depression/anxiety medication - help or hinderance?

Hello there
I have been struggling with pain every day for 17 years
Back/legs major but also now elsewhere
It all started at 21 and despite having been depressed and very anxious since then. Cause or effect?I'm not sure!
I have always avoided medication for this, except for a very brief and unsuccessful flirtation with Prozac.

I'd be really interested to hear thoughts and experiences about this and if such meds are considered to help or hinder any TMS based recovery?

Many thanks

 

Hi Bernard,

It can be like a vicious circle-- when we have anger and depression that we haven't dealt with, it can lead to TMS, but then the symptoms themselves can makes us more anxious and depressed. For me, for many years, my biggest problem was not the level of pain, but the anxiety raised by feeling like I was so restricted, and missing out on life.

I am not a TMS therapist, but I am a psychologist, and in my experience working with people, usually medication either doesn't actually help the symptoms, or else it helps some but then people often aren't as desperate to get at the root of the problem. Occasionally someone is so disabled by pain and/or the mental anguish that goes with it that they can't function, then medication can be a short term help, just to get them going. If it were me (and it has been ) I would work as hard as I could at TMS programs and see what happens, and think about medication as a last resort. However, there are very many doctors, psychiatrists and psychologists who would disagree with this, and of course no one can dispense medical information for you over the web. Perhaps if you are unsure you could find a professional for advice pertaining to you personally, and to guide you through the process.

I'm sure others are more informed about what TMS professionals have to say about it.

 

And then there are the nasty side-effects of the meds themselves (such as mass shootings) as the following blog post documents:

from website Reality Sandwich.com
Shooters

Steven Taylor

Several writers of my acquaintance, such as Allen Ginsberg and Ed Sanders, developed the habit of keeping extensive files of press clippings on stories of personal interest. Noam Chomsky, we're told, does the same thing. An individual news report may mention something in passing that may seem secondary to the main narrative, but when multiple stories collected over time repeat the same seemingly secondary data, important patterns can become apparent.
For example, for many years Ginsberg clipped New York Times articles having to do with the international traffic in narcotics. This collection eventually served as one of the sources for historian Alfred W. McCoy's definitive study linking the heroin trade to U. S. government agencies, The Politics of Heroin.
Now, amid the sickening media parade endlessly looping, one aspect of the mass shooter phenomenon is continually skipped, but a survey of press reports on the spate of bizarre violence that has arisen since the 1990s reveals a pattern.
In the past few days, following the Newtown murders, various experts have weighed in on the difficulty of profiling the mass shooter type. (An accurate psychological profile, presumably -- and hideously problematically -- could enable parents, teachers, doctors, and law enforcers to predict which individual is headed toward being the next shooter.)
Despite the difficulty of such profiles and predictions, there are two things that such characters have in common. First, they are mostly young white males. Second, many of the perpetrators are reported to have been taking psychoactive prescription medication.
The website "SSRI Stories: Antidepressant Nightmares" offers a sortable database of more than 4,800 newspaper articles, scientific journal reports, and TV news items linking antidepressant use to cases of extreme violence.
It is important to note that this site is not peddling some conspiracy theory. It is not speculative at all. The website is an index to reputable sources reporting on actual criminal cases, and in all cases reported, prescription meds are implicated.
The articles show that these violent acts were perpetrated by consumers in the 50 billion dollar a year selective serotonin reuptake inhibitor (SSRI) industry. This is a class of drugs whose warning labels and pharmaceutical literature note that a small percentage of SSRI consumers fantasize about and/or exhibit extreme violence.
I was originally tipped to this in July of 2012 in an article by RS regular Jonathan Zap, which he wrote in the wake of the so-called Batman shootings of that summer.
Zap notes as follows.
"Mass shootings, like the one that just happened in Aurora [Colorado], have become a recurrent nightmare that haunts the collective psyche. As the nightmare repeats, we see patterns emerging. One, which we don't have confirmation on yet in this case, is that the shooter will almost always turn out to be on an SSRI (selective serotonin reuptake inhibitor). For example, Colorado's other most famous mass shooting, Columbine, was masterminded by 18-year-old Eric Harris who was on the SSRI medication Luvox. Here's an index of shootings and the SSRI connection someone put together."
The website Jonathan links us to, "SSRI Stories: Antidepressant Nightmares," concentrates on reports implicating Prozac (the FDA's number 2 drug for violence), Zoloft, Paxil (number 3 for violence), Celexa, Lexapro, Luvox, Remeron, Anafranil, Effexor, Cymbalta, Pristiq, and Wellbutrin.
Here are a few samples of reports from the site, with comments.
"Tim Kretschmer . . . walked into Albertville Secondary in Winnenden, near Stuttgart, at 9.30am on Wednesday armed with a 9mm Beretta he had stolen from his gun enthusiast father and wearing a K4-Schutz bulletproof vest and the black fatigues of Germany's elite forces, the Kommando Spezialkräfte. . . . He killed nine pupils at Albertville, all but one a girl, and three teachers, all women, in less than 10 minutes. He then shot and killed three bystanders as he tried to escape, before taking his own life after a shootout with police. . . . It emerged that Kretschmer had been suffering from depression . . . and receiving medication for the condition." --Scotland On Sunday, Edinburgh, March 14 2009.
"Hours before he walked into a Northern Illinois University lecture hall and inexplicably started a shooting rampage that ended five lives and his own, Steve Kazmierczak called one of the people he was closest to and said what would be a final goodbye. . . . [According to his girlfriend] 'he was anything but a monster. He was probably the nicest, most caring person ever'. . . . [She said] he saw a psychiatrist monthly but stopped taking Prozac a few weeks ago. She said the medicine 'made him feel like a zombie'." --Chicago Sun Times, February 8, 2008.
What we might call the "zombie effect" seems to come up in many of these cases. Also common is that the violent behavior tends to occur when the patient is either having the dosage adjusted, or has just stopped taking the pills.
The "SSRI Stories" site notes the following.
"The danger of withdrawal from antidepressants and antipsychotics is well documented. The brain tries to compensate for the blockage of the serotonin and dopamine receptors by growing additional receptors for these neurotransmitters. When the medications are discontinued, these additional receptors contribute to an 'overload' of serotonin and dopamine flooding the receptor. This is known as 'supersensitivity psychosis' and 'antidepressant discontinuation syndrome'."
"BEMIDJI, MINN. -- Jeffrey Weise had ‘a good relationship' with the grandfather he shot and killed on Monday as prelude to his deadly assault on students and others at Red Lake High School, according to relatives who are struggling to understand what might have pushed the teenager from sometimes bizarre behavior to mass murder and suicide. . . . They wondered, too, about medication he was supposedly taking for depression, and a recent increase in his prescribed dosage. . . . 60 milligrams a day of Prozac." --Star Tribune (Minnesota), March 24, 2005.
Consistent with the "zombie effect" noted above, many sources indicate that some perpetrators who survive their crime scenes report being in a dreamlike state in which they feel they are watching their actions but not in control of them. Some of the literature notes sleep disorders, and speculates that the drugs induce a state of waking dream in which one becomes a passive witness to one's actions. (Christopher Pittman, who killed his grandparents and set fire to their house told his father afterward that it had been like watching a TV show.) Other sources say the shooters do not remember their crimes or do not associate themselves with what occured.
"Huntsville, AL. -- 15 year old Hammad Memon is free on bond, awaiting trial on murder charges for the February 2010 shooting death of fellow Discovery Middle School student Todd Brown. . . . Memon has a history of being treated for Attention Deficit Hyperactivity Disorder and Depression. He was being medicated with Zoloft and other drugs for the conditions. . . . Memon's mother is quoted as saying 'My son is not normal. He is immature (mentally) for his age. He has become very depressed and withdrawn for the past 2 years, especially in the last 12 months. He does not have insights into what crime he has committed'." --The Free Republic (Alabama), Feb 5 2012.
"CARTHAGE, NC -- Jurors in the Robert Stewart murder trial reached a verdict Saturday. He was found guilty of eight counts of second-degree murder in a shooting rampage at a North Carolina nursing home in 2009. . . . Stewart's defense lawyers said the 47-year-old was essentially sleepwalking at the time due to taking a combination of prescription drugs. . . . Defense attorney Jon Megerian said Ambien and other drugs in Stewart's system caused him to be in a zombie-like state of mind when he entered the nursing home. . . . In pleading Stewart's case, his defense said he was full of remorse, but couldn't remember anything. --WTVD television, North Carolina.
There have been a number of cases where defendants have been found not responsible for their actions due to the effects of the medication.
"STAMFORD, CT -- A Stamford lawyer who shot at a motorist, then broke into his ex-wife's house was found not guilty by reason of mental disease or defect yesterday. Eric Witlin, 40, will be committed to Whiting Forensic Institute for evaluation until he returns to court July 14. Judge Richard Comerford could commit Witlin for the time he could have been sentenced to prison, a total of 70 years. . . . Two psychiatrists, including one hired by the prosecution, testified that Witlin suffered a psychotic episode brought on by Adderall and Prozac, which were prescribed to treat attention deficit disorder and depression. . . . Senior Assistant State's Attorney James Bernardi said Witlin's mental state on the night of the incident was uncontested, since both psychiatrists agreed. --Stamford Advocate, May 20, 2008.
"Anna L. Tang, the troubled former Wellesley student, is finally free to resume her life and has been discharged from court custody. . . . Tang came to the attention of most MIT students in October 2007 when she stabbed her ex-boyfriend, Wolfe B. Styke, then a freshman, in his Next House dormitory room. . . . Tang has bipolar disorder, which she sought help for when she first arrived at Wellesley in 2005. At that time, she was diagnosed with depression and was prescribed an antidepressant. However, as Tang’s psychopharmacologist Michael J. Mufson testified during the trial, bipolar disorder cannot be treated with antidepressants. Doing so creates oscillatory behavior. 'It made her lows lower and her highs get higher', Mufson said. That combination of misdiagnosis and mistreatment led to her attack on Styke. Judge Henry found in December that Tang lacked the substantial capacity to conform her actions to the requirements of the law and that she lacked the capacity to appreciate the wrongfulness of her actions. The Tech (MIT student newspaper), Feb 8, 2011.
In other legal news, there have been some 450 suicide-related lawsuits settled out of court by GlaxoSmithKline, the maker of Paxil.
"Since Paxil came on the market in 1992, there have been three separate types of failure to warn lawsuits filed: birth defects, suicide, and addiction. Roughly 150 suicide cases were settled for an average of about $2 million, and about 300 cases involving suicide attempts were settled for an average of $300,000, according to a December 14, 2009 report by Bloomberg News. Glaxo paid an average of about $50,000 each to resolve about 3,200 cases linking Paxil to addiction problems. . . . All total, Glaxo has paid out close to $1 billion to resolve Paxil lawsuits since the drug came on the market in 1992. The company's provision for all legal matters and other non-tax disputes as of the end of 2008 was listed as $3.09 billion in its annual report." --Dissidentvoice.org.
To summarize, FDA warnings, court finding, and too many news reports to count make a connection between one of the most widely prescribed drug types and bizarre, ostensibly "inexplicable" violence. And though there are thousands of sources and multiple vectors of association implicating the 50-billion-dollar business in SSRIs to some of the most hideous crimes of our day, the major media continue to spin their wheels about the "unexplainable." This story needs to go viral. Now.

 

Hi there Bernard. My sense is that anything which suppresses our emotional life (such as either prescription drugs, alcohol or other recreational drugs) is unlikey to help in getting over TMS. This is primarily because the effects of such substances can act in the same manner as defense mechanisms which the mind/brain can use (such as chronic pain) in order to ensure that threatening material from the unconscious does not arise. Substances which have a sedating effect on the central nervous system work by suppressing our emotions. Complying with this agenda is not the way forward with successfully treating TMS. Around 50% of people on SSRI antidepressants report that they have an 'emotional dulling' effect, clearly resulting in a sedating effect. The other people can suffer from an increase in agitation, anxiety, panic, sleep disorders etc. In addition to their likely-to-not-be-helpful-with-TMS properties, there are a raft of potential adverse side effects with psychiatric drugs which can compound the range of problems for those already suffering. There are good biological reasons for the adverse side effects which some people experience.

As i explain on p.310 of 'The Hidden Psychology of Pain',
Some people enthusiastically report that going on to an antidepressant has been the best thing for them, while others report that their depression radically worsened as a result, bringing them to the point on suicidal despair. These widely different responses to psychiatric drugs are in some part attributable to differences in liver enzymes which are now detectable with genetic testing. All substances which we put in our body need to be metabolized in order that the chemicals be expelled from our system. If this process does not occur, we become poisoned by an accumulation of the chemicals. Many drugs also require bioactivation to form the active compound and desired effect within our body. Pharmacogenetics is the scientific study of inherited variations in the ability to metabolize different drugs via specific liver enzymes.
One family of liver enzymes play a large role in the metabolizing of antidepressants: the CYPs. The existence and amount of these particular liver enzymes in any individual, seen in the cytochrome CYP450, derives from our genetic inheritance. We usually have two copies of each gene, but if one or both copies of the gene don’t function properly, then the drug will be processed too slowly. The blood concentration will then be higher than normal, as the rate of excretion from the body is too slow. With antidepressants, this can lead to side effects such as worsening depression; increased anxiety, panic and agitation; increased suicidal ideation; and a raft of physical adverse effects.
If a person has both CYP450 genes that do not work properly, s/he is referred to as a poor metabolizer. The person who only has one of the genes working for that enzyme (referred to as an intermediate metabolizer) processes the drug more slowly than normal, but not as slowly as a poor metabolizer. A person who has both genes working is called an extensive metabolizer (i.e. “normal”). And people who have more than two relevant genes are referred to as ultrarapid metabolizers.
These genetic differences have a very large role to play in how our body reacts to drugs, however they do not explain everything—there are other relevant factors. People who are lacking in the cytochrome CYP450 system are likely to be the ones who experience the most adverse side effects from antidepressants currently being prescribed. A poor metabolizer is likely to experience the onset of adverse side effects soon after taking the antidepressant, whereas as an intermediate metabolizer may experience side effects over a period of time, as the chemicals from the antidepressant slowly accumulate in their system—this may take months or even years. Extensive metabolizers are less likely to experience problems with antidepressants at the recommended dosage levels; and ultrarapid metabolizers are the least likely to experience side effects, as their system is able to quickly metabolize and expel the chemicals.
These differences in genetic inheritance go a long way to explain the wide range of responses that people can have to antidepressants. In fact, these genetic differences can explain about 75% of the variations in responses to the drugs. As the cytochrome CYP450 system is also responsible for the metabolism of alcohol, cannabis, nicotine and amphetamines, the combined use of these substances with antidepressants or other psychiatric drugs can cause additional problems. This is due to the metabolic pathway already being busy with the psychiatric drug when the additional substances are added. The body becomes even less able to expel the chemicals, due to the pathway being overloaded, and more problematic side-effects can be experienced.
Many other drugs will also increase or decrease the activity levels of various CYP enzymes, either by directly inhibiting the activity of the enzyme, or inducing the biosynthesis of enzymes. This can cause dangerous interaction effects between drugs as changes in the CYP enzyme activity may affect the metabolism and clearance of other drugs. As such, if one drug inhibits the metabolism of another drug, the latter drug may accumulate in the body and reach toxic levels. This is particularly relevant for people who are taking both antidepressants and pain killers, as many analgesics are metabolized by the same enzymes as are antidepressants (e.g. CYP 2D6). Some high profile celebrity drug deaths in the last few years could be explained by this phenomenon. Sudden changes in dosage levels of one of the drugs can lead to unanticipated problems in metabolizing and clearing the other drugs.
Another example of a contributing substance is the herbal depression remedy, St. John’s Wort, which acts as an inducer of CYP3A4, but as an inhibitor of CYPA1, CYP1B1, CYP2D6 and CYP3A4. Bioactive compounds in seemingly innocuous grapefruit juice can also inhibit CYP3A4 mediated metabolism of certain medications, leading to an increased possibility of overdosing because of the increased bio-availability of the substance which the juice creates.
For these reasons, it is advisable that people on combinations of medical and recreational drugs consult with a pharmacist who is aware of the role of liver enzymes and different interaction effects, prior to making any changes in dosage levels.

Without undertaking a simple (but unfortunately fairly expensive) genetic test to assess for your genetic loading of these liver enzymes, any phyisician prescribing psychiatric drugs to you is simply playing Russian roullette. You may or may not experience adverse side effects. This is in addition to the lack of demonstrated usefulness of antidepressants with chronic pain; the lack of benefit which they are likely to provide in approaching TMS (via emotional dulling); and the lack of demonstrated effectiveness in treating even anxiety and depression (see Irving Kirsch- 'The Emporer's New Drugs').

I would suggest that it makes good sense to obtain some competent psychotherapy to assist with anxiety and depression- these are not untreatable problems. Personally, i advocate the use of Eye Movement Desensitization & Reprocessing (EMDR) to assist with anxiety and depression, although research does suggest that when it comes to these problems, most forms of psychotherapy are likely to be helpful (EMDR is more likely to be helpful when the chronic pain, axiety and depression is resulting from psychological trauma). See my website for more details:- www.drjamesalexander-psychologist.com

 

Great the way you conjoin the psychological with the neuro-biochemical, Dr Alexander. I think the great French structural anthropologist, Claude Levy Strauss, once observed that the cutting edge of all human knowledge is where apparently dissimilar systems of thought are synthesized by creative minds to create a new field of study. Productive cross-overs between apparently unrelated disciplines and fields of knowledge, it seems to me, are where new human knowledge occurs and impact the world at large.

 

thanks MorComm. I think there is a real confluence happening between psychology and neuroscience- why wouldnt there be? They are just difference levels of analysis which are looking at the same topic, and there seem to be some basic truths operating in nature. I recently read another blog by a physical therapist who was critical of Sarno's approach. He was stating that there was no support for the TMS model from neuroscience in general, and the neuromatrix model in particular. Just because he is not aware of the supporting evidence from neuroscience does not mean there isnt any. In fact, i'll past my response here below:-

If i had time, i would go through a point by point rebuttal of many of the issues you have raised- alas, i dont. In short, i will say that what you call Sarno’s approach predates both him and the neuromatrix theory of pain by many decades. You might want to dismiss anything Fruedian, however if you were as familiar with neuroscience as your article suggests, you would also be aware that there are many aspects to Freud’s model of the psyche and general psychological functioning which are reciving a great deal of support from modern research in this field- modern neursoscience finds it much harder to dismiss than do most of Freud’s critics. When ‘Sarno’s’ approach was being developed (the precursers even predate Freud, but you also have to look at Franz Alexander), there was no neurmatrix model. Neurological knowledge was extremely primitive, and there was not a lot of point trying to make sense of complex experiences like chronic pain via neurology. Sarno began developing his own variation of these ideas in the 1970′s- again, neurology did not offer a lot at the time. As such, like Freud, he didnt bother attempting to explain his approach with neuroscience language- instead, he used the psychological language that was available at the time. If he was beginging his career now, my guess is that he would be utilising the neuromatrix model, primarily as there is no inherent contradiction. You might like see how these two approaches can be quite easily blended in my book, ‘The Hidden Psychology of Pain: the use of understanding to heal chronic pain’ (2012).
Sarno is now in his 90′s, and is obviously beyond such a project. I, however, am not. Critics of Sarno have to contend with a few basic facts. There is abundent evidence (from both his own clinical outcome research, as well as that of others who use similar approaches) that these notions work- ie. a great many people get better (ie. become pain free) as a result. The piece of science which his critics need to address (usually people who make money from physical approaches to working with chronic pain) is that there is not one physical therapy for chronic pain which has been demonstrated to work beyond mere placebo rates. Sure, some people will get better- but some people will get better from rubbing ‘special’ butter all over themselves as well. When physical therapies are compared against placebo treatments, none of them (including those who purport to be mind/body therapies, but which tend to revert to a focus on the body as their default position) show better rates of improvement beyond chance in their treatment of chronic pain. Physical therapist would be much better advised to stick to what the evidence shows about their efficacy, ie. with acute pain.
Creating ‘straw-man’ arguments, just for the pleasure of knocking them down, and advancing your own pet theory/therapy, hardly advances the state of knowledge. As neuroscience has advanced in recent years, so has the next generation of theorists/therapists who are further advancing Freud’s, Franz Alexander’s, and Sarno’s approach. You, and your readers, would do well to familiarise yourself with this next generation of TMS/neuromatrix theorists/therapists. There is a convergence happening, and attempts to poo-hoo what clearly works for many people sounds more like professional territorialism than science. PS- there is plenty in Sarno’s approach which is supported by contemporary science. Read my book and see.

 

Bravo, Dr. Alexander, for your well-reasoned rebuttal. I'm looking forward to reading your book, and also want to thank you for reviving Franz Alexander's reputation as a pioneer. You must already be familiar with Candace Pert and her studies of neuro-transmitters and their role in perpetuating chronic pain? Reconciling neuromatrix theory with Freud seems like it's going to yield some important discoveries in the years ahead.

 

Thank you all for you useful insight
I've not wanted to go down the meds route and this forum has convinced me that I should try other alternatives
Dr Alexander - many thanks for the pointer to EMDR. I'll have alook into that
All the very best for 2013

 

I came across this old post while asking myself the question that is addressed here. I have heard of many that have gotten in touch with their emotions, have had a cathartic release of pent up emotion, and have recovered. I have been trying to engage in various emotionally-cathartic exercises (such as those presented in the program on this site) to affect such a release of emotional tension. Unfortunately, more often than not, I find myself unable to access the emotional component of troubles, past and present. I am nearly certain that this is a direct result of taking Prozac. I feel I'm caught in a vicious cycle: I have TMS as a result of not being able to get in touch with my emotions, in part because of Prozac. When I try to discontinue Prozac, I experience extreme symptoms of withdrawal, likely as a result of having TMS.

 

Well you guys are throwing around a lot of facts ....but as for me a SSRI as stable me and as not numbed my emotions I still feel and cry had very little sides effects for a short time.. I was able to get out of bed and go to work and fully engaged in tms healing ..

I find that you can pull up negative comments on all medications even aspirin . I feel antidepressant get a bad rap because people don't take the time to wait for them to work 6-8 weeks min.

 

Everybody's different. I took Zoloft for a couple of years because I was so anxious, seemingly out of the blue - this was some time before I learned about TMS and the very real mind/body connection. It helped a lot with my chronic pain probably because it somehow cut down on the chatter between my subconscious and my body, but I stopped taking it maybe a year ago. After I stopped, I realized how drugged I had been. It was a low dose but I am hyper-sensitive to drugs, non-drowsy formulas knock me out, etc.

Redsox, if you are seeing success with your SSRIs that's great!

 

I was on Wellbutrin for about 9 months and it did nothing to alleviate the physical pain, but it helped in restructuring my emotional response to the pain. So instead of thinking, "I'm in pain, and I"m so frustrated about it, and my day is ruined," I would think, "I'm in pain, but I know that if I just change activities the pain will go away. Maybe if I call a friend or cook dinner or do something productive, the pain will go away." And sometimes it did!