Knowing What You Don’t Know about Psychiatric Medication

Ah psychiatric medication. I know; it’s really what we all love to hate in mental illness. Psychiatric medication can fix you up or pull you down and many of us have experienced both these things.

But there are more risky psychiatric medications and less risky psychiatric medications, in my estimation anyway. And one of the major ways to judge risk is based on history.

What We Know About the Psychiatric Medication Fluoxetine (Prozac)

For example, you take a look at fluoxetine (Prozac), one of the first selective serotonin reuptake inhibitor (SSRI) antidepressants out there, and you can feel pretty assured that we know what there is to know about that psychiatric medication in terms of effectiveness and side effects. If you look at the literature, fluoxetine has been studied in many contexts and fluoxetine is actually approved by the Food and Drug Administration (FDA) for treatment of the following:

  • Major depressive disorder
  • Obsessive compulsive disorder
  • Bulimia nervosa
  • Panic disorder
  • Premenstrual dysphoric disorder

And, of course, it’s also commonly used off label in other treatments like for premature ejaculation, fibromyalgia and migraine.

In addition to everything we know about this psychiatric medication’s usages, we also know all about its warnings, interactions and contraindications.

Honestly, that’s an impressive list for any psychiatric medication and you see it with fluoxetine because fluoxetine is old.

But with new medications we don’t know so much. It’s only after thousands of people have taken the drugs for years that many of the side effects become clear. We’ve seen this time and time again with every type of drug, not just psychiatric medication. We see drugs every year pulled from the market because of what we didn’t know.

Knowing about Psych MedicationsNew Psychiatric Drugs

Of course the problem with judging psychiatric drugs on history comes when there isn’t any. When a drug is new, how can you judge it at all? All you have is a few (relatively) small studies to go off of and your doctor’s recommendation. That’s a scarily scant amount of information.

And right now I’m looking at one of those new medications on my coffee table.

According to Wikipedia, it was approved on October 28, 2010 for the treatment of schizophrenia, “after a review that found that two of the four Phase III clinical trials supported efficacy, while one showed only marginal efficacy and one was not interpretable because of high drop-out rates.”

Ah, good then. A whole half of studies showed it was effective in treating schizophrenia. Did I mention I have bipolar disorder?

Knowing What I Don’t Know about Psychiatric Drugs

So, basically, I’m taking this psychiatric drug on faith. Or hope. Or something like that, because it sure isn’t because of science. I mean, it’s better than throwing a dart in the pharmacy and taking whatever it skewers, but it still feels like a complete gamble. Given that this drug is an antipsychotic, I’d say I’m possibly at major risk for cardiac, musculature and metabolic issues that have yet to reveal themselves.

Maybe.

Or maybe not.

That’s the thing. We just don’t know enough about this psychiatric medication to say. And, of course, I also don’t know whether this psychiatric medication will work or what the side effects will be, but that’s just par for the very-unfair course.

Why Take a Psychiatric Medication We Don’t Know about?

The answer to this one is simple – even though I feel absolute terror when considering taking yet another antipsychotic (a class with which I have a bad history) I’m going to do it anyway because something needs to change in order for my illness to get better.

And that’s what it comes down to a risk versus reward ratio. Even though I know we do not know about this psychiatric medication I’m in a place in my treatment where that risk is worth the possible reward of getting better. I’m not suggesting that other people make the same decision, but for me, having tried almost everything on the market, choosing something new is pretty much the only choice left.

So knowing what I don’t know is frightening. But what I do know is this: Change nothing and nothing changes.

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  1. People say these drugs are harmful. They work for some and may not work for others but you have to give the drugs time. They are not going to work overnight. As for the side effects: they may be minimal or severe for some. I had side effects with Effexor but the effects were not incapacitating, just annoying. I came across the site cchr and I read about Peter Breggin who speaks out against psych meds. He speaks very badly about psychiatry saying the drugs are disabling and saying the drugs cause mental illness. I was on Effexor 225 mg, I went to my psychiatrist and told him i wanted off the drug and he said ok. I tapered the drug down slowly but when i got to 37.5 mg I completely stopped the drug. Bad idea!! Soon came the confusion, I began to misplace items but I thought nothing of it. On this med I was stable. When I stopped it I started to do things out of character for me such as crying because I couldn’t make my bed and I am a grown woman! I thought maybe I’m stressed out, I didn’t think right away that it was my emotions reacting to the meds leaving my body. Another time I was on the hwy driving and i felt confused and disoriented but i thought i was just tired. That was 5 months ago and i am not taking anything. I wish I wouldn’t have stopped Efexor because everyday now I feel confused, people talk to me and I do not know what to say. I also stopped Trazodone cold turkey, another big mistake. I have not slept in 5 months. I get probably 20 mins of sleep each night and it has been a nightmare for me and my family. I constantly feel I’m in a fog. I don’t leave the house anymore. I was an outgoing, articulate person. I was not mentally ill before, just depressed. Now I don’t know who I am anymore. There’s a lot of propaganda out there about psych meds. Don’t read about these meds and get scared. Listen to your own body. People say these drugs cause tardive diskenesia. Well that is probably the worse case scenario and if it happens to one doesn’t mean it will happen to you. I was on various meds for depression for many years but i was a functional sociable individual. Now I can’t even remember how to spell certain words and i was an english major in college. Some people can stop these meds with no difficulty but if you’ve been dealing with psych meds for many years, i wouldn’t recommend it. I don’t even think getting back on meds will help me. The only reason i haven’t killed myself is because suicide is a sin. I told my mom I was going to overdose and she said make sure you don’t do it today, i have to go to work!

    • Hi Tina,

      You’ve brought up so many issues.

      First, if there’s one organization I wish I could remove from the web it’s that freaking cchr organization and don’t get be started about Breggin. They do more to scare people into not getting properly treated than anyone else. Of course, they have a right to their opinion, but I don’t believe in using fear that way.

      As far as tardive dysinesia, yes, that is always a concern with antipsychotics, but you are right, it is the exception and not the rule for second-generation antipsychotics. It’s a risk everyone should know about but it’s nothing to be terrified of when handled properly.

      As for you, I wonder why you’re not willing to try antidepressants again if they were so successful last time? You don’t have to live the way you are. If you found your life better during treatment, I would recommend you seek treatment again.

      – Natasha Tracy

  2. I am taking Lamotrigine as well, I can only tolerate 150mg and then I get skin rashes. Something I’m experiencing and wondering if it’s Lamaotrigine issue or not is, headaches and photosensativity. I’ve made an appoinment for an eye exam (though I know my vision is still 20/20).
    I have to take 75 mg of Seroquel everynight so I can sleep and I have told myself that I have to take them or I can’ fall asleep, are they habit forming?

    • Hi Jessica,

      Seroquel is an antipsychotic and antipsychotics are not addictive: http://natashatracy.com/medicationtype/psych-meds-addictive-antipsychotics/

      Keep in mind though, if you couldn’t sleep before starting the antipsychotic, if you stop the antipsychotic you might go back to not being able to sleep again. That’s not indicative of habit-formation it’s indicative of an ongoing problem.

      (In my personal, non-medical opinion, a small dose antipsychotic is a pretty good way to help sleep long-term assuming you’re not seeing other side effects.)

      – Natasha Tracy

  3. I bet the “new” anti-psychotic, only for Schizophrenia, laying upon your coffee table is: Latuda, right?

    I only haphazard a guess because in May 2011, a Psych Nurse Practitioner prescribed it for me and handed me a Sample pack. Only she didn’t tell me one iota as to what it was, what it was for, or even why she was prescribing it. All she said was that it was a new med, on the market, that had a low incidence of systemic system reaction by way of itching and rash as a adverse side effect and it would likely do well for me.

    I went home and well, looked it up. Latuda is one of the newest kids on the block anti-psychotic only labeled for schizophrenia and it’s primary reported adverse reaction is tardive dyskinesia like symptoms… from what I remember and COULD BE so wrong (memory shotty thanks to topiramate). I only think I remember that because I immediately threw it in the back of the cabinet and refused to take the 1st dose… I had all that when I took Abilify and, many years earlier… Compazine (a very old anti-psychotic now used moreso for nausea/vomiting within cancer treatment).

    Now, some folks may have absolutely no problem with twisting, jerking, spazing and their tongue swimming around and around in their mouth while their lips pucker like a gold fish continuously with no sense of control… all for the sake of possibly, “feeling” a wee bit better until they have to change it out again in a few months to some years later… but not me.

    Plus… the cost, without insurance and at that time – no job.. was stratospheric (to me, anyway). Yet, she was kind to give me a sample pack to get started (a wee of sarcasm).

    If, of course, it’s not Latuda… sorry… still, personal perceptive view conveyed…

  4. Ewwwww…. I hate antipsychotics. But, I keep some just in case I’m bouncing off the ceiling, seriously, for me they bring (relative) sanity within an hour :-)

  5. Yes, Natasha, you’ve hit the nail on the proverbial head – because we feel so lousy, we’re willing to take almost ANYTHING, at least once, just on the *hope* that it will help, regardless of the risk.

    I think Big Pharma knows this; hence, the multi-million-dollar advertising campaigns for psych meds.

    Sigh. Thanks for sharing. It’s good to know we’re not alone! :)

  6. Prozac isn’t one of the first anti-depressants; tricyclics and MAOI’s predate it by decades, as does the use of benzodiazepines for depression

  7. I am in the same boat. I’ve tried almost everything that is on the market – with no results. It is frightening to gamble what health you have on the possibility of improvement. But what choice do we have? I recently subscribed to your blog and am impressed with your posts. Finally I have found someone who is in a similar situation. Thank you for letting your voice be heard.

  8. It’s such an individual thing, what works and what makes you worse. I’m on Lamotrigine which works up to a point, but I can’t go higher than 100mg without extremely severe insomnia. I needed something in addition so we tried Quetiapine (Seroquel) XR. It was absolutely awful, I had aggressive outbursts for a week, I was asleep for 13 hours a day and then half awake for another 5. I got increasingly depressed, ant-social and irritable. I gave it 3 weeks and there was no let up in side effects. I was told to come off it and I am still recovering. I’m more depressed and unstable now than I was before I started taking it. Coming off it also triggered a major flare up of Fibromyalgia.
    The thing is, lots of people do really well on it, just not me. I think the psychs ruled out this class of drugs for me now. Amitriptyline, in a tiny dose for pain, sent me to sleep for 11 hours a day and I became dangerously irritable. A short while later I lost touch with reality, thankfully I had a flash in sight and was taken off it pronto. The psych said something about them both having something to do with Histamines.
    Lithium is now under consideration, but as I’m already diabetic and have an underactive thyroid, amongst other health problems, we’re waiting a while. I also have tests concerning other medical fields and we need to see what happens there are some conditions may be contra-indicated with Lithium.

  9. Thanks for sharing this Natasha. Know that there are many of us out there wrestling with that costs benefit analysis and making the same choice. Good luck!

  10. I suppose I’m fortunate. I never hesitate to try something new, including antipsychotics (probably because I’ve already tried everything else in the way of antidepressants and mood stabilizers.) That’s how I began aripiprazole (Abilify) in late 2009/early 2010, when it was brand new in Canada. It was a good bet; worked like a charm for me (despite what Electroboy Andy Behrman feels about it.) Only in 2012 did I have to give it up, in order to avoid possible tardive dyskinesia, which seemed imminent. Like all drugs, it had its trade-off troubles.
    On the other hand, ziprasidone (Zeldox; Geodon in U.S.A.) which was also very new in Canada, worked for me but I needed another med whose name escapes me, to ameliorate the nasty side-effects. But they were too much, so I had to quit the drug entirely.

  11. One thing you don’t mention is “collaboration” between the provider and consumer. The provider’s experience with the drug is always improtant. Also, with collaboration comes teamwork…..no medication choice should be rigidly adhered to if it is not doing the job one expects. That always gives me comfort to know that I can always change with the help of my provider if there are problems.

  12. Seroquel (such a nice soothing name) has been a great drug for me, but it’s also killing me. Metabolic syndrome and 50 pound weight gain.
    For the last few months I’ve told myself, get off of it. But I have no insurance and the newer AP’s are incredibly expensive and I know that I’ll be trading these side effects for other side effects that may be worse. So, do I want to trade weight gain for movement disorders?
    The P.I. on Amitriptyline, which I took 30 years ago, could wallpaper my living room.
    I stopped reading the side effects when I got to ‘black hairy tongue’. It was hard enough to get a date as it was. Know what I’m saying, Natasha? I can’t I imagine being a parent and having to make the decision.to put my 10 year old on any psych drug. (as usual, I’m off topic, sorry)
    I love your writing, Natasha.