Meds VS drugs can you tell the difference?

Admittedly, I'm not all that uncomfortable with primary care docs prescribing antidepressants, so long as they take the time to diagnose properly. If it's a reactive depression there is probably no need to medicate it. If an antidepressant is employed in the manner that antibiotics are indiscriminantly prescribed I get pretty shrill. My beef is with the manner in which atypical antipsychotics have been wedged into primary care. Just. Too. Risky. I'm seeing a five year old whose pediatrician is prescribing Zyprexa to help him gain weight. An antipsychotic for a picky eater? That's way out of bounds. Hard to believe that other options were not given first consideration. I've cranked on him and he's discontinuing it. Whew!

I have such mixed feelings about stories like this. On the one hand, it was my family doc who missed the boat and failed to see that my depression was a sx of hypothyrodism. Instead of thyroid hormone he gave me Prozac, which did pull me up for a brief time but--since it wasn't correcting the physical problem--crapped out quickly. From there I was on a carousel of anti-depressants.

However, in my experience in my area of the US PCPs rarely, if ever, put people on med cocktails or even two psych meds at a time. It's the psychiatrists who do that sort of thing and they do it wholesale. They routinely put people on five or six meds at a time and move them on and off the individual meds as if they're solving a jigsaw puzzle in someone else's brain. They also denigrate their patients a lot.

All in all, I tend to advise people to get their antidepressants from their PCPs on the theory they will only get one at a time. You can try out one or two, see if they help and drop them if they don't. People feel much freer to drop what's not working when it's a PCP. You're also much less em-meshed in the mental health system with a PCP, which makes it easier to back out. You can tell a PCP you are dropping out of the psych med roulette game. Try doing that with a psychiatrist. Those guys seem personally insulted, as if they personally whipped those drugs up in their back room.

These observations are strictly germane to my locality. And yes, there are some decent psychiatrists. Just so few and so difficult to find (or see, if you have Medicare) and the drugs so unhelpful it hardly seems worth the effort. The two or three I've found are 90 miles away. And "good" all too often means "not overtly abusive" when it comes to that profession.

In my former employment I had a ringside seat from which to watch the guys who troll the SSDIB/SSI evaluation pool for potential sexual abuse victims. So yes, you could say I'm jaded.

Yes, the PCP is the one that prescribed Prozac for anxiety which ended up giving me unbelievable withdrawals, suicidal thinking, and wild erratic behavior. The same doctor also handed over a package sample of Seroquel for anxiety and insomnia, tried to convince me to take Zyprexa samples for anxiety as well. I wonder which drug company rep said to use the word "anxiety". Cold turkey off of 40mg of Prozac was living hell, and cause to miss 3 solid months of my life & work.

Careless, without regard are these PCP's. Not once was I given any warnings of side effects, or told for example what the drug was (a SSRI or antipsychotic).

This sounds like GP bashing to me.

In the Reuters article to which you linked, a number cruncher from Thomson Reuters ventured some policy scolding about how well depression is managed in primary care. The simple fact is there are not enough specialty providers to meet the need out there.

Personally, I would prefer to deal with a family doctor. If you have a bad reaction to a psych drug, a family doctor is more likely to recognize it as a drug reaction. A psychiatrist will just say "Aha, you're even sicker than I thought!" and give you a more dire psych label and, no doubt, more drugs.

I'm thinking specifically of when patients develop mania on SSRIs. 99 shrinks out of a 100 will claim the antidepressant "uncovered" underlying bipolar disorder. Just like smoking "uncovers" your predisposition to lung cancer. Kidding.

"I'm thinking specifically of when patients develop mania on SSRIs. 99 shrinks out of a 100 will claim the antidepressant "uncovered" underlying bipolar disorder."

I will say that family doctors might be inclinced to give fewer antidepressants at any one time. Andera Yates' shrink gave her both Effexor & Remeron in high doses at the same time. This is what she was on when she murdered her five children.

Here is a case [in part] of a woman who was given probation for shooting and killing her 11 year old daughter because her Prozac uncovered a "latent" bipolar disorder. Never let it be said that the Prozac caused the murder. It is always the "latent" bipolar disorder that caused the murder!

http://www.ssristories.com/show.php?item=1153

Paragraph 14 reads: "Higgins said Pinckard's doctors believe the Prozac she was taking before the shooting caused her behavior; it acted as a catalyst for a hidden bipolar condition".

Last paragraph reads: "Higgins said Pinckard's psychiatrists testified that if she had not taken Prozac, her condition may never have manifested itself.

http://www.thetowntalk.com/html/1B1F2639-6036-415A-AC2E-53C8CE2976AB.shtml

Woman who killed daughter released on probation
Julia Robb
Posted on July 11, 2003
File Photo
Paula Pinckard: had been "the all-American housewife," attorney says.
COLFAX -- In March 2000, Paula Pinckard shot her 11-year-old daughter Aubrey to death before shooting herself in their Rock Hill home.

I wish there was more information on where the research community stands on understanding how these drugs create hyperglycemia and diabetes. The Oliver D. Howes study on Clozaril and impairment of glucose control without changes in insulin resistance, American Journal of Psychiatry , February 2004, in further regards. The implication of the study is that insulin resistance was already high (upper quintile of healthy range of IR) in the clozaril users, and as such, this condition brought on the diabetes and hyperglycemia in the patients, such elevated IR as a major counterpart condition, or even sole condition, for the metabolic disturbance development. That would mean "energy deficits" in areas such as mitochondrial ATP production probably was present and as such a prerequistie condition for the metabolic disturbance development. Along with other features, that is too technical to get into here. In any case, I think the the Howes study needs to be expanded and further investigated for further elaboration and elucidation of the Howes study highlight facts, found in the results and discussion section of his research piece. There seems to be counter thinking in other research areas that the drugs somehow upset the glucose control mechanism in the sympathetic nervous system, as the August 14, 2008, Schizophrenia Bulletin seems to indicate. And that could well be the case. Yet, one must remember 70% of the people that take the AAPs initially for six months to a year experience no hyperglycemia. And that fact seems to indicate that there has to be some already present subclinical condition present in the other thirty percent who do develop some form of hyperglycemia. And the energy deficit presence as expressed in the 'upper-quintile of healthy range insulin resisitance phenomena' seems to be a satisfactory major condition that allows glucose control loss in the patients. While others who don't possess such 'insulin resistance elevated status' are exempt from glucose control loss via the AAP's effects. That seems to be the fact. Such above are some central unanswered issues on the AAP matter and the metabolic disurbances that ensue from their mal usage.

"If it's a reactive depression there is probably no need to medicate it. If an antidepressant is employed in the manner that antibiotics are indiscriminantly prescribed I get pretty shrill. My beef is with the manner in which atypical antipsychotics have been wedged into primary care. Just. Too. Risky."
Dark

Dark,
I'm concerned with both. I have seem many people with major depression being prescribed:
- Paxil (worked for 6 months)
-Prozac ( worked for a few months....

Effexor, Zooloft, Celexa.... no improvement whatsoever.
Many of them end up taking electroshocks.
Lately they are prescribing the cocktail:
AD + antipsychotics+ mood stabilizers
It doesn't work either.

Both antipsychotics and antidepressants are very harmful.
Dear Lord! I wish it was common knowledge by this time.
Only benzodiazepines, costs nothing compared to the incredible prizes of ADs and antipsychotics, are "perhaps" not good for your health.
Seroquel costs Us$ 200 here in Brazil.

When my GP first (mis)diagnosed me with depression he said "I have some samples from company X here. I haven't tried this drug in a while - let's give it a go!"

Chalk that one up to the drug rep.

I have been attempting to practice psychiatry for 15 years. Everyone who has posted speaks some truth as psychiatrists are more likely to prescribe insane cocktails of drugs but primary care is dishing out a large portion of them. Taking a psychotropic is like taking an aspirin mostly. It is done on purely subjective grounds and tells us nothing about cause or suffering. I stopped teaching medical students and residents as I could no longer teach them the lies that are part of the standard medical-psychiatric paradigm and what program directors want is for you to teach what will be on the test. I recently agreed to speak at a primary care symposium after initially saying no. I did so simply because all of medicine both primary care and psychiatry are poisoning America with huge amounts of expensive, at times dangerous and often useless psychotropic drugs. This is because Drs have been educated in a superficial manor and do not understand what a construct is.(An idea we give artificial substance too) People may feel depressed but there is no such "thing" as a "Major Depression" regardless of what someone says about what an SSRI makes them feel like. Until Drs recognize how little they can actually say about another persons mental life they will continue to believe they are giving cures for mythical diseases mostly created by drug companies and the psychiatric establishment. To pretend you can understand another persons mental complaint and "Dx" them in 15mins or an hour or even ever is self deception of the most dangerous kind. I decided to speak at the symposium and remind them how little we all can know hoping maybe one fewer person will be needlessly medicated.

To be fair, many PCP's would rather not prescibe psych meds but are unable to find psychiatrists who can take their patients, especially children, due to the severe shortage child psychiatrists across the country. Rather than repeat my entire argument from a post I wrote, see Children's Access to Mental Health Care for more on this. In it I point to a study documenting PCP's problems in referring their patients, a Boston globe op-ed by a pediatrician & a post by a family physican blogger.

I am of the opinion that GP's should not diagnose and treat mental illness. For 6 years before being finally diagnosed as bipolar, I was on 3 different SSRI anti-depressants at different doses, which were prescribed by my general doctor. I actually had 2 different doctors in that period of time, and the second took over as conductor of the anti-depressant train without batting an eyelash. Of course none of the drugs worked and some made things worse. Not once did either of them ever suggest seeing a psychiatrist or therapy, or anything. Just... "oh, not working? Feeling worse? Here lets try another drug in the same class. Ok now, bye-bye." My psychiatrist that I to go now, is very attentive and thoughtful when prescribing and discussing my medication, and I feel much safer and confident having him do it.

When I was attending an out-of-state college, I saw a psychiatrist near my school. He would communicate with my primary care doctor in my home state, who would call in a prescription, which my parents would pick up and mail to me. The reason we did this was because my primary insurance plan (through my mom's workplace) didn't cover non-emergency out-of-state costs, while the my supplemental student insurance barely covered prescriptions.

Dr. Sorboro,
"I decided to speak at the symposium and remind them how little we all can know hoping maybe one fewer person will be needlessly medicated."

Please tell me because I'm dying to know: how was your talk received at the symposium???
Sherry