I’m off my antidepressants We’re now long distance pals

** Disclaimer: Not a medical professional. My views based on my experiences only. Please visit your GP, mental health professional, or Mind for more expert advice! **

I’ve not been taking my medication for a month now. GP approved, for immediate clarification. I would never endorse taking yourself off your medication without talking it through with your GP first. Sorry to be ya mum, but… do as you’re told. 

It’s been… ok? I think. It’s hard to self-reflect, especially when you live with different forms of anxiety. I try to differentiate between ‘me’, ‘me with anxiety’, ‘me on medication for anxiety’ and ‘me having just come off medication for anxiety’ which is a whole new territory.

I came off them for a few reasons, some of them good and some of them bad. I felt ready to try and come off them, primarily. That should always be the main reason. Do it when you’re ready. But I also came off them because some of side effects had started to make my anxiety worse: I put on three stone in a year and I had absolutely no sex drive. Zilch. Nada. Nothing. IT WAS SO SAD.

I know that those reasons are trivial compared to the fact that I could now function, but them being relentlessly thrown in my face when I couldn't fit in my clothes anymore, or when I saw a flash of my boyfriend's bum and didn't start growling, was getting tiresome. So when I felt confident and comfortable to try and come off the medication, those particular side effects made my decision much easier. 

I started to cut down at first. I skipped taking them on weekends, then I only took them every other day, then I only took them every three days… then I didn’t take them at all. This was definitely the best way of doing it. The withdrawal effects weren’t strong but they were definitely there even at the start of the slow process, so I’d never recommend going cold turkey. 

The withdrawal effects I’ve had so far have been:

• Mad dreams. Like... really weird. Baffling. Could-consider-for-a-Tim-Burton-movie dreams.
• Slight trouble sleeping. Courtesy of the above, mostly. But I've been super nervous of going to sleep and haven't slept through a lot.
• Weird appetite. One week I wasn't hungry at all and the next I was reaching for the pregnancy test because surely I was eating for two?
• Irritableness. Sorry friends.

Aside from the simmering anxiety of being off them, I think that’s it. For now, anyway. No, the weight hasn’t just dropped off but I’m hoping that I can have a better relationship with my body now that I feel more in control of it. And yes, my sex drive back. Bangin’. Literally. 

I feel good. The anxiety is definitely there but my eye's on it. I’m happy I made this decision and, to be brutally honest, I’d be absolutely gutted if I needed to go back on my medication. But I know that that’s a possibility and I shouldn’t feel guilty or ashamed at all if it came to it. But one step at a time… 

Antidepressants are wonderful things. I’m definitely pro-medication, and I’m also pro-doing what’s best for you. If you don’t get on with medication, that’s fine. If you need medication for the rest of your life, that’s fine too. There are many different treatments for mental health struggles for a reason; one type won’t work for everyone. I, personally, hated counselling. But medication turned my life around, and once that was working in my system, I then learnt how to self-care properly and the combination of the two worked marvellously.

For me, medication gave me a boost in confidence and a gap between something triggering my anxieties and my anxieties acting upon them. It gave me time, and it gave me hope. It let me sleep, it let me believe in myself, it let me go out, it let me learn and adapt, and it let me improve my relationships. 

It also gave me weird appetites, made me put on a lot of weight, beat up my sex drive, made me twitchy, and sometimes made me clumsy, forgetful, and ‘not with it’, but those last effects only happened when I had to up my dose earlier this year. That dose didn’t last, needless to say. 

I still keep my trusty Sertraline on my bedside table. Just having it there in my sight makes me comfortable. I know it’s there if I need it, though I desperately wish I won’t. I don’t feel scared of ‘going at it alone’. I did, at the start of this year. The thought of not taking medication terrified me and made me so vulnerable. But I depended on it then. I relied on it to get me through the day. But I can get through days myself now. Weeks. Months! Look at me go. I’m far from over with my mental health struggles but, for now, I’m keeping up with them. We’re friends.

Adult Children Who Cut Off Their Parents an Interesting Variation on This Theme

My posts on this blog (May, 27,2014) and on my Psychology Today blog (November 17, 2014), Are Parents Who are Cut Off by Their Adult Children Really That Clueless, generated more comments than almost any of my other post (37 and 163 respectively). Additionally, the post itself on this blog has had more hits than any of the others.

In the posts, I reproduced letters to newspaper advice columnists from parents who had been cut off by their adult children, and who claimed to have no idea why their adult children felt the need to do this. I also printed one letter from the adult child of one of those letter writers telling the other side of the story. Without addressing the issue of who's "fault" it was that the cutoff took place, or who was "wrong" and who was "right," I opined that the apparent cluelessness of the parents was in most instances feigned. They usually knew to a greater or lesser extent exactly why what had happened had taken place.

Well the comments from readers came fast and furiously from family members on both sides of this divide, and they were very predictable. Adult children who had cut off a parent generally wrote about all the bad things their parent had done to them and how the parent would never admit to any of it. Parents came back with a vengeance saying, in so many words, "I didn't do anything wrong," and they accused me of parent bashing.

Here's a typical exchange:

Anonymous: Yes, you are correct. Virtually all of the time, when people cut off parents, or anyone else in their immediate family, you can bet there's a damn good reason. The parents will act like the poor victims. Don't believe them. There's actually a forum on the Internet where they can all get together. At first they maintain their innocent victim stance, but you will soon see their vicious hatred expressed toward their children.

Emelu: Not so. I have done nothing wrong. I've been in counseling. Been open to understand if I did wrong. Been totally honest with myself. And there is nothing I've done wrong.

I always find it interesting that whenever I write posts - particularly on the family dynamics of borderline personality disorder - adult children with the disorder who make comments often seem to accuse me of blaming them, while the parents of such children often accuse me of exactly the opposite: blaming the parents.

In most of these cases, I think the reason for these opposite reactions has to do with selective reading of the posts. This, in turn, is triggered by guilt and defensiveness. Or, occasionally, some of these folks just hate it when I give away their secrets.

In general, both of the positions "It's all my fault" and "I had nothing whatsoever to do with this" are, equally, both irrational and cowardly for any of the involved parties. 

In cutoffs, however, can it sometimes be that the parents really are completely clueless about why their children are avoiding them? That they are absolutely at a loss to understand what has happened? Some commenters said their cut-off children even accused them of things that they know they did not in fact do. Is that always denial?

As everyone was taught in school about true-false tests, beware of any question containing the words "always" or "never." I do think that, in a very limited proportion of these cases, the letter-writing parents are indeed genuinely flabbergasted at their adult children's negative responses to them and the phony accusations. In these cases, IMO the adult children are hiding their real reasons for the cutoff.

So why would a child cut off a parent who was not guilty of any significant abuse, neglect, or invalidation?

One common reason occurs in situations in which the parents feel tremendously overburdened and overwhelmed by the responsibilities of child care, or feel that the child's needs are preventing them from doing other things that they really badly want to do. They feel guilty when they admit this, even to themselves, and they always take care of their children when they are supposed to, and do so appropriately for the most part. They do not usually take their internal frustrations over being exhausted directly out on the children to a major extent, and genuinely love them.

They think that somehow their children are not aware of how tired and frustrated they are, but they are kidding themselves. The attachment theorist John Bowlby theorized that children observe their parents very carefully, without attracting too much attention when they do, and become experts on what their parents are all about and what motivates them by the time the children are just two years old.

In videotapes of family therapy sessions with small children in the room that I have seen, as the therapist speaks with the parents, one may observe the child playing with a toy in the corner. The child seems to be oblivious to the adult conversation. But then, when something concerning them comes up in the conversation, the child suddenly makes a comment about it. Without even looking up. Clearly, they are listening the whole time.

Parents in the situation under discussion in this post do in fact give a lot of clues as to how burdened they feel. They might for instance constantly and compulsively complain to their friends and anyone else who might listen, saying something along the lines of, "I'm always there for my kids! They're my #1 priority. I respond to everything they need, even though I have to work full time. I so wish my boss would understand this better. There's just never enough time. And I'm sooooo tired. I used to have hobbies I really enjoyed, but I've had to put them aside. I sure do miss those days!"

Even after their children reach adulthood, parents like this may have a very hard time trying to not cater to their adult child's every need - or even his or her every whim. While still complaining about it to everyone else.

In such cases, children may get the impression that the parent really wants to be free of them, but just cannot admit it. In response, they sacrifice their own desires for a good relationship and make themselves scarce. They cannot tell their parent the real reason for their doing that, because they know that this will make the parent even more miserable than he or she already seems to be. 

A truthful statement would make the parent feel even guiltier for wanting to be free of any family burdens. The parent would probably deny these feelings anyway, because the parent is under the mistaken impression that admitting this would drive their children even further away.

In order to avoid causing their parent to feel this way, the adult child may in difficult cases volunteer to be the villain in the piece. They may purposely make it look like they are cutting off the parents because they are selfish or narcissistic. If that does not work, they can escalate. They up the ante by making what they know are false accusations about parental misdeeds. That way, the parent can easily maintain the belief that he or she had nothing to do with the cut off. 

As an alternate strategy, or in addition, they may influence their spouse to make it look like the spouse has taken control over them and is domineering and purposely creating trouble with the parent and enforcing the cut off. For more on this, see the post, Your Spouse's Secret Mission.

Anything to help parents avoid looking at their own conflicts!

This is a sad state of affairs because, ironically, if the parents could admit to their ambivalence and negative feelings, any problematic resultant family conflicts can in most of the cases be fairly easily resolved through metacommunication and negotiation. The children's efforts to "help" the parents to deal with their guilt backfires and prevents a solution.

I know that many readers react to these kinds of formulations by thinking I am giving people too much credit, and that most of them do not operate with this level of sophistication. When it comes to fitting in with one's kin, church, or ethnic group, I strongly believe that they not only can, but they do. 

States Pick up Where Feds Left Off in Fining Drug Companies for Deceptive Advertising

After the Feds did their job, the states are now getting into the action.  Pharmaceutical companies are now starting to be fined in state courts for fraudulent promotion of their psychiatric medications.

Anyone who is still wondering why there has been an explosive increase over the last two decades in the use of two classes of psychiatric medications  - so-called “atypical” antipsychotic medication and anti-convulsants - for the treatment of a variety of diagnoses for which they are not indicated need look no further than to my previous posts about U.S. Department of Justice fines levied against pharmaceutical companies for said fraudulent promotion. (2/17/10, 3/22,10, 3/27/10, 4/28/10, 4/30/10, 10/1/10, 12/20/10).  

This blog has also focused on how, with an enthusiastic assist from pharmaceutical companies, the definitions of the psychiatric disorders for which the drugs actually are indicated have been expanded to the point where they are in danger of becoming FUBAR’S (F***’d up beyond all recognition).

To summarize what the US Department of Justice previously found:

May, 04. American pharmaceutical manufacturer Warner-Lambert agreed to plead guilty and pay more than $430 million to resolve criminal charges and civil liabilities in connection with its Parke-Davis division’s illegal and fraudulent promotion of Neurontin.  One of these uses was for bipolar disorder.  Studies later indicated the drug was ineffective for bipolar disorder.

January, 2009. Eli Lilly pays a settlement to the DOJ of $1.4 billion for concealing side effects and off-label marketing of Zyprexa just as their biggest seller, Prozac was about to go off patent in 2001.

September, 2009. Pfizer agrees to a settlement for $2.3 billion for off label marketing of several drugs including the atypical anti-psychotic Geodon

April 2010 - AstraZeneca fined $520 million – off label marketing of Seroquel.

April 2010 - Ortho-McNeil-Janssen Pharmaceuticals Inc., fined $81 - off label marketing of Topamax.

September 2010 - Novartis Pharmaceuticals Corporation fined $422.5 million off label marketing of Trileptal.

December 2010 – Elan Pharmaceuticals fined $203 million – off label marketing of Zonegran.

Now the states of South Carolina and Arkansas have fined Ortho-McNeil-Janssen Pharmaceuticals, a subsidiary of Johnson and Johnson, for overstating the effectiveness and minimizing the risks of their antipsychotic medication Risperdal.

The following summaries of what happened are paraphrased without permission from the American Psychiatric Association’s Psychiatric News.  These legal actions were also widely reported by the press throughout the country.

First was South Carolina, from January of 2012:

A South Carolina judge upheld a $327 million civil penalty against Johnson & Johnson for overstating the safety and effectiveness of Risperdal.  A  jury had decided that they violated consumer protection laws by sending doctors a misleading letter in 2003 about this. The jurors also determined that the warning-label information was deceptive.  They found that the company had falsely claimed that Risperdal was better than competing drugs in a letter was sent to some 700,000 doctors nationwide,. The Food and Drug Administration (FDA) issued the company a warning letter about false and misleading claims that minimized risks such as diabetes and overstated the drug’s benefits. South Carolina’s law allows a judge to decide whether the company can be fined as much as $5,000 for each letter sent to South Carolina doctors.

Arkansas got involved just recently:

Johnson & Johnson "lied to patients and doctors" in its claims about Risperdal, said Arkansas Attorney General Dustin McDaniel, after a jury found the company guilty.  This is the latest case regarding fraudulent claims about the company's second-generation antipsychotic). The jury determined that the company downplayed and hid risks associated with the drug, which has been linked to increased risk of stroke and death in elderly dementia patients and to seizures, weight gain, and diabetes. After the jury's decision, Arkansas Circuit Court Judge Tim Fox, issued a penalty of $1.19 billion for the nearly 240,000 violations of the state's Medicaid fraud law. The New York Times reported that he also fined the company $11 million for violations of the state's deceptive practices act. 

Like the title to one of my previous posts, the hits just keep on coming.  Unfortunately, the companies are treating these fines as a cost of doing business and are still making huge profits on these medications.  They know quite well that the damage has already been done.

With Rispiridal, it’s kind of a shame, since in my clinical experience its side effect profile in some ways actually does compare somewhat favorably with two of its main competitors -  for patients who are actually psychotic, of course.

Yet Another Drug Company Fined for Off Label Marketing of Psych Medication

Since I started this blog way back in March of 2010, I have posted several times about big Pharma companies being fined for the off-label marketing of various psychiatric medications. Well, the hits just keep on coming.

The Consumerist was one of several news sources to recently report that: 

"New York Attorney General Eric Schneiderman announced the settlement Thursday resolving allegations that Bristol-Myers Squibb improperly marketed and promoted the drug Abilify.

Abilify — the brand name for the prescription drug aripiprazole – is a second-generation antipsychotic prescription drug, commonly, commonly referred to as “atypical antipsychotics,” that were originally used to treat schizophrenia.

According to the states’ complaint, which was also filed today, BMS engaged in off-label marketing, which is the promotion of drugs for uses that are not FDA-approved.

For example, the complaint claims that BMS improperly promoted Ability for pediatric use and for use in elderly patients with symptoms consistent with dementia and Alzheimer’s disease.

This, despite the fact that in 2006, Abilify received a “black box” warning stating that elderly patients with dementia-related psychosis who are treated with antipsychotic drugs have an increased risk of death.

Additionally, the complaint alleges that BMS violated state consumer protection laws by misrepresenting and minimizing the risks of the drug including metabolic and weight gain side effects and by misrepresenting the findings of scientific studies.

Under the proposed agreement, BMS is prohibited from promoting Ability from off-label uses; making false or misleading claims about the drug; compensating health care providers for attended promotional activities; using grant funds to promote Ability; and providing samples of the medication to health care providers who do not intend to use it for labeled purposes."

Bristol-Myers Squibb settled the claims with 43 states for a total of 19.5 million dollars. That sounds like a lot of money, but for big drug companies, it is actually a paltry sum. Fines like that are considered a cost of doing business

As readers know, I am rabidly against the use of antipsychotic medications in non-psychotic children, which is unfortunately becoming more and more common. However, I must admit I have negative feelings about that black box warning regarding the use of any (not just Abilify) antipsychotic medication in patients in nursing homes with advanced dementia due to Alzheimer's disease or other severe brain conditions. 

Things have gotten to the point where docs are afraid to prescribe these medications even in such patients who are actively psychotic with hallucinations and/or paranoid delusions, for which there are no other effective treatments.

Even in non-psychotic demented patients, antipsychotic meds are often the best agents for controlling assaultive behavior in this population. Unlike other sedatives, they do so while only minimally exacerbating memory and cognitive deficits in these people. Our society seems to want to pay nursing assistants only the minimum wage to take care of our impaired family members as they age. Long-term facilities are very expensive as it is. Not only that, but we under-staff them as well. While there may be psychosocial interventions which would reduce assaultive patients with dementia, we do not want to pay people to provide them.

Given those conditions, what is left? Medications, that's what. Do we really want to expose underpaid and overworked caretakers to dangerous aggressive behavior from patients who basically have no life anyway - just to prevent a tiny percentage of them from dying a little sooner due to the medications' cardiovascular side effects? Time to either pay up or shut up.