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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

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19 thoughts on “Psychiatric Medication Doesn't Work”

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

  7. 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. 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

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