column about how her son came to be diagnosed with ADHD and became a member of the ballooning "Ritalin Generation." "Just a little medication," the teacher told the boy's mother, "could really turn things around" for the boy, who was having trouble focusing on class worksheets and lining up quietly for transitions between classes. When the mother firmly responded that she and her husband weren't going to medicate their son, the teacher backtracked, sounding mock-horrified. She wasn't explicitly suggesting medication, she said. The law prohibited such a thing. She just didn't want him to fall through the cracks - and thus was was merely suggesting the boy's parents have him evaluated by a psychologist. The boy was evaluated, and sure enough, he ended up on Ritalin for a short-time, though he quit it on his own a year later, matured out of his former inattentiveness, and eventually ended up a well-adjusted, school-loving honor-roll student - and medication-free. Such stories are commonly invoked as cautionary tales about the alleged over-diagnosis of ADHD and other behavior disorders and over-prescribing of drugs like Ritalin to keep children's behavior in check. Teachers recommending meds for disruptive students often feature prominently. In fact, the debate over school involvement in medicating disruptive children showed up as early as the early 1970s.
Psychiatric medications have a lot of potential hidden costs. We don't know, for example, how taking them from a young age affects long-term brain and psychological development in kids. They have myriad of side effects, some serious, like diabetes, high cholesterol, neurological impairment and birth defects when taken in pregnancy. They carry stigma, both from others and self-imposed. But I'm not talking metaphorically about costs here. I'm talking straight-up financial outlays. Taking psychiatric medications can really add up, even for those who have health insurance, and even when they can take generic instead of brand-name drugs. One big reason is the so-called "medication merry-go-round."
With all the attention on the misuse of psychiatric drugs, I think it's worth taking a look at how the increased scrutiny affects people who have a diagnosis and a legitimate prescription. I don't mean to suggest that just because someone has been diagnosed and a doctor has seen fit to prescribe her medication that she necessarily needs the meds - or even that she "should" be on them. Plenty of people have unjustified diagnoses and unneeded prescriptions. But for those who do benefit from treatment, you've got to wonder how all the media attention affects their experience.
In recent years, there has been a huge increase in the prescribing of psychiatric medication to treat aggression in children. Specifically, atypical antipsychotic and mood stabilizing drugs, originally developed for schizophrenia and bipolar disorder in adults, are now routinely prescribed to treat the aggression that occurs in a variety of childhood psychiatric disorders. Prescriptions for atypical antipsychotics increased sixfold between 1993 and 2002, and the majority were prescribed to treat non-psychotic aggression, according to a task force that recently published guidelines on how to treat aggression in kids. But these drugs carry the risk of serious side effects, notably severe weight gain and metabolic changes that can lead to Type 2 diabetes. Critics, including many in the medical community, have said they are over-prescribed. At the same time, we're in the midst of a collective national hand-wringing over how to reduce childhood bullying. Might drugs that curb aggression be the answer?