How much do we really know about the efficacy of psychotropic medications?

If there’s one thing I’ve learned over the years from my own experiences and those of others, it’s that there’s still plenty we don’t know about the brain. Beyond that obvious little tidbit, we have plenty of evidence to suggest that the same substance may help one person and harm another.

It goes without saying, then, that we can’t predict exactly how a particular substance will affect the brain of a particular person.

Having taken four different psychotropic medications–and having tapered successfully from the last one–I’m no stranger to both extreme viewpoints when it comes to the efficacy of these drugs. I went from being an ardent apologist for them to being an equally ardent member of the “I survived psychotropes in order to warn people away from them” camp.

Over time, though, I read enough stories about people who’ve actually benefitted from these drugs–in ways that I never had. And when I read responses by well-meaning but ultimately unhelpful people saying, “I know you think you’ve benefitted from these drugs, but that just proves how well these drugs work at blinding you to the damage they’re doing,” I found myself asking, “How the HELL do you know that for sure?”

Because they don’t. And I don’t. In fact, I’m not entirely convinced that a doctor on either side of the issue can know more about how effective a particular medication is for a particular person than the person taking it.

I don’t recall any real benefit to the medications I tried (Effexor XR, Zoloft, Celexa and–for about 2.5 years–Lexapro), but, along with the very real stories of people who’ve suffered horrific side-effects from these drugs, I’ve read plenty of other very real stories about people who credit their medications with saving their lives, saving their marriages, or just helping them through a rough time.

If my best friend were sitting next to me and telling me “If I hadn’t started taking <name of medication>, I’d probably be dead, now. That’s how bad it was,” I think I’d be more grateful that the drug was helping her than inclined to say something like, “Oh, honey, that’s the drug talking. I know you think it’s helping, but those drugs can only do damage.” I wouldn’t say that, because I don’t know that it’s true. At least, I don’t know that it’s true for everyone.

It seems those who believe that these medications are all objectively harmful–that the evil they do outweighs any “perceived” benefit–don’t like to hear stories of people who went from suicidal to hopeful with the help of one of these medications.

Likewise, those who believe that the benefit of taking a medication far outweighs the risks or the relatively mild side-effects they’ve experienced, don’t like to hear stories of those who’ve experienced horrific–even devastating–side-effects from taking one medication or another.

If all the varied stories from those who’ve taken these drugs can teach us anything, it’s that one person can benefit from a particular medication, while another person taking the same medication may experience only negative side-effects. Can either person tell the other, “That drug is poison. It can only do harm,” or “That drug is a life-saver! Whatever you suffered, it wasn’t from the medication.”

Nope. Because no one other than the person taking the medication can say with any certainty whether a particular medication is helping or hurting.

Granted, it’s easy to blame a medication for pre-existing issues that may be exacerbated by a medication. It’s also easy for those who’ve benefitted from a medication to assume that those who share their stories of increased suicidality, akathisia, tardive dyskinesia, and other unpleasant side-effects are probably exaggerating or have been brain-washed by scientologists.

I’ve read books written by Dr. Peter Breggin with real stories of people whose lives were made worse by these medications. I don’t discount them. I remember my own experiences.

I’ve also read books like Dr. Daniel G. Amen’s, Change Your Brain, Change Your Life, which details how SPECT brain scans reveal abnormal activity in certain areas of the brain, which have been tied to specific types of psychological distress. Dr. Amen has seen first-hand the effects of certain medications on people whose brains he’s scanned. The results of the SPECT scans–as well as what he’s gathered by talking to each patient–have helped him determine which medication was most likely to help a particular patient. And he shares stories of how those patients’ lives have been improved–often dramatically–by the medications he prescribed.

Is it possible that some of his patients ended up having to switch to a different medication when the original prescription failed to help them? Sure. I suspect most doctors who prescribe these drugs have had to prescribe alternatives when the first (or second, or third, etc.) medication didn’t work for a patient. The good doctors are more than willing to try something else if the first drug they prescribed isn’t helping someone as it should (when it maybe has helped other patients).

Honestly, while I don’t remember experiencing any benefit that outweighed the unpleasant side-effects of the medications I tried, I can’t honestly say for certain that no medication could have helped. Because I haven’t tried them all. Frankly, I don’t want to. Withdrawing from Lexapro took about six months, when I finally found a slow-enough tapering schedule. My doctor prescribed progressively lower doses, and my husband bought me a pill-cutter.

And I celebrated my freedom back in December of 2008.

But, yeah, I still struggle with anxiety. And even some depression, though I’ve never been suicidal. Not even when I was taking any of the medications.

Given a choice, though, I’m more inclined to try what’s called Cognitive Behavioral Therapy, which my doctor suggested as an alternative.

Unfortunately, our insurance doesn’t cover that.

The “cadillac plan” offered by my husband’s employer covers that, but that plan costs significantly more per month, and given our current financial situation, that’s really not an option.

So, since we still have internet access, I’ll be looking that up.

If you’re still reading this, let me know if you’ve learned anything about CBT. It sounds a lot like what’s called “the power of positive thinking,” but there may be more to it than that.

Also, if you have any stories to share, or if you blog about your own experiences in this area (psychotropic medications and/or therapy), please share your blog address as you comment below.

Looking forward to reading your story, too.

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6 thoughts on “How much do we really know about the efficacy of psychotropic medications?

  1. Thanks for your thoughtful post. I have had both good and bad experiences with meds as well. I currently do take one, but it forms only a small part of a holistic approach to my mental health: inner emotional and spiritual work are the cornerstones. CBT is useful as one tool among many–you can find the basics of it in David Burns’ book Feeling Good.

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    1. Thank you so much for the helpful book suggestion! I’ll be looking that up, shortly. And I wholeheartedly agree with the importance of spiritual as well as mental, emotional, and physical health. Any approach to healing should address the whole self. πŸ™‚

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  2. Wonder full post. I have tried 4 meds for Clinical depression and they didnt work. The placebo effect was usually the reason that I felt better immediately.
    I found alternative methods for healing the wounds that are the root of my depression and work with them now.
    I think trying to think or act our way out of dis-ease is myopic and not self-centered but outward centered, which I think is only putting a band aid on a open gash.
    Our blog is at shoe1000.wordpress.com

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    1. Thanks for the thoughtful reply. I’d be interested to know more about the alternative methods you mention, so I’ll be visiting your blog shortly. πŸ™‚
      Also, though I haven’t tried CBT, and my only experience with therapy was less than encouraging, I do believe that our thoughts (spoken or otherwise) and our actions affect our minds–for better or worse. Still, I think I see where you’re going: focusing only on our external action and words isn’t enough to address deep-seated emotional pain.

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