ON MENTAL ILLNESS: Medication is Not Always the Magic Bullet

By Jack Bragen
Friday November 02, 2012 - 09:14:00 AM

Taking medication is important for most people who suffer from a psychiatric illness. Since these illnesses are usually caused by a brain malfunction, they (the psychiatric illnesses) must be addressed by addressing the problem. Mental illnesses are believed to be caused by an imbalance of neurotransmitters in the brain. Psychiatric medication changes the balance of neurotransmitters. 

It may be impossible with current medical technology to fix the balance of neurotransmitters perfectly. However, if the medication is functioning ideally, it gets the person's brain into the "ballpark" of normal functioning. 

Psychiatric medications are currently not developed enough to be site specific. This means that in order to correct a problem in one area of the brain, you're introducing a change to the entire brain with the medications. For example, if a person is psychotic, there is a specific area near the middle of the brain that is believed to have excessive dopamine and/or serotonin. The antipsychotic medication lowers the effect of these neurotransmitters in the entire brain. Thus, you have a lot of side effects. Sometimes, one of them is depression. 

Antidepressants and mood stabilizers, in comparison with antipsychotics, will have other side effects. Prozac and some other antidepressants can trigger a manic episode, and can affect someone in a similar manner to a stimulant. Mood stabilizer medication, which is used to treat bipolar illness, has the effect of not letting a person get up too high (and hopefully not too low) on the mood scale. These medications can also directly slow a person down. This could be part of the reason that mood stabilizers can cause weight gain. 

None of the medications that today are used to treat persons with mental illness are without some kind of significant side effect. Drugs haven't been invented that exactly replace a missing brain enzyme. Some day, we hope that such drugs will be invented. 

Synthroid, for example, used to treat hypothyroidism, is produced by a strain of bacteria that has been genetically engineered using human genes to secrete something that exactly mimics the human thyroid hormone. The same goes for today's insulin-it is no longer extracted from cow livers. It is manufactured in a lab with genetically engineered bacteria. 

Why can't the same technology be used for psychiatric illnesses? I don't know how close we are to scientists being able to exactly replace a missing brain enzyme to treat mental illness. I do know that the latest round of antipsychotic medications leave much to be desired. While these medications may work to alleviate much of a person's psychosis, the new medications have severe health risks, and worse side effects compared to the older generation of medications. 

When "atypical antipsychotics," as they're called, were first discovered, they were promoted as not having the same life-ruining side effects as the older medications, one side effect being "Tardive Dyskinesia." This refers to involuntary movements of the mouth, face, and upper body which are disfiguring and disabling. 

The new generation of medications, contrary to the exaggerated claims of their enthusiasts (the drug companies and some psychiatrists), do sometimes cause Tardive Dyskinesia. It was originally assumed that they did not, but the substances had just been invented. It takes several years of being on a medication for the Tardive Dyskinesia to appear. The medications originally had not been tested on humans long enough to know. 

Imagine trying to shave, brush your teeth, drive a car or carry on a conversation when your face is moving and twitching all over the place. People see that and they automatically think "weirdo" and will shun that individual because of the disfigured appearance produced by this problem. 

Medication will do some things to help you if you have a mental illness. While you may be sedated or have other side effects, the medication may restore you to a workable state of mind. Medications do not do a perfect job of restoring the mind. But once you have a foothold on "normal" you may potentially be able to use cognitive exercises to get to an emotional state that is more acceptable. Otherwise, life could at least be tolerable if on medications other than ones that (it varies from person to person) have unbearable side effects. 

A person with mental illness should not rely on medication to solve all emotional problems. With medication, there will always be some level of discomfort, unless a person is sedated into oblivion. A certain level of discomfort should be tolerated before looking for a change. If things are completely unbearable, then yes, medication ought to be changed. This would entail addition of a new medication and/or getting off an existing medication, or could entail changing dosages. 

However, it is clear that the right medications for persons with mental illness, while they may be a prerequisite to getting well, are not the entire answer. As an adjunct to medication, some type of techniques of mindfulness ought to be used. This could be Zen meditation, it could be Neuro-Linguistic Programming, or it could be some other type of non-chemical therapeutic treatment that helps the mind let go of what is not needed. 

I find that the meditation that I do, which is my own brand of acceptance of emotions, can also be helpful with the side effects of medication. Physical exercise can also help to alleviate some side effects. Although I don't exercise, even though I should. 

Medication is a necessary evil for most people with mental illness and can not be depended upon to fix everything. Once stabilized on medication, the journey to wellness has only begun.