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Psychiatric Medication Doesn't Work

Today I read another article on a reasonable person’s assertion psychiatric medication doesn’t work. The evidence is thin, they say, and the studies don’t always show a meaning difference between the drug and the placebo. According to them, everyone with a mental illness doing better on psych meds is experiencing the placebo effect.

OK, so let’s look at this for a minute.

The Placebo Effect

The placebo effect is a real thing that confounds doctors and researches. For some reason some people will get better when given a pill that does nothing. This happens with all diseases. No one understands why.

This is why drugs are tested against placebos. Because if you just say 64% of people responded to the drug, that number doesn’t mean anything unless you also know how many people also responded to the placebo, the pill that did nothing at all.

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It’s bizarrios.

Drug Trials

Drug trials are very specific, controlled things. Only people with condition A as defined on rating scale X and meeting the physical characteristics Y are given the pill. A bipolar medication, for example, might be tested on people with bipolar 1 disorder in their first manic phase while in hospital.

That’s pretty darn specific.

Sometimes they get a bit fancier and will test out a drug added to treatment as usual (TAU) which means people who are already on a drug, like lithium, get the new drug added to it. But the TAU can’t just be any old thing; it has to be a treatment that falls within the study guidelines.

And more than two drugs? Forget about it. There are way too many variables to account for in that scenario.

When it comes down to it, pretty much no drug has been tested in the situation which the vast majority of people with bipolar disorder (and a smaller number of people with depression) find themselves. Remission for most of us just don’t happen without multiple drugs; and clinical testing of endless combinations just isn’t reasonable.That’s the way the tablet crumbles.

We Don’t Have a Clue

And the cold hard fact is we don’t know exactly how medications work. Lithium? Been used for perhaps hundreds of years (in some form) and we still have no idea why it works (aspirin was similar until recently). What we do not know is astounding.

The Trouble with Studies

To no one’s surprise, drug companies pick a study population they think will respond to a drug. These are not people who have tried six meds without response; these are not people who have been depressed for ten years; these are not people with bipolar with psychotic features. No, these are garden variety folks. It’s easier to predict their response and there are fewer variables for which to account.

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Additionally, people who are severely ill are rarely in placebo-controlled studies. This is because doctors won’t let these people take placebos. They need treatment too badly. To give them a placebo is dangerous and unethical. (And studies have to be approved by an ethics committee.)

Who Benefits From Drugs?

So, in my opinion, the people who benefit most from drugs are the very people they do not study because either they can’t or won’t. Not to mention getting a drug FDA-approved for “bipolar type II rapid cycling with blue eyes” is a considerably less lucrative proposition than getting approval for straight bipolar mania.

I’ve Benefited from Drugs

Anecdotes are not evidence, I’ve said it before and I’ll always say it. But I’ve had three dramatic responses to drugs during my treatment and there is not a doubt in my mind those responses were drug-related and not due to anything else. It is crystal clear to me drugs make my life worth living. I am absolutely certain drugs are pretty much the only thing standing between me and death (or something death-adjacent).

But that’s me.

That’s not a scientific argument, just a personal one. Drugs saved me. There you are.

Do Drugs Work?

I can’t tell you if drugs work, only that some of them, in some combinations, have worked for me. And that’s kind of the most important thing.

You can find Natasha Tracy on Facebook or @Natasha_Tracy on Twitter.

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate and author of Lost Marbles: Insights into My Life with Depression & Bipolar. Find Natasha Tracy on her blog, Bipolar Burble, Twitter, Google+ and Facebook.

19 thoughts on “Psychiatric Medication Doesn't Work”

  1. Steph I don’t know what combo’s you’ve been on but I take 5 meds to keep things more or less in line, Right now: Seroquel, Lithium, Adderall, Clonazepam, and Lamictal.
    I good psychiatrist or psychopharmacologist can help. Don’t give up hope.
    I’ve been on 40 meds.

  2. I have been diagnosed with bipolar 6 years ago. I have had 3 suicide attempts and 4 hospitalizations. I have all and all used 17 different drugs over the 4 year period and had ect done as well. I am bipolar 2 with ultradian cycling and unfortunately for me NONE of the drugs were in any form a life saver. Those who helped helped only for a while and many of them made the symptoms worse. Some would help only to make things worse. I wish so much that there was something out there that could bring me some peace but I have made peace with the fact that for someone like me , medication is unfortunately not the answer. I dont know what is and i dont know if my story will have a good ending. I wish you guys all the best though and am happy that you found treatment that works for you. As for me, i`m still waiting for the miracle drug to help me have some normality that last for longer than a few hours. 🙁

  3. well i took several meds cause i thought i had underlying problems like anxiety lol, stress, low self esteem, low confidence and motivation, possibly having adhd, and nothing worked, i came to the conclusion that i might have adhd because they say if you dont take of the disorder early it will take over you which i think its done that, im getting more frustrated with myself, the world, just living day by day seems meaningless going to college, getting low grades, even though i kind of know my interests i still dont want to establish my future cuz of the low frustration and motivation in doing things.

  4. Hi Simon,

    “Psychiatry still has a huge way to go and the science solution is stil VERY PRIMITIVE in terms of treatment options.”

    You’ll get no argument from me on this. Science/medicine is doing the best it can but the brain is still a black box in many ways.

    Yes, you are right, medication doesn’t help everyone. No argument here.

    – Natasha

  5. All very well and good but what if the patient encounters difficulties in use of drug treatment? I have vitiligo and Lithium AND anticonvulsants exacerbate the autoimmune disease. I’m left with zyprexa and stuff like that – packs on the weight in a matter of weeks and causes diabetes in a very short time. My blood sugar went high on it. Psychiatry still has a huge way to go and the science solution is stil VERY PRIMITIVE in terms of treatment options. Psychiatry is crap in my view. Many people are helped and many millions are not.

  6. Your objections on psychopharmacotherapy, Ms Tracy, as the dominant approach in current treatment of psychic disorders are truly provocative and interesting as well. By me as clinical psychiatrist, the main defect in the treatment of mentally illness is the utilization of identical guidelines of somatic medicine in psychiatric causality. Even psychiatry is medical branch, it posses some characteristic peculiarities that makes it different from somatic entities. Moreover, placebo-efect of any drug is entirely psychological effect, that till now isn’t regard with respect from basic and clinical investigations. And these features are due to complex biopsychosocial dimension of mental apparatus that becomes us functional creatures. For this reason, it should to have an integrity approach in the successful management of mental diseases, when medication with psychotropic substances should to be associate with psychosocial interventions. As long as psychiatry didn’t establish its specific clues in the research and clinical procedures, it will staying behind other medical branches, like cardiology, oncology, gynecology and so on. Decisive undertaking, in this direction, are scientific investigation in neuroscience, with these we would be able to treat better numerous mental illness.

  7. I almost went into a drug trial several years ago for bipolar at the University of Penn. At the time I was taking 6 different drugs for my illness. My doctor said that I would be committing “moral and physical suicide” if I discontinued the drugs I was on. Needless to say I did not participate in the trial.

    Since then I have cut down on some of my meds and have completely gone off some of my meds. The smaller cocktail I am currently on is working really well. I feel that all the work that went into finding the meds to help me was worth it. It sucked at the time but now I look and see that I can finally have a future staying on the drugs.

    My husband calls me a “drug addict” because of the drugs that I am still on now. He does not understand the nature of bipolar even though I gave him quite a bit of literature to read. He is stubborn and narrow-minded and I do what I have to do to feel better. It is so important for people with any mental illness to have the cooperation and understanding of those around them. For those that don’t have the support don’t stop doing what your doctor or therapist tells you to do. You need to be your own advocate in what very well may be the “fight of your life.”

  8. Hi Dan.

    Well I do. 🙂

    Well, OK, I don’t need them to know they work on me, but I’m a science-y gal and that science stuff matters to me.

    “For the millions of people out there on psychiatric medications, all they need is the realization that with these medications they are better, without them they are sicker.”

    You’re right, that always is the question. And all the science in the world doesn’t change that question. If you’re better off with meds, then you are, if you’re not, then you’re not.

    I tell people this all the time, because the door swings both ways. When people want off meds, it’s exactly the same question.

    I know my answer. Particularly right now. Answers, however, tend to be slippery. And that when that science-y stuff comforts me a little.

    – Natasha

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