Last updated on January 6th, 2024 at 08:33 am
Did her Treatment-Resistant Depression (TRD) kill her or was it her treatment!
I have not read her book on her lifetime battle with depression but she was extremely open with both her mental health problems and her extensive treatment including multiple psychiatric medications and also their side effects such as bloated face, major hair loss and hand tremor among many others. Mrs. Judd was aware that the above were side effects of her medications but many times adverse side effects are assumed by the patient (and often the prescriber as well) to be a part of the “disease” and not a side effect of the drug.
It is obvious that Mrs. Judd totally believed in the current, and dominate, psychiatric thinking that depression, anxiety and other mental disorders are brain diseases and the primary and effective treatment are psychiatric drugs. To use her words she was eventually diagnosed with “treatment-resistant severe depression” and was exposed to multiple medications including lithium and others. Apparently when her depression did not respond to antidepressant medication lithium was prescribed for a possible bipolar depression. I did not read this but since she was diagnosed with TRD she was obviously prescribed one or more FDA approved add-on drugs to treat acute schizophrenia. When the latter does not work the next step, before biomechanical treatments, is usually lithium. Mrs. Judd was convinced her mental health problems were the result of a brain disease and she was very ready to go the last mile in looking for a drug cure for her mental health problems. The patient was also diagnosed with anxiety and in view of the above psychiatric drug history I suspect she was also prescribed benzodiazepines to treat a generalize anxiety disorder. During my days of managing behavioral healthcare for employer self-insured employee health plans it was not unusual to find depressed patients on 3 to 5 psychiatric drugs, perhaps some to treat the assumed primary disorder and perhaps some to treat emerging side effects of the medications.
Naomi Judd described a very extensive and varied history of both psychiatric and non-drug treatments. In view of very limited improvement one might think one of her providers might have had the thought that perhaps a drug approach is not working and one might try something else. For example, what about tapering the patient off all psychiatric drugs to find out who is the real Naomi Judd, the person and her particular emotional disorder rather than drug effects! This would have been a very good starting point. However, beginning with the advent of Prozac psychiatry over the years has become increasingly enamored with the idea that mental disorders are brain diseases and the cure is to determine the putative neurotransmitters (serotonin, dopamine, etc.) and to treat it with drugs; when drugs are found not to work the next step is to offer several biomechanical methods such as electroconvulsive therapy or a growing number of new drugs and biomechanical treatments.
In the old days psychiatrists were trained in various types of psychotherapy and would along with psychologists practice psychotherapy with patients but those days are long gone. I had read about a psychiatrist who said he had tried several psychiatric drugs on one depressed patient and nothing helped (much like Naomi Judd’s history); the psychiatrist said that the patient’s only hope was for the pharmaceutical industry to come up with a psychiatric drug that would effectively treat his patient’s particular depression. I guess if you only have a hammer everything is a nail! In the 1960s psychologists and psychiatrists both believed that when you have seen one depression you have seen one depression and that depression was only the final common pathway of the disorder. That is, in diagnosis you have to know how and why the depressed person got and is depressed and what about the depressed person’s mental makeup and behavior sustain the depression.
In the 1950s psychiatry was something of a step child of medicine but during the following years psychiatry began talking more and more about brain disease as the cause of mental illness and treating it with drugs, in effect becoming more and more like their medical colleagues.
