April 27, 2009

Internet Psychiatrist, Now Convicted Felon, Defends Anti-Depressants Without Exam

I know some of you are aware of the case of Christian Hageseth, a Colorado psychiatrist, who was convicted earlier this year in California of prescribing without appropriate licensure to a Stanford student. The drug in question was Prozac, Hageseth prescribed it over the Net after the student filled out a questionnaire, and the student later killed himself.

Hageseth faces 9 months in jail.

Now Coloradoan.com has a fascinating article in which Hageseth defends Internet prescribing as serving the poor and underinsured with depression and basically says he knew what he was doing was illegal, but that his sense of mission in serving people with depression justified his actions. He's a true believer and has been on anti-depressants himself for many years. So has his wife--for 20 years. Hageseth says he wants to start a non-profit that will give vouchers for doctor visits to depressed people without insurance.

I think Hageseth is out of his mind. While there are obvious problems with health care access for the poor and underinsured (I know this so well personally) and while I'm all in favor people getting help for depression, prescribing anti-depressants, as Hageseth did, without a proper medical and psychiatric exam is a huge ethical breach and dangerous, regardless of prescribing laws in various states. Questionaires on web sites simply don't cut it. And Hageseth's voucher idea would be little more than a one-way ticket to SSRIs, not psychotherapy of any kind and likely not to a doctor who's going to press the patient to go through appropriate steps (watchful waiting, exercise, diet) prior to sticking them on a drug.

What's more, the Hageseth case also makes me wonder about the propriety of doctors who take anti-depressants prescribing anti-depressants to patients. I've encountered a few of these sorts over the years and they are so deeply biased in favor of anti-depressants at all times (and for long term chronic use) that they ought to come with a warning label or disclaimer of some kind.

Posted by Philip Dawdy at April 27, 2009 11:48 AM
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What's more, the Hageseth case also makes me wonder about the propriety of doctors who take anti-depressants prescribing anti-depressants to patients.

It's a sort of conflict of interest, isn't it. I mean people by nature want to justify what they do themselves and the easiest way to do that is to convince others it's the best thing too.

Posted by: Gianna at April 27, 2009 12:49 PM

It's kind of like someone who is legally drunk administering field sobriety tests. Someone mentally altered by these drugs can't judge normal as we see all of the time.

Posted by: Sally at April 27, 2009 01:16 PM

Peace be with you

I don't think most psychiatrists would have any problem doing what Hageseth did. I recently met a man here who while trying to defend himself in court was sent to a psychiatrist to be checked out to see if he was mentally fit to represent himself. In the first paragraph of the psychiatrists report to the court the psychiatrist says that the defendant refused to talk with him, but on the last page the psychiatrist made half a dozen diagnoses from that silence. I believe psychiatrists will take any answer on the questionnaires to mean the questioned needs to be doped.

Hageseth should get life without possibility of parole, and so should any other psychiatrist who kills a patient with those drugs. If one could be held responsible for firing a gun willy nilly into a crowd and killing someone, then why shouldn't a psychiatrist who dopes a crowd willy nilly. In both cases they should of been well aware of the dangers.

love eternal
tad

Posted by: tad at April 27, 2009 07:34 PM

He should get a medal.

Posted by: yoyo at April 27, 2009 07:50 PM

Regarding doctors who themselves take SSRI's: she wasn't my prescribing doc, but the therapist who I worked with in my last phase of med withdrawal, and who sat through many a diatribe about the poor treatment that had me on up to 5 psych meds at a time over nearly a decade, herself took antidepressants. She was also the only care provider I ever had who billed my visits under something other (and much less stigmatizing) than my original (incorrect) bipolar diagnosis. In a sense, she undiagnosed me, without my having to ask. She fully supported my successful drug withdrawal and recovery. So, like most such generalizations, there are exceptions.

Posted by: Tilting at Windmills at April 29, 2009 01:24 PM
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