Well Stated!

“Post-traumatic stress syndrome” (whether from rape or combat) is a perfect example of the foolishness of considering a person’s problem from a “chemical viewpoint”. A moron can see that the chicken came before the egg. The same applies to losing a job and getting “depressed,” to being suspect in an accounting error and being “anxious,” to taking PCP or crack and feeling “everyone is out to get me,” to losing at love and feeling “apathetic.”

Each person enjoys being treated as a stand-alone being worthy of consideration, admiration and respect. People have an inherent sense of honor, justice, right and wrong as regards themselves and others. How do you alleviate the “depression,” “anger” or “paranoia” of years of slavery followed by segregation and second-class citizenship with chemicals? Could you administer a chemical that would make someone cheerful in their circumstances or numb to their situation?

Believers in todays “medicalized” society gaze at our communities and knowingly say that folks taking coke and crack are “self-medicating”. As if the populous have some nerve to resort to chemicals outside the circles of academia and corporate profits. As if the believers have something better to offer other than the possibility of fewer side-effects. Which is why Big Pharma and Big Psych are so very touchy about their own side effects and rely more on public relations strategies and tactics than on science to sell their own dope.

Martin Luther King, Jr., knew all the emotions from apathy to paranoia to anger to exhiliaration and successions of highs and lows. He also knew that he and all his fellow man were worthy of consideration, admiration and respect, and that the chemicals involved in this and in his whole body were worthless and of no account in comparison.

An industry engaged on chemical offerings to man’s emotional, mental and spiritual ills is bankrupt, no matter what their profits.

:)

Alert the media! We deserve medals! ;+)

I still think I would prefer to know my disease had a concrete biological origin, but I can only guess what it’s like in someone elses shoes. You never really know.

I do agree HC, that you and I are not that far apart in our views…

:)

You wrote: As a physician, I can say that, sometimes, physicians are lazier about these issues than we should be. I know that in your work, you know physicians from whom you would never seek treatment, but who frankly can be good for a bump in NRXs or share.

Dr Helm, you are so right!!! I have often said the bad thing about being a drug rep is you develop a long list of physicians to whom you would not send your dog, let alone family or friends. The main reason for this is docs who don’t keep up and/or those who are just billing machines.

I have one psychiatrist (I don’t talk to him, because he doesn’t see reps–it would interfere with his revolving door) who sees comm mental hlth ctr patients. He sees them every 6-8 minutes!! These are the chronically mentally ill–schizophrenics for the most part. All he is doing is checking the box and billing Medicaid. Another I know ONLY prescribes Zyprexa and Clozarel. He doesn’t talk to reps (except to tell me my drug “uses big numbers for dosing” and his patients don’t like big numbers), he doesn’t go to dinner programs, he doesn’t read clinicals…I happen to believe that if he listened to a little pharma marketing, he might be inclined to try something besides Zyprexa, but who knows?

I was talking to several of my child psych residents about atypicals in kids…not SSRIs…and they said medication is the last step in a set of guidelines that emphasizes behavioral intervention, psychosocial investigation, parental and family counseling…yet it seems that medication is the first place many doctors go. My youngest complains he can’t focus in school; he gets distracted all the time; noises and lights take his attention off of his work…I am having his evaluated for ADD, but with an eye to finding behavioral modifications and study tips that will help him focus better without medication.

All of that is kind of tangential…sorry.

truthman,

You and I agree. The problem with using medication is that it is too easy to ONLY use medication, and ignore the underlying WHATEVER that is the source of the depression or anxiety. First of all, medication shouldn’t be used for most situational depressions. Grief and sorrow should be experienced and in a way, embraced. But for long-standing endogenous depression like I have, one has to dive into the pit and face the demons. Otherwise, the problem comes back. And for me, medication alone doesn’t even bandage me enough to function–I have to work on the underlying cause.

truthman, you and I are not so far apart. I think you would argue better not to use medication so that you don’t fall into the trap of relying only on the meds…I would say better to have a physician who pushes you to find the means to face the causes of your depression while also being willing to use meds if needed.

I was thinking about you as I got dressed this morning, truthman (NO! Not that way!!) I am visiting my parents with my kids (hubby not here bec of new job) and so my self-maintenance is minimal. No make-up, no jewelry (I think I am on the autistic spectrum,–jewelry bugs me, as does make-up, and really, clothing, but I can’t go naked). I buy all my “play clothes” at Target and I’m wearing $15 shoes. Left to my own devices, I prefer to accumulate as little as possible in the way of “stuff” (except for work clothes and shoes). My sister, on the other hand (and my mother) is a big accumulator (and they have the money for it). Every once in awhile, I go shopping with her, and I am in awe of her spending capabilities. Anyway, the point is that I think I am happier when I don’t buy into all that BUYING and HAVING. That is what made me think of you–thinking of how we often try to buy things to fill in that big hole inside of us. And how it doesn’t work.

Agreed that the Canadian paper does not contribute to knowledge.

Also agreed that MDs typically (though not always) know how to write a prescription, but not how to advise on discontinuation. A Child and Adolescent Psychiatry colleague of mine says his (academic/referral) practice now consists mostly of removing the polypharmacy started by others (usually psychiatric hospital-based, and general psychiatry specialists), and arranging appropriate out-paitent therapy.

Just noted last PM that Archives of General Psychiatry just published another TADS follow up report on sustained responses in the three arms. Haven’t read the report yet. Maybe Ed will pick that story up too?

Finally, agreed that knowing the findings that didn’t survive the edit for publication is always revealing. I hope there’s a better chance of getting the straight skinny on the TADS data since it is NIH funded, but you never really know how that will go.

I may be too trusting still. I know that certain journals and reviewers are very conscious about the kinds of studies and conclusions they will publish for fear of affecting advertising revenues…

We are a long way from a comprehensive picture in children’s mental health, and there will always be a lot of individual variation.

Canadian Report: Again, this study isnt worth the paper its written on, a Physician’s perception of a patient file is evidence of nothing, as we see more tragedy in children and adolescents who are abruptly withdrawn from a medication. Physicians, patients and family are poorly educated on how to safely taper, Ive been there,..I know.

As far as the TADS Study: Id like to see the raw data, because,..believe me,.. that paints a much different picture than whats submitted by Industry in patient summmaries,.. have personally seen how things are drastically changed