Deprescribing: Are You Better Off Medication Free?
I know that strategic medication tapering can be a ticket to an authentic experience of yourself. I get feedback like this, every week:
Is Gloria some kind of freak anomaly of someone who could possibly feel better off medication? You can see that part of her process was shifting out of a mindset that she was fundamentally broken, in need of medication as some sort of normalcy prop. I believe deeply in personal reclamation through a rewriting of this story of the broken self. But what if medications actually contribute to a poorer quality of life, not because of their metaphysical role in self-identity and outsourcing of power, but simply because of their toxicity, particularly in combination?
The Problem With Pills
We know that it’s not a matter of opinion, (despite what the NY Post would have you think!), that medications - properly prescribed - are the third leading cause of death in this country. 1 This does not include the quarter of a million deaths from medical errors 2 3 and overdose, which in 2016 killed more than the entire Vietnam War. 4
These reasons and more are why I was delighted to read Poly-deprescribing to treat polypharmacy: efficacy and safety 5 in the journal Therapeutic Advances in Drug Safety. This longitudinal, prospective trial addresses the major symptom of our fragmented, specialist-driven, the left-hand-doesn’t-know-what-the-right-is-doing-health care system: polypharmacy.
Polypharmacy is ambiguously defined as the prescription of 2-11 or more medications, simultaneously, 6 encompassing more than half of the American population. 7
The author, Garfinkel, states that the epidemic of polypharmacy is driven by:
(1) the increased number of doctors/specialists and clinical guidelines; (2) the lack of evidence-based medicine (EBM) and knowledge regarding drug–disease–patient interactions in polymedicated; (3) barriers/ fears of medical doctors to deprescribe.
His study was conducted on patients >66 years old taking >6 prescriptions (never mind the 666!), and this intrepid clinician endeavored to offer them the opportunity to discontinue more than 3 of their meds, strategically assessing quality of life parameters.
Getting Free, One Med At A Time
After approximately four years, Garfinkel found that: Overall, 57.4% of PDP patients/ families reported an improvement as early as 1 month after the intervention. In 82.8% health improvements occurred within 3 months of the intervention and among 68% improvement persisted for more than 2 years.
Like the parable of the blind men and the elephant, feeling and describing only their part, neglecting the comprehensive appreciation of the whole animal, Garfinkel states:
...all too often specialists who treat patients ‘by their book’ have but one aim, to deal with their one aspect of the disease spectrum; no in depth consideration of the ultimate effects of medications they prescribe combined with other consultant’s interventions on patients’ overall welfare.
He also references the domino effect of prescription toxicity leading to new diagnoses and new medications, stating:
“The problem is further aggravated due to ‘prescription cascades’ where symptoms resulting from ADEs are perceived as representing ‘new diseases’.”
So, it turns out that when real life studies assess the effects of medications, stopping them - several if not all of them - can lead to a better quality of life.
I love his hopeful message, in conclusion:
Conclusions: This self-selected sample longitudinal research strongly suggests that the negative, usually invisible effects of polypharmacy are reversible. Poly-deprescribing] is well tolerated and associated with improved clinical outcomes, in comparison with outcomes of older people who adhere to all clinical guidelines and take all medications conventionally. Future double-blind studies will probably prove beneficial economic outcomes as well.
The study doesn’t particularly reference psychiatric medications (in fact, he references starting them during the study window), which, in my opinion, are the most difficult chemicals on the planet to detox from. While I acknowledge that the physiologic relief from discontinuing a medication may, itself, result in near-immediate improvement in quality of life, psychiatric medication taper seems to ask something more of patients intending for a medication-free life. The taper process asks for healing. Physical, emotional, and spiritual...and this healing does more than improve quality of life...it sets you free.
References:
- 1 https://www.ncbi.nlm.nih.gov/pubmed/25355584
- 2https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us
- 3 https://www.ncbi.nlm.nih.gov/books/NBK225187/
- 4 https://www.vox.com/policy-and-politics/2017/6/6/15743986/opioid-epidemic-overdose-deaths-2016
- 5 http://journals.sagepub.com/doi/abs/10.1177/2042098617736192
- 6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635569/
- 7 https://newsnetwork.mayoclinic.org/discussion/nearly-7-in-10-americans-take-prescription-drugs-mayo-clinic-olmsted-medical-center-find/
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