The Anti-Depressant Trap Leads To Bipolar Disorder Diagnosis, Lithium Toxicity
An estimated 27 million to 30 million Americans–mostly adults, but Big Pharma is working on that!–take an anti-depressant each day. I once saw an estimate, one I cannot find right now, that several million people had been on anti-depressants for a decade or more. Among all those people were me and a recently-made friend, a 30something woman who went on anti-depressants in her mid-20s for depression and anxiety and has been on Paxil and Effexor at fairly high doses for more than 10 years. She also sees a therapist, one who sends her to a nurse practitioner for her “mental meds.”
So a few weeks ago my friend shot me an instant message and complained that she hadn’t slept well in weeks and that she felt agitated and antsy. I pointed out to her that her problems could well be connected to her anti-depressants, both of them well-known for producing such side effects. What’s more, she and her now-ex boyfriend bought a house together a few years ago and because they are underwater on their mortgage they are still living together. No possibility of stress and tension there! She told me that she knew she’d have to be off her anti-depressants someday–she’s read the long term studies of their effects on women–but that she’d basically need a “benefactor” to pay her bills for six months as she expects to be non-fucntional while undergoing withdrawal. Not an unreasonable expectation.
I really didn’t know what to tell her beyond pointing out that her anti-depressants and the stress she was under could well be causing most of her troubles with sleep and agitation. I would have never expected what came next.
Sometime in early November, she went to see her nurse and instead of the nurse suspecting a case of low-level akathisia and stress, the nurse diagnosed my friend with bipolar disorder type 2 and added Lithium to her regimen. Later that evening, she messaged me and I told her that I flat-out didn’t buy the BP2 diagnosis (diagnosed quite late while having anti-depressant problems and never having a hypomanic episode) and that the BP2 diagnosis itself had its critics within psychiatry (David Healy chief among them). She told me that she trusted her nurse. I know this person well and she’s pretty stable and the BP2 diagnosis simply makes no sense to me.
A few days later she messaged me again, complaining of leg cramps, twitching in her hands and a salty metal taste in her mouth. “That’s Lithium toxicity,” I told her and pressed her to contact her nurse immediately. She did and the nurse, to her credit, called my friend after-hours, denied that it was a toxic reaction to the Lithium and pressed her to continue taking the drug. Which she did. A couple of days later, toxic symptoms persisting, she finally listened to me and stopped the Lithium and went to see the nurse again a couple of days later. I knew she’d end up on another mood stabilizer of some kind and sure enough my friend is now taking Neurontin (well, at least it wasn’t Depakote).
I’ve pointed out to my friend that her nurse likely doesn’t have a ton of training in diagnosing and that what she has gotten likely came at a pharma-sponsored CNE (the nursing equivalent of a CME). I pressed her to get a second opinion from a psychiatrist and recommended a couple of decent ones here in town, all to no avail. I’ve done what I can for her for now and I’ll leave it at that for a while.
I bring all this up because I think it illustrates another element of the anti-depressant trap in America. Instead of long-term anti-depressant use leading to health problems and physical dependence (or addiction, if you prefer), it’s now leading to people being re-diagnosed with another disorder. I’ve been deeply suspicious of the whole “Your depression is bipolar disorder” line being bandied about much of this decade and I wonder how many people with long-term depression problems have wound up being diagnosed with bipolar disorder 2 principally as a result of a reaction to anti-depressants. I don’t have an answer. But I do have a hunch. And I don’t like it.
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