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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.

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19 Responses to Psychiatric Medication Doesn’t Work

  1. Lisa says:

    Natasha, thank you so, so much for this, once again, well-written article. I can not express to you how timely it is. I am putting together an information packet for my dad to try to help him understand my illness from both a clinical and personal standpoint. (He doesn’t have a computer and lives 4 states away, or else I’d just point him to the right sites!) I have already included some of your older posts in the packet as a way to explain to him how I feel (I hope that’s ok!), but his biggest issue is and always has been with the medications themselves. He doesn’t understand the need for them or so many of them and I haven’t been able to put it into words for him. But this post puts it quite succinctly without being preachy or defensive. Thank you so much for all the good work you do. It definitely does not go unnoticed or unappreciated.

  2. Miriam Hyde says:

    Excellent.

    I, too, owe my life to the medical providers who patiently ran me thru different meds until finding the right combination for me. I was down-hearted and frustrated by all the time it took, and the time I lost to my bi-polar, but it was worth it in the end.

    I’ve now been 99% stable since early 2000. I’ve never had this kind of response before. More, I’ve never been able to live life like this before.

    No one can tell someone else what to do or not do. But when I am asked, I always say that without the right medications and support, I wouldn’t be here today.

  3. Hi Lisa,

    In my perfect world, everyone would understand and wouldn’t need a packet.

    In my slightly less perfect world everyone who needs one would get a packet, and I’m honored to be part of yours. If I can express what’s going on for you, then my job as a writer has been successful.

    This may also be helpful, I’ve written about what it feels like when the meds work. I think it’s compelling and it might help get the point across. The following link is to my personal blog and is in no way affiliated or endorsed by HealthPlace: http://natashatracy.com/mental-illness-issues/feel-psych-meds-work/

    - Natasha

  4. Hi Miriam,

    “I was down-hearted and frustrated by all the time it took, and the time I lost to my bi-polar, but it was worth it in the end.”

    That’s pretty common. Hopefully all the “ends” are as successful as yours has been.

    “I’ve never been able to live life like this before.”

    That’s one of the things that people gloss over about mental illness treatment. It’s not a “feeling” that gets better, it’s your whole life because suddenly you’re not using every molecule of energy just to survive. When you’re well, you have energy and time and brain-space to live the life you want instead of simply survival.

    Thanks for bringing that up.

    - Natasha

  5. It is fashionable today to question the benefit of psychotropic medicine. Many people “go bare” for a variety of reasons. (In the world of drug and alcohol abuse they become what we call “dry drunks” – i.e. – the psychological issues at the root of their mental illness do not improve.) — Of course, prescribing medication for mental illness is a blend of art and science; technically challenging. — But. — To say they don’t work is simply ridiculous. I have been taking Lithium for over 20 years – and other drugs as well – and – in combination with “talk therapy”, have gone from being nearly destroyed to mastery to peace of mind to phun. And I am far from alone, I have met so many nice people who – like you – owe their very lives to carefully prescribed and managed meds.

  6. hicksrobin42 says:

    All I can say is that the “meds” saved my life, and my entire treatment team at the V.A. tends to agree!

  7. Ash says:

    Honestly… without medication, I would not be here right now. Some days I wish that I’d never started taking it (those are also the days when I wish I was dead. I still have those, but less frequently while on medication), but most of the time I’m glad I made the decision. I’m slowly gaining back control of my life.

  8. Dan says:

    I don’t need clinical trials, studies, research, or somebody’s opinion to tell me whether or not psychiatric medications work. I have been taking psychiatric medications long enough to know which ones work on me and which ones don’t. And to what extent they work, or don’t work. When I am suicidal, or manic, certain medications save me from the brink. When I am somewhat stable they keep me from falling back into the throws of depression or the craziness of mania. That’s all the proof I need. 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. The proof is in the results, period.

  9. Hi Alistair,

    “It is fashionable today to question the benefit of psychotropic medicine.”

    Yes, I suppose it is fashion as much as it is anything else. Perhaps I’m trapped in someone’s ill-fitting fall line.

    “And I am far from alone, I have met so many nice people who – like you – owe their very lives to carefully prescribed and managed meds.”

    Yes, and it’s nice to hear from these people here and there so others know it can happen. It’s not just a myth. It’s not just a “big-pharma” conspiracy. People do get better with meds. It’s a long, brutal, often horrific journey, but it happens and many are living proof.

    (As you mentioned, complimentary therapies are important too :)

    - Natasha

  10. Hi Ash,

    “Some days I wish that I’d never started taking it (those are also the days when I wish I was dead.”

    I know that feeling. As much as I know meds help. They have helped in the past and will likely help again, some days I really wish I’d never heard of them. But I agree, it’s that dark, nasty “die now” voice that’s saying it, not particularly one that’s grounded in the real world.

    It’s great you’re getting control back over your life. Everyone, crazy or not, wants that.

    - Natasha

  11. 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

  12. Kate White says:

    Good one, Natasha! Bizzarios it is indeed.

    (i’m so stealing that word, btw.)

  13. 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.”

  14. Dr Musli Ferati says:

    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.

  15. Simon says:

    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.

  16. 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

  17. hoot3 says:

    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.

  18. Steph says:

    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. :-(

  19. Phil Jordan says:

    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.

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