Tag Archives: Medication

Documentary: Take your pills: Xanax (2022)

Watch Take Your Pills: Xanax | Netflix Official Site
Netflix Documentary: Take your pills: Xanax

Xanax, an anti-anxiety that I’m very familiar with from the 7 year working in a psychiatric clinic. I was excited to see this title showing up in the list of recommended shows as I was trying to find something to watch over the weekend, after waking up really late from watching the World Cup (Qatar 2022).

It consists of most things I already know, and many things that I’ve explained to many laypersons over the years, I definitely recommend this to everyone who experiences anxiety, who knows someone who’s taking anti-anxiety to watch this (essentially everyone), and think about it… Unfortunately it’s not the most “interesting” documentary with a twisting story-line, but it’s important to learn how we are often fed certain drugs (and nicely called medicine) when there are many things else we can do to cope with it, might be harder and sometimes more costly, but without any side effects, dependence, tolerance and withdrawal symptoms.

My stance is clear, I don’t mean to not take any pills for anxiety, because sometimes the anxiety can be so strong that it’s almost impossible for anyone to deal with, leave alone function, so this is when pills like Xanax can play a role, but when you’re feeling better, definitely do not just believe that you can just keep popping the pill into your mouth the next time when it happens, instead, learn about anxiety, your triggers, how you can cope with it the next time it happens, and practise those coping techniques. It takes a while, but you can ultimately depend on yourself and nothing else…

Feel free to read about my older writings on medication.

Medicine side effects vs the illness itself – Which is worse?

The illness itself, or the medication side effects – which is worse? Perhaps people who are taking medication can share their experience?

I’d always thought it’s the illness. Of course, it’s something that you don’t get to choose and can’t control. To many people, it just happened, then their lives changed.

So whenever people complained about side effects of medication (e.g. many anti-psychotics cause so much drowsiness that patient can sleep all day; or some antidepressants cause dry mouth, constipation etc), I’d tell them the gains are much greater than the losses, or that you get more advantages than disadvantages out of it. So tolerate with it, and it’s going to fade away anyway  (when patient gets better the dosage can be reduced, or maybe when their body get used to the drug then the side effects diminish!)

Till this morning when I saw this young girl. She was completely disorientated, perplexed, restless, with limited response, almost zero eye contacts and tremor hands when I held her. It’s not possible to hold a brief conversation with her, leave alone doing psychotherapy. I knew it’s a psychosis case, but in my mind i kept wondering why her presentation was like that. It’s hard to believe she was once a happy and easy going girl, doing well in the schools, despite her kind of difficult family background.

Then I recalled what her auntie told me in the emails – the medicine she was taking from the hospital following the first onset and admission couple of weeks ago. Suddenly it became much clearer. I have seen this quite many times, most of them are patients who were already taking medicine when they first came to us. It’s not the presentation of the illness itself. It is the side effects of the medication (you can perhaps email me to ask what drug it is; I think to many people, the answer is obvious) given by the GH.

If this were one of my family members, I wouldn’t want it. I’d rather to have her having difficulty sleeping, some hallucinations and being a bit paranoid – ok, this might be equally bad I can’t deny it. But It’s really difficult. Isn’t it?

What would you choose? Do you have any experience tolerating side effects of medicine that you take?

N.B. Don’t get me wrong, I’m not asking everyone to stop their medication due to the side effects. Most of the time I still think that medication would be beneficial and helpful despite the side effects. However, if you suffer from intolerable side effects (another common one from anti-depressants – sexual dysfunction, ranging from changes in drive, arousal, erectile/orgasm problems, satisfaction), do speak to your consultant, quite often there are substitutes.

Introducing “Listening to Prozac”

By Peter D. Kramer
By Peter D. Kramer MD

Last year I bought this book for RM5 from the Popular RM5 book fiesta (by now you probably have realized that I bought a lot of books there, and yes you’re right, I do spend time to go through those non-fictions and try to pick some treasure!). It is written by an American psychiatrist.

This is really a book that I’d strongly recommend, to … certain people, like me – who know quite a bit about psychopharmacology, but not enough, not much about their history – who have seen how all those drugs are used practically and in day to day life, but not read much about the facts and dark stories behind them. It is an old book I have to say, but I learnt so much about the older generation anti-depressants (tricyclic like Imipramine, Monoamine Oxidase Inhibitors which is not so common these days) and those that I’m so familiar with, i.e. the SSRIs (e.g. Prozac (Fluoxetine)!).

It made me think a lot about how those so-called legal drugs are prescribed, used and misused, how it can change a person from the inside (personality! how they see themselves all their lives simply changed after they started the medicine!), how vague the definitions of psychiatric diagnosis are, how tiny the difference between well and unwell could be etc etc. It may not be a book for everyone, I’m sure some might fall asleep reading it, but it’s probably the first time I’m reading such old book (published in 1993 -before I attended elementary school :P, some updates in early 21st centuries at the back) but still get so astonished and learnt so much!

Drug Use & Drug Abuse

More specifically, it is Psychiatric drug use VS Illicit drug abuse

If I have depression, or dysthymia, or an inability to experience pleasure (anhedonia), why do I need to take psychiatric drugs? I can take cocaine, amphetamine, heroin or opium too, they make me happy and feel high too. It reminded me of the patient who took his own life by jumping off from a building. He said gathering with his bunch of friends and taking those pills are his kind of pleasurable activities (case study here), just like women go shopping or people go gym. Yea, right, how about that? Take a few “pills” and I’m better?

Antidepressants like Prozac and Lexapro (the SSRIs) do not provide pleasure, it restores the capacity for pleasure. It is neither excitatory like cocaine nor satiating like heroin. The drug taker doesn’t crave Prozac and does not feel relief when it enters the system. The desired effect, a change in responsiveness to ordinary pleasures, occur gradually and is unrelated to the daily act of consuming the drug. So unlike cocaine which produces quick, strong but short-lasting “high”, people don’t “usually” get addicted to the SSRIs.

Drug addicts use stimulant drugs hoping to cope with intolerable feelings. Without medication, they may experience little enjoyment. Prescribed medication makes drug addicts who kick the street-drug habit feel less empty and better able to enjoy ordinary pleasures. For the addict, the hope is to enhance the ability to “postpone gratification”, something antidepressants may do by increasing the ability to imagine future pleasure. If and when ordinary pleasure becomes appealing (after a drug addict is treated with psychiatric medicine and begins to experience “ordinary pleasure”), it’s hoped that self-understanding and self-control will follow (no longer rely on illicit drugs to achieve “instant pleasure”).

So can we use anti-depressants (and some other medication) to treat stimulant drug addictions? I believe with a combination of behavioural therapies, and supports from the immediate family members, anti-depressants would work. But taking only anti-depressants without strong mental and motivation to quit and sufficient social supports is definitely not enough, not in long-term for sure.

Psychiatric Drug Abuse?

But anti-depressant drugs (focusing on SSRIs here) can also be abused. There are patients whose depression were treated with the SSRIs, once successfully weaned from the tablets, want to restart it, not because they are depressed, but because life seemed brighter when they were medicated. In psychiatry it’s a bit difficult to decide where treatment ends and depression starts again.. but doesn’t this seem a bit like taking illicit drugs? Same applies to people who take excessive anxiolytics (anti-anxiety drugs / tranquilisers) to make them calm and functional, how do we define when it’s legal psychiatric drug abuse?

There are people who feel more mentally sharp and agile, talk more fluently, and more socially confident when they are on anti-depressants, they continue to take it even when they don’t show any signs of depression at all. Unlike amphetamines which also make people more alert and productive but at the same time is addictive and causing paranoia, most of these SSRIs don’t lead to any significant side effects (and (if) any discomfort tend to go away after first few days). So does this make it morally and ethically fine to take anti-depressants to increase alertness, quickness of thought, and verbal and mechanical fluency, in the absence of illness?


P.S. SSRIs stands for Selective Serotonin Reuptake Inhibitors, which are newer drugs used to treat depression, but also work for OCD and anxiety disorders. Some commonly used in Malaysia include Lexapro (Escitalopram), Prozac (Fluoxetine), Zoloft (Sertraline), Luvox (Fluvoxamine).

N.B. This post focuses more on major and minor depression, dysthymia and anhedonia.

Taking psychiatric medication in long-term?

“Do I have to take these pills in long-term? Do I have to depend on them for the rest of my life?”

This is one common question asked in the psychiatric clinic, especially during their first visit when they are prescribed with medicine, and again especially so in the Asians, who seem never quite keen to take western medicine (including myself).

I believe different consultant psychiatrists have different response to this question. More commonly, the answer is either, “not in long-term, but you will have to maintain stably for few months” (so before you are stable, it’s not taken into consideration), or, “yes, that will be better for you; though you should be able to maintain on a minimal dosage” (for some people, maybe just half a tablet of Lexapro 10mg).

And then they will continue to throw you with more questions… But today I just want to focus on this first question. And please take note that I have a background in clinical psychology, not medicine, and I had worked in a national forensic psychiatric ward (UK) for 3 years then in a private psychiatric outpatient clinic (KL) for almost 3 years too. (For differences between psychology and psychiatry, please see here)

I’d advise that you seek advice from your consultant. But if for any reason, you need a second opinion or some reassurance, these are a few points that you can consider…

  1. Are you in a stable state now? Do you and your closed ones around you think you are well? How functional are you compared to the time before you become unwell? (It’s obvious, if you are not even stable on the medicine, do you think you will be fine without it?)
  2. Is this your first episode? (I don’t think any psychiatrist would advocate long-term antidepressant treatment for people who have had a single episode of major depression; It may be different for people with anxiety or psychotic related problems)
  3. If this is not your first episode, how close is this episode to the previous one? How severe is this episode? Is it getting harder to manage, to return to your ‘normal’ state? (The general pattern was a decrease in the interval between episodes and an increase in the severity and complexity of the episodes, until finally rapid cycling set in. As time passes, it requires ever smaller stimuli (e.g. stress, a bit of change, an argument) to trigger an episode. The latter recurrences would typically include all the symptoms of earlier episodes, plus additional symptoms. So, if there has been a number of episodes, and it seems to get harder to manage and cope, you are strongly recommended to continue with the medication instead of withdrawing)
  4. Any early traumatic or stressful life events, e.g. physical/sexual abuse, separation from main carer, death of a parent, prolonged hospitalisation, marital quarreling, mental illness in a family member etc when you were young? (Those are not just memories, the incidents could also have altered your brain, leaving it more susceptible/vulnerable to stress, separation, rejection, loss etc. Click here for more details. Anti-depressant medications have been found to prevent further neural damage and block cell loss.)
  5. Are you someone who’s very sensitive and/or easily stressed? (It might suggest a vulnerability originated from the brain, please refer to 4.)
  6. Are you doing any psychotherapy? Are you responding to it? Does it help? (Not everyone responds well to psychotherapy. But as a psychologist and a psychotherapist I will have to add this point to the list! It is always good to learn more about the illness, to spot the early signs of relapse, to cope with stress and adversities in life etc. How can psychotherapy help after one’s stable with psychiatric medication? I have a post here in Chinese that explains it.)

Again I would like to emphasise the importance to discuss this with your consultant, whether you have financial difficulties, or maybe you think you are stable enough to stop or reduce, or maybe you think psychotherapy will help you in long-term. Sometimes it’s not a bad idea to have a second opinion, but that’s after sticking to one consultant long enough (a few months at least) and things still never improve.


A few readings that is related to the topic:

The need to maintain on psychiatric medicine (psychotic and related illness)

The more you worry about having to take medicine, the more you need to take them

Is psychotherapy for me? (Well, if you are now stable and really are not keen to continue with medicine, check here to see if psychotherapy may be for you)

Anti-depressant & Anti-anxiety Medicine (Maybe you are thinking to try to reduce some medicine without the advice from your consultant? See this first)

精神藥物的角色 (The role of psychiatric medication, in Chinese. It also tells you the role of psychotherapy after you are maintaining well on medicine)

In the news: Mum killed for asking son to take psychiatric medicine (No, don’t force them. If they are not willing to take the medicine, try to get professional advice to see what you can do to help, but don’t make them take it…)

Psychology Today: 7 ways childhood adversity can change your Brain (How those adverse experience make you more vulnerable…)