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.
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.
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.