(3 minute read)
A few weeks ago I wrote about the hidden underbelly of the antidepressant medication world; how the research is tainted, the placebo effect entwined with the drug effect, the withdrawal symptoms that can occur and the fact that the whole premise of many antidepressants — that they address an insufficiency of serotonin in the brain — is false.
You might say "Perhaps antidepressants are a problem, but there are lots of other medications that work for other problems." Let's have a look at that by examining the three other major classes of psychoactive drugs:
Anxiolytics
This is a fancy name for anxiety-reducing drugs. Lots of drugs can reduce anxiety — alcohol and marijuana, at least in the short term, are examples — but when the medical profession talks about anxiolytics, they generally mean a class of drugs called Benzodiazepines. You might have heard of the more well known brands such as Xanax, Klonopin and Ativan (or Alprazolam, Clonazepam and Lorazepam, to give them their chemical names). You might have heard of Valium and Librium from earlier years. These have been big, big sellers for many decades.
The good news is that they work. We even know how they work: They enhance the activity of a brain chemical called GABA, and since GABA helps slow down brain activity, Benzos calm you down. The first time people take them they can feel absolutely wonderful, which is why the medical profession jokes that this is one class of drug where patients don’t ever skip their dose.
The bad news begins with the fact that the longer you take Benzos, the less they work. Your brain habituates to them, and pretty soon you need to increase the dosage in order to get the same effect. Sadly, there’s a limit to how much you can increase the dosage, because at a certain point, it has a very nasty side effect — you die. So now you’re stuck, taking a big dose of a drug that in as little as four months has lost its effect. Then, when you try to reduce your dosage, you might get something called rebound anxiety. Your brain has gotten used to its artificial level of GABA enhancement, and has returned to its previous level of anxious activity. When that GABA enhancement is removed, the brain goes into overdrive. Your anxiety is back: not just the way it was before you started the drug, but WORSE. Sometimes much worse.
Benzodiazepines are very dangerous drugs indeed, and that’s become increasingly recognized by the popular media Not only are they addictive, not only do they often cause terrible withdrawal symptoms, they also have a long list of pretty unpleasant side effects. And if you combine the drug with alcohol, overdose and death are not uncommon.
Does this mean no one should ever touch a benzodiazepine? Absolutely not. Used judiciously for specific situations, they can be both appropriate and effective. If you’re feeling very anxious about going home to visit your difficult parents for a week, or terribly worried about an upcoming performance review at work, or have to give a speech when you hate public speaking — these are times when a pill can lower your anxiety to tolerable levels and enable you to do what needs to be done. But if you find yourself using it week after week, you are probably heading for trouble.
Stimulants
These are drugs that are best known for producing a sense of energy, alertness and well-being that many people enjoy. At one end of the spectrum lies caffeine; at the other, illegal drugs such as cocaine, amphetamines, methamphetamine and the like. But where the medical profession gets involved is in prescribing stimulants for Attention Deficit Hyperactivity Disorder (ADHD). The most actively marketed have names such as Ritalin, Adderall, Concerta and Vyvanse.
Stimulants most definitely have an impact on our mental state, as anyone who’s experienced a jolt from a morning expresso can vouch for. And these ADHD drugs have that same impact. Children and adults become less distractible, more able to focus and can therefore get more work done. If you’re prescribed one of these drugs and you find yourself working more effectively (or if your child is getting their homework done), you may be tempted to think you’ve got ADHD. After all, if you didn’t have the condition, the drug wouldn’t work on you, right?
Wrong. Stimulants work on pretty much everyone, so you don’t need to have ADHD in order to find a benefit from ADHD drugs. Unfortunately, that benefit comes along with side effects. (I’m hoping you're getting the picture that there’s no such thing as a drug that doesn’t have at least some side effects.) So if you want to be more effective at the office, you’ll need to be prepared to handle a long list of other issues including sleep problems, upset stomach, weight loss, irritability, headaches, flat affect, fatigue, tics and so on. (For a complete list of side effects look here.)
ADHD drugs can also be misused. Widely available, it’s easy to take far more than prescribed, or even to crush tablets and snort them, thus delivering a cocaine-like buzz due to the rapid absorption of the drug.
If you’re considering giving stimulants to your child because of an ADHD diagnosis, you should read this first.
One last problem: stimulants are addictive, both physically and psychologically, although if used according to a doctor’s instructions, addiction is unlikely to be an issue.
Anti-psychotics
Despite their name, these drugs are not just given to people who are psychotic (ie. have lost touch with reality). Increasingly, they’re given to people with anxiety and depression. The most notable brand names include Abilify, Risperdal, Seroquel and Zyprexa.
The main thing to note about these drugs is that they have a list of pretty terrible side effects. While these are less likely at the low dosages generally prescribed for anxiety or depression, these are not risks to be taken lightly. And if you have a person in your family who suffers from bipolar or schizophrenia, be aware that some of the worst side effects are not reversible: even if medication is stopped immediately, the side effects remain for life.
First generation antipsychotics were developed in the 1950’s. If you’ve ever seen One Flew Over The Cuckoo’s Nest, you’ll know what drugs like Thorazine and Haldol can do to a person over time. It’s not pretty. Fortunately, the pharmaceutical industry came up with a new class of anti-psychotics, helpfully dubbed “Second Generation”, into which class the likes of Abilify, Risperdal and the others fall. Unfortunately, an enormous study sponsored by the National Institute of Mental Health in the USA in 2005 demonstrated that there was, with one minor exception, no difference in side effects or effectiveness when treating people with schizophrenia. Second generation anti-psychotics are no better for consumers than first generation. They are, however, much more expensive, so they do have a positive effect on the bottom line of the pharmaceutical industry. Which is why that industry works very hard to conceal the terrible things their drugs can do to people.
It’s worth noting that studies looking at outcomes of patients with schizophrenia found that third world countries do better than first world. While papers have been written ascribing this odd finding to culture, a more obvious possibility is the fact that in third world countries, anti-psychotic medication isn’t widely available. Is it possible that the long term effects of taking these drugs is worse than the disease itself?
Summary
The situation with psychoactive drugs isn’t good. If you’ve read my earlier article on Antidepressants, you’ll know that they don’t work much better than a placebo. You now know that medication can help with anxiety, attention problems and psychosis — but that the side effects and/or addiction potential are so great that you probably don’t want to go there except for short periods of time.
You may be frustrated that the pharmaceutical industry hasn’t served us better. To be fair to them, they’ve struggled to come up with drugs that work and don’t have terrible side effects, and they’re frustrated too. Which is why they’ve cut research spending on these types of drugs by 70% over the last decade. It turns out it’s awfully hard to develop a drug that does just one good thing to the human brain without doing a whole lot of other not so good things.
Fortunately, the research proves that most psychological problems improve over time, and that exercise and psychotherapy are very effective in speeding up that improvement. So next time you are feeling depressed, anxious or can’t focus, don’t reach for a pill — go to the gym or call your therapist. Better yet, do both.
If you enjoyed this article, you might also be interested in How The Science Of Mental Health Fails Us: Psychiatrists, Drug Companies and Universities