budge wrote:
>
> On Fri, 8 Aug 2003 at 9:55am joanna bujes wrote:
> >
> > My own experience bears this out. The drug companies push
> > drugs as the cheaper solution, but the truth is that in
> > the long run they are not. My mother has been on
> > anti-psychotics for thirty five years, and she will take
> > them until she dies. That cannot possibly be cheaper than
> > a couple of years of analysis/therapy. Oh, and while this
> > drug regimen has kept her from going over the edge, it has
> > done absolutely nothing for her agoraphobia or her
> > anxiety. The side effects, they are plenty and not
> > pleasant.
>
> I do not know your mother (or whether she is indeed
> psychotic), but this paragraph betrays a serious
> misunderstanding of what psychosis is and how it is
> (effectively) treated. Even the Fruedians gave up the
> misguided notion that schizophrenics can be "talked out of"
> their psychoses, oh, about 50 years ago.
>
There's hardly a single medical treatment that is not (with varying frequency) used when not appropriate or when the side-effects are greater than the original ailment. I particularly like my orthopedic surgeon because of her commitment to using the least destructive and/or invasive treatment. [Amusing story on that which I will append to this post.] This is undoubtedly even more the case with mental illness (in respect to _both_ pharmacological _and_ therapeutic treatment: It is not just Freudian analyses that can go on too long). The side-effects of the medications used for both schizophrenia and bipolar can be very serious -- but the impact of those two mental illnesses is so destructive (almost always in the case of schizophrenia; very often in the case of bipolar), that it would be worthwhile to refuse drugs only if the side effects were worse than death.
Depression _can_ be accompanied by psychotic symptoms, and there is a separate illness labelled "schizo-affective disorder: I don't know much about it but it seems similar to depression plus voices. The most common "message" those voices carry is "You are worthless." I don't know how much therapy alone can aid with psychotic symptoms of non-psychotic illnesses. One friend in the support group, a woman in her forties, has fibromyalgia in addition to depression, the fibromyalgia developing whenever she gets a sinus infection. (She then uses a motorized wheelchair for several weeks.) She also hears voices (not for the last year or two), which tell her how worthless she is.
(It's my understanding that the classification "psychosis" is no longer used; rather the term "psychotic symptom" is used for a number of symptoms which can occur with various illnesses (always with schizophrenia and schizo-affective disorder, occasionally with other mental illnesses, especially bipolar but also depression.???)
Incidentally, the question of anti-depressives not quite identical with the question of SSRIs. As Miles pointed out, there are other neurotransmitters than serotonin involved in depression -- probably including neurotransmitters the existence of which has not been discovered. One AD used in Europe _blocks_ the flow of Serotonin, but is still effective for many. An article by Northwestern University professor of psychiatry on Medscape, taking off from the success both of conflicting medications and of ECT, and arguing also that we still don't really know much about depression, suggested that the effect all these techniques had was simply giving a jolt to the brain. (ECT of course is _the_ controversial treatment. I know several people who had it and have flourished since ECT, after being on the verge of suicide. I also know patients who have not been helped and still had their memory damaged. But then depression itself damages memory.
My own experience offers no evidence either way on ADs -- no one's personal experience does, since there are too many variables that can't be controlled for. My first experience, however, while not evidence, was dramatic. I had had to cease my first AD (dysarel) because of medically unacceptical side effects, and began slowly building up on a second one (the only one available at the time), Elavil, starting at 50 mg & moving up 25 mg every 5 days. By the time I reached 100, I was slipping down hill, & at a Thursday afternoon class about 10 minutes into the hour my voice started slowing down (intervals between words expanding) & simply stopped. I had to dismiss the class. The next morning, at 5 minutes to 9, I was sitting in my office wondering how the hell I was going to get through the next hour (it had been days since I had been able to do any class preparation). And then with nearly an audible snap, my mind was back. No trouble that hour or for the rest of the semester.
Carrol
P.S. re my orthopedic surgeon. When I was carried into the ER with a broken hip in January 1990, they asked me if I had any preference for a surgeon. I gave the name of a man who had treated a sprained (possibly broken) ankle for me 30 years before and was told he was in Florida but his daughter was now part of his practice. So I said o.k. Later when Jan was talking to me & I gave her the name of the surgeon I had chosen, she said she thought she had heard a negative report on her but couldn't remember what it was. Oh Well. But later Jan remembered what it was. Another woman working at the P.O. had had back pains and had gone to Dr. Judy Wright. Wright had taught her some exercises -- _and cured her back trouble_, but the woman was disturbed anyhow because Wright had not operated! Apparently some people feel cheated if they are treated without surgery, even if the treatment is successful.