You said, "I also know, however, that agressive medication for something like bi-polar disorder (what used to be called manic depressive, right?) can make the condition worse if the patient stops taking the medication. At least that was the thinking many years ago when I drove an ambulance for a living in the NY area.
It's not that "aggressive medication makes the condition worse." That's a common misconception. Their condition gets "worse" because they stop taking their medication in the first place.
More specifically about bipolar disorder: As a general rule medications don't make a bipolar condition "worse." The bipolar symptoms only get worse if the person stops taking their medication. In fact, medications such as lithium, SSRIs & SSRI-related antidepressants are often the only thing that allows a person with serious bipolar illness to live a relatively normal life. Find any person with bipolar disease who has been properly diagnosed and has been stabilized on psych medicine(s) to keep their disease at bay -- they'll tell you their life was a living hell before finding the right combination of medications.
I've often wondered where this "Psych meds make it worse" line of thinking comes from. I don't know, but I suspect several things:
First, it may originate from the fact that there are many, many people out there walking around with undiagnosed mental illness -- people that you and I see everyday. Naturally, since they don't even know (or care) they have a mental illness, they aren't taking medications for it. And since they're "undiagnosed," their circle of friends or acquaintances (you and I ) don't notice their abnormal behavior that much because there's not a "name" to label it with. We just think of them in terms of being "irresponsible," "crazy as hell," or for the men, "a full-blown psycho-b*tch." (I've never seen an equivalent term for males!). When they finally get a diagnosis and get stabilized with medications, unless it's someone we know well, we don't even notice.
.... [Fast forward in time a little bit. -------->] ..... A few weeks/months later, they stop taking that medicine and subsequently get sick. If it's bad enough & they get suicidal or lose touch with reality, we hear about it (usually after-the-fact). So then this person's story -- the story that gets passed around among 2nd & 3rd degree acquaintances -- gets twisted and the part about him always being "crazy as hell" gets left out. The story that does get passed along goes something like, "Yeah, he was fine until he got on those psych meds. Then he ended up in the hospital!" Based on an incomplete history, people start assuming the medications made his condition worse.
The 2nd suspicion I have involves the propensity for people with mental illness to develop a "tolerance" of sorts to their psych meds. For no apparent reason, a medication can stop being effective on certain people and they develop symptoms of mental illness again, even though they're still taking that same medication that worked last month. And as the mental illness progresses, the behavioral symptoms can worsen. (This happens with schizophrenia. A lot. Schizophrenics often become "treatment resistant.") Everyone around this person whose medicine stopped working just assumes "the psych meds did it" when in fact, the person became tolerant to that particular medication.
One other 3rd possibility: a doctor has no way of knowing what medication will work on any particular patient. Take someone with schizophrenia, for instance. That person may have to take several different antipsychotics (Risperdal, Zyprexa, Seroquel, Geodon, etc.) before finding one that controls the symptoms. Meanwhile, the patient is becoming more and more sick. Some people just assume "it's the psych meds" that making them sick. This kind of medication management can be difficult, to say the least. It usually results in a hospital stay to get the patient stabilized on another medication that's more effective in symptom management.
On another note, you said:
There are also cases where someone who is bi-polar starts taking sleeping pills for related problems. I know personally of a case where someone stopped taking Ambien and went into a psychotic episode within days, taking the couples young children and just disappearing for a few weeks of wandering around. She's now institutionalized and that was a case of stopping the medication triggering a reaction.
Abrupt discontinuation from sedative-hypnotics (Ambien/zolpidem) or anti-anxiety medications (benzodiazepines such as Xanax) is known to cause problems. That's another reason why people shouldn't just stop taking their medications without doctor supervision. In some cases the withdrawal syndrome for these types of medications can be severe, especially if the medication has been taken in high doses regularly for a long time. For one, research has shown that many people who suddenly stop taking a sedative-hypnotic may experience a grand mal seizure. In cases of severe withdrawal, a person can develop problems with reality testing (e.g., hallucinations, illusions, or delirium). That's just one more reason why people who take psychiatric medications should take them responsibly. It's often the people who don't take them responsibly that give medications the bad reputation.
I didn't mean to say so much and ramble on and on. I think it's because I just spent all day at a hospital watching some very sick people who were there because they needed some psych meds.
And of course, it goes without saying that everyone here is entitled to their own opinion. Your mileage may vary. :-)
No, you are exactly right and I agree with everything you said. I was very casual and tossed off a post on a serious subject without fully explaining myself. I do feel that, once on the correct meds, there will be a larger reaction during the withdrawel for such a patient than might be the case (notice, "might") if they stop their meds. That is the total extent of the conventional wisdom from my time on an ambulance way back when (1970 to around 1976 in the NY City area). It's not that the meds make the condition worse, it's that the withdrawel from the meds can exagerate the symptoms that might (notice, "might") have not been so severe had they not taken the meds in the first place. Of course, that assumes that they could have gone on without the meds, which is a big (and probably wrong) assumption. As I read what you wrote on the subject I think you're saying the same thing and I think you're saying it much better than I have.
And the comments about the sedative/hypnotics are exactly in line with (but much better stated) than what I have understood to be the case.
I got out of the business all those years ago because I could no longer deal with the emotional price I had to pay. I was never bothered by an emergency, no matter how traumatic (except crispy critters) because I had a job to do and was able to turn off all emotional reaction. But on a professional ambulance you are mostly doing "routine transports" from hospital to hospital, nursing home to doctor or some type of treatment or therapy. Under those circumstances you have to allow some sort of emotional connection to the person you are transporting. What's worst was the regular appointments, "Bob on Thursday morning" or "Martha's weekly accupuncture treatment for MS." You get to know the people. You (I) can't avoid developing bonds and caring. You either watch them go on with the treatment not making any improvement or, the worst thing, showing up one morning and being told "oh, we're sorry, we forgot to call you and cancel..."
Although I will wait to see the transcript of this show, I saw this note a while ago on another forum:
"On Catherine Crier -- Farese says no medical documentation of pre existing mental condition"
Doesn't seem like he would be saying this now, with all the things floating around that he has already said in the past few days alluding to her mental condition being very poor and PPD being a possibility. Perhaps the poster got it wrong. Will wait and see.
Some good info about psychiatric drugs here. I would just like to add that I have recently experienced Severe Discontinuation Syndrome from going off Effexor. I had severe episodes of nausea and vomiting three times within 48 hours after missing a dose or stopping it to switch to another anti-depressant. The info to TAPER OFF ANY PSYCHIATRIC DRUGS is very important and even then you will sometimes have problems. And sad to say there is still a lot of stigma attached to mental illness (including depression) in some areas.
Whether or not this has any bearing on the Winkler tragedy, I admire so much the way they and their community are handling this tragedy