Rethinking relapse

For every psychiatrist and patient who thinks believes that schizophrenia is a chronic biological disease that causes people to invariably relapse because of their "disease" after discontinuing their medication I am thrilled to present the following excerpt from the recent New York Times magazine article, Depression's Upside

Consider a 2005 paper led by Steven Hollon, a psychologist at Vanderbilt University: he found that people on antidepressants had a 76 percent chance of relapse within a year when the drugs were discontinued. In contrast, patients given a form of cognitive talk therapy had a relapse rate of 31 percent. And Hollon’s data aren’t unusual: several studies found that patients treated with medication were approximately twice as likely to relapse as patients treated with cognitive behavior therapy. “The high relapse rate suggests that the drugs aren’t really solving anything,” Thomson says. “In fact, they seem to be interfering with the solution, so that patients are discouraged from dealing with their problems. We end up having to keep people on the drugs forever. It was as if these people have a bodily infection, and modern psychiatry is just treating their fever.”

I, too, relapsed the first time I tried to go off an antidepressant. I got back on the medication for a few months, rethought my exit strategy, looked further into homeopathic substitutes, and the next time I attempted to get off them, I was successful. For a while during this ordeal, I almost had myself convinced I was chronic. So what, then, is so special about coming off medications when the person is diagnosed with schizophrenia? The difference, I suspect, is stigma. Many doctors just can't get out of their heads the idea that schizophrenia is chronic and that medications prevent someone from relapsing. They are afraid of the lurking beast. Rather than revert to treating the patient with understanding and empathy, they pile on drugs to prevent the scarier aspects of psychosis from rearing their heads. The meaningful but hard work of psychiatry is avoided in favor of prescription writing.

Coming off schizophrenia drugs should involve exactly the same thinking that this study has shown. In other words, you analyze the situation, you add more non-drug therapies (like CBT or other therapies I write about in this blog) and you resist the conclusion that most doctors are only too willing to hand you, that people with schizophrenia will always need their drugs because they just can't function without them.

Relapse can mean that you are simply not there yet, that you haven't yet developed the coping strategies and the self-awareness that is needed for a steadier toe-hold on life. It doesn't mean that you are a chronic case. Relapse can occur while on the drugs or off the drugs but has a lot to do with your particular circumstances at the time. People often relapse witin a year of getting off their drugs. Relapse at this stage should not be attributed solely to the fact that the person is off the drugs. It is a dangerous connection to make. A far better way to look at it is to reason that maybe there are other things that you should be doing to develp your life coping skills, to make you more emotionally resilient. This is a strategy coming out of strength, not weakness. The weaker response is to succumb to the fear that there is nothing you can do to change, to admit that you are chronic and forever dependent on your drugs.