We can hope that prescribing practices will change but if there is a common theme in the mental health system, it is that words and deeds rarely intersect. I'll wait to see if it can be empirically established that psychiatrists change their prescribing practices, regularly consider the health implications of medications they prescribe, and recommend non-medication based approaches. Until then it is likely that too often treatment in its entirety will be medications alone and prescribers will use their existing resource and symbol of authority, the prescription pad.

Medication is a tool but it should not be the only tool and should not be used everywhere all the time. There are too many human needs and wants that can't simply be addressed with a prescription.

Is this still the norm? "Psychosocial Treatments Rare For Schizophrenia Patients", Psychiatric News, August 15, 2003. Excerpted: The full of range of recommended psychosocial treatments for people with schizophrenia is rarely provided in routine psychiatric practice, according to results of a study from APA’s Practice Research Network (PRN).... Moreover, more than half were receiving three or more different medications, and 14 percent were receiving five or more.

http://pn.psychiatryonline.org/cgi/content/full/38/16/12

Or this,

Clinicians Urged To Better Monitor Drug-Related Side Effects, Psychiatric News, July, 7, 2006.
Excerpted: Based on data from several studies presented at APA's annual meeting, it appears that less than 10 percent of patients on the medications [SGA's] are being monitored using the APA/ADA consensus protocol.

http://pn.psychiatryonline.org/cgi/content/full/41/13/1-a

Posted by: Joe at November 28, 2007 06:56 AM

In the whole Washington D.C. area we have found TWO psychiatrists who use supplements; one of whom calls herself an orthomolecular psychiatrist. She has been investigated by the Maryland Board of Medicine for this "crime". I am sorry to say that I think it will take a lot more that Carlat and Leo to change the game....living nearby the FDA, several of my progressive colleagues are considering a "die in" up at their grounds. It will take even street theater to raise awareness and change behavior.

Posted by: Sorrowful at November 28, 2007 07:52 AM

Nothing is going to change the medication paradigm, prescribing meds or remove psychiatry. It's an industry. But what has happened that is what people need to focus on, [at least I am] is the raising of awareness.

In my advocacy of late I had a list. So long that when I told it to an ER nurse while in a medical crises last year, she told me to take one thing on that list at a time.

Sounds simple. Not easy. Patients/consumers who want change within the system and infrastructure can have candid discussion with their own psych/doc like I have regarding DTC for example. It was a great discussion and eye opening as well.

My point is, that Carlat is still a practicing psychiatrist, still rx'ing Effexor, and what he has done while at work--is open this up for awareness--face it if he had not written that letter we wouldn't have this discussion or ability to bash the guy for his $30,000.00 "mistake". Several people including myself suggested if he really wants to take 30K and do something to "pay back society", then start funding a respite facility or Soteria House. Give patients/clients a place to go to receive non-pharmaceutical based support, care and therapy.

Whether Carlat does anything like that is his business. It also doesn't stop patients for example, Jayme,who is opening a respite center herself. Take a minute to read her blog in that link.

At this point it begins with one voice at a time. So make it YOURS. It's a golden opportunity to write a letter from a patient point of view.

Posted by: Stephany at November 28, 2007 09:21 AM

Does Dr. Carlat do speaking events? By the way, I've had about 15 people personally thank me for having you come to NCF, including one person who said it was the best event New College has ever had. The woman who cut your check even commented that a turnout of 70+ people is unheard of. I will definitely be asking you back next semester.

Posted by: NAP at November 28, 2007 10:36 AM

Thanks for your debates, I've decided to put a link to this blog in my portuguese-language blog.

Indeed a blog for people who'd like to think a bit.

Thank you

Posted by: SAM at November 28, 2007 12:49 PM

"He [Carlat] provides a great example of how gullible and malleable the profession is." Give us a break, will you, Johanthan Leo. The psychiatrists are not gullible, their patients are. The profession is not malleable, it's avaricious in the extreme: I believe that psychiatrists charge the highest hourly rates of all doctors. Mr. Leo has switched the roles of psychiatrists who impose their will on us patients daily into into ignorant patients deceived by drug companies and generally too busy to read independent medical literature. Mr. Leo's article, as is Carlat's original article, misses a cardinal ethical principle of medical practice, that of competence. Psychiatrists, like any other doctors, must be competent. They must know their stuff. In contrast, Carlat's article missed another key ethical principle of the medical profession, that of the undivided loyalty of the doctors to their patients.

Posted by: Red Rover at November 28, 2007 03:50 PM

Stephany said "But what has happened that is what people need to focus on, [at least I am] is the raising of awareness."

Me too, Stephany. We're unlikely to have the Mental Health Act repealed but we can open up the debate. People are shocked when I tell them what's been done to me under the guise of mental health "treatment." Awareness is that critical first step to change.

Posted by: Francesca Allan at November 28, 2007 05:38 PM

Phychiatrists are missing a key principle of their profession, which is "First, do no harm." After losing my son to Zyprexa, I had a discussion with his long ago, compassionate psychiatrist (who only ever gave lithium as a med). When I told him I had turned into an activist and would never quite, he not only accused me of "becoming a Scientologist" but started telling me of a case he was having success with - using Zyprexa. I begged him to stop. Why did I need this information. The ultimate damage had been done. This doctor is an "emminent" researcher, teacher, and clinician at Stanford. A former revered friend who could not stand the fact that I was taking a different stance on things. I could and will never be passive again.

Posted by: Sorrowful at November 29, 2007 08:36 AM

The ethical concept of "Do No Harm" can't apply to psychiatrists because their profession has no real standards, unless a patient is dangerous to himself or to others. My other point is that doctors change over time; I've had a few non-p doctors who changed for the worse with times, be it because of reduced insurance payments, increase in patients, what not. Your experience is not unusual. Also, psychiatrists , more than any other doctors, are influenced by political or economical changes: since the government (FDA) has determined that administering Zyprexa is cheaper than paying for institutional care of patients, psychiatrists quickly follow the lead.

Posted by: Red Rover at November 29, 2007 07:56 PM

wait, death is usual?!

Posted by: Stephany at November 29, 2007 09:38 PM

Sorrowful, I lost my daughter due to the misguided treatment of Stanford psychiatrists -- Paxil and Risperdal with a little Depakote thrown in on the last day just to put frosting on the cake. Are you in the Bay area? I just attended a book reading at Kepler's about Iris Chang, another victim of Stanford psychiatry, another Risperdal case. I tried to stir the pot at the book reading but it's not really the forum to be too confrontational. The author was up there twitching, blinking and stuttering from her own drug use so it was easy to see why her book missed the whole point of what happened in the last few months of Chang's life.

Posted by: Sara at November 30, 2007 03:39 PM

Yes, Stephany, death and its cost are an accepted element in the economic calculation of what's effective and at what price. It's used by the policy makers in enacting laws, by executives in enforcing laws (such as approvals of new drugs), and by courts in administering laws.

For example, in civil (non-criminal) law, the cost of death under the same circumstances varies depending on who died. A doctor who commits negligence (rather, his insurance company) will pay more if the decedent earned a good living, was healthy, and was relatively young; in contrast, the same doctor (or the same insurance company) would pay less if a bipolar patient died: he didn't have a good earning record, few dependents, and his life expectancy was shorter than of an average man.

This is a foundation of the economic policy of the United States.

In your case, you've encountered it when your daughter exceeded her life-time health insurance limit. It was no accident. Someone has calculated how much health insurance a person needs in a life time, and appropriate regulations were enacted to enforce it. It was no accident.

Posted by: Red Rover at November 30, 2007 04:21 PM

red rover,

thanks for reminding me about the insurance issue. that was one of my main complaints to the companies [they pass the info on to others, so just gaining new insurance doesn't change that cap]I couldn't imagine how anyone could determine how many days a person was "allowed" to be sick, with mental health issues. It angered me to no end, because for example what she is left with now as a young adult, [unless some sort of parity happens] is state insurance, and frankly not all places take that, it's basically medicaid/medicare at age 19. Limits have been set up for making it in this system at her young age, and the reason many ppl fall into the category of low recovery rate, and die young or really ill, because of low quality of care and services available with that medical coupon.[try finding a dentist that takes it, and one of your own preference, that's another issue in itself.]

The death as a side effect of medications is just so intolerable for human beings, that is another personal gripe of mine, that it's so accepted as a "side effect"...death should be the black box warning on any drug it's ever listed in the fine print--which is many.

Oh, and one of the hospitals she was inpatient had a "no insurance floor", which I was shocked to know existed within a hospital period---and I remember thinking how on earth could my 18 yr. old be on floor that seriously made me feel less than adequate as a provider. That's when she attained the state coupon, and I remember asking what the difference was between the 2 floors? was she receiving equal care? they claimed she did...but then why label the floor at all? now they have changed that, and all floors are equal with patients with/without insurance, and when talking mental health care, there's a case of parity needed for sure. The mental health system DOES have tiered care, and it's WHY there are less than best outcomes and lessened life spans.

We sometimes read studies that say just that. Less than adequate care or services results in shortened life span and recovery ability for schizophrenia for example. It's not the illness, as much as the quality and quantity, and availability of care for those clients, who are often [not always] low income, and sometimes homeless.

It's an obvious answer for positive recovery rates to increase, isn't it? if all people had access to all levels of care, outpatient pdocs of choice, private hospitals or private care facilities could impact a person for the better outcome--I've seen the low income stuff already, and ive got to say, we need more funding to support our fragile members of society.That is also why the medication based paradigm doesn't cut it for real success. Patients need more than meds, we all know this.

Posted by: Stephany at December 1, 2007 03:25 AM

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