As I’ve said, mental illness treatments often don’t work. And you have to keep trying treatment anyway. Because without doing anything new, you are condemned to being stuck in the same mental illness mire you are currently in.
But in all honesty, mental illness treatment requires faith. Trying psych med after failed psych med requires a belief that something will work in spite of the evidence to the contrary. It requires a belief that is not based on personal experience.
I hate that.
Why Does Mental Illness Treatment Require Faith?
Faith has several definitions, one is:
A strong or unshakeable belief in something, especially without proof or evidence.
And let’s face it, that describes a lot of what we do in mental health treatment. Don’t get me wrong, that doesn’t mean it isn’t going to work, but it does mean that trying treatment after failed treatment requires more faith than logic.
Faith in Polypharmacy (Multiple Medications)
Seriously-ill folks, often with bipolar, schizophrenia and treatment-resistant depression, are typically on lots of medication: One or two antipsychotics plus one or two mood stabilizers plus an antidepressant. Some of us get by with less medication, but many don’t.
And there is little evidence about the efficacy of polypharmacy, or indeed, how to go about applying it.
And yet, many people are on multiple psych meds.
[push]For bipolar, there was a recent recommendation against antipsychotic polypharmacy stating multiple antipsychotics are not more than effective than one, and they pose greater side effect risks.[/push]
Sure, you could blame an evil drug company conspiracy, but I suspect the answer is much simpler: it just works better for some individuals. But those people need faith to believe that. These people need faith that using these medications provides their best treatment outcome.
And all those people on antipsychotics plus anticonvulsants plus antidepressants are really going it alone. These just are no studies in these situations.
Studies on Polypharmacy
But of course there are few studies on polypharmacy. There are innumerable combinations and trying to find funding for this kind of research is extremely difficult. And even if you could, the outcome would be extremely hard to interpret due to the number of variables involved.
(There are a few exceptions. For example, fluoxetine (antidepressant) and olanzapine (antipsychotic) have been tested and approved together under the name Symbyax. Of course that is only two medications and not the many on which many of us find ourselves.)
You Gotta Have Faith
(Feel free to hum George Michael at this point. I can’t seem to stop doing it.)
My personal cocktail is on the ridiculous side of treatment. It’s that kind of cocktail doctors despise. And my doctor, being responsible, would like to reduce the number of meds.
I get it. I do.
But I really, really don’t want to get worse. Or, you know, dead.
So I have to have faith. I have to have faith that making an alteration to this cocktail will be beneficial in the long run.
But I Hate Faith
But I’m not big on faith. I’m not big on anything that isn’t logical and evidence-based. Unfortunately, that just isn’t an option here.
Faking Faith
I have to fake faith. The idea of which make me smile.
I suspect if George had written that oxymornic statement, his song wouldn’t have been such a hit.
(Of course, he was faking heterosexuality, so maybe he’d appreciate the irony.)
Natasha,
I was under the impression that anti depressants are not good for bipolar disorder. I have read that in many places. They can bring on mania.
From experience I realize relief from both anticonvulsants and antidepressants. Attention is paid to sequence and time of medications. Unfortunately not all medications and dosing methods apply to many like people. If faith is not in your vocabulary, consider faith the placebo that works. The two millennium adage is good Rx – “Know thyself”.
Right now I am running on pure faith that I will find the right medication for my bipolar depression. I have been on more than 30 different medications and combos of medications. In the past 6 months my long time go to anti-depressant slowly stopped working. I have been working closely with my psychiatrist to find the right medication to replace it. We’ve tried two so far. Both have had side effects that have made me so physically ill that I could not continue taking them. Both required weaning off the medication & some withdrawal symptoms. I am now on no antidepressant medication because I can’t get in to see my psychiatrist until 12/20. I am on her waiting list for cancellations. I know 2 doesn’t sound like many, but when added to the list of the many others it seems like just another overwhelming failure. The holidays have always been tough for me and without any antidepressant, I am hanging on by my fingernails.I have to have faith that we will find something that works for me without making me physically ill. Faith and only faith are getting me through now.
I’m on five meds for bipolar I Disorder. I’ve always been on multiple meds and usually at high doses. I’m evidently a fast metabolizer.
To me, your brain doesn’t know how many pills you take. When I took Amitriptyiline, it was dirtier than three drugs combined and made a lot happen in your brain. Now I’m on five and have less side effects. Seroquel, Lithium, Lamotrigine, Adderall, and Clonazepam. Time to party! I’ve talked to people on over 8 meds.
I don’t have faith or fake faith, I pick up the script, take the pill, and wait to see what happens. Really, just another day.
I like the word faith but I also like luck. I have been on such a bumpy road since being diagnosed with bipolar 1. In the moments before suggesting ECT my psychiartrist said, “try this Deplin for a week and let me know how you feel.”. For now ECT has been tabeled. A little orange pill parted the courtains just enough to make a difference. I have since learned that I have a deficiency in which my body does not produce enough folate or the important B vitamins. Who knew?. I have tried Zyprexa, seroquel, desprimine, amyliptrline, Zoloft, Lamictal, depakote, and am currently on lithium. Since my psychiatrist is also certified in holistic medicine I take a crazy amount of supplements and we are currently in the process of trying the “natural” mood stabilizers, inositol and choline bitartrate. I just had hormone testing done. Those results are in some areas off the charts bad. My doctors are also looking into auto immune disorders since my blood work results is not promising I don’t sleep without a whole lot of prescription sleep meds nor do I eat. It has taken an enormous amount of faith to keep going each and every day. I live with the hope that things will get better. I have faith that things will get better. My three little boys need me as well as my husband! So I am looking for faith any where I can find it!
Hi Jen,
Well, faith you can control, luck you can’t, so I think faith is a bit preferable than waiting around for luck.
It’s great that Deplin has had a positive effect for you. That’s actually rare but good news when it happens because of the few side effects that come with that medication (as you know, it’s a supplement).
I know you’ve tabled ECT now, but just know that if you do decide that’s an option for you, it’s not the end of the world. You might want to read some of my articles on it:
https://natashatracy.com/treatment/neurostimulation-treatment/ect/electroconvulsive-therapy-works-ect-shock-therapy/
https://natashatracy.com/treatment/neurostimulation-treatment/ect/myths-realities-journey-ect-bipolar-badger/
https://natashatracy.com/treatment/neurostimulation-treatment/ect/talk-electroconvulsive-therapy/
There are others as well.
Yes, it sounds like it takes a lot of faith for you to continue but obviously you have it. You’re taking many positive steps forward in getting well. You’re working with your doctor on all avenues. That’s good. Many people have a hard time getting to that point – but you’re there. you have a lot to be faithful in. If they have found these problems then it means they can address them. That’s actually good news.
And the fact that you are focused on those around you is also good news. You have so many reasons to get better. Just keep staking those steps and trust that one of them will elicit a positive result. And drop by here any time.
– Natasha Tracy
i hate taking meds. i have a fear of choking and so every time i have to take them i stress out, and it is multiple times a day, which is worse. i dont like being on meds, but i am afraid of what could happen if i am not. sometimes one has to bite the bullet and do what they must.
Hi Tamarion,
I understand the “hating to take meds,” thing. It’s really understandable.
All I can suggest (if you don’t mind my opinion) is that your stress and choking is a psychological reaction, not a physical one. If you apply a little CBT to the issue you could probably get over it and make your days easier. (That’s the kind of thing CBT is really successful at handling.)
One absolutely does have to bite the bullet, but sometimes we can make the biting a bit easier :)
PS, I used to feel something similar when taking pills and I was able to, eventually, calm myself.
– Natasha Tracy
Thanks for the article. Yup, we don’t exactly have a lot of options do we? I do think a lot of people tend to give up too quickly, even after a few days, saying a certain medication ‘doesn’t work for them.’ They’re not giving the medication a fair shake. All of life requires faith in one way or another though and honestly I believe that’s how we were designed. This is contrary to modern thought where people like to be in control of everything, but when it comes to mental illness we have to have a measure of faith and keep on trying. I just gave up and then my Doctor asked me to try something new. I said I was tired and refused, so he asked me to try for him. For him I was willing to try (I have an awesome Doctor). That medicine which is a mood stabilizer has given me my life back and I will always be grateful to him for that.
Hi Elizabeth,
No, there aren’t a whole lot of options. Really just the two. Live or die. And life is messy and involves work. It annoys me, but it’s true.
Unfortunately I think doctors may incorrectly set patient’s expectations. (Or commercials do.) People may think medication is a walk in the sunshiny goodness by day four when those of us who have been doing it for a while can tell you it takes weeks for a proper medication trial. Doctors don’t like to say this up front though. It’s too scary.
And unfortunately, the losers, are, as always, the patients. They are the ones who ended up abandoning medication that could have made them better.
Well, we have ultimate control and we have no control. We have control over living but we have no control over the efficacy of medication. It depends on how you want to look at it.
A friend of mine once said he was amazed at how dedicated I was to a failed paradigm. True, I suppose. But in all my years at this, medication is the only thing that has ever made me better. True, it fails a lot, but not always. That’s a better track record than anything else I’ve tried.
I understand being tired but it sounds like you were lucky to try one more thing. Years ago the same thing happened to me. And sometimes a doctor can be a motivating factor, it just depends on your relationship. I believe your doctor was trying to get you to do what he thought would make you better; which is what I think most doctors do.
Luckily, you listened to him :)
– Natasha Tracy
Great article. I am on an anti-depressant that I tried to come off on the advice of my psychiatrist. It’s called Cymbalta and it was hell coming off it, so now I am back on it.
My psychiatrist works from the belief to keep trying thing that have worked for you. This has worked for me.
I do agree keeping the faith is important.
Hi Madam,
Staying on or going off a med is a personal choice. For what it’s worth, Cymbalta is a hard med for many people to get off of.
It’s great if it’s working for you. Faith in your continuing success.
– Natasha Tracy
Can I ask just how ridiculous your personal cocktail is?
Hi Darren,
Well, you can ask, but I’m not saying ;)
I don’t like to discuss those sort of specifics, but I will say it’s one of the worst I’ve seen in terms of the number of medications (although not _the_ worst).
– Natasha Tracy
Some how that scares me.
It amazing what you can adjust to over the years.
Is that better or worse?
– Natasha
I think that scares me worse. I’m not sure I want to know what it’s like to get used to, I don’t know, lets say 5+ meds. But I’m sure that’ll happen eventually.
Hi Darren,
Well, look at it this way…
I do not poke myself with needles. I would not like poking myself with needles multiple times per day. But people get used to it because they have to. Or they get used to not being able to walk. Or they get used to be blind. And so on and so forth.
Really, it’s survival of the most adaptive.
We’re just built that way.
– Natasha Tracy
Yeah, but I still don’t like it :)
Darren,
Well, I can’t help that. And I don’t blame you at all.
– Natasha Tracy
Hi Null,
I would disagree.
Of course there is fear of the unknown, and certainly, any time a medication is changed, that can crop up.
” It says that taking multiple versions of the same thing is counter productive. Either one works or it doesn’t. ”
This is not correct. Not all SSRIs are the same. Just because something works on serotonin it doesn’t mean it works on it in the same way as all the rest. Medications work on subreceptors and a specific subreceptor profile can differ within class. It is no where near as simple as you suggest.
Of course it isn’t bad that doctors wish to remove meds, but that doesn’t remove the fear or the need for faith.
The risks and the unknowns are immense when dealing with complex medical cocktails. In the end, logic will only take you so far.
– Natasha Tracy
Natasha,
What you say about not all SSRIs being the same is true (although I wouldn’t necessarily say it’s worth trying *all* of them before trying something with a different primary mechanism if you’re not having any luck). Although all SSRIs do increase the amount of serotonin available by blocking the transporter (the site where reuptake occurs — although their antidepressant effect is believed to be due to secondary consequences, such as receptor down-regulation, which is why it takes a few weeks for most antidepressants to start working), they may have other activity as well. For example, fluoxetine (Prozac) has a metabolite, norfluoxetine, that actually has significant affinity for the norepinephrine transporter (so it is a NE reuptake inhibitor too) at steady state levels, so in actual practice it’s not really all that “selective.” Other SSRIs have their own secondary actions or metabolites that contribute to their activity. As such, I don’t think it’s correct to say two different SSRIs necessarily constitute “multiple versions of the same thing” —
Usually drugs that have a significant affinity for receptors believed to be relevant (like 5-HT2a and 2c, alpha-NE, etc.) won’t be described as SSRIs, and the activity will be listed in the drug monograph (i.e., the package insert, which you can get from the pharmacy), but sometimes drugs have activity that isn’t discovered until after they’ve already been FDA-approved; then you may not find out about it until the monograph gets updated.
However, I disagree that experimentation requires “faith.” I have never felt a need for what I’d consider faith. It’s a fact that psych meds work, and even though we don’t have a very good understanding of how to predict which ones will work in which cases, if you try different things — first one at a time, then in combination (although some illnesses, like bipolar, may require combinations from the start) — sooner or later you’ll find something that will help.
It’s true that when you’re seriously depressed, it’s easy to feel like giving up. I looked at it this way: even if it’s not going to work, might as well try it — and in the end, I did find something that worked. If you’re having a tough time, a support group can make a big difference, because seeing that other people have had success — sometimes only after many attempts — can be very helpful, although a severely depressed person may still engage in what my therapist described as “‘yes-but…’ thinking,” rationalizing that s/he will be the exception, the one who never finds anything (as in “yes, but…”).
I’d say “intuition” and “luck” are more accurate descriptions for the elements of chance and guesswork involved. If you’ve had a lot of treatment failures you may want to find a psychiatrist who has some expertise with tough cases, which can be difficult if you don’t live in an area where there is a community of psychiatrists with research experience. I suffered for several years from treatment-resistant depression before I got lucky (fortunately there was a degree of “on-off,” but often, the longer an episodic illness goes without being treated effectively, the longer, closer together, and more severe the episodes tend to become, an effect known as “kindling”). My doctor referred me for a consultation with a colleague of his who had done some clinical research on unusual treatments. I was also fortunate that my doctor was willing to take his colleague’s advice and try one of these way-off-label treatments, which proved a great success in combination with a more conventional antidepressant.
I would definitely say that having access to an academic medical center with a first-rate psych department was part of what made the difference for me. Although there were reports in the literature of the treatment that ended up succeeding for me, it was something that I think most doctors would be reluctant to try if they didn’t have a colleague who had experience with it and was willing to recommend it and advise them as to how to use it. A support group can also make a difference here, because sometimes other people will have experiences that can lead you to the right treatment.
-Mari
Hi Mari,
I’m not sure where you’re reading about SSRIs but there’s no reference to those in the above article.
I agree, they are all different. They have different chemical formulae de facto as they are patented. And yes, you can affect serotonin in many different ways.
“However, I disagree that experimentation requires “faith.” I have never felt a need for what I’d consider faith. It’s a fact that psych meds work, and even though we don’t have a very good understanding of how to predict which ones will work in which cases, if you try different things — first one at a time, then in combination (although some illnesses, like bipolar, may require combinations from the start) — sooner or later you’ll find something that will help.”
That’s certainly one perspective. But once you have experienced, oh, say 30 failures faith becomes more of an issue.
“I’d say “intuition” and “luck” are more accurate descriptions for the elements of chance and guesswork involved. If you’ve had a lot of treatment failures you may want to find a psychiatrist who has some expertise with tough cases,”
I would agree. I’ve seen several. And yes, of course after many combinations, way-off-label is pretty much all I do.
I’m a very logical person and I agree, logically speaking a working treatment will _likely_ be found. But it is also a scientific fact that 20% of people will not find any meaningful relief from medication.
– Natasha Tracy
I get the feeling that it’s not so much faith about meds, it’s more fear of the unknown. Fear of change. Fear of all those demons we face.
Logic is your best friend here. It says that taking multiple versions of the same thing is counter productive. Either one works or it doesn’t. The practise of augmenting one med with another from the same family makes no sense.
Doctors now realise this and so you get the desire to remove selected meds. Is this a bad thing? Maybe, but then the variables are epic so as with all medical procedures it has risks. Doesn’t stop someone getting a new kidney tho does it (yes very simplistic but it gets the point across)