Antidepressants and Addiction, Dependence – Talkback

The Bipolar Burble recently received a couple of comments on the antidepressants and dependence / addiction post from Tabby. My response to her second comment ended up being so long I decided to put it in it’s own post.

Here is an excerpt from Tabby’s comments (edited for length). If you would like to read them in their entirety, please see here and here. (Symbol […] indicates removed text. Other ellipses are from the original text.)

Antidepressants and Addiction and DependenceComment on Are Antidepressants Addictive?

I know of people who cannot go not 1 day without their medication and the medication not be a life saving med like a blood thinner but be a Anti-depressant. They become all anxiety ridden and panic filled because they just know that if they miss that 1 dose or those 2 doses for that 1 day […]

They can’t sleep and they get agitated and they get quite vile until they get that dose or doses. They resort to sobbing, they resort to melodrama of threatening suicide…

[…] I’m talking a cymbalta, or a lexapro. I work in a MH agency and we have patients call cause they’ve gone 1 day without their prescription. […]

I am also one with Bipolar and when your entire day, or entire life, is solely dependent on whether you took your pill or pills that 1 day… I dare to say, you have a dependence.

Now… you have blood clots and you miss 1 day of your blood thinner.. then we may have a major issue. You miss 1 day of your Seroquel, or your Cymbalta, or your Depakote… seriously, it will be okay… if not, use your psychotherapy techniques. Oh, that’s right… not too many actually do psychotherapy… it’s all the meds baby.

[…] I am well aware of the benefits of medication compared to no medication for those with Mental Illness. My point was – too many people seek out the comfort of the medication to handle their daily life’s issues […] than to try and work on figuring why they are having the problem in the first place.

Folks do not wake up, naturally, anxious. Something has to have occurred to trigger that emotion and anxiety is an emotion that triggers a physical response. Yet, too many run to the cabinet and down pills to “calm” the anxiety rather than try to do something else non-medicated that […] The first reaction is to kill the emotion/feeling… not to try and figure why it’s happening.

No therapy doesn’t work in all settings or all situations but if you never try, then it will certainly never work. In that your blogs are predominately med supporting… I could say that you mock those who try to use more psychotherapy than meds.

Seroquel and Depakote are not equivalent to Warfarin or some of the other medications needed for literal body functioning. Yet, if you have been on a med for a long period of time, for example Seroquel to put you to sleep every night.. and then suddenly you miss a dose or 2… YOU WILL HAVE SYMPTOMS. That’s med dependence and you’ll have a psychological dependence because you’ll become frantic wanting your med.

[…] Many folks suffer with their Bipolar symptoms, or any MI symptom, long before they ever take the 1st pill. So, the life-saving aspect is only a “feeling”.

I  know the meds help but have they literally saved me? No. They take away the uncomfortable and the frightening… but they don’t keep me from dying. If they were the sole and only reason, then I’m a walking med cabinet.

Even folks that take a plethora of meds, every single day and swear on a stack of their most revered book… still kill themselves […]

Thanks Tabby for your response. I think your thoughts on the issue represent a perspective of many.

Psych Meds for Bipolar and DepressionAntidepressants (and Mood Stabilizers) Are Not Life-Saving

Naturally, I would beg to differ. While yes, people  live with a mental illness before  treatment, and obviously, they don’t successfully kill themselves, that is not proof psych meds do not save lives.

There are two types of people (at least) for whom psychiatric medications are life-saving:

  1. Those who would have killed themselves if not been treated. (Often those who previously attempted suicide and failed.)
  2. Those for whom the medication keeps them from falling into a tremendously dangerous mood such as severe depression or mania which is unpredictable and can easily kill a person (or even those around them.)

In neither case can you “prove” whose lives were saved, but many of us on this side of the illness believe we wouldn’t be here but for the medication.

(Quick FYI on suicide. When autopsies are done of suicide victims it is almost always the case that they do not have a full concentration of psych meds in their system. They either didn’t take the drug or hadn’t taken it regularly.)

Mental Illness Isn’t a Physical Problem

You suggest a blood-thinner is a necessary medication because it fixes a physical problem. Well, so do psych meds. I’ve talked here many times about the biology of mental illnesses like depression. But on top of that, mental illnesses have many physical symptoms like:

  • Headaches
  • Join and muscle pain
  • Hypersomnia / insomnia
  • Eating far too much or far too little
  • Cognitive and memory problems
  • An inability to make reasonable decisions
  • Delusions, hallucinations, psychosis

Those effects alone can lead to death, particularly the psychotic symptoms which can be present in mania, depression schizophrenia and other illnesses. These effects lead people to do things like jump off a roof. All of that sounds pretty physical and much of it life-threatening.

Mental Illness is “Just” a Feeling

I can’t comment on how you experience mental illness, but it certainly isn’t “just a feeling” for me. On top of whatever physical symptoms I may have the feelings themselves are completely out of control. Being driven to slice your wrist with a razor blade is not simply a “feeling.” Driving with your eyes closed isn’t just about a “feeling.” Spending $10,000 that you can’t afford on clothes you don’t need isn’t just a “feeling.”

And on, and on, and on.

While spending what you earn in four months on clothes may not kill you, it sure may kill your life.

You Do Not Just Wake Up with Anxiety

Certainly, you can feel that way, but a person with an anxiety disorder would likely beg to differ. Anxiety may be the sign of a troubled marriage, a bad dream or Starbucks running out of scones, but it may also be a real, organic mental illness, like any other.

I Mock People Who Do Therapy

[push]I’ve done more therapy than anyone I know.[/push]

Um, no, I really don’t. I don’t mock people for it in the slightest. I think it’s a good idea. Some people have problems that can be solved through quality therapy. You’ll get no argument from me on that.

As for non-medication treatments, I have talked about many. Light therapy, triple-chronotherapy, the importance of strict schedule, the importance of sleep and so on and so forth. This week, in fact, on Breaking Bipolar I talked about six areas to increase mental wellness that are not pharmacological.

Dependence on Antidepressants Makes You a Walking PillI Need Psych Meds to Function so I’m a Walking Medicine Cabinet

If you say so.

As you’ve mentioned, you draw a line between psych meds and other meds which you deem “acceptable” to be necessary. That’s your call. But a mental illness is just an illness and medication for it is just as critical as it is for any other illness.

I’d say the distinction there is not fair, accurate or supported by data.

People on Antidepressants Are Dependent

In the non-disordered sense of the word, yes, people are physically dependent on antidepressants. Like all people on all long-term medications.

As for psychological dependence, well it’s a grey area. For psychological dependence the drug must produce pleasure for the user. Antidepressants do not produce pleasure; they treat an illness and reduce pain. This makes them very different from a drug like cocaine, which does produce pleasure.

 

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