In the first season of HBO’s Girls, Dunham stirred up debate by, among other things, repeatedly revealing her less-than-perfect body while playing the show’s main character, Hannah Horvath. What got people talking as the second season progressed, though, was how serious the show seemed to be getting, especially with its depiction of Hannah coping with a resurgence of her OCD symptoms.

Critics, fans, mental illness activists and patients have largely praised the Girls’ depiction of OCD, which they’ve hailed as convincing and nuanced, but agonizing to watch. One hollywood.com writer and self-described former OCD patient called it “some of the darkest, most difficult material with which Girls has wrestled to date,” lauding the show for avoiding the temptation to turn OCD into a mere joke.

The fact that Dunham revealed in a March cover story for Rolling Stone that she’s struggled with OCD since childhood – and taken medication for it on and off – gave the topic more buzz. (I discussed what she revealed-and what she didn’t-here).

In a HBO behind-the-scenes look at one of the episodes, Dunham disclosed a little more about the connection between her experience and the show’s representation of Hannah’s OCD – though she didn’t go into specifics.

For those looking for a more direct comparison, here’s a look about what Dunham has said about her own experiences with OCD symptoms and treatment – and how they compare to Hannah’s.

How it all started

In the Rolling Stone story, Dunham reveals her symptoms started at age seven and that she’s been seeing a therapist ever since. On Girls, we learn from Hannah’s parents, who happen to be in town to witness the return of her compulsive behaviors, that she struggled with OCD back in high school. It’s not clear if that’s when her symptoms started – or just if that was the last time they posed a serious problem for her.

The Number 8

Dunham discusses at length in the Rolling Stone article her obsession with the number eight and her compulsion to perform behaviors eight times as a way of dealing with what were evidently disturbing thoughts. She’d imagine a murder eight times, look to either side of her eight times to make sure no one was following her, and once even confessed to her mother she’d just thought about having sex with her eight times in a row.

Hannah’s anxiety, which flares up again in the face of a short-turnaround e-book deadline, largely manifests in the same compulsion to perform activities in sets of eight. She jabs her elbow into a stranger’s elbow eight times in a restaurant, and confesses that when absorbed in her compulsions, has to imagine a murder eight times in a row, or masturbate eight times a night to keep her anxiety in check.

Denial

Going on the record in a national magazine about one’s psychiatric disorder is more or less the opposite of denial – even if some commentators have characterized the move as a not-so-subtle way of hyping the show in advance of the OCD episodes.

Talking publicly about her disorder doesn’t mean Dunham’s never been in denial about a relapse herself, but she does capture beautifully on the show the way even people with a long history of psychiatric problems can delude themselves into thinking that they’ll be okay – that the old symptoms cropping up are no big deal.

Hannah’s parents confront her about the symptoms’ reappearance, but they leave Hannah feeling infantalized. Like so many young people with a history of psychiatric problems, she wants very much to believe she’s over her old troubles.

Medication

As I discussed in a previous post, Dunham hasn’t said much about medication that hasn’t been said a many times before. In high school, she felt “drugged,” and gained large amounts of weight. She weaned off the medication toward the end of college, and, the Rolling Stone story implies, has engaged a flurry of productivity and creativity ever since.

Although Dunham now takes a small, regular dose of the antidepressant Lexapro and takes the antianxiety medication Klonopin as needed, her hypochondria causes her to worry excessively over side effects. Her tone in the Rolling Stone profile is light, self-deprecating, but it’s hard to know if her relationship with medication is more complicated than she lets on.

As for Hannah, it’s a little tough to tell what’s going on with her medication – whether she’s been taking it ever since high school, or has gone off it before.

Toward the end of the season, when her parents recognize what’s wrong and make her see a psychiatrist, she emerges with a prescription.

Her father later asks her over the phone, Are you taking your meds, sweetie?” Hannah snaps back, “Of course I’m taking my meds!” In fact, she’s decided they make her too sleepy to write her e-book, so she’s quit them. The irony, of course, is that going off the drugs leaves her completely unable to write the book at all.

Hypochondria

Dunham suffered from intense hypochondria as a child and says the tendency continues to this day- especially when it comes to critical Internet commentators. ““I channel most of my anxiety into intense hypochondria,” she told The Hollywood Reporter.  But she appeared to make light of her tendencies, maybe as a way of not seeming to be too troubled by her critics.

Hannah’s hypochondria is a running joke on Girls, but it turns serious in the show’s final episode, when an unwashed, housebound, anxiety-wracked Hannah starts obsessively Googling some of her irrational worries: “Do millions of microbes really live on our skin?” “How does your body know to stop breathing?” “At what age does your body start melting down?” and “Normal tongue.”

Fallout

For all that Dunham still struggles with anxiety, she’s something of a hyperproductive wunderkind. Besides creating, writing, starring in and sometimes directing Girls, she’s written personal essays and humor pieces for The New Yorker and received a much-publicized $3.7 million advance for her memoirs.

Hannah, in contrast, is so wracked with anxiety and compulsions that she falls miserably behind on her commissioned e-book, disappoints her editor, loses the assignment and prompts him to threaten to sue her for the advance

In a now-famous scene, she deals with a compulsive need to clean her ears by aggressively mining her ear with a Q-tip – and gruesomely puncturing her eardrum. When the ER doctor refuses to clean her other ear to even things out and assuage her anxiety, she does it herself.

The second season ended on a generally hopeful, even romantic note for most of the characters. For Hannah, it concludes with her ex-boyfriend Adam dashing through the streets to rescue her from a cocoon of bedclothes. In the season’s final shot, he sweeps her up in his arms like a little child.

Hannah may not have a therapist or doctor she likes, or be taking her meds as prescribed, but, the finale implies, she at least has a protector. Will that be enough? We’ll have to wait until the third season to find out.

Follow @kbellbarnett

Part of the cringe-inducing delight of watching Girls is hearing Hannah say things and do things she knows she shouldn’t. And part of what’s refreshing about Dunham herself are her irreverent, indecorous comments and self-revelations, whether on Twitter, New Yorker essays, or interviews.

So I was especially curious to hear what Dunham had to say about her obsessive-compulsive disorder and medication use in a just-released Rolling Stone cover story. Especially since it was titled Girl on Top: How Lena Dunham Turned a Life of Anxiety, Bad Sex, and Countless Psychiatric Meds into the Funniest Show on TV.

As often as Dunham gets cast as one of the most insightful and prominent voices of her generation, she is, at heart, a profoundly personal commentator. So I didn’t expect any illuminating, sweeping insights about psychiatric meds and Millennials.

Still, the sub-headline billing “countless psychiatric meds” as a source of her inspiration certainly piqued my interest. I was curious what she’d have to say on how taking medications – and, later, quitting them – shaped her sense of herself, maybe even her artistic vision.

Turns out I was hoping for a little too much.

Dunham on Having OCD

Dunham dishes plenty, though not very revealingly, about her OCD symptoms, which began at age seven and has led to her seeing a therapist more or less ever since. A childhood obsession with the number eight and a fear of sex, for example, prompted her to proclaim one time to her mom, “I just had to imagine having sex with you eight times.”

What’s lacking is the self-analysis I’d expect from someone who is in other arenas so hyper self-aware. The having-sex-with-her-mom comment, for example, is free of any account of what it’s like to be a child who imagines such a thing.

Instead, she just remarks that her mom “really took it in stride” and reassured her that the whole thing was in her imagination.

Perhaps that really was the end of it, though I’m not sure such a reassurance would necessarily be comforting for someone with OCD.  The torment comes not from believing your thoughts are real, as in psychosis, but rather from being unable to get the obsessions out of your head. Dunham, though, doesn’t elaborate on what it felt like to be absorbed by such thoughts and compulsions-she merely relates them for us.

Maybe she was strategically stoking speculation and saving the drama for her character’s upcoming resurgence of OCD. But I’d still like to know what it felt like for her personally to be enveloped by such upsetting thoughts, especially as a child.

Dunham on Taking Medications

Dunham’s account of her medication use is even less revealing. Maybe it’s the interviewer’s failure to draw her out in any kind of interesting way on the topic, but basically she limits her discussion to saying that by high school she was “drugged like a big horse,” taking “massive” doses of antidepressants.

The meds made her tired, gave her night sweats, made her gain weight. Those side effects are hardly insignificant, but the article doesn’t offer anything interesting or probing about how the side effects affected Dunham’s attitude toward her OCD and her treatment, except to imply she disliked them (who wouldn’t?).

Left unanswered are loads of important questions that too rarely get asked of celebrities or even ordinary people coming public with their psychiatric problems. Did the meds control Dunham’s symptoms? Did she consider the side effects worth it? Why did she taper off the meds in college?

And, importantly, given the debate over the relationship between creativity, mental illness and medication, does Dunham view her post-college productivity – which the interviewer implies resulted from no longer taking the meds – as related to her disorder or her treatment in any way ? Does she agree that it results from feeling more energetic and clearer-headed without medications? If so, does she thinks she lost anything by stopping medication?

Or does she view herself as having outgrown the worst of her symptoms or having better learned to manage them?

How She’s Managing Lately

On the outside, Dunham has been excelling spectacularly. But she acknowledges lingering anxiety (hardly surprising for someone with as much on her plate as Dunham has).

Since last year, she’s been taking a “small dose” of the antidepressant Lexapro, which she reports takes an edge off her anxiety. So does the antianxiety medication Klonopin, which she carries around in her purse but seems to take a little reluctantly, having Googled the drug and found some of the prevalent internet horror stories on it and other benzodiazepines such as Xanax and Ativan.

But she keeps mum about whether she thinks the nature of her anxiety has changed, how she thinks meds affect it, or what prompted her to try them again after quitting them toward the end of college. We do learn that she has resumed Transcendental Meditation, something she began practicing at age nine, inspired by her mom.

Her Overall Take

Dunham’s final word on her disorder?

“Some of my anxieties might be better solved by a better awareness of what’s actually befalling this planet and what makes everything run and what’s come before us,” she tells the Rolling Stone interviewer a little cryptically. “But it overwhelms me too much. It makes me want to take a nap.”

“And in that respect,” she adds, “I really relate to people in my generation.”

Too bad Rolling Stone didn’t give Dunham a chance to go beyond “shocking” revelations about OCD symptoms and jokes about medication side effects. Those are attention-grabbing, sure, but it would be more enlightening to see them supplemented with some real insights about how diagnosis, symptoms and side effects have affected Dunham as she’s grown up and achieved such success.

Follow @kbellbarnett

We keep asking ourselves “how?” and “why?” And, with authorities still trying to piece together evidence, the public has to make do with limited – and often incorrect – information.

First came reports that the shooter, Adam Lanza, might have Asperger’s. To my knowledge, no authoritative source has yet confirmed Lanza had a formal diagnosis of that or any other emotional, behavioral or developmental condition.

But that lack of evidence – as well as expert consensus that Asperger’s was extremely unlike to have triggered a shooting rampage – didn’t stop an army of commentators from weighing in.

Now, comes the speculation about whether Lanza might have a history of taking mood or behavior-altering medication.

Don’t get me wrong, here. I’m not blaming journalists, bloggers, pundits, Twitter users, and the general public from wondering if Lanza might be taking psychiatric meds.

In fact, it’s one of the first questions that came to my mind – even before I heard the reports of his possible Asperger’s.

In my opinion, regardless of the legal definition of “criminally insane,” anyone who shoots up a school must be somehow sick in the head. Does that make them the moral equivalent of the 20 percent of American adults who have suffered from mental illness in the past year, or even the equivalent of the 5 percent who have suffered from serious mental illness? Certainly not.

But it does mean that looking into a history of mental health problems and treatment is a relevant line of investigation. After all, contrary to popular belief, mass killers don’t always just “snap.” Often, as in the case of the Tuscon shooter, Jared Loughner, there are ample signs of trouble far before they hurt anyone.

That doesn’t always mean parents, classmates, or school personnel go around fearing for their lives or those of others – although many parents struggle with seriously troubled children for whom there seems to be no adequate help and plenty of opportunity for violence, as one mother’s recent viral essay on the topic poignantly demonstrated.

Rather, mass shooters can be withdrawn and isolated, as abc.com points out on an article about schools as a first line of defense in identifying troubled kids. “Most of these kids aren’t acting out, they’re acting in,” the associate director of high school services for the National Association for Secondary School Principals told ABC. “And kids that act in often get overlooked.”

That seems to have been the case with Adam Lanza. The principal of Lanza’s high school told The Wall Street Journal that Lanza was permanantly assigned to a school psychologist as a ninth-grader because school officials worried he might be the victim of bullying, or that he might hurt himself.

But, despite these reports, I’ve yet to see an authoritative evidence about other mental health treatment Lanza received, including whether or not he was prescribed or ever took psychiatric medications.

Yesterday, Hearst Connecticut Newspapers reported that a search of the Lanza home had yielded cellphones and gaming materials, but no psychiatric medications. Investigators are pursuing search warrants to look into Lanza’s medical records to see if he was being treated for any psychiatric ailment and if he was prescribed drugs for any such condition.

Despite a lack of evidence – or maybe because of it – there are ample rumors circulating about Lanza’s possible medication use (I suspect that the Anarchist Soccer Mom, whose essay on her violent, mentally ill son mentioned putting him on “a slew of medications” has only fueled speculation about the same being true for Lanza).

In particular, many outlets have named Fanapt, a relatively new antipsychotic drug approved for treating the symptoms of schizophrenia. Like many antipsychotics, doctors also prescribe Fanapt for conditions besides the one it’s officially approved for, including those that involve considerable aggression and irritability.

This afternoon, Business Insider ran an article about problems getting Fanapt approved, titled “The Antipsychotic Prescribed To Adam Lanza Had A Troubled History All Its Own.” The article cited a New York Magazine post that reported Lanza’s uncle had said his nephew had been prescribed the drug.

The New York Magazine post, meanwhile, attributed the information to The New York Daily News. But neither the link to the article provided in by nymag.com nor a search of the Daily News website turned up any such information.

A web search I conducted produced only rumors, especially from those who clearly have an anti-medication agenda.

Believe me, I’m as curious as anyone to know details of Lanza’s mental health history: what kind of mental health treatment he received, including any formal diagnoses, whether he was currently taking medication or had taken meds in the past, and, if so, what kind.

But so far, it looks like the responsible thing to do is sit tight and wait for some more solid information.

Pills spilling out of a pill bottle forming a question mark available at Shutterstock

Follow @kbellbarnett

How can people say what constitutes overmedication when they can’t – or won’t – specify what would constitute an acceptable number or percentage of kids taking psychiatric meds?

Still, I do care about the numbers, because they can give us clues as to which kids and how many are getting appropriate treatment for emotional and behavioral problems.

A recent and widely publicized study by researchers from The National Institute of Mental Health provides data on some -but not all – key measurements of youth medication use.

Its main finding: Just one in seven teens with a diagnosable psychiatric conditions have recently taken medications to treat it.

Among Kids With Diagnosable Disorders, Low Rates of Recent Medication Use

The study, which was published  online in the Archives of Pediatrics and Adolescent Medicine, surveyed a large, nationally representative sample of more than 10,000 teens ages 13 to 18.

It found that about 14 percent of kids with DSM-IV psychiatric diagnoses had been treated with medication in the past year.

The percentage ranged widely, however, depending on the condition. Thirty-one percent of teens with diagnosable ADHD reported having taken medication for that condition in the past 12 months, compared to just 11 percent of those with anxiety disorders.

Researchers Find ‘No Compelling Evidence’ For Overmedication

The research team – which includes several major figures in this field – considered these percentages to be reasonable, especially considering the amount of distress and dysfunction involved in the kids they surveyed. “There was no compelling evidence for either misuse or overuse of psychotropic medications,” they wrote.

“The majority who had been prescribed medications, particularly those who received treatment in specialty mental health settings,” they added, “had a mental disorder with severe consequences… functional impairment, suicidality, or associated behavioral and developmental difficulties.”

The study also found that most kids were taking a medication commonly prescribed for their diagnosis, such as antidepressants for depression, or stimulants for ADHD.

Antipsychotic use, which has been growing dramatically in recent years and is the subject of much debate about alleged overprescribing, was very low overall, ranging from 0.1 percent of those with anxiety as their primary diagnosis to 2 percent of those with developmental disorders as their primary problem.

Moreover, just 2.5 percent of kids who didn’t qualify for a psychiatric diagnosis reported having taken meds in the past year.

But even this small percentage of kids who didn’t meet the formal criteria sufficient for a diagnosis at the time they were surveyed weren’t necessarily inappropriately mediated: 78 percent reported having a prior mental or developmental disorder (like autism) that caused distress or impairment.

What’s Missing From The Study

It’s important to note that this study collected data between 2001 and 2004, so it’s possible medication use in teens – or at least the use of certain medications, like antipsychotics – has expanded since then.

And an important measurement was missing from the article that would provide key context about under- or over-treatment. Although researchers queried teens and families about where they received mental health services (in school, from a general practitioner, a mental health specialist, etc.), the text of the article didn’t indicate what percentage of the medicated kids were also receiving other services, such as psychotherapy. It also didn’t indicate what percentage of the unmedicated kids were receiving other services.

That’s crucial, because medication isn’t the only treatment out there. Other therapies have been shown to be effective, and a number of studies have found combined therapy and medication to be superior to either treatment alone.

Therefore, the issue isn’t so much what percentage of kids are taking medications  – or even what percentage of kids with a bona fide diagnosis are taking them, the focus of this study.

Rather, the more salient questions are whether kids with troubling emotional and behavioral problems have appropriate and sufficient access to treatment, and whether they and their families consider that treatment – and those who administer it – adequate and effective.

An editorial accompanying the article made that point convincingly.

The editorial also pointed out that this study included a relatively high percentage of well-off kids with private insurance, which might account for the low rates of medication use. Previous studies have shown that kids with public insurance, especially foster children, are far more likely to be medicated at higher rates.

So What Do We Still Need To Know?

Although this study provides valuable information showing that relatively few teens take medication for their psychiatric disorders, we need a study that examines how common psychiatric diagnoses, medication use and other treatment modalities are in youngsters from diverse backgrounds.

And that same study should also measure kids and families’ opinions about access to and effectiveness of different kinds of treatment, as well as their level of satisfaction with the medical and with mental health professionals who administer it.

Kids with pills available at Shutterstock

Follow @kbellbarnett

When I was interviewing my peers for my book about growing up taking psychiatric meds, I started with what I thought was a basic question: Can you give me your medication history – which meds you’ve taken in the past, and for how long?

I was shocked at how many people couldn’t answer the question with any confidence. They’d begun taking medications as children and didn’t know the names. Or they’d simply cycled through so many drugs that they couldn’t remember them all.

The more research I did, the more I realized that having trouble remembering your psychiatric medication history was, to a great extent, the nature of the beast.

Too Many Meds, Faulty Memories

That’s a major reason that researchers who study people’s adherence to medication – how closely they follow the doctor’s directions about how and when to take the drugs – don’t like to rely on patient self-reports. People’s memories simply aren’t very reliable (they may also be motivated to claim they took the medications more regularly than they actually did).

When it comes to recalling drugs you’ve taken years ago, the risks of memory lapses are even greater.

Trial and Error and the “Medication Merry-Go-Round”

The situation is complicated by the fact that many people with emotional or behavioral problems cycle through many drugs, searching for one that relieves symptoms without causing intolerable side effects.

That’s true of medications for other conditions, too. However, more so than in other medical specialties, doctors rely on trial and error to determine which psychiatric medication will work for a given patient. They make their best guess based on their clinical experience, the patient’s symptoms, professional guidelines and which drugs have been approved by the FDA for which conditions.

Sometimes patients luck out. A drug relieves their symptoms and they’re able to stop taking it after a few months or a few years. That’s the end of their story when it comes to psychotropic medications.

But very often, the initial drug doesn’t relieve symptoms, or it causes intolerable side effects, or it works for a while, then peters out. As clinicians often point out, psychiatric medications are treatments, not cures.

To complicate matters, patients commonly decide, for any number of reasons, to quit taking their medication. Some stop for good, but others resume the same drug, or try a new one.

As you can see, psychiatric medication histories get awfully complicated awfully quickly.

Technology to the Rescue?

In theory, we now have websites and apps that can help us track medication use over time. Many of the people I interviewed for my book had been member of the website PatientsLikeMe, which allows people to enter data about their symptoms and treatments. When they couldn’t remember which meds they’d taken when, they consulted their profile on the site.

I myself recently began using a smartphone app, MyMedList, put out by the National Library of Medicine, that lets you enter all current and past medications, dosages, and when you started and stopped taking each drug.

But even well-meaning people easily get disorganized when it comes to keeping track of their medication use over time. People enter some information in a notebook or a Word document on their computer, then start using a website that they abandon, then try out one app and then another. Medication information easily gets lost along the way.

Medical Records

And relying on your doctor’s medical records is more complex than it seems – especially if you take medication for many years.

Young people are especially likely to undergo multiple life transitions -including moving away from home, switching to adult doctors, and going from their parents’ health insurance to their own – that can make piecing together their medication histories a near-herculean task. And even older people switch clinicians frequently, because of changes to their insurance, because they stop treatment for a while, or because they’re just not satisfied with the prescribing doctor.

Amid all these transitions and life stressors, making sure medical records are transferred to each new doctor often isn’t a top priority. Electronic medical records, once universally adopted, should make the sharing of information among doctors much easier.

But in the meantime, with only about half of doctors using electronic medical records, and many employing incompatible or substandard systems, many patients – both young and old – find it easier just to report to each new doctor what medication they were last taking and rattle off the top of their head other drugs they remembering having taken.

For some people, this kind of approach works out fine. But others sacrifice their health, or waste time and money, when they can’t remember why they stopped taking a particular drug, can’t recall what dosage of a drug they took previously was effective for them, or what kind of bad reaction they had to another medication.

Prescribing psychiatric medication may be a process of trial and error, but it’s one that goes much more smoothly when doctors have a medication history to draw on.

How do you keep track of your medications, or your child’s meds? Or do you just not bother, and hope your memory will serve you well?

medicine cabinet shelves filled with pill bottles available at Shutterstock

Follow @kbellbarnett

A new study, published in a supplement to the November issue of Pediatrics, suggests that coexisting psychiatric conditions and problem behaviors might account for much of that prescribing.

The study, which examined children and teens ages 2 and 17 with autism spectrum disorders, found that 80 percent of children with a comorbid psychiatric condition were taking medication, compared to just 15 percent without any psychiatric comorbidity.

Depending on the condition in question, those with a comorbid disorder were between 5 and 17 times more likely to be taking a psychotropic medication as those without the additional disorder.

The study included 2853 children enrolled in a registry run by the Autism Treatment Network, a consortium of 17 academic medical centers in the United States and Canada that is associated with the advocacy group Autism Speaks.

The registry used DSM-IV-TR criteria and the Autism Diagnostic Observation Schedule to diagnose autistic disorder, Asperger syndrome, or pervasive developmental disorder not otherwise specified. It relied on parent reports for information about comorbid psychiatric diagnoses and medication use.

Some metaanalyses have questioned the effectiveness of treating ASD with psychiatric medications, though they have not always taken psychiatric comorbidity into account. Comorbidity is very common in autism spectrum disorders, with studies finding that between 70% and 95% percent qualify for at least one additional psychiatric diagnosis. Other researchers, however, have said these high rates partly reflect overlapping symptoms and problems with diagnostic criteria.

The Pediatrics study didn’t collect information about why the children and teens had been prescribed medication – that is, whether the meds were to treat the comorbid condition, symptoms of the ASD, or both.

However, it found that current psychotropic use was also correlated with high scores on the Child Behavior Checklist, a measure of overall problem behavior. That suggests that more troubled children are more likely to be medicated. It’s possible that children with higher scores on the checklist would also be more likely to have a comorbid psychiatric diagnosis, although this study didn’t examine the relationship between those two factors.

Previous studies have found rates of psychiatric medication use among children with ASD to range from 24% to about 80%. The authors of the Pediatrics study speculated that the relatively low overall rate of medication use in their sample – 27% – stemmed from the large number of young children enrolled in the registry. Medication use, they found, was more common in older kids, with just 1% of children under 3 receiving medication, compared with 11% of those ages 3 to 5, 46% ages 6 to 11, and 66% ages 12 to 17.

The study also found that children with sleep disorders and gastrointestinal complaints, both of which are common in children with ASD, were slightly more likely to be taking psychotropics than those without. But the difference was not nearly as marked as the finding about psychiatric comorbidity.

In addition, white children were more likely to take medications than ethnic minorities, as were those with private insurance, as compared to those with public insurance or no insurance.

ASD are far more commonly diagnosed in boys than girls, but the study found that boys and girls with ASD were prescribed medication at about the same rate. IQ didn’t correlate significantly with prescription rates, either.

The researchers noted that no medication has proved effective for the core symptoms of ASD, such as social and communication problems. Just two drugs, the antipsychotics Risperdal and Abilify, carry official FDA approval for treating irritability associated with autism in children -an umbrella term that includes aggression, severe temper tantrums, and self-injurious behavior.

Nevertheless, the authors concluded that “the evidence for the effectiveness of medications is gradually accumulating, and physician prescription of these medications to treat ASD and comorbid psychiatric conditions will likely increase over time.”

boy carrying a stool behind him available at Shutterstock

Follow @kbellbarnett

In reality, though, many people taking psych meds drink anyway. They have various reasons: not wanting to curtail their fun, not putting much stock in the warnings, or simply thinking it’s easier to take a proffered drink than explain why they’re turning it down.

Doctors oftentimes don’t bother to talk to patients about potential dangers. Or they tell patients not to drink, but don’t explain why. To make matters worse, because of a lack of studies on the subject, patients inclined to do their own research will have a hard time just how risky it is to drink while taking various kinds of psychiatric medications (I’ve written elsewhere about this troubling lack of evidence).

A widely publicized study that came out last month in the journal Neurology underscores the problem. The findings, which pooled data from 16 studies, showed that people taking SSRI antidepressants like Zoloft or Celexa were 40 percent more likely to suffer a type of stroke caused by bleeding in the brain and 50 percent more likely to suffer any bleeding in the skull.

The overall risks remained tiny (this kind of rare stroke occurs in just 26 out of every 100,000 people in a given year, and taking SSRIs could be expected to increase the likelihood by about 1 person out of 10,000).

But in the journal article itself and in multiple news articles, the study’s authors cautioned that people who drink heavily might want to talk to their doctors about switching to a different antidepressant. That’s because numerous studies have shown that drinking heavily also increases the risk of this kind of stroke.

As a journalist, I’m skeptical of exaggerating dangers – especially since this study didn’t even look at at alcohol use directly, and because the risk of suffering brain hemorrhages is so low overall.

But as someone who has taken SSRIs for many years and done my fair share of college and post-college heavy drinking, I have to confess to being slightly unsettled by these warnings.

I also didn’t find it particularly reassuring that the lead author suggested that heavy drinkers might want to switch to a different kind of antidepressant, such as Wellbutrin or an older tricyclic drug like Pamelor or Elavil. Both Wellbutrin and alcohol increase the likelihood of seizure, which makes combining them extra-risky (something I only learned after years of doing just that). And tricyclics carry their own risks when combined with alcohol.

The obvious answer, you might say, is simply to be safe, not sorry. In the absence of studies examining the relationship between alcohol, particular psychiatric medications and specific negative health outcomes,  it’s probably wiser to abstain from drinking if the drug you’re taking warns against it.

But that’s easier said than done, especially for young people. Teens and young adults face significant peer pressure to drink – and drink heavily.

Binge drinking – defined as four or more drinks in one sitting for a female and five or more for a male – runs rampant in this age group. More than forty percent of 18 to 25-year-olds report binge drinking at least once a month, with rates declining as people age, according to U.S. government statistics.

Even for young people taking psychiatric meds who don’t want to drink (and many do), it’s tough to invoke medication as an excuse without raising eyebrows as to what kind of medication. At this age, it’s rare to take meds regularly for anything other than a psychiatric condition.

So, given these realities, what should young people – or older ones, for that matter – do when it comes to mixing meds with alcohol?

Should they trust the warnings, despite a lack of evidence as to specific risks, and abstain? If so, how should they explain their choice to people who want to know why they’re not drinking?

Or should they just throw caution to the wind, drink like they would if they weren’t taking meds, and hope nothing bad happens?

Feel free to share your own experiences. And for more on this particular dilemma – especially as it relates to college students – check out my column on the subject here.

Follow @kbellbarnett

With the explosion of mobile apps and websites such as PatientsLikeMe, which help people chart symptoms, medications and side effects, we’ve entered a new era of unprecedented medical self-monitoring.

Is this a good thing when it comes to psychiatric medications and mental health?

At first glance, the expanded opportunities for medical self-monitoring would seem helpful for both doctors and patients.

Without physiological tests to gauge how meds are working, doctors make treatment decisions largely on patients’ self-reported symptoms and drug side effects. But relying on memory can have its pitfalls  For example, the effects of drugs that take weeks to kick in, such as antidepressants, are notoriously hard to gauge for many patients because they set in so gradually.

Not being sure how – or whether – a medication is working can not only be frustrating for the doctor but also troubling for the patient. It’s hard to keep adhering to a medication regimen when you’re not sure whether the drugs are providing relief, or whether they might even be making things worse.

If patients can, with a few finger swipes or keystrokes, look back and see how they fared after changing medications, adding a new medication or adjusting a dosage, it may well help them and their prescribing doctor see how effective their pharmaceutical treatment is.

Some professionals also think charting symptoms and side effects can be good for mental health in and of itself. It can help people avoid triggers for troubling moods or behaviors and provide motivation for engaging in activities or strategies that seem to have improved psychological wellbeing in the past.

Mostly, I think tools – high-tech or not – that let people take charge of their own mental health and medication treatment are a great boon. But a tiny part of me wonders: Is there such as thing as being too aware of your mental health and your meds?

This might seem like a bit of a strange question coming from me. This spring, I published a book, Dosed: The Medication Generation Grows Up, in which I argue that taking psychiatric medications starting at a formative age adds many extra layers of complexity to the process of growing up and “finding yourself.”

Part of the answer to this tangle of figuring out what’s you, what are your symptoms of mental illness, and what are the effects and side effects of your medication, I argue in the book, is encouraging young people to be more self-aware and involved in their treatment.

Kids and teenagers tend to have a better relationship with their medication, I found, when they have opportunities to think and talk with their family, friends, doctors, and other mental health professionals about why they are taking the drugs and how they feel about taking them. And part of making an informed and educated decision about the latter involves being aware of how they affect various aspects of your physical and emotional health.

But I do sometimes wonder if there’s a downside to constant self-scrutiny, especially for people are already prone to ruminating or obsessing.

From interviewing my peers who take medication, I know I’m not the only one who can drive herself crazy (crazier?) trying to parse the effects of medication.

Consider the possibilities if I’m feeling particularly anxious. Maybe my meds have stopped working and I need a new dosage or a new drug. Or perhaps I’m experiencing side effects from meds (some antidepressants can exacerbate anxiety, while some anti-anxiety drugs, like Xanax and Klonopin, can cause rebound anxiety when they wear off).

Or perhaps there’s something situationally very stressful about my life that I need to remedy.  Or maybe I’m just not exercising or sleeping enough.

That is, even if I’ve kept a careful record of my medication changes and doses, what foods I’m eating, how much I’m sleeping or exercising, etc., there may be too many variable to attribute my anxiety to any one cause.

Alternatively, a number of therapists I’ve interviewed worry that too much focusing on symptoms and medication side effects – especially from a young age – can lead patients to see everything through that lens.

In this scenario, young people, especially, may learn to see normal emotions as symptoms of their disorders – an indication the meds aren’t working, say, instead of an indication that they might need to change something in their attitude, habits, or behavior.

What do you think? Does encouraging kids – or adults, for that matter – to tune into effects and side effects of their medication promote a healthy sense of involvement in their treatment? Are apps and websites that help do this useful tools?

Or is there such a thing as too much monitoring of one’s meds and moods?

medications to help health and treat disease available at Shutterstock

Follow @kbellbarnett

Natasha contends that using the politically-correct, cheerier-sounding term “mental health” trivializes psychiatric disorders and ends up shortchanging those who suffer from mental illness. That got me thinking again about a question I’ve often pondered: Can long-term, maintenance treatment with psychiatric medication take someone with a “mental illness” and restore him or her to “mental health?”

The answer isn’t as obvious as it might seem.

Some people do take medication for just a year or two, begin to feel like to their “old self” again, and successfully taper off the medication without a recurrence of symptoms.

But many others – myself included – end up on psych meds for the long haul, either because their symptoms reoccur when they quit the meds, or because they are too frightened of that possibility even to consider abandoning medication.

Indeed, psychiatrists and other mental health professionals often emphasize that psychotropic drugs are “a treatment, not a cure.” They may help get some people through temporary emotional rough patches, but for those with chronic mental illness – the people Natasha Tracy is concerned about – the drug treatment effects don’t last once you’ve quit them.

This is a grave shortcoming when it comes to the drug treatment of mental illness because it potentially involves decades of treatment from early in life: Unlike many other chronic health problems, psychiatric disorders manifest early.

Half of all mental illnesses begin by age 14, according to the National Institute of Mental Health. Accordingly, a major health policy goal, as National Institutes of Mental Health director Thomas Insel has often explained, is early intervention. Mental illnesses, Insel said recently, are “the chronic disorders of children” – with potentially serious long-term repercussions if left untreated.

That intervention needn’t necessarily take the form of drug treatment. But for myriad reasons, many of them financial, the choice often comes down to medication or no treatment at all.

For young people whose suffering is severe and/or intractable, I believe medication is far better than no treatment. But, as I detail in my recent book about young people who grew up taking psychiatric meds, drug treatment from a young age brings its own set of challenges – psychological, physical, social, familial.

Not least among these challenges is the perennial question of how long to continue taking meds. For people who began psychotropic treatment at a young age, it’s not unreasonable to think that they might have outgrown their old problems. On the other hand, as I can attest myself, it’s sobering – even traumatizing – to attempt to abandon medication only to rapidly spiral downward and feel you have no other viable choice except to restart treatment.

Journalist Robert Whitaker makes the provocative claim in his book Anatomy of an Epidemic that psychotropic drugs cause lasting changes in the brain that practically guarantee the return of symptoms once the drugs are withdrawn. He declares it a tragedy for a generation of young people to be chained to drug treatment, facing a return of symptoms – or even worse symptoms than they had in the first place – if they were to quit.

If this is true, it would represent the dark side to the often-made claim that psychotropics are “neuroprotective” – that taking them prevents more frequent and more severe breakdowns.

Regardless of what the larger truth turns out to be, for now, individuals still face the same haunting question. When you have been mentally ill and are restored to normal or near-normal functioning by medications, are you well? Or are you just buying time?

The reason? Abuse of stimulant medications like Adderall and Ritalin is rampant on college campuses, where the medications are used as “study drugs” and also to provide a boost of energy during long nights of drinking and partying.

As a result, students with such prescriptions can find themselves under intense pressure to share or sell their pills.

But when students keep their meds a secret from peers, does anyone actually benefit?

As someone who thinks we need to talk more openly about medications and explore their impacts on different aspects of young people’s lives and identities, I find this call for secrecy unsettling.

It’s true that ADHD stimulants are widely abused, both by young people who have prescriptions for them, and by those who don’t.

That’s also the case for antianxiety benzodiazepines like Xanax and controlled sleeping medications like Ambien. Young people take the latter either as mellow party drugs that enhance the effects of alcohol or to counteract certain effects of stimulants, such as anxiety or insomnia.

It’s also true that abuse of controlled psychiatric medications is a real risk among young, college-aged adults. According to U.S. government statistics, nearly 6 percent of young people ages 18 to 25 use psychiatric medications nonmedically. That’s two to three times the rate of teens ages 12 to 17 or adults 26 and older.

Still, I don’t think keeping controlled medications a secret serves the important aim of helping young people striking out on their own to learn to responsibly manage their treatment.  And it hardly bolsters longtime efforts by mental health advocates to reduce the stigma surrounding psychiatric disorders and their treatment.

Instead, I think that keeping mum about one’s psychiatric prescriptions is more likely to feed into a culture of shame and secrecy surrounding medication use.

For those looking to abuse the drugs, driving meds underground may make them harder to procure, but scarcity could also increase their allure and make them even more sought-after.

Just as important, though, is to the detrimental effect secrecy could have on the young people with prescriptions for the drugs.

Certainly, anyone who takes psychiatric medication has the right to disclose it selectively to certain confidants, or not at all. But, in my mind, no one should feel that they have to keep their prescriptions secret for fear their peers might pester them for pills.

That is hardly a productive strategy for coming to terms with one’s condition, developing a healthy approach to treatment, and forming trusting relationships with peers who can provide crucial social support during time of relapse or extreme stress.

Far more useful, I think, is to learn when it is appropriate to disclose one’s medication use and to whom – and how to say no firmly and confidently when peers clamor for illegal handouts of pills.

Please feel free to weigh in with your thoughts!

medicine cabinet shelves filled with pill bottles, available at Shutterstock

Follow @kbellbarnett