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christian counseling today
Vol. 20 no. 2
T
he movie, Apollo 13, was
based on a real-life explo-
sion on a lunar spaceflight
that threatened the lives
of the crew. The mission flight direc-
tor responded to the crisis by ordering
his engineers to “work the problem”
and find a solution, as “failure is not an
option.” In medicine, failure is not just
an option, but often a frequent real-
ity. Some patients do not respond to
pharmacological treatments or cease to
experience any therapeutic benefit after
varying amounts of time. This kind of
“failure” often depletes patients of their
most precious commodity: hope. From
this hopeless position, patients can self-
medicate, drop out of treatment alto-
gether, lose jobs, ruin relationships, fade
spiritually, and have an increased risk for
suicide.
The reality is that medication
management does not always work in
addressing a patient’s clinical problems.
Sometimes, we do not fully understand
the complexities of the diseases that
we are attempting to treat or have the
appropriate technology to treat even a
fairly well-understood problem. Nev-
ertheless, there may be an answer if we
“work the problem” adequately, and
failure should not be considered as an
option. To document what working the
problem would look like, we monitored
patients over a two-month period who
presented with pharmacological sce-
narios where medications were either
not working at all or had ceased being
effective. The following is a list of the
problems that were “worked” and cor-
rected, resulting in recovery becoming a
reality for these patients. It bears repeat-
ing: these were real, not theoretical,
situations.
n
Substance Use Disorders:
Using alcohol, cannabis, methamphet-
amine and cocaine were associated
with depression, anxiety and psycho-
sis. Nicotine use can speed up (induce)
liver enzymatic clearance (flushing) of
some psychiatric medications from the
body. Reducing or stopping nicotine
increased blood levels and psychotropic
performance.
n
New Medical Problems:
The
onset of the following was associated
with worsening of a variety of psychi-
atric symptoms: thyroid disease, low
testosterone levels, menopause/peri-
menopause, diabetes, polycystic ovar-
ian syndrome, anemia and chronic pain
syndromes.
n
Medication Side Effects:
Psy-
chiatric symptoms were temporally
associated with starting a variety of med-
ications including: Keppra and Topamax
(for epilepsy and seizures), Arimidex and
Lupron (for cancer), chronic hepatitis C
antivirals, and Prednisone (an immuno-
suppressant). Several psychostimulants
(Attention Deficit Hyperactivity Disor-
der) and appetite suppressants were also
associated with mania.
n
Medication Interactions:
Oral
contraceptives reduced Lamictal (an
anticonvulsant) blood levels (enhanc-
ing the risk for bipolar depression).
Methotrexate (for autoimmune dis-
eases) reduced folic acid levels (enhanc-
ing depression). Asthma medications
enhanced anxiety as a side effect of
Wellbutrin (an antidepressant).
n
Sleep:
Anything that disrupts
normal sleep cycles can have psychiatric
consequences. Examples of this include
cough/cold medications, sleep apnea,
barbiturates (sleeping pills), leaky CPAP
(continuous positive airway pressure)
masks for sleep apnea, caffeine/energy
drinks, jet lag and stimulating nutri-
tional supplements.
«
Michael R . Lyles , M .D.
shrink notes
When Failure Should Not be an Option
