Bipolar Medication Myths: Dr Joanna Moncrieff

First Aired: 08-26-2010 -- 14 comments | Add comment
Dr Joanna Moncrieff

Is bipolar disorder a disease? Can medications like lithium correct chemical imbalances and stabilize mood? Do psychiatric drugs act completely differently on the brain than recreational drugs?

UK psychiatrist Dr. Joanna Moncrieff, author of The Myth Of The Chemical Cure: A Critique of Psychiatric Drug Treatment, discusses how seeing psychiatric medications as treatments for disease misleads the public about how they actually work, and obscures their potential for abuse as tools of social control.

http://www.critpsynet.freeuk.com
http://www.academyanalyticarts.org/moncrieff.htm
http://www.mentalhealth.freeuk.com/howwork.pdf

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14 comments on “Bipolar Medication Myths: Dr Joanna Moncrieff

  1. I’ve been given the diagnosis of Bi-polar Disorder even though I have not had any full blown manic episodes or consequential depressive episodes.What I probably have is Cyclothymia,a mild Bi-Polar like disorder with mood swings.
    Some jackass psychiatrist at a US Veteran’s Administration Medical Center gave me that diagnosis because I had a lot to say and felt I needed to speak quickly the first time I met with this shrink as I had no idea how long the appointment would last.
    He put me on Depakote and Risperdal which had absolutely no effect on me.
    My mood swings continued,and I dropped him like a sack of hot potatoes.
    What I do have which has significantly impacted my global functioning, is Attention Deficit Disorder.That’s when I began taking cerebral stimulants aka Dextrostat,a member of the class of drugs known as amphetamines and an adjunct mood stabilizer to keep a reign on the Dextrostat under the management of a board certified family physician specializing in ADD/ADHD,and Tourette’s Syndrome.
    The stuff worked,I began to concentrate better and remain focused.That lasted several years until I began experiencing untoward effects:as the Dextrostat dose wore off,I felt as if someone applied a clamp to my head,not unlike experiencing a hangover,and felt as if I was having a fever when I really wasn’t.
    Well,the insurance company at my new job(I did have a history of job hopping/terminations–>ADD related)refused to pay for the Dextrostat until a got a second opinion.
    Well,guess what,the second opinion psychiatrist stated that I did not need Dextrostat ,but that I had Bi-Polar Disorder.
    So I went cold turkey and for quite some time took absolutely nothing.
    Then I landed a job with the state at a state hospital and found another psychiatrist who echoed the one before.
    This guy was real personable and all and put me on… (now I forget the names of all but one medication).Well the med did nothing ,I still had mood swings and now underlying depression(mix of situational and clinical).
    I canned that guy too-but he did put me on a drug that I swear by:Seroquel.In my case I had not been able to get more than 4 hours sleep each night for 2 years until I started taking the stuff.Works like a charm-sleep like a baby most nights.
    I finally found a psychiatrist that got me on a cocktail of a sustained release anti-depressant,an anti-anxiety drug,and Neurontin,a neuroleptic used for a variety of maladies ranging from neuropathic pain to,(in my case,an adjunct to the anti-anxiety drug),and of course Seroquel which i now am on a maintainance dose of 200 mg(one starts a patient on 25 mg and see what happens,upping the dose to the desired effect)
    Plus,a few months later,added Adderall a cerebral stimulant as I felt like my focus was waning again.
    I used up the anti-depressant,don’t think it helps and have not refilled the prescription and am now taking;Adderal,Klonopin,Neurontin,and Seroquel.I’m also going to ask my psychiatrist if I really need to be on Neurontin(not sure it’s helping)and will ask into Abilify.

    So,why all that about me?
    I believe I’ve been mis-diagnosed as having Bi-polar disorder by one rather stupid psychiatrist and that diagnosis has dogged me from one psychiatrist to the next.
    Worst thing is,the money grubbing Life Insurance Company I buy Term Coverage from(through the state),has capped me-meaning I can’t buy the maximum allowable coverage because I’m Bi-polar and every company insurance underwriter knows that such customers have a much higher than normal suicide rate(really now).That really angers me.

    Moral of my story:Psych Drugs do work,when prescribed by competent psychiatrists.(I just got my 5 years’ faithful service certificate from the state,no small achievement given my spotty job history).
    If I had to get off the medicines,(i.e. beneficial to the patient)I’m on ,I’d have a hard go at my job,my family ,and all the crap that life throws at me.

    If you don’t think the psychiatrist you are using is helping,fire the incompetent,and find one that can help you.
    Yes,you may have to go through trials of medications,but isn’t a week,a month,a quarter,or a year or more of sanity worth it?

    Reply
    1. Multiple doctors gave you the samediagnosis. In what way does that equal one bad diagnosis having followed you anywhere?

      Reply
  2. joanne

    you hit the nail on the head. i’ve been thinking this for a while myself.

    1. how can they prove lithium causes the remission when long natural remissions occur?
    2. how can they even apply the scientific method when comparable test samples of patients cannot be selected because of the great variance in frequency of episodes and the near impossibility of predicting anyone’s outcome?

    i’m not a scientist, but it just doesn’t seem that lithium has been proven to work. i have had two breakdowns on 800-1000 mg of lithium, and was compliant. nevertheless, nursing staff accused me of not taking lithium and causing my family great pain! because they are so brainwashed into thinking lithium actually works. i’ve read of lithium efficacy rates of 40 and 43 percent in the new york times and british journal of psychiatry respectively. if one were to do a cost benefit analysis, that kind of efficacy would not compensate for the massive side effect profile of lithium, not to mention those god awful antipsychotics. my psychiatrist’s refusal to admit to ANY side effects on any of these drugs is clearly unethical. in any other business, it would be criminal to withhold information relating to efficacy and side effects as was done to me. i was completely misled, misinformed, you name it.

    I have no problem taking these drugs when i’m psychotic, but to take them when i’m well is inhumane as far as i’m concerned. i feel utterly cheated by the constant stream of lies my psychiatrist told me to get me to take these drugs. She told me i’d be able to function highly in work and home, be creative, etc. all i wanted to do on them was sit in a chair and stare into space. she may as well have locked me up in a back ward in a straight jacket or lobotomized me because that is how i felt for three years on those drugs. And despite my constant begging and entreaties to my relatives and support group members, only one person empowered me by saying that it was my choice whether to take them or not.

    Unfortunately, I have remained compliant but have weaned down to 600mg lithium and no antipsychotic. The weaning down process at this stage was pretty scary. I’ve had a few sleepless nights and I was talking a bit more than usual. But I seem to be balancing out. Intuitively I feel it’s vital to taper down off lithium as slow as possible.

    I should have known my psychiatrist was going to shaft me entirely. Following my first breakdown, she put me on an antidepressant alone, an almost surefire way to cause another episode. Miraculously, I had a three year remission but was very irritable for three years. My psychiatrist acted so nice and caring and compassionate and reassured me that all my fears about these drugs were unfounded. From all my years studying (I even went to the LSE for an MS in 91!), working in politics in Washington and then finance in New York, I have NEVER been so utterly lied to in my life. And I am angry at myself for letting my guard down and believing this idiot woman.

    She acted as though my retardation, for want of a better word was some kind of incomprehensible personal development unrelated to the drugs. Every single complaint I had about side effects was attributed to the underlying condition. After every single person and I complained about the two facilitators in her mental rehab program, the psychiatric nurse told my mother, the complaints were due to the symptoms of our mental illnesses!

    The worst stigma I have experienced has been at the hand of the psychiatrist and the psychiatric nurses whom i feel have not shown me the minimum amount of respect reserved for a human being because I have bipolar disorder. Nothing I ever say has any credence with these people. They come in and take over like clucking hens, like everything they do is for your own good, when in fact they are deeply dangerous because quite simply none of them really knows what she or he is doing. The ignorance of psychiatric nurses with respect to mental illness and drug function is truly shocking. But the ignorance of the psychiatrist is pretty frightening too. It took me months to persuade her that abilify is a weight gainer. i had to send her an article from the new york times. she wasn’t even bothered when i failed to menstruate for TWO YEARS on Risperdal. then she put me on abilify (on top of the lithium) and admitted that i kind of unfocused and zonked on the risperdal. No bother to her. she had me on a drug that she admitted made me unfocused for two years! What kind of human being can do that to another?

    thankfully this horrible person who destroyed 7 years of my life has retired. god knows what kind of lunatic we’re going to get next. i’m very worried. i don’t want to let my family down. my mom’s bipolar too and down to 200 mg lithium hoping to come off it. but my siblings have put unbearable pressure on me to stay on these drugs. they never helped me or seemed concerned by my zonked state. they just want to get on with their lives and not have to bother with me. i just have to find the courage to get off this lithium and be myself. i feel a million times better on 600 mg. i truly haven’t felt this well for almost 8 years because of first wrong meds and then overmed. it’s like getting to know an old friend again. thats how detached i was from myself. i feel born again. i can enjoy the sight of the ocean and the mountains and music. none of these things which i’ve loved had any meaning for me for all these years. i’m crying now for the first time in about four years (since i started lithium at 800mg)

    Those psychotic episodes are terrifying but they only last a week or two. I only stayed in hospital a week for each of my four episodes. While I don’t want another episode, the fight on my hands is to minimize my meds. That has occupied all of my time since this whole thing began. The big fight has been with the psychiatrist. It’s not been about my recovery so much as a battle of wills to get me to submit to a draconian drug regimen that simply has not worked in my case.

    I’m beyond angry at this stage. I’m also very scared because I have to rely on these people in the event that I do have another episode. When I asked a locum to reduced my antipsychotic, he threatened me with the possibility of having to stay in the psych ward for months instead of weeks if i had the inevitable next breakdown. Unbelievable. I have never been treated so poorly in my life. It’s abominable.

    anyway – i better stop writing now. thanks for giving some sense to the mess that is bipolar drugs!

    Reply
    1. Thank you TJ for your thoughtful comment — people need to know the risks of lithium and other drugs prescribed for bipolar. Medical professionals often blame the illness for medication side effects, and I am meeting more and more people who tell me their worst hospitalizations or crises occurred only after they started taking meds. Lithium plays a huge role in many people’s return to crisis and hospitals, which it is supposed to prevent. At the same time lithium is essentially a sedating drug, and so I know people who rely on it to keep their emotional/mental states under control, though of course as we are discussing at some point the reliance on the medication might be because the medication itself creates brain changes, not because of an underlying problem, and there might be placebo effects and other factors, but that is an individual issue and depends on the person to discover for themselves. You write clearly and strongly and I hope you write more about your story in detail and share it with others. – Will

      Reply
  3. well, I never heard back from Dr. Moncrieff but I’m sure she’s very busy. Here’s what I wrote her.
    Joanna Moncrieff – I was so happy to hear you on the latest Madness Radio. Will Hall and I worked together for a number of years on the Icarus Project and I recently went back to school and ended up using an essay you wrote in a paper that got turned into an article. I quoted you towards the end:
    http://slingshot.tao.ca/displaybi.php?01
    It’s not my favorite piece of writing, but I learned a lot while I was writing it. And your perspective and clarity were very helpful.
    Here’s something I wrote on the Icarus site one night which you might appreciate:
    http://www.theicarusproject.net/forums/v
    The whole issue of meds is very confusing for me: I’ve been taking lithium for almost a decade and, while complicated, its hard to argue that its been incredibly helpful as a stabilizing force in my life. Ask anyone who knows me and you won’t hear stories of someone with a blunted personality. I think I might fall into that category of folks they labeled “manic-depressive” back in the day who is really helped by having some lead weights on my wings. I don’t hear that part of the story in your narrative about the drugs, that they can actually be helpful for some of us. When we started the Icarus Project it was about creating some space to talk about the nuances because there were all these people critical of the biopsych model and the drug companies who were having really positive (or at least really interesting and complicated) experiences with the drugs themselves and there wasn’t anywhere to talk about it. That was part of the reason we started it. Politically I understand why you draw the stark lines the way you do, but I don’t hear my experience reflected in your story. And that’s a bit frustrating, because in the end I’m not sure that’s going to be helpful for the movement we want to build. What do you think? Regardless. I’m so happy to have an excuse to write you an email! I’m so glad you’re doing the work you’re doing. Mad love,
    Sascha

    Reply
    1. Hi Sascha, I emailed Joanna Moncrieff to hear what she might have to say. Looking at her book The Myth Of The Chemical Cure, she writes that “all sedative drugs that have been trialled in mania have been found to be more effective than placebo.” That would be consistent with your experience that lithium is helpful. Her book, like Whitaker’s Anatomy of An Epidemic, does summarize studies that confirm the usefulness for some people, even if it didn’t come across in the interview.

      Her essay with David Cohen How Psychiatric Drugs Work, found here: http://www.mentalhealth.freeuk.com/howwork is really worth a read. She argues for a “drug centered approach” that honestly acknowledges how drugs work – by creating an altered state of consciousness that may or not be experienced as useful, an altered state associated with degrees of toxic effects (hence the word “intoxication”). They don’t work as suggested by a “disease centered approach” by treating the specific biological pathology of any mental illness.

      “Blunting” is a misleading and imprecise word because plenty of people take lithium and benefit from it without being overmedicated to such a degree as the word suggests. (Some people do definitely get “blunted” by lithium – when I was on it I definitely was.) Either way, lithium is still basically a sedative (animal studies, unfortunately, show this). It can certainly be a sedative and, as you say, thereby work for some people as “lead weights on their wings.”

      In her essay with Cohen she compares models of psychiatric drug action;

      Disease centred model Drug centred model
      Drugs correct an abnormal brain state

      Main indication is the presence of a particular disease

      Therapeutic effects arise from the action of drugs on an underlying disease process

      Drugs create an altered physical and mental state

      Indication is the value of particular drug induced effects

      Therapeutic effects are a consequence of being in an altered state

      How human consciousness responds to a “sedative” and the associated altered state of consciousness is going to of course be individual and unique. An example is alcohol – alcohol is definitely a sedative, but many people find that they when they drink they get more excited. This is explained in part by the relaxation of inhibition and the easing of restrictions on expression that sedation, at lower doses, creates. So there’s no simple equation of any psychoactive drug to a simple reaction in consciousness. I also think that ‘psychoactive’ and ‘intoxication’ are gradations on a continuum. At the more subtle end are the reactions on mood and consciousness we get from eating different foods- some people find bananas and fried foods sedating. So the language starts to limit our discussion, as you point out by objecting to “blunting” being equated to “sedating” in the interview.

      Reply
  4. Listening to Montcrief makes me feel sane for the first time in years. I am bipolar. After my first episode, I refused bipolar meds and recovered fine without them and had a three year unmedicated remission. Then I had a second breakdown and agreed to go on Lithium. Despite being on Lithium, I had another breakdown a year later and agreed to be put on Rispderdal on top of Lithium. Despite being on Lithium AND Risperdal, I had ANOTHER episode a year later. Needless to say, I was a complete zombie for the following three years and my quality of life was truly zero. I finally was taken off the antipsychotic and finally am coming down on the lithium under doctor’s supervision. But I feel really angry that I lost those years on meds and had breakdowns anyway. Just reducing the lithium to 600 per doctor’s instruction (after I begged her to let me reduce it) has left me very tired and with a few rocky nights. Withdrawing from these drugs is scary and time consuming. But what really worries me is how on earth will I cope if I have another psychotic episode. I will once again be at the mercy of the psychiatrist. I am really sick of giving someone else so much power over my life. I feel like she lied a lot to me.

    Reply
    1. YOUR STORY IS SIMILAR TO MINE..PSYCHIATRISTS ARE MERELY OPINION DOCTORS..I AM A SURVIVOR OF SEVERE ABUSE IN WHICH MY ABUSER WAS CALLING THE CORONER ON ME AND HAVING ME ADMITTED TO SEVERAL MENTAL HOSPITALS AFTER HE WOULD ABUSE ME. THE PSYCHIATRISTS WERE LABELING ME WITH EVERY DIAGNOSIS UNDER THE SUN ON TOP OF FORCING ME TO TAKE THESE MEDS. WITHOUT EVER ASSESSING ME FOR ABUSE OR GRIEF WHILE FORCING MEDS DOWN MY THROAT..THIS IS A FORM OF ABUSE AS WELL…I FEEL FOR YOU AND UNDERSTAND

      Reply
  5. Really enjoyed the interview, if only I heard this kind of information a few years ago. I don’t wish to write a story but after two hospitalisations and years of drugs have had huge weight fluctuations and permanent changes to my body from drugs, which, looking back, did not seem to help at all. So treatment has made things worse.

    Anyone interested in more of this in detail another book is Users and Abusers of Psychiatry by Lucy Johnstone to go with Joanna’s book.

    I cannot imagine things improving for ‘service users’ or psychiatry changing. I expect things to get worse. But we must do what we can, spread awareness.

    Reply
  6. Very interesting show…
    Especially to hear this information from a psychiatrist.

    @Andy,
    Thanks for sharing your story. Quite inspiring!

    I’ve been on lithium for 7 years and feel much better now without the stuff.

    I must say I feel very betrayed at times.
    If I knew then what I know now, I would NEVER have started taking them.

    Reply
  7. Thank you very much for this broadcast. Without doubt, almost every mentioned aspect of bipolar disorder and its treatment with lithium and other “mood stabilizers” closely reflected my situation and experience. This is my condensed story.
    In mid spring 2007, my life completely and dramatically changed. I ended a long-term relationship, moved out on my own and begun to party excessively with my newly found liberation. I started to have difficulty sleeping because I was not used to being single. After abusing my body with drugs and alcohol, terrible sleep, poor diet I began to have manic symptoms. At first I felt motivated, brilliant, daring and strong. I felt a sense of being spiritually connected. Eventually, I degraded into a state of confusion and delirium, even having had the experience of auditory hallucination. The scary part was that having never experienced this, it all seemed very real. I started acting extremely weird, in ways that only made sense to me. Once my behavior really started to scare my friends and family, I was taken to the emergency room.
    In July of 2007, I had been hospitalized for the first time in my life, diagnosed as bipolar, kept in treatment for two weeks, and released on a cocktail of drugs namely: lithium, abilify, an anti-psychotic and a drug to counter the tremors of the anti psychotic. Being on pharmaceuticals was the beginning of a living hell.
    My intelligence plummeted. I could not manage the manual dexterity to play guitar, at the time one of my only means of outlet. My motivation was lost. I felt in a constant daze. Driving seemed difficult and dangerous. I never had anything to say to anyone. I had chronic diarrhea and had regular accidents–which is unacceptable at 25. I moved out of the party house I was living at shortly after release to go back to my parent’s home. I convinced my manager at a delivery driving job to give me my job back (I had lost it when I was manic.)
    It seemed I had little going for me. I think the time when I was on meds especially Lithium was the only time my life was at risk for suicide. I never wanted to do it, but I had this scary image appear in my mind like a prediction of me doing so. I did not tell my doctor about it because I did not want to be put on even more drugs.
    I eventually tired of ****ting myself every week and decided to ween myself off of the Lithium et al. The next time I went to my psychiatrist, I told her what I had done and why. She seemed to think it was very important that I must remain medicated so she started me on Depakote. It wasn’t nearly as bad as the Lithium, though I experienced the side effects of sleeping 12 hours per day and weight gain.
    Throughout this time, I was not paying my medical bills. My mom was buying my Li and others out of pocket. When I switched to Depakote, I received the free trial packets from the hospital Pharmacy. I moved back out of my parents house and eventually my psychiatrist was not returning my calls. I ran out of medication and decided to try being without meds. I have been off pharmaceutical drugs since late Feb. 2008.
    I got back into the partying and living carefree and impulsively but never slipped back into the mania I had experienced before. I tried to pay close attention and make sure that I slept enough if I started to feel weird again. Eventually I got into some serious legal trouble drinking and driving. Six months later I decided to change my life by going sober. I have been clean since Jan 1, 2009.
    Since that time I have gotten into health, fitness and eating healthy foods. I returned to school and finished my core curriculum studies. I ran a marathon. I have not experienced severe mania or depression since getting off the pharms. I could never have accomplished what I have done and am doing under the influence of Lithium or “mood stabilizers.” Yes, I do have moods. I get sad when I’m lonely. I feel a little manic if I drink too much coffee or do not take care of myself such as sleeping enough. With sobriety, a focus on health and fitness, and some CBT I am doing very well living a non medicated and productive life. I am now living off campus in a college town, pursuing my undergraduate degree at a state university.
    Through some research, I have found that a ketosis diet, also used to treat non drug responding cases of epilepsy, is also thought to help with bipolar. I have experimented with this and found that it does indeed have a mood stabilizing effect for me. However, I do not wish to be in full blown ketosis and with a CHO intake of about 100g/day, seem to do quite well.
    I appreciated this podcast. I often would think of the use of pharmaceuticals as “social engineering.” I feel that not unlike our food industry, the American Drug industry is in itself sick and twisted beyond control. My apologies for such a long post, again this had just struck such a chord with my experience that I had to share it.

    Reply
  8. Great Job Will and thanks to Joanna Moncrieff for speaking up. We all need more of her. As usual I found myself impressed with your ability as a host to zero right in on questions and comments which need to be asked and made.

    I think you need your own TV talk show Will. You would be very good at it. You are definitely the Oprah of the ‘Mad.’

    Reply
  9. Hi again all, here is what Joanna Moncrieff just emailed me:

    >>>
    It is very difficult to tell in any individual case whether medication has
    been helpful or not, because of the unpredictable nature of manic
    depressive relapses. In other words, if you have been well for a while,
    you just don’t know whether it is the medication, or whether you would
    have been well anyway.

    Lithium is a sedative drug, and therefore logically it may reduce the
    onset of manic episodes, but the research evidence is not at all
    conclusive. This is because long-term trials of lithium have been
    confounded (messed up) by the fact that we know that coming off lithium,
    especially if you do it suddenly, can make you more prone to having a
    relapse than if you had never been on it in the first place. Since some or
    even all of the placebo group in long-term lithium trials had previously
    been on lithium, they are at higher risk of having a relapse because of
    lithum withdrawal, and the differences between lithium and placebo can be
    accounted for by this fact. Also, one large recent randomised controlled
    trial of lithium prophylaxis found no difference between lithium and
    placebo (and sodium valproate by the way).

    Moreover, when you follow up large numbers of people who have taken
    lithium who are not in trials, and compare them to people who have not
    taken it (and these are not tighly controlled comparisons admittedly),
    there seems to be no clear advantage to taking lithium.

    So to my mind, we just don’t know whether lithium is effective or not.
    What I am trying to do is to give people a clear and critical view of the
    research evidence so that they can make better informed decisions about
    their medication.

    — Joanna Moncrieff

    Reply
    1. One stay I had in a private mental health hospital was dragging on and on, over a month long stay, because I had refused to take their prescriptions, and instead stay with spiritual healing and a kindness vegetarian diet and also probably the fact that I had excellent insurance paying the big bill .

      So , I took the pills prescribed into my hand several enough times. And sure enough, I had so many compliments from the Staff on how well I was doing after I took “their Prescribed treatment” that they let me go very soon thereafter.

      I never ingested the pills. They thought, they saw, and they believe in that power of those meds. I believe in an omnipresent power, and It is Free, It is Liberty.

      Peace and thank you,

      “Vegan is for on earth as it best is in heaven”

      Reply
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