I've stayed on Prestiq several months enduring Horrible nightmares, zapped sex drive, shaking and withdrawl symptoms if I'm late taking it because I haven't had luck with other meds...

The pharma dispensing magician that can not admit defeat is a poor one.
"Pride comes before a fall."
"if you are too confident about yourself, something bad will happen to show you that you are not as good as you think you are"

Pristiq is not available in Europe. The regulators turned it down citing a concern about lack of effectiveness.

Here is the article on www.SSRIstories:

http://www.ssristories.com/show.php?item=3536

First sentence reads: "Abstract: Wyeth withdraws its application for European approval of its antidepressant Pristiq ; cites European Medicines Agency concerns about drug's effectiveness; Pristiq is called Ellefore in Europe (M)."

WYETH PULLS APPLICATION FOR PRISTIQ USE IN EUROPE
Wall Street Journal, The (abstracts) - Thursday, October 16, 2008
Author: SHIRLEY S WANG

I'm curious about the patient's comment that Lexapro "wasn't quite doing what I wanted it to."

As a doctor who tries to use as many non-pharmacological interventions as possible before resorting to medication, I must also say that much of the motivation to prescribe comes from the other side of my desk.

Perhaps this patient's sex drive was so nonexistent that he/she pleaded to get off Lexapro (which seems reasonable) but felt ill-equipped to manage life without meds, and pleaded just as desperately for an alternative medication. While I, personally, wouldn't have switched to Pristiq (expensive drug, unknown effects), it would have been difficult to let such a patient leave without a new prescription, especially when that's what they were coming in for.

(This is why I prefer to work with patients who agree to lifestyle changes & therapy in addition to meds, but they're few and far between.)

I once choked on a piece of pizza. Wasn't much fun.

Philip Dawdy responds: was that pizza fda approved as safe and efficacious? was it given to you by a doctor?

Hey Steve, how can you blame the patients when they are inundated with pharma ads whenever they turn on their TV or open a magazine that claim to fix everything under the sun? I bet those drug makers' marketing firms are experts on instilling the potential customer with the belief of an easy fix, that it's not their fault they have whatever problem the drug is intended for, and all you have to do is head to the doctor and ask for a prescription.

More importantly, did you choke due to a lack of pizza in your throat?

SteveBMD,
I've long felt that if you whine long enough and hard enough in the presence of a doctor you'll end up leaving with a prescription.

And that's clearly what a lot of people want. I've met so many people on "cocktails" of five or six meds, totally absorbed in the distraction of the ones they're going on and off (and they're always doing one or the other or both, usually both).

Most of the people I've seen mired in this situation have doctors who "don't do trauma" (I'd like to "not do" cancer myself). Amazingly, I've had many people then immediately go on to describe what sure sounds like a trauma flashback to me. Go figure.

In the end, I've come to the conclusion that there are many places on the route to what we call recovery in which one can become stuck. Often they are stages along the way, sometimes natural reactions like anger. Sometimes they are treatment options...like medication (which, generally speaking, isn't terribly effective in dealing with the effects of trauma).

It's easy to get stuck. But I've seen many more people than I'd like to see choosing to remain on dangerous, distracting drugs with doctors who "don't do" trauma or anger. (That's another one I find interesting. It's especially interesting to meet a doc who *specializes* in trauma but who doesn't "do" anger. WTF?)

Scott, I entirely agree. That's why I appreciate this blog so much. I'm not blaming the patient. Big pharma-- not to mention a lot of academic psychiatrists-- have created "disorders" so they can make a buck on people who think a pill will make them well, when they're just experiencing what it means to be human. Who can blame the patient for listening to these "experts"?

I don't mind telling a patient that he or she doesn't need medication, when behavioral interventions might be more appropriate (and safer). But it's a tough conversation to have-- especially when the patient expects a prescription when they walk out the door. And unfortunately in our system it's a lot easier (and far more lucrative) just to write the script and send the patient on his or her way.

Sherry,

Or how about the MD who "doesn't do addiction" but will be happy to prescribe Xanax or Valium or Adderall or Oxycontin because, after all, the patient says he's anxious, inattentive, or in pain!

Paul: No, but the point is, you eat pizza, you run the risk of choking. Live with it.

Maybe a more apt example would be Jack Daniels. Some people can't handle hard liquor. Some people can't handle antidepressants. Boo hoo, but don't hold that against Jack Daniels.

SteveBMD,
Yesss! I used to get guys in my office all the time in withdrawal from librium. This was in the days of 28-day rehab (who decided 28 days was the ideal tx time for EVERYone in ETOH rehab???). The docs would prescribe librium the entire time, then discharge them with a five-day supply. By the time they were in my office they were, finally, in full blown substance withdrawal. Thanks a heap, guys.

Needless to say, those clients relapsed immediately unless they clung to AA like a shipwreck survivor to a piece of flotsam. Say what you will about AA, it's free and ubiquitous and available to all comers. Which is more than we can say for any medical treatment in the US.

My sweetie went to his doc who recommended medication for his somewhat high blood pressure. The poor guy almost fell of his chair when Sweetie declined but suggested losing weight and exercise might do the job. Apparently that's not the usual course of these discussions. He's lost--and kept off--40 pounds, walks regularly and I quit my low down, salt-heavy culinary ways. His BP is fine now without meds. Another bullet dodged.

I have a lot of trouble keeping my doctor focused on finding out the *cause* of a problem so we can work on a solution. He keeps wanting to fix the symptom. Usually the symptom isn't bothering me enough to want to swap it for a set of side effects and a bunch of money. But I DO want to figure out what it means and fix any underlying problems. He always seems happy once I redirect his attention, but I have to do it every time.

Keep having those discussions. The motivated people will stick with you and it will opens doors for others. Sometimes you've just gotta do the right thing because it's the right thing.

Patients (people) want relief. This culture gives the message that relief from discomfort, including psychic pain, is both possible and quick. That societal message is bolstered by slick pharmaceutical ads.

The truth is, sometimes relief from pain is not possible: you are going to feel awful when your spouse dies, and nothing will prevent that. And even when it can be achieved, medicated relief is seldom quick and almost never permanent. (You can squelch anxiety with a drug like Ativan, but that is only a temporary reduction in a symptom, not lasting relief from the underlying problem).

But we are bombarded with ads for products that are supposedly newer, faster and/or better at cleaning sinks, washing hair, and/or wiping out depression. The idea that pain is unavoidable, or can only be eased through time and hard work, simply goes against what we are led to expect. So people don't come to their doctors hoping to be told how to work for their well-being. They want it handed to them in pill form.

Blaming patients for wanting quick relief is not helpful: people desire the magic 'cure' they've been told exists. Blaming doctors for giving prescriptions is only slightly more useful; most doctors are doing their best to assist people they see only briefly and occasionally, but who are suffering from problems that are lifelong and complicated. Drugs offer physicians the illusion that they are helping their patients, and they make patients feel like a cure is underway.

The key is to fight pharmaceutical industry advertisements and promotions with truth. In an ideal world, every dollar devoted to selling psychiatric drugs would be balanced by a dollar spent describing their side effects and limitations. That won't happen, but the internet can go a long way toward countering deceptive claims. I believe even many psychiatrists would respond to information from knowledgeable figures and well-designed studies demonstrating lack of efficacy. Patients would shy away from drugs if they knew how little they actually help, how bad the side effects can be, and the difficulties they will face when they try to come off the medications.

This won't solve every issue. In particular, involuntary treatment abuses need to be addressed. But clear, factual information about pharmaceutical drugs needs to be widely disseminated. I have heard prominent psychiatrists, at major conferences, point out that you have to treat 10 or 12 or 14 patients with a given drug to benefit one of them. That is, they freely say that over 90% of the people taking the drug don't get any benefit. This is the kind of information we need to spread around.

Almost every mistake well-meaning people make can be traced to ignorance. Blame heightens conflict. Only education will help.

As tempting as it can be, feeling outraged that a multi-billion dollar industry profits from exploiting psychiatric patients is naive. That fact won't change until the influence of wealth in our culture is reduced. And when that day comes the status of many people, not just those with mental conditions, will be improved.

I write all this because there seems to be a lot of finger pointing about who is causing the problem, when the solution is actually pretty straightforward. Most doctors are not evil. Most patients are not dumb. Our problems come from well-intentioned but poorly informed choices. The answer is information, not incrimination.

I just happened across this blog and I LOVE it! It's such a relief to know that there are professionals out there that don't believe in prescribing drug after drug after drug to fix emotional issues. I had a very good friend that when I met him he was on 5 psychiatric medications because he was "bipolar." It seemed that every time he went to see this doc, if he complained of anything, he was given a new drug. The doc never even asked him about life circumstances. This friend is now not on a single medication and has been doing great for over a year. He is not bipolar. He needed help, but not in the form of medication.
As a nurse practitioner I frequently see patients on numerous psych meds. It makes me sad, and I often feel helpless.
12 step programs is another area where I see time and time again people diagnosed with mental illness that "amazingly resolved" when they started working the steps, were able to face much of their pain and were given tools to deal with life on life's terms.
Thank you guys for being out there.