kyburg | Some kind of wonderful -

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Some kind of wonderful -

You'll hear me rant about overmedication a lot - well, it's a sore point. Giving pills is cheap - compared to long-term talk counseling with active therapy. Trouble is, the pills stop working. Oh, you can cycle through a ton of stuff - it's out there - but the expensive, labor-intensive-with-a-real-person is where long term results lie (unless you're one of the people who truly HAVE a chemical issue, and one of the hallmarks of THAT is the pills don't stop working and you don't have to cycle, yadda ya).

Then I hear about Cymbalta. Holy chrome. This stuff is being prescribed off-label right, left and center for things OTHER than depression...and damn if it isn't doing some incredible things, mostly related to pain relief (and we all know I think that's going to be HUGE when it happens).

But for depression? *wiggles hand* Not so much. Read about coming off it and UH.

...and so many, many reports are from people who came to this medication because - you guessed it - they needed to cycle from something else.

I have to wonder about what this all about - and if the cycling is a Good Thing, or a sign that this is not the right way to treat depression, period.

Yeah, maybe I do more than wonder. Like - NO.

Here's a thought for the day - isn't it still addiction when it's legal and you don't have to worry about getting it on a daily basis? You go without and you're not going to feel good, yanno. But get your drug and everything is fine.

What makes that okay?

As for me, I'll pass. And yes, I know that's a privilege.

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I am a firm believer that medications alone cannot treat a mental illness.

That being said, I am lucky that I had help when I needed it. I would probably still be on medications if I had not both medication and therapy and the will to be medication free at the end of my treatment.

Of course, this is just my opinion.

Agreed. If nothing else, therapy is vital to correct wrong thought processes and behaviours and trauma brought on by the illness itself. It's very important for quality of life. And we know that it can help bring on chemical changes in the brain that are similar to drugs, for those who can be helped by it, that last for a good long time before a relapse (usually situationally triggered) occurs.

In many cases, however, depression means that years of therapy won't do squat, and life changes won't take effect, without medication. This also goes for ADD and a number of other conditions. Years of therapy never made a dent, no matter how hard I tried, until I got by chemicals balanced and suddenly it was easy. And after that I didn't need therapy, and still don't.

Therapy can be just as addictive as drugs, IMO. Especially bad therapy.

Is it addiction when a diabetic takes their insulin? I've seen the blood tests and EEGs and other brain scans from family members before and after Prozac. This post is pretty offensive.

ETA: Also this "feeling okay with it and not without" == addiction is the same kind of thinking that lost me a decade of my life to crippling pain before someone had the mercy to give me something for it. It's not addiction. And it is just fine to take medication to help you survive.

ETA2: Actually, it's not just pretty offensive. It's really offensive. Extremely. And it's the kind of attitude that makes people who need help less likely to get it, and to feel ashamed that they do. How dare you accuse people struggling from a known illness of being addicts because they need medication to function and live normal lives. "Not going to feel good"? Try suicidal. Homicidal. Infanticidal. I lived with an unmedicated mother for my first 18 years. How dare you suggest that she's only a good mother and grandmother now because she's an addict. Seriously. Get the fuck over yourself.

Speaking as someone who depends on multiple medications to survive -- some of them being psycho-active medications -- I don't find the term "addiction" necessarily to be so offensive. Can there be healthy addictions and unhealthy addictions? Does my absolute dependence on meds qualify as a healthy addiction, given the needs of my body?

As a side note, I did see that

kyburg added this qualifier:

...(unless you're one of the people who truly HAVE a chemical issue, and one of the hallmarks of THAT is the pills don't stop working and you don't have to cycle, yadda ya).

This is not entirely true. Even for people with imbalanced brain chemistry, the meds eventually can stop working -- and it can become a hell in itself to find a new cocktail of meds that does. There's even an accepted medical term for the phenomenon. It's called "Poop-Out Syndrome".

I find it to be extremely offensive, as someone who's been refused vital treatment on the grounds that I could become an addict. And I know that the chemical process of addiction is not the same as the chemical process of filling a void in someone's metabolism. It's not addiction. It's not the same thing. To conflate the two is beyond outrageous. I take medication that other people abuse to get high, I take it so I can walk, eat, dress, and leave my front door. I get no high. I get no pleasure from it. I am not an addict. Neither is anyone I know who takes medication to cure an illness.

Moreover, from that comment about the fact that people who really have a problem don't have to change meds, it's obvious that

kyburg is woefully uneducated as to the mechanics of treating biochemical disorders with medication, and should not be making declarations that -- regardless of how YOU feel about it and how you'd like to candy-coat it -- threaten to further ostracize people with mental illnesses.

Further, it is also obvious that she has no idea of the emotional strain of relying on a controlled substance or a drug that could "poop-out" (sorry, but I've never heard that term used by any psych I've been to). Living your life on the kindness of people who are willing to fill out your prescriptions, being under constant scrutiny, having to fight with insurance companies, having to choose between groceries and sanity, being at the mercy of under-educated physicians who insist that you try inferior and damaging alternatives before giving you sufficient treatment, being at the mercy of physicians in Big Pharm's pocket who will lie to you and poison you because they get a kick back, being at the mercy of physicians who are too cowardly to prescribe a "potentially addictive" medication and instead allow you to lose your job and your family, choosing between employment that doesn't cover drugs and disability that does, not receiving life-saving tests and treatment because as soon as your medications are revealed your serious concerns are written off as "patient is anxious", waiting for the medication that's given you a chance to live life FAIL and plunge you back down into pain or insanity or even the brink of suicide ... none of that is simple or easy.

If I were a drug addict, I could go get more medication whenever I wanted. Same with the rest of my family. It is not simple, it is not easy, it is not fun. It is not a free ride to feeling good. It is a potentially dangerous, expensive, trying way to gain some semblance of normalcy. None of us are drug addicts with a free pass. Using a term that is inextricably connected to criminal activity and anti-social behaviour to describe the actions of people taking medication to function and live well is offensive and cruel.

Trust me when I say that as lightly as you may be able to take it, most people do not. It is a terrible, terrible thing to rely on something to survive that could be taken away from you at any time. It is not an addiction to be disabled and to require pharmaceutical treatment to function.

One, I was married to the Type I diabetic. Two, I've been on and off the couch since I was 8 - last major depressive crisis was when I was 27, thank God. I dodged a major bullet this year - but it wasn't pretty. (Keep a job you know is bad for you because you don't want to rock the boat. Go ahead. Should have left years ago. It was painful - but it wasn't pathology.)

Every time. EVERY TIME - they wanted to add drugs. Over that long a span, you can imagine what they wanted me to 'try.' It likely would have been Seconal in 1969, it was Valium in 1978...and they thought Paxil was just the bomb the last time it was mentioned. Every time - I've refused.

And gee, I've gotten through it. Very durable, actually. Have I been Little Mary All-Is-Fine? *laughs*

One thing I know - I'm not the addict. I have a liquor cabinet that remains full of stuff that sits for years. Just not interested. There's a ton of addictive behavior in my family (there hasn't been a generation without an addict in five that I know of - Dad died of an accident overdose in 1967) - but the whole thing holds no appeal at all to me.

For the record, most of the research that developed the SSRI class of medications came out of addiction studies. Yes, they paid heroin addicts to stay addicted so they could figure out what the big deal was. Pity they didn't notice they stopped getting high - because even then, the 'poop-out' effect was very clear. Addicts stop getting high. Just before they take overdoses that kill them.

There are chemical issues that respond to replacement therapy - lithium is the best example I know of, and it's no walk in the park. As far as cycling through every SSRI ever developed - ghads, the cost in human suffering just wipes me out every time I look at it. I won't say I understand it - but what I have to do is question it. I'd love to find someone too cowardly to prescribe - most of the cases I know of have been people too busy to spend more than 15 minutes to work up a case, or working within a managed-care system that only has funds available for the cheapest possible option. 15 min visit plus $20 in drugs - or - $125 an hour, weekly counseling? HMMMM. Oh, and most would want that $20 in drugs and 15 min monitoring as well. Fat chance.

Meanwhile, the 'heavy service users' remain dependent, miserable and vulnerable. That, my friend, is extremely offensive to me.

My own family is amazed at how 'normal' I am these days. It's so nice to be considered 'damaged goods' - so don't tell I don't know about it. Faking it until you make it - believe me, I know.

It's also not hard to link criminals with mental illness, considering the penal system is now the largest provider of mental health services today, full stop. I did mention lowest cost of providing care? Right. Moving on -

My pain is not your pain - and comparing them? Please don't. No, really. Looking at your paragraphs above? Been there. I'll give you credit for it being the truth because I know it is. Yeah, I have an idea. I have first-hand experience, thank you very much.

Whatever it is for you, good on you for finding it.

It's addiction, unquestionably. And I'm a Cymbalta addict. I hate the fact of addiction, not to mention the cost of the co-pays -- but I'm enormously grateful for what it's done in my life.

I'm one of the chemically-imbalanced, though. Cymbalta is actually prescribed on-label for two conditions: depression and peripheral neuropathy (PN). Along with Lyrica, the only other med specifically designated for treatment of PN, Cymbalta has alleviated my chronic pain on a long-term basis. It works for me, too, as an anti-depressant.

Some side effects suck. I truly believe that I've had memory loss from long-term Cymbalta use. The sexual side effects are more difficult to quantify. Longer to reach orgasm, and sometimes I'm non-orgasmic -- but when I do ring the bell, it's like a switch has turned on and I can lather-rinse-repeat for hours.

I am one of those who needs psychotropic medications to make it more than a week; less for depression and more for mania, but I did want to point out that even for those of us whose brains need the chemical fixing, the medications can and do stop working eventually. Because we don't know why the brain isn't functioning properly in the first place, drugs are steak knives trying to perform microsurgery.

Eventually, all the places they might work become points of failure. A new medication or medication combination is needed to exploit alternative trigger points.

I do not want to wade into the debate on addiction. I know which drugs I can... and can not... take without suffering "side effects" if I stop again.

What makes that okay? The fact that I'm a sane and functional human being on drugs, whereas without I am not. I consider it no different from someone who needs insulin, and I don't like the 'addiction' and anti-pill mentality which prevents a lot of people from ever trying meds - which leads to suicides and ruined lives. I take birth control to keep from going psychotic and hitting things, too. If that's an addiction, I'm okay with being addicted to sane functionality, because it's a lot better then psychosis and suicidal depression. But calling it an addiction just adds to the burdens people face in getting help.

Which isn't to say that I think meds are under-prescribed. But I think a lot of mild to moderate cases of mood issues are getting pills when they need therapy - not to mention a ton of people with biological health issues, like pain, which get called 'depression' as a convenient label.

Cymbalta actually has an on-label for fibromyalgia now. I am not convinced that it's any more effective than the handful of cheaper, older antidepressants which many fibro people take offlabel for nerve pain, but this lets the Cymbalta people make money. Still, I'll take the research and add it to the stack; we'll take all the pain research we can get, even funded by chemical salesmen.

There are different chemical flavors of depression. In my case, my depression appears to be norepinephrine rather then the usually assumed dopamine. Dopamine antidepressants make me worse, and if I hadn't done my research I'd have been either cycling or off the drugs and not getting the help I needed, because therapy never made a dent. Cycling doesn't mean the drugs aren't right, but it may. There's also a lot of people who cycle through meds saying that the first one didn't work, when in fact it's likely to be a compliance issue.

*nods* When I hear people talk about their medications in terms that mimic exactly the talk you hear addicts use? Aren't we just locking them into something just as dysfunctional, and leaving them just as much at risk? I'm not talking about the people who use these tools effectively, get relief from them and move on. No, I'm talking about people broken, promised a fix who never get it. Just shuffled from one medication to the next. Promised what everyone takes for granted. That's just not fair - and really mean, if you ask me.

And I've mentioned the addiction studies that fostered the whole SSRI class of medications. I'd like to forget I know about that, frankly. Every time I hear about a Paxil suicide - or a homocide, because that stuff makes you paranoid, no kidding - or someone coming off Effexor for something else? I can't forget. And it makes me ill. Then angry. Looking at the increased suicide rate as a side effect for most of them? No words.

I'm glad to see depression getting the attention it needs, particularly for the chronic pain that goes with it. (Chicken and the egg, you ask me - which came first?) Any drug regime that isn't replacement therapy? (Come on, I'm surprised how that isn't clear - insulin is replacement therapy. It can be argued that hormonal therapy qualifies as well. Cymbalta - ain't.) Is a controlled poisoning. It's a very targeted attempt to control a naturally occuring process within the body - usually with reasonably predictable results. Reasonable. Medicine is a practice, after all.

It's oversimplification to say what goes for me, goes for everyone. But - sheesh - shouldn't we at least be questioning something that leaves such a wide swatch of human misery in its wake? That's the only point I'm trying to make here.

And for the people who get caught up in this, I have nothing but sympathy for them. That, and $5 will get you a latte at Starbucks - but there you have it.

I am THRILLED to see this class show promise for chronic pain. It works. Holy cow, it works WELL. All the time. Tickled, even. All the hallmarks of a good tool - and that's what I think medication needs to be viewed as. Your mileage may vary.

I've refused to be put on medication for my depression. I KNOW my depression has a psychological, not physiological, root and giving me happy pills wont fix my thought process. I'm not saying medication isn't necessary for some but I do agree that it is all too often treats the symptoms but not the cause.

ETA -- I've had antidepressants prescribed to me, for all things, migraines that "might be attributable to depression" as well as depression itself. Never filled them because, WTFingF man.

(unless you're one of the people who truly HAVE a chemical issue, and one of the hallmarks of THAT is the pills don't stop working and you don't have to cycle, yadda ya).

I'm one of those people who for sure, absolutely has a chemical issue. And the drugs don't stop working.

They never work in the first place. So I take nothing. Same result, fewer side effects.

Frankly, I wouldn't wish that on anyone.

Got a question for you.

What makes you so sure you're not the most normal one in the room? (Mercurial, grouchy, sure. That's not a pathology.)

There are days I wonder what people think this stuff is supposed to. I really do.

No, mercurial and grouchy is not a pathology. However I've had my diagnosis for 20 years this year. If that's all it was, it would be easy.

It's very *clear* I am not the normal one in a room. Any room.

*nods* You wouldn't believe (or maybe you would) what I got for diagnoses over the years.

I think I've had every curse the DSM-IV can toss at me.

Not many of them were true, accurate or useful. I was never 'depressed' - I was so anxious I couldn't eat or sleep. *shrugs*

And who would be normal - that's like being perfect. I don't think it exists.

See that's the thing. I've gotten one diagnosis. One.

However, what *has* happened is I've been "diagnosed" as pretty much everything by people who were simply looking for a new nasty thing to call me for whatever reason or another. Because knowing you HAVE a Dx apparently means it's a free for all on what it is.

Word, dude. Word UP.

Because the internet has made everyone into a trained medical professional, don'tcha know.

I agree, if you have anything other than a simple chemical issue, pills alone are not enough. And everyone can benefit from a little therapy now and then. I call them "tune-ups."

But it's not addiction, it's dependence. Which is actually different. You can see either dependence or addiction with pain meds, one is the natural consequence of chronic use, and the other is a problem and involves abuse and not following the proper instructions. But there's other meds people are dependent on as well, it's just that antidepressants are WAY overused.

And you're the pharmacist, right?

I have to disagree. Abuse - is abuse. Dependence or addiction? One is psychological, the other is physical - that's what I remember about the difference between the two.

Depending on a good tool isn't wrong - shoot, you could say I was addicted to my car, in that case, neh? I have no complaint about it -

It's the case after case of nothing but side effects and no relief that bother me. REALLY bothers me.

But then again, I have to have a different POV than most - I can look back and wonder why we did all the work (and some of the work was expensive and painful) while Cliff was alive...for essentially nothing.

Why do we do this to people. When it isn't helping. I don't get it.

Yep, I'm a pharmacist, and these are technical terms.
Basically, I have chronic pain. I take at least 2 doses of Lortab every day. If I don't take it, I suffer. I am dependent. i take it as directed, but I'll have to taper off over time to be able to stop taking it without feeling like butt.
If I start taking more than I am prescribed, mixing it with other things to get high, that's addiction. It's also abuse. But people who are dependent are not considered addicts unless they break the rules and start acting all funny.
You could say that people are dependent on antidepressants, and they are also dependent on insulin if they are diabetics.
BUT, we are using these things more than we should, we really don't have a lot of knowledge about how the brain works, it's all theory. Because once you open one up to look under the hood, it stops working. We have to cycle and try different things because we really have no idea what we are doing. It makes me mad that we don't know more. Bipolar folks really get the short end of the stick here.
And yes, everyone should start with therapy when they get their pills. If they get stable and comfortable, just continue the pills if the reason for the depression is continuing. And when you have a bad spot, go back to therapy on as add needed basis.

And what do we do when none of it works? Would you believe shock therapy? Ewwwww. I don't like the idea of loss of memory.

I hear it's still the gold standard for treating intractable depression. Wouldn't a man to man talk with a doorknob do the same thing?

*shakes head* I have addicts in the family, dearling. It does not matter how one uses the object of addiction...the hallmark is that they can't do without it and lose all control of their lives in the face of it. If you're addicted to peanut butter, you're going to eat it on corn on the cob and cinder blocks...but you'll never do without it, or else.

You can abuse and not be addicted. The twinkies who do cough syrup with their pals? Abuse. The person who doesn't do anything without having a drink first? Addict.

Some abuses indicate addictive behavior - but one is NOT the same as the other.

Make sense?

It totally makes sense, but that was what I was taught in pharmacy school and in seminars on pain control.
Shock treatment is quite effective, but the cost is so high. Each patient has to decide for themselves. I don't think I'd do it.

Oh, I'd have words if they tried that with me in the room. LOUD ones.

Words matter. Words being used badly in a teaching environment? To titled professionals who control other people's lives.

Loud words. VERY loud words that matter, hon.

I'm sorry, but in this case, you're the one abusing words here. On the subject of these particular medications, you're trying to redefine well-established words to fit your own agenda, using vague rationales and contradictory statements.

As

drlaurac pointed out, abuse, dependency and addiction are well-understood technical terms and do not mean the same thing as each other. You're trying to redefine "abuse" as meaning "use I disagree with" and "addiction" as meaning "any dependency that I don't like", which is just bogus, and borderline propagandist.

If I start taking more than I am prescribed, mixing it with other things to get high, that's addiction. It's also abuse. But people who are dependent are not considered addicts unless they break the rules and start acting all funny.

If you do anything with a drug besides take it as prescribed - that's abuse. Not addiction.

People who are dependent on a drug need it to function, but are aware of the dependency and continue to use it as directed.

People who are addicted can not live without it, and often have other psycho-social aspects that preclude definition as dependency. I might define dependency and addiction as the difference between awareness and denial. It also includes abuse - but abuse in and of itself does not indicate addiction. It might indicate stupidity, but that's another story.

She's also claiming she was 'taught' per the original statement above - which does not even jive with your own defense. Abuse, dependency and addiction are well-understood terms that mean different things - if you look again, you'll see that one is the other 'if I do weird stuff with it.'

I've known a lot of folks who have really pushed the envelope with pain meds and alcohol, for example, when they've been on them. It's stupid, but it isn't addiction. It's abuse. Not the same thing - even by your own defense.

Addiction is not abuse writ large. Dependency is not addiction writ small. Abuse is using a hammer to open jars of pickled beets.

Reacting emotionally, perhaps? It would be within tolerances, considering the subject matter.

But you'll have to allow the accusations are inflammatory, dude. Gimme a break.

First of all, what "defense" are you referring to? I never claimed to be defending anything (except perhaps the English language, but I'm pretty sure that isn't what you meant). And are you referring to me or to you when you ask about reacting emotionally? If you're referring to me (which I'm guessing you were), why is it you assume this is an emotional subject? Could it possibly be because you've presumptuously assumed you know everything about me and my positions on these subjects? Could it be because you automatically assume anybody who doesn't agree with you must be a certain kind of person? This is not the first time you've condescendingly (and erroneously) implied you know all about me in order to belittle an opposing point of view. As a tactic it's both arrogant and rather telling, and something I'd expect to see in a Republican campaign, but not here. Please check your prejudices. Maybe you don't know as much about everyone as you think you do.

Moving along, however, regarding the definitions in question, with the exception of the "start acting all funny" bit, which I (and I think any reasonable person would) assume was a colloquial generalization on

drlaurac's part, and not a literal quote of what was actually taught,

drlaurac's definitions of these terms, while not entirely complete, are essentially correct, and yours are substantially less so.

Specifically, in a pharmaceutical sense, "abuse" means using something in a way contrary to its directed use or its intended purpose. (as a side-note, even the useful off-label applications you mention above are actually abuse, BTW. Abuse has nothing to do with whether something works or not, or whether it has good or bad results, it only has to do with whether it's being used the way it was intended to be used.)

(And no, actually, using a hammer to open jars of pickled beets is not abuse. The hammer is being used for its intended purpose (hitting things), and thus by definition is not being abused. Just because you don't believe it's the right choice to apply it in that way does not mean the application itself is abuse.)

"dependency" is fairly obvious, and I don't think we have a lot of disagreement on that term. Anything which requires somebody keep using it in order to maintain a particular condition or state is a dependency (what state is being maintained is really irrelevant to the term).

"addiction" is specifically a dependency which has become a compulsion or obsession. That is, the dependency on a substance has affected the person to the point where they can no longer make rational judgements about its use. The important point here is the decision making process of the individual in question. Addiction is almost inevitably coupled with abuse, because obviously if one is no longer able to rationally control one's usage, one is extremely unlikely to continue to use something only as directed.

Therefore, in answer to your originally posted question with the example of a legal drug used, rationally, as directed, no, that is not addiction. Attempting to characterize it as such is an abuse of the term.

I guess I'm one of those good cases. It took me forever to find a pain medication that worked. It only took one try for a depression medications, though. I've been on both for... 8 years or so now? No signs of them no longer working. On the other hand, if I'm off the depression med for 3 days or longer, it's noticeable. The longest I was off it was 6 months when I was out of work and couldn't afford it. The pain med I can go longer without, but problems get cumulative until I'm in constant pain.

I'm never ungrateful I'm as healthy as a horse and don't have a chronic pain issue. Really really.

I'm glad I'm fixable.

That's a lot for me to think about right now, as I'm on medication holiday and really depressed. However, I also found out I have low thyroid, so maybe Dr. H. will see what thyroid medication does for the depression, since he's the one who decided to wean me off my meds and then revisit the idea of medication tomorrow.

For myself, yes, there's something obviously chemical going on. How much is thyroid and how much is neurochemistry, who knows at this point? Therapy has never done much for me. Lexapro was a godsend, as was Celexa (which I went on only because it was cheaper) to a lesser extent. Don't know why he put me on Trazodone, but glad I'm off of it.

That's not to say that there aren't issues to deal with, but dealing with them is less effective without medication of some type.

Just so you know, though, I'm hoping that thyroid meds help the moods without the need for an actual antidepressant.

I don't know if that makes any sense.

There are a TON of people on my FL with thyroid issues, and I think nearly all of them have weighed in with - YES - it does affect mood. Big time.

But chances are, most will prescribe an SSRI in addition to the replacment therapies - because it will make you feel better. Riiiight.

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