Medication is Not Addiction: A response to a misinformed column

I spent way too much time on Sunday on Twitter, joining a chorus of voices who were yelling at David Lazarus, a columnist or the Los Angeles times. Lazarus wrote a column in which he discusses his own experience at trying to withdraw from anti-depressants. The title of the column? “Hi, I’m David. I’m a drug addict.”

Yep. Only went downhill from there.

Ironically, Lazarus discussed important issues like the over prescribing of medication, failure to adequately warn patients about side effects and discontinuation syndrome. These are real, important issues. They merit serious, thoughtful consideration. Instead, Lazarus decided to call millions of Americans (like me) drug addicts. He esoterically wondered “Who am I, really?” about taking anti-depressants. It’s a tragic, misguided view, one which reinforces stigma and will prevent people from getting help they need. And the language used by Lazarus is just appalling. If I’m a drug addict, so is everyone else who uses medication to survive for any other condition.

Really, this is just an ugly article.

I wrote a response which the Los Angeles Times did not accept, citing their policy to not run op-eds in response to other op-eds. Fair enough. My response, then, is below.

Don’t believe crap like what Lazarus decided to spew. Medication can be a vitally important part of any therapeutic regimen. It has saved thousands of lives.

Let’s say you are a diabetic and require insulin to live. One day, a friend tells you to quit insulin. Stunned, you ask why. Your friend responds: “Well, you can’t live without insulin. That makes you a drug addict.”

That’s absurd, right? Taking a prescribed medication in recommended doses doesn’t make you a drug addict. That makes you a responsible adult.

But the above scenario would never really happen, right? No one would ever claim that taking medication to treat diabetes, Parkinson’s or Alzheimer’s would make you a drug addict.

But, apparently, such an understanding does not apply to the millions of Americans who take medication to manage mental illnesses. To Americans like me.

For eighteen years, I’ve been diagnosed with a major depressive and generalized anxiety disorder. I’ve been suicidal. The medication which I take, in conjunction with therapy and lifestyle changes, has saved my life.

About five years ago, I made the decision, as a Pennsylvania State Representative, to start discussing my battles with depression, anxiety and suicidal ideation. I did so in response to the stigma which surrounds mental illness. Depression isn’t a weakness. It can’t be willed away. Taking medication doesn’t say anything about one’s character any more than having heart disease indicates a moral failure.

That’s why I was so disheartened to read Mr. Lazarus’ column: It took serious issues like over-prescribing  and discontinuation syndrome – issues which deserve thoughtful, reflective discussion – and conflated them with drug addiction. To be sure, medication is not a panacea. It often takes months, if not years, to find appropriate medication and dosage. Prescribers sometimes fail to appropriately monitor their patients. Side effects are real and dangerous. All of these issues demand thoughtful consideration and conversation.

However, such problems exist in virtually all areas of medicine, and no one would reasonably or seriously suggest that we should stop prescribing scientifically proven medication to people in need. Yet, that is exactly what some suggest when it comes to mental health.

Mr. Lazarus refers to himself as a “drug addict” for taking anti-depressants. Yet, he also discusses being a diabetic who takes medication for chronic Type 1 diabetes. Strangely, he declines to refer to himself as a “drug addict” for requiring insulin to manage his blood sugar levels. I wonder why.

We should never, ever be so foolish as to conflate appropriate use of anti-depressants with drug addiction. To do so makes people who take anti-depressants to live sound like sound like a caricature of a drug addict, desperate for their next hit of smack…or, as I like to call it, the pills which help me not want to kill myself every morning.

Contrary to what some believe, anti-depressants are not happy pills which whisk you away on a cotton-candy cloud, carrying you to Lollipop Island to float with gumdrops all day long. What they do is help you control symptoms, improve your mood and make other forms of change – like psychological therapy and lifestyle changes – easier to obtain.

Taking medication for mental illness doesn’t change who you are. It allows you to be who you are.

Far too many Americans have ignored their own minds and medical advice, choosing to try and “tough out” spells of depression, to “man up” or ignore these painful and rehabilitating symptoms. Too many Americans have powerful fears that taking anti-depressants makes you weak. This stigma must be crushed and rebutted in the same way intelligent society has pushed back on those who attack vaccines.

Anti-vaxxers and those who deny the positive impact of anti-depressants are flip sides of the same coin: They seek to use pseudoscience and stigma. Science has given us incredible tools which can be used to our great physical and emotional benefit. To ignore those tools, or to somehow wrap their use in shame, serves only to pull us into a darkness which we should have left behind decades ago.

The nearly 1 in 5 Americans who suffer from mental illness – including me – deserve to have our challenges discussed with respect and a comprehensive understanding of mental health treatment options. This discussion is simply incomplete without discussing the importance, effectiveness and risks of medication. No one who takes an anti-depressant is a drug addict, any more than a person who takes Prilosec for heartburn is addicted to not having their chest feel like is on fire.

The facts are stark. Depression rates are skyrocketing, rising sharpest among today’s youth, who have seen nearly 50% increases in rates of depression. 47,000 Americans – and 2,000 in my home state of Pennsylvania – died by suicide last year, an increase of 34% since 1999.

We need serious, sober conversations about mental illness and how to treat it. There are many concerns with anti-depressants. These are valid, serious concerns which must be addressed. But these conversations must occur using words and arguments which shatter stigma and support science. To do otherwise does an incredible disservice to those of us who suffer.

 

A new nasal spray for depression

There’s a new anti-depressant treatment now available: Spravato. It’s related to Ketamine, and if it sounds familiar, there’s good reason for it: It’s biologically related to the party drug “Special K.”

Obviously there are major differences. This drug is a nasal spray and actually given in doctors offices – in other words, you won’t be taking this one home and having it in the morning like a standard anti-depressant. That is because, per this Vox article:

….because it can sedate patients and bring on out-of-body experiences, the FDA is only making it available through certified clinics, where patients are to be monitored for at least two hours after taking the drug.

This drug is meant for “treatment-resistant depression” – meaning those who have tried at least two other major depressant treatments and not had their depression ameliorated.

Operators of these clinics – no surprise – were overwhelmingly supportive of the FDA approval. From a USA Today article:

“This is an enormous deal in terms of access to care,” Levine said. “And the degree of advancement can’t be overstated. This is truly the best new option in over 60 years. And more will be coming down the pike.”

Treatment doesn’t work like standard medication. The same USA Today article told the story of Jonathan Herbst, who credited the drug with saving his life:

A financial services manager in Philadelphia, he began ketamine treatments in August – five or six treatments in the first two weeks, then one maintenance treatment every three or four weeks.

Are there side effects? You bet, and they sounds like a very fun time! They include: feeling disconnected from mind and body, dizziness, nausea, sedation, vertigo, decreased feeling or sensitivity, anxiety, lethargy, increased blood pressure, vomiting, and feeling drunk. Additionally:

The FDA warned that esketamine distribution will be tightly controlled due to the potential for abuse, suicidal thoughts and sedation along with possible problems with attention, judgment and thinking.

It’s also worth noting that this drug’s approval did not come without real controversy over its effectiveness. This drug was approved after four clinical trials – three of which lasted only four weeks – and two of those short-term studies “did not meet the pre-specified statistical tests for demonstrating effectiveness.”

What do I think? I honestly have no idea. As usual: I’m not a Doctor. Go talk to your Doctor if you are interested. All I’m trying to do here is update my readers about this new drug. If you have treatment-resistant depression (high five, fellow sad people!), it is certainly worth exploring this option. Just be aware, however, that it’s still a relatively new drug with real side effects and some questions about its effectiveness. At the same time, however, there is clearly enough evidence to warrant its approval by the FDA, and there are absolutely people who credit this drug with making major improvements to their life.

And, as always: If you’ve had any experience with ketamine (good or bad!) or any thoughts to share, please write them in the comments below!

Why the idea of a “pill for loneliness” has me nervous

I came across this article in The Guardian: Scientists are apparently working on a pill for loneliness.

The article does a great job of noting a fundamental truth about humans: We are social creatures. When we are denied social interaction with others, we become depressed and lose our ability to function. As a result of societal changes, a changing family and work structure, the increasing business of human life (and more!), humans are spending less and less time with others. We’re spending more and more time by ourselves. This has frightening implications for our ability to function as a society and as individuals.

Loneliness is bad for you. This is something which The Depression Cure concentrates on, and the Guardian article correctly notes:

Loneliness elevates our risk of developing a range of disorders, including cardiovascular disease, neurodegenerative diseases, cognitive decline, and metastatic cancer. It also weakens the immune system, making us more susceptible to infections. Left untended, even situational loneliness can ossify into a fixed state that changes brain structures and processes…

The cure, in my opinion, has to start on the individual level. We have to prioritize getting off the damn phone and spending time with others. It is very much within our ability to change our lifestyles and re-prioritize how we use our valuable time. The change won’t be easy, but it will come.

That being said, there’s a “promising” line of research creating medication which would “interfere with the ways loneliness affects the brain and body.” Initial studies have shown that the medication reduces perceptions of loneliness among those who take them.

This has me really, really itchy and uncomfortable.

Look, let me just clarify something: I am very pro-medication for treating depression. I’ve been on anti-depressants for almost half my life and I know that they have saved my life. They’ve given me an ability to function which I never would have had otherwise. Medication, combined with therapy, can give someone their life back.

But, that doesn’t mean that we should default to medication when other options are available.

I’ve taken medication for depression – along with millions of others – because traditional therapy wasn’t enough. I viewed it not as a first resort, but as a second/third one (I wouldn’t even say last because there are more intensive forms of therapy, like ECT). But the notion of someone being lonely and turning to a pill has me uncomfortable because there are less radical options which are relatively easily available. 

People who are lonely can undergo a slew of social efforts in order to meet people. Sometimes, this means making yourself attend classes or events. Other times, this means picking up the phone and calling someone in your social network and redeveloping a preexisting connection. But, more often than not, there are ways to deal with loneliness. That’s why I’m nervous here. We can’t just turn to pills to fix something when there are other solutions available.

I suspect I am not completely understanding this. There is something in the article about how taking the medication can actually help people reconnect with others – loneliness can work like depression in that it can create a “cycle” of loneliness – you get lonely and feel too “stuck” to fix it, so you don’t connect with anyone and you withdraw further from your social circle, and then you get more lonely, etc. I get that. But I fear that a pill to cure loneliness will, in the long run, just make us all more lonely.

This is one of the more controversial things I think I’ve said lately about depression and medication, so I’d be curious to hear what you have to say. Am I right or wrong? Let me know in the comments below!

The danger of Benzodiazepians

If you’ve suffered from any sort of mental health disorder, odds are good you are familiar with Benzodiazepians (aka Benzos). Benzos are a class of drugs which are used to treat anxiety and a slew of other conditions, including insomnia, seizures and more. In the short-term, they can be very helpful in getting people through panic attacks. Personally, I’ve used them in the past for rip-roaring anxiety attacks, and they can be helpful in getting through the worst of these condition. When taken in conjunction with therapy or other long-term medication strategies, they are a useful tool in treating mental illness.

Use of benzos has dramatically increased. From 1996-2013, the amount of adults prescribed benzos increased 67%, going from 8.1 million to 13.5 million. Those increases are also seen among individuals who have been prescribed opioids – and that has led to overdose issues.

According to government research, over 30% of opioid overdoses also involve benzos:

Line graph showing causes of death from opioids, benzodiazepines and opioids, and opioids without benzodiazepines between 1999 and 2015

 

Meanwhile, overdose deaths from Benzos have shown frightening increases of late:

Number of Deaths Involving Benzodiazepines

There is also evidence of late that shows that Benzo prescriptions for those with PTSD may increase suicide risk, and that use of Benzos may be tied to an increased risk of Alzheimer’s.

So, am I telling you to throw away your Benzos? No, no, and hell no. When used under a doctors care, and responsibly, Benzo medication can be an important part of any therapeutic regimen. Candidly, when my anxiety was at it’s peak, I walked around with tranquilizers as a “just in case.” Knowing I had those to fall back on gave me the confidence to continue my daily routine in terms of my school, work and social life. If I hadn’t had those, I would have had major difficulties functioning. Eventually, modifications to my regular medication and therapy helped me address my anxiety issues, ones which (thankfully) have not come back.

Benzos can be helpful – you just need to be careful in how you use them!

PS: GO VOTE TOMORROW!

Study: Depression can be treated with…anti-inflammation drugs…??

A friend was kind enough to send me this article, and this one is too strange sounding not to share: According to a new study, depression is “a physical illness caused by a faulty immune system” that can be treated with anti-inflammatory drugs.

From an article on the study:

Current treatment is largely centred around restoring mood-boosting chemicals in the brain, such as serotonin, but experts now think an overactive immune system triggers inflammation throughout the entire body, sparking feelings of hopelessness, unhappiness and fatigue.

It may be a symptom of the immune system failing to switch off after a trauma or illness, and is a similar to the low mood people often experience when they are fighting a virus, like flu.

“In relation to mood, beyond reasonable doubt, there is a very robust association between inflammation and depressive symptoms.  We give people a vaccination and they will become depressed. Vaccine clinics could always predict it, but they could never explain it.

According to the article, more tests will begin next year to see if anti-inflammatory drugs can help alleviate depression.

Obviously, this piqued my curiosity, so I did a little bit more digging.  First, this area of study isn’t new – there are studies dating back at least six years that would support the notion that inflammation and depression are linked.  From that article:

Previous studies have linked depression with higher level of inflammatory markers compared to people who are not depressed. When people are given proinflammatory cytokines, people experience more symptoms of depression and anxiety. Chronically higher levels of inflammation due to medical illnesses are also associated with higherrates of depression. Even brain imaging of people with depression show that their brain scans have increased neuroinflammation.

The article went on to recommend that everyone take anti-inflammatory steps (which are good for you regardless), including better diet, stress reduction, exercise, mind-body exercises and breathing exercises.

This is new to me, and fascinating.  That being said, it makes me nervous.  I’ve always operated under the assumption that depression – and mental illness in general – are not caused by – or treatable with – a single bullet.  They are a combination of things: Genetics, stress levels, thinking patterns, etc., that make someone mentally ill.  As such, the notion that one thing – inflammation – could be the cause of depression – well, it gives me pause.

It would be so, so wonderful to be wrong!

Two points about this research, and understand, please, that they are coming from a layman, not a doctor!:

First, more tests are required, so don’t run out and buy an anti-inflammatory today.  More information, specifics and treatment options are still needed.  For now, keep going to therapy and taking your medication, darn it!

Second, let’s say, for a moment, that future studies confirm a connection between inflammation and depression.  That does not (necessarily) mean that you should stop taking your medication or going to therapy.  Remember, all body-mind reactions are a two way street.  Yes, your body can affect your mind, of course, but the way you think can affect your body.  When you are scared, your heart rate accelerates, your breathing speeds up and you get sweaty.  Don’t think that being depressed, having negative emotions or damaging thought processes can’t potentially cause the inflammation that causes depression.  I’ve always believed – at least for me – that a combination of medication and therapy are the best way to deal with depression.  If you believe that too, don’t think that therapy will no longer be necessary just because you take some pills that can make the swelling go down.

This is fascinating.  And potentially hugely promising.  I can’t wait to track more information about this, and I really hope that this can provide people with real relief in the future.