Psychiatry is designed in such a way such as to get you addicted to... psychiatry itself

     

    This article serves as a short critic of the way psychiatry handles certain symptoms. I will speak of the usual process of treating mood and anxiety "disorders" with medication inside psychiatry, so I do not claim that what I write here applies to the treatment of, say, schizophrenia or ADHD. It applies to people having symptoms ranging from depression to mania to anxiety to OCD and phobias, i.e., what is usually treated with the help of SSRIs, SNRIs and other antidepressants.

    The first thing to point out is that each antidepressant medication, on its own, has a low chance of working on a specific individual at a time. For example, while it is more complicated to compute a specific probability, since this is dependent on many variables, there is around a 40-60% chance that your antidepressant medication will work on the first try* for people with unipolar depression.

    This is why the general algorithm for treating mood and anxiety disorders in most people is like this: you go to the psychiatrist, you talk to them for a short time about your symptoms and they give you a med or a combination of meds. You meet again in one month. If your symptoms improve after this, good, you will get a prescription for more months (ex: 6 months) and you will only have check-ups every few months to ensure that everything is under control. If your symptoms do not improve or perhaps even get worse, the psychiatrist will add one medication, switch your medication and/or increase your dose (ex: they may double the does of your SSRI, they may try another SSRI or they may add an antipsychotic like Abilify to your SSRI to "increase its effects") and then you meet again in one month. Rinse and repeat this process - meet again every 4 weeks if your symptoms do not improve, each month switching your medication, until you find a combination of meds that "works". The psychiatrist is not able, with the current scientific developments, to perfectly predict what medication will work, they can only try to guess which med or combination of meds has the highest probability of working for your individual case (ex: do you have emotional liability but with more depression than mania? Lamotrigine is slightly more likely to work than valproic acid. Are you greatly disturbed by sexual side-effects? Try Wellbutrin; etc.).

    This is how "the general algorithm" of treating mood and anxiety disorders in psychiatry is based on trial and error, with very little predictive ability. This wouldn't be much of a problem if there were a way of determining causality retroactively. However, we know very well from basics of statistics that correlation does not equal causation. Consider the situation in which, after four months of trying out multiple combinations of meds which worsened your depression in these four months and added various side-effects (sexual dysfunction, digestive problems, weight gain, etc.), after trying the fourth combination of meds, your depression is finally gone or at least "less severe" than initially. How is anyone able to distinguish causality from correlation here? It is impossible. How do we know that your symptoms improved because of the last combination of meds that you tried, or whether it was a coincidence that your depression went away for some other reason and it just happened that you tried our some medication 1-2 weeks before? The psychiatrist does not care to determine such causal effects - they will make a blind guess that this correlation is in fact a causation and insist on keeping you on this last combination of meds that you tried for 6-12 months or perhaps even more, with no guarantee that the meds did anything. Perhaps your depression improved because of therapy, perhaps it simply went away on its own (like it often happens), it is impossible to know for sure - the only way to find out would be to travel back in time one month and live your life in the exact same way with the only difference being that you would not try out that medication - only then you would determine causation. But we all know that time travel is impossible.

    The second, probably even worse, problem with psychiatry, that is somewhat related to the one above, is the way it is designed to create addiction. We know that almost all psychiatric meds (SSRIs, SNRIs, other categories of antidepressants, mood stabilizers like lamotrigine or carbamazepine, antipsychotics, benzodiazepines, pretty much anything) creates dependence - this means that once you take them regularly for a few weeks, you cannot quit them "cold turkey" without experiencing withdrawal symptoms and it is generally recommended to taper them slowly, gradually reducing the dose at a certain interval of time (this is even more important in the case of benzodiazepines in which withdrawal can occasionally be deadly). However, I want to argue here that there is a second factor causing dependence - the very process of psychiatry itself. The patient is not only dependent on their medication, they are psychologically dependent on "going to the psychiatrist". This is inherent in the very way the process is designed combined with the way in which the medication works.

    The idea is this: after you have already trying various combinations of meds for a few months, quitting them will cause withdrawal, even if you taper them slowly. Trying out a new antidepressant will usually worsen your symptoms on the short-term, for most people this is 2-3 weeks, but with the promise that perhaps, if you are lucky this time, after 4 weeks your symptoms will improve. However, tapering your medication slowly (in the case that you want to quit them) will worsen your symptoms for around 4-12 weeks (depending on how slowly you taper), and after all this struggle, in the end you will end up back at baseline, like how you were before your first visit to the psychiatrist. Hence, the patient is always confronted with a decision between two options: you either try out a new medication and see the psychiatrist after another 4 weeks, or you quit your current antidepressant(s). The system is designed in such a way such as to make it seem more profitable on the short-term to always choose the former option.

    Let me give a concrete example: I myself have been submitted to this horrible process about 1-2 years ago. I've had symptoms of depression and mood swings. After 3-4 months of depression, I went to my first psychiatry visit. I've been given a combination of escitalopram and valproate. After 4 weeks, my depression got worse so I went at another visit and we switched them for another combination of meds (venlafaxine with abilify, if I remember correctly). They did nothing so I went for another visit after 4 weeks and we switched the medication again.

    After 3 months, my symptoms have been worse than in the beginning. Before I continue the story, now put yourself in my shoes: I had to make a choice between two options. Either try out another combination of meds, which will cause other side-effects for the first 2-3 weeks, and hope that this time I am lucky and after 4 weeks my symptoms will improve; OR start tapering my medication and quit antidepressants and psychiatry altogether. If I choose the first option, I will almost definitely continue suffering just as much (if not more) in the first 2-3 weeks, but there is a chance that I will get better after 4 weeks. If I choose the second option, I will have to slowly taper all my medication so I will almost definitely suffer more for at least 2 months, and hopefully after those 2-3 months of tapering, be back to baseline, to the depression I had before my very first psychiatry visit. It is obvious that, on the short-term, it seems way more profitable to always choose the first option.

    This is simply a more perverted and extreme version of the sunk-cost fallacy. Once you are in, you are hooked, and it always seems "more logical" to choose the option of continuing the process of "trying out another combination until my symptoms hopefully improve". There are a few people, however, for which antidepressant medication simply does not work at all. But there is no way of knowing from the beginning if you are one of them. So in the case that you are unlucky to be one of those people for which psychiatric meds do not work, and you end up trying them anyway, you will be stuck trying out another combination, and another combination, hoping that "this time, after one more month" your symptoms will improve. If SSRIs themselves cause a level of physical dependence, the dependence on psychiatry itself is a much more messed up dependence, metaphorically similar to the dependence on synthetic cannabinoids in which you are hooked after the first 2-3 hits.

    In my case, the story continued and I tried multiple combinations of meds until after about 5 months of trying meds, the sixth combination was a certain dose of Wellbutrin combined with a certain dose of Lamictal. After 1-2 weeks of trying out this combination, my depression was almost gone, or at least way better compared to how it was six months before, before the first psychiatry visit. The psychiatrist assumed that my depression got better because of this last combination of meds and kept me on it for 6 months. I will never know for sure, however, whether my depression got better because of the Wellbutrin/Lamictal, or if it simply happened that it got better for some other reason (therapy, other factors, etc.) around the same time which I tried that combination of meds, and maybe the meds had absolutely no effect on my depression. Or, it's even possible that the Wellbutrin/Lamictal made my symptoms worse, and it just happened that 1-2 weeks after trying them some other thing happened in my life that improved my symptoms significantly more than the meds made them worse, such that the effects cancelled them out. The only way for me to find out the true causal effect of those medications would be to travel back in time and try out something different, thus doing a scientific A/B test with two groups each made of only one person (me) - to have an experimental group made of me in one timeline and a control group made of me in another timeline. But we know that time travel doesn't exist, so this is impossible.

    It is clear from this analysis that psychiatry clearly lacks a lot of scientific rigor. It has no way of determining causality and distinguishing it from correlation, which errs on the side of pseudoscience. Even though in the research experiments themselves, you can determine causation by having a double-blind trial with a control group, those experiments do not translate 1:1 to the psychiatry clinic itself, since each person reacts differently to the meds. You cannot do an A/B test on yourself, you cannot clone yourself and try out two different combinations of meds on each of your clones to see an actual causal effect. This is pseudoscience, the irony being that psychiatry has thus become a discipline that would only become properly scientific with the invention of either cloning or time travel...

    With all this said, one should keep in mind that I intended to keep this post short and thus my analysis has been over-simplified to the extreme, so be careful when drawing any conclusions from what I said. Please note that:

1. Most of what I said here may or may not apply to the treatment of other conditions such as psychotic disorders, ADHD, autism, etc...

2. Not all treatments follow in a rigid way "the same algorithm" of trial and error. Not all psychiatrists check in on you at exactly 4 months, in some rare cases there may be some ways in which to predict causality, etc. I oversimplified my example to give you the most general or even "archetypal" model of how this "trial and error" of trying out a new antidepressant every 4 weeks happens in most cases. Hence, what I said here applies in most cases of the treatment of mood and anxiety disorders, though not all.

3. DO NOT quit your psychiatric medication cold-turkey just because of what you read in my post today, especially if your medication works on the GABA receptors (benzodiazepines, barbiturates, etc.) in which case withdrawal can be deadly. Consult with your psychiatrist if you want to quit your medication, or if you must insist on doing it yourself, taper off your medication slowly, gradually decreasing the dose every 1-2 weeks.

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*: https://effectivehealthcare.ahrq.gov/products/depression-treatment-ssri/research-protocol