The Stark Reality of Medication Treatment-Resistance
Years of presenting Psychopharmacology seminars and writing this newsletter have resulted in my receiving thousands of e-mails. Here’s an example of a recent one:
“Dr. Wegmann, I’d like to ask you about the new antidepressant Fetzima. I’ve been taking it since January of this year, and although I got off to a good start with it, here I am beginning to taper off. My anxiety is as high as it’s ever been, and I can barely stand being in my own skin. I have GAD and depression, and it now feels treatment-resistant. My anxiety is primarily the ‘I dread everything type.’ I have isolated myself mostly… I go to work, and come home. That’s it. I see a psychiatric NP. Last month we tried Buspar in addition to Fetzima, but I had the worst heartburn and stopped taking it after a week. I have only had a good response to Effexor, however it stopped working in 2011. I have been in a downward spiral since then.”
I’ve received so many of these that read exactly the same way, only the senders are different.
Psychotropic medication resistance has doubled every five years since the early ’80s and there has been a 3000 percent increase in reference literature that addresses treatment-resistant psychiatric circumstances during the above-mentioned time frame. Affected people are increasingly being viewed as primarily a complex series of neurobiological pathways that need to be untangled, activated, inhibited or massaged in some way. And this is referred to as “evidence-based” practice — a term that I find wanting. Given these resistance numbers, I’m hard-pressed to call this “evidence” of people being helped.
I’m concerned that some in our profession aren’t advocating for mental health, but instead remain mired in a mental illness model. I’m concerned that objectifying patients in a reductionist way – no more than a compilation of the signs, symptoms and complaints they present with – slows progress toward getting them where they want or need to go. Health is about helping patients achieve self-mastery, organizing their lives and taking charge of themselves; not reaching into the medication grab bag to find another drug to tame a pesky or emerging symptom. So that means NOT treating symptoms pharmacologically because doing so would deter a patient from taking steps to find the courage to explore what THEY need to do to get the engine of change moving steadily forward – instead of hoping and wishing for drugs to do it for them.
The saddest part about the e-mail example that I cited above is that this individual has come to rely on Fetzima, Effexor or whatever to do what only other people can do. Dread feeds social isolation, and the two together fuel a lousy attitude and apathy. And since social interaction isn’t part of the equation here, all this person has left are the pills. As such, here’s somebody who isn’t going to arrest his/her depression and anxiety because medication use has replaced healthy relationship development.
Climbing the rungs on the neuroscience ladder yields a two-fold outcome. The science reaches new heights but also eventually encounters unforeseen roadblocks — testing the limits of how far it can take us. The paradox of evidence-based pharmacological practice is that far too many patients aren’t getting better on medications, particularly antidepressants.
Ideally, various treatment disciplines would apply good, old-fashioned doses of common sense. Non prescribers would caution patients about the limits of psychotropics and focus on psychosocial interventions to generate improvement, as they routinely do; and prescribers would exercise restraint and write prescriptions only when there is a clear rationale for medication utilization. I’m dubious about the latter happening.
The last thing we need is for certain classes of drugs in psychiatric medicine to become the antibiotics of physical medicine.
Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.