How good to see that Consumer Reports has wised up to this issue, even if the KOLs haven’t. The KOLs are still pushing antipsychotic drugs for nonpsychotic depressed patients, with reckless disregard for the low benefit versus the high risk.
Wow, what a great little video! Let me throw this opinion out to my psychiatry colleagues reading here, and if any other physicians read here too, think about this perspective before you write your next psychiatric script:
writing antidepressants for depression or anxiety without doing a full evaluation, which does take longer than the five to ten minutes that most PCPs/NPs/other non psychiatrists take when clicking that pen to paper, is just like writing for an antibiotic because the patient has a sore throat. How many doctors support giving antibiotics without evaluating and getting at least some type of culture to have an idea what you are treating? It is the same process when just dishing out antidepressants for people who are complaining of being depressed or anxious. And that goes for writing for benzodiazepines too.
Frankly, my colleagues have dumbed down mental health concerns to such a degree, I really wonder if people will ever see consistent improvement in treatment if all they want is a freakin’ pill!
Can’t medicate life. Oh, and by the way, WHEN consequences play out with giving antipsychotics to people who don’t need them, who is going to be sued? The primary care guy who starts it, or the foolish psychiatrist asked to take over the further complicated picture when the PCP panics and dumps it on the psychiatrist’s doorstep? This is where we are now, psych colleagues!!!
“Trying three or four antidepressants before finding one that works.” I love that. All that means is that the passage of time has healed all wounds. Seriously: In the old days we were taught that the natural history of depression was remission over time, even without treatment. After the Pharma industry hijacked psychiatry, that all changed. Why you had to keep on taking medications, could never get off them, or had to keep searching for one to correct your “chemical imbalance.” And no, I am not a “pharmascold” by nature– I believe antidepressants are necessary for SEVERE depressive states, especially accompanied by suicidality. But the trend to just tossing an antipsychotic at depressed people (meaning outpatient, non psychotic depressives) is horrifying to say the least.
Dr. Carroll, I agree — the irony that it took Consumer Reports to point out the obvious is rich. Patients have become, fundamentally, “consumers” — open mouths into which doctors throw drugs.
Allow me to also say that even though you might not feel any benefit from an “add-on,” they still can be a b*tch to quit.
I saw a girl recently on Cymbalta “augmented” with Abilify which made her gain weight so she was on Adderall to suppress her appetite. She noticed my mouth was agape and asked, “Was it something I said?”
Better living through chemistry. Once had a patient on 19 meds in the hospital, and it turned out at least 7 were for side effects created by prior ones she was on. She left on just 7, and the patient told me I was the only 1 of about 4-5 who treated her during the inpatient stay who advocated for less. Thank god in the end she and I prevailed and convinced the others to back off and let her access other interventions besides meds. And no, not all were psych meds, but she was on 4 antihypertensives and was hypotensive as one of the problems.
Every day, people are getting prescriptions for psychiatric drugs at dangerously high dosages, in ridiculous combinations, and for far too long. But far be it for me to criticize!
Hopefully, Consumer Reports will wise-up on the use of antidepressants as well, and inform the public that they are (per Marcia Angell, M.D.), “worse than useless”.
In the meantime, they got it right with the neuroleptics (nerve-seizing) drugs….
And they are”drugs”, not medication.
They are not “medicinal”.
How good to see that Consumer Reports has wised up to this issue, even if the KOLs haven’t. The KOLs are still pushing antipsychotic drugs for nonpsychotic depressed patients, with reckless disregard for the low benefit versus the high risk.
Wow, what a great little video! Let me throw this opinion out to my psychiatry colleagues reading here, and if any other physicians read here too, think about this perspective before you write your next psychiatric script:
writing antidepressants for depression or anxiety without doing a full evaluation, which does take longer than the five to ten minutes that most PCPs/NPs/other non psychiatrists take when clicking that pen to paper, is just like writing for an antibiotic because the patient has a sore throat. How many doctors support giving antibiotics without evaluating and getting at least some type of culture to have an idea what you are treating? It is the same process when just dishing out antidepressants for people who are complaining of being depressed or anxious. And that goes for writing for benzodiazepines too.
Frankly, my colleagues have dumbed down mental health concerns to such a degree, I really wonder if people will ever see consistent improvement in treatment if all they want is a freakin’ pill!
Can’t medicate life. Oh, and by the way, WHEN consequences play out with giving antipsychotics to people who don’t need them, who is going to be sued? The primary care guy who starts it, or the foolish psychiatrist asked to take over the further complicated picture when the PCP panics and dumps it on the psychiatrist’s doorstep? This is where we are now, psych colleagues!!!
“Trying three or four antidepressants before finding one that works.” I love that. All that means is that the passage of time has healed all wounds. Seriously: In the old days we were taught that the natural history of depression was remission over time, even without treatment. After the Pharma industry hijacked psychiatry, that all changed. Why you had to keep on taking medications, could never get off them, or had to keep searching for one to correct your “chemical imbalance.” And no, I am not a “pharmascold” by nature– I believe antidepressants are necessary for SEVERE depressive states, especially accompanied by suicidality. But the trend to just tossing an antipsychotic at depressed people (meaning outpatient, non psychotic depressives) is horrifying to say the least.
Dr. Carroll, I agree — the irony that it took Consumer Reports to point out the obvious is rich. Patients have become, fundamentally, “consumers” — open mouths into which doctors throw drugs.
Allow me to also say that even though you might not feel any benefit from an “add-on,” they still can be a b*tch to quit.
I saw a girl recently on Cymbalta “augmented” with Abilify which made her gain weight so she was on Adderall to suppress her appetite. She noticed my mouth was agape and asked, “Was it something I said?”
It was…
Better living through chemistry. Once had a patient on 19 meds in the hospital, and it turned out at least 7 were for side effects created by prior ones she was on. She left on just 7, and the patient told me I was the only 1 of about 4-5 who treated her during the inpatient stay who advocated for less. Thank god in the end she and I prevailed and convinced the others to back off and let her access other interventions besides meds. And no, not all were psych meds, but she was on 4 antihypertensives and was hypotensive as one of the problems.
And this was back in 1992.
Oh, the stories I could tell…better yet, read them for yourself: http://tinyurl.com/3o4k3j5
Every day, people are getting prescriptions for psychiatric drugs at dangerously high dosages, in ridiculous combinations, and for far too long. But far be it for me to criticize!
Good for Consumer Reports.
Even better for the American public.
How can adding a dopamine antagonist as an adjunct possibly help with depression? !
The idea is void of common sense!
Duane
Hopefully, Consumer Reports will wise-up on the use of antidepressants as well, and inform the public that they are (per Marcia Angell, M.D.), “worse than useless”.
In the meantime, they got it right with the neuroleptics (nerve-seizing) drugs….
And they are”drugs”, not medication.
They are not “medicinal”.
Duane