Psychiatric Medication Improves Lives

Advances in psychiatry have been rocky, with some innovations, such as prefontal lobotomy leading to disastrous misuse. Others, like ECT (Electroshock Therapy), have been refined after a rough introduction in the mid-20th century when it was poorly understood and sometimes overused. Novels and films like “One Flew Over the Cuckoo’s Nest,” which in 1975 won five Oscars, including Best Picture, have poignantly documented the abuse of these treatments.

Perhaps no intervention is more widespread than the use of psychiatric drugs. These too have suffered a lot of negative press, in part due to sometimes unpleasant side effects, like tardive dyskinesia, a neurological disorder that sometimes afflicts long-time users of anti-psychotic medications. Yet these medications continue to be widely prescribed because of their success in treating hallucinations and delusions, which are among the most debilitating of psychiatric symptoms.

The most dangerous psychiatric illness, however, is not psychosis but depression, which if left untreated wrecks lives and can result in death by suicide. Antidepressants have been shown to be consistently effective in treating major depression. Though it sometimes takes time and some tweaking of different medications, those who stick with it, and get help from a well-trained psychiatrist, are treatable. Still, there has been a lot of push back against antidepressants. When SSRIs (Selective Serotonin Reuptake Inhibitors) were introduced in the 1990s, they were considered revolutionary, in that they seemed to be able to treat a great variety of disorders. Not only did they help the acutely depressed patient, they also seemed effective in treating milder, more chronic low moods, as well as some kinds of anxiety and even obsessive-compulsive disorder (OCD). Peter Kramer, a Harvard-trained psychiatrist who teaches at Brown University Medical School wrote his book, Listening to Prozac, asking this question: What can we learn about the relationship between depression, anxiety, and other symptoms from the fact that these drugs seem to be effective for all of them?

SSRIs work by increasing the flow of chemicals called neurotransmitters between the synapses in the brain. They have been refined and reconfigured many times since Prozac hit the market, and they are now among the most widely prescribed drugs on the market. This has created something of a backlash, with critics arguing that we are over-medicated and reliant on pharmaceutical crutches. While this is certainly true often enough, psychoactive drugs are capable of relieving suffering and should not be lumped together as all bad. Not only can they improve people’s lives by lessening painful symptoms, they help restore functioning to emotionally constricted individuals and help them become more able to live up to potential.

The question often arises: Should people with “milder symptoms” be treated with medication? Shouldn’t they “tough it out” if possible? Many people have the feeling that what’s natural is best and if we want to be at an optimum level of health, don’t medicate if you don’t have to. Certain medications, however, restore us to what is actually a more “natural state.” An example is diabetics who need insulin, a medication that corrects a dangerous imbalance, restoring a more ‘natural’ state.

But surely psychiatric medications don’t work that way — many people assume — they are taken because people want to “feel better,” but are really an option rather than a health necessity. Kramer, in another book, Against Depression, refutes this idea with evidence that shows how untreated depression causes physical changes in the brain. The longer the depression, the bigger the changes. Upon autopsy, some areas of the brain are literally physically smaller in those who have been depressed.

But that still leaves the arguments against “designer drugs” for the mildly unhappy. Why shouldn’t these people learn to cope with their problems without these interventions? One reason is that some people suffer from chronic states of mild depression that they compensate for (i.e. function adequately, more or less) but are caused by the restriction of neurotransmitters in the brain. And while evidence exists that talk therapy alone can help improve the flow of these chemicals, for some the addition of medication can make a big difference — a difference that restores them to a more “natural” state.

A similar case can be made for those who suffer from obsessive-compulsive disorder. While cognitive therapy has shown to have some effect in treating this illness, it is often very responsive to medication, transforming lives of ritualized misery in a matter of weeks. Patients are “freed” to live more productively and enjoyably, no longer subject to these debilitating symptoms.

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