by Charles O'Meara, RN
If I had to pick one topic that has dominated my career as a psychiatric nurse, it would be medication. This one topic has been and continues to be at the center of debates, arguments, hospitalizations, and tons of angst and bad feelings. There are myths and misconceptions galore, proponents of medication and those who rail against it. People who know next to nothing about mental illness often don't have an opinion about neurobiology or the function of the amygdala in bipolar disorder but they're happy to spout off about medication. I could write an entire book on this subject. Instead, I'm writing this and subsequent essays. Medication is usually the issues in mental health treatment. It has produced successes and failures, it has strong proponents and equally strong detractors, it raises ethical questions and it's been the single most commonly used tool for treating mental illness. But patients and families are almost constantly confused by it, scared by it, unwilling to take it and more. (And each psychiatric diagnoses comes with its' own particular medications, so everything I have said so far could apply to mood stabilizers, antipsychotics, antidepressants, anti anxiety medications and so on). As I said, it's funny how lay people will say 'E=mc2??? Gee I don't know anything about physics. That's physics, right? You'll have to ask someone else." But when the topic is medication, which is based on chemistry, anatomy, physiology and (to some degree) genetics, gender and who knows what else, it's a different story. Nice folks who can't tell you how many chambers the heart has or what a covalent bond is or how hemoglobin functions in the bloodstream will be happy to explain to you that psychiatric medications are "bad," "mind control," and "turn people into zombies." They (or someone in their family) will tell you that they heard on a report on the news that such-and-such medication gives you brain tumors and refuse to believe they heard it wrong even when you show them all the research data. Then there are the people who with loudly let you know that their cousin's stepson's girlfriend's aunt had a good result with X medication and ask why you aren't giving X to their kid. And then there are the misconceptions about what a psychiatrist is. They are medical doctors. They know all that doctor stuff plus some more brain stuff. They aren't "shrinks" and psychiatry isn't "voodoo" or "pseudo-science". As practiced in America in the early 21st century, it relies heavily on studies and testing that show how altered brain chemistry affects normal thought and how medication address (or don't) that chemistry. I don't mean to sound arrogant here and look down my nose (or down my knows ha ha) at people who have knowledge gaps. I have them. I have learned to shut up and listen when the mechanic explains what's wrong with my car, because I can't fix cars. I don't give lectures to the tree guy when he comes over to take down a sixty foot maple, because I don't have the training to do it. I'm just suggesting here that before one criticizes something it's a good (and polite) idea to realize you might want to make sure you do a little research (and not on Alex Jones' website) and remain open minded. And ask questions instead of getting frustrated. Let me pause and say a couple things about not only to medication but to anything that goes into your body. People often complain about "side effects." Everything you put in your body causes a "side effect" (we say "adverse reaction" now). If you eat a lot of jalepeno peppers and have a sensitive tummy, the side effect is a world class case of heartburn. The side effects of smoking include decreased oxygen in the blood stream. Too much alcohol? I think we all know the side effects there. People get angry over ads for medication that list a whole host of negative side effects. But imagine, for example, if the following totally accurate label was placed on the side of a vodka bottle: WARNING: use of this product may cause blurred vision, nausea, vomiting, poor coordination, bad judgement, headaches, behaving like a fool in public, insulting your boss, sleeping with someone you didn't mean to sleep with, car accidents, and financial problems. Long term use may cause damage to liver, kidneys, stomach, esophagus, your marriage, pancreas, brain, nervous system and any respect your children have for you. How's that for a list of side effects? Doesn't stop people from overindulging or becoming alcholics, does it? Yet, as I said, when it comes to medication, people scream. "I quit taking XYZ because it made me gain weight/sleep too much/caused insomnia/gave me gas, etc." And I'll say, "I hear you, I understand. How are the voices in your head? And your suicidal impulses?" "Oh those are almost all gone but I can't keep taking this medication." When medical people speak of medication, they use the word "compliance" a lot. That doesn't just mean taking your medication, it means taking it as directed, i.e., the right way. Not your way. How about I lighten the mood? A guy walks into the doctors office with a rectal complaint. The doctor examines him and says 'You have hemorrhoids. I'm going to write you a prescription. Take this and come back in two weeks." So the guy has the prescription filled and it's for suppositories. The pharmacist asks "You know how to use these, right?" The guy doesn't want to look ignorant so he says "Sure." The label says "Use one daily," so the next morning he wakes up, gets a glass of water and swallows a suppository. He does that every day and after two weeks returns to the doctor's office. The doctor examines him and says "I don't understand it, your hemorrhoids should be gone. Did you take the whole bottle the way it said to?" And the patient replies, "Yeah but I might as well have shoved them up my ass for all the good they did." That's not exactly made up, by the way. You'd be surprised. Anyway...when a pill - which is a bunch of chemicals - enters your mouth, your body begins to go to work on it, breaking it down, sorting out the chemicals and getting them to where they need to go - to your bladder, to your thyroid gland, to your brain, whatever. There are lots of things that can interfere with this process. Imagine you a going to drive a car from Chicago to New York. You do some figuring and come to the conclusion the trip should take X hours and require X gallons of gas at X price per gallon and that if you leave by a certain hour on Monday you will arrive in New York at a certain day and hour later in the week. Fine. Nice plan. Then things go wrong. Traffic jams, a wicked headache that causes you to pull over and sleep for four hours, sudden bad weather, sudden even worse weather, road construction, a flat tire and hey! lucky you! Another flat tire! Now imagine that a pill is like that car, going on a trip from your mouth to, say, your brain. According to what's been worked out in laboratories, it should take X minutes to begin working, it should continue to work for X hours and it should clear out of your body in X hours. Unless there are obstacles. You have poor nutrition, don't eat right, so the medication doesn't find the chemicals it needs to help it work. You drink alcohol or grapefruit juice or something else with your medication which, you were told, will make it NOT work at all. You don't take it at the right time or in the right way. You're supposed to take it twice a day but most days you only take it once and some days you skip entirely. Or you're supposed to take it on an empty stomach and you take it five minutes after breakfast every day. I know people like to say "I know my body, it'll be OK," but unless you know a lot about anatomy and physiology and pharmacology, you're wrong. This results in one of two problems: 1. the medication doesn't do what it's supposed to do so the patient decides, that the doctor "doesn't know what the hell they're doing," and doesn't go back. Or tells the doctor it's not working and forgets to mention all the things they do wrong so the doctor doubles the dose. 2. the patient concludes the medication isn't working, badmouths the doctor, tells others "that medicine is no good, i took it and it didn't do anything," and their original problem gets worse and worse. When this happens, non-compliant patients (from my experience) often 'mis-remember' how they take their meds or just flat out lie about it. "I take my Depakote every day!," then you do a valproic acid level and it comes back so low that either they're being untruthful or they have a serious metabolic deficiency. Do you think an active alcoholic is going to be honest with a doctor when asked "Are you drinking with this medication? Because alcohol will keep your antidepressant from working." Usually they say something like "No. Well, maybe I had a beer or two in the past week but that's it." And for the record, when I say "alcoholic" i'm including homeless people and CEOs and suburban moms in the same group. NOTE: this is part of an ongoing series about medication. Future essays will address ethics, efficacy, history and more. None of the information here should be used to make a diagnosis or medicate yourself. These statements are based on my experiences as a psychiatric nurse for more than two decades. Consult a medical professional if you have medication issues. |
charles o'meara, r.n.I have worked as a registered nurse for more than two decades, ninety percent of that time as a psychiatric nurse. Archives
June 2017
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