A Disturbing Trend

I got an email at work the other day from a woman who had read an article of mine on psych meds. She is a newly diagnosed bipolar and said she had some questions. We spoke by phone a couple of days later. She wanted my advice on meds, because she said she had been through several psych docs recently and was confused. The typical story of insurance companies picking what doctors she can go to, doctors who spend no more than 15 minutes with her and prescribe her medications without telling her how they work, much less how to be a newly-dx'd bipolar (a pretty dicey time in one's life that M.D.s should be very concerned about, but often aren't) and what to expect and how to make it all work for you.

I told her I couldn't really offer her medical advice, but could give her my opinion that all bipolars need to be on a mood stabilizer of some kind, at a minimum. She told me her doctor had prescribed her Zyprexa a few days before. Nothing else? No, she said, he told me it was mood stabilizer. She added that she had never been hospitalized, and she sounded very stable and aware to me, so I mentioned to her that I found it a bit odd that her doctor had gone straight for the Zyprexa.

He had apparently given it to her right away during a very brief appointment. Had he asked if she or her family had a history of diabetes? No, she said. Do you or your family have a history of diabetes? I asked. Yes, she said.

You need to see another doctor, I told her. Then I pointed her to basic resources on the Internet that are at least honest about treating mental illness.

I hope she gets another doc because the one who gave her Zyprexa is incompetent. Not only because he didn't do due process and do a proper medical history on this woman before prescribing her something that can cause elevated blood sugars, among other side effects, but because he hit her with an atypical anti-psychotic as her first bipolar med when she wasn't even in bad enough shape to be hospitalized.

I am troubled by the trend among docs to very aggressively medicate patients right out of the box. Often a diagnosis of bipolar disorder leads to the immediate prescribing of atypical anti-psychotics—as their name implies, they are most properly meant for psychotic episodes—when in fact the patient's symptoms don't demand such heavy artillery. This is doubly true because of the profound side effects of these meds. (Obviously, the Rx ball game is quite a bit different for treating schizophrenia.)

What the hell happened to starting with a classic mood stabilizer alone? What the hell happened to medical conservatism? Using atypicals as a first-line approach with mild or moderate bipolar disorder is about like recommending open heart surgery for varicose veins.

This is a trend in psychiatry that has led to the over-medication of millions of Americans, some of them children and teens. It is a disservice to patients. I believe it is also a violation of the doctor's ethical responsibility to act in the best interests of their patients. But that's another story.