If this is the first time you’re reading my blog – Welcome!
If not, you know that I’m … ummm … mature and that I’ve been restless enough to study many branches of medicine.
My current credential is in psychiatry, and like Rodney Dangerfield, we shrinks “Don’t get no respect.” Read more on Researchers Are Short-Sighted When Looking At Data…
I could not believe it when the patient asked me about ketamine. I had just seen an episode of “House, MD” on one of those cable super-stations the night before and it dealt with this weird drug. I told my husband about my experiences with it during my surgical career. Then, the next day, this patient brought up the same rare drug. When I looked at him closer, it became believable. He was old enough — in his sixties — that in the swinging sixties he had surely been one of those “knowledgeable” druggies who pride themselves on knowing all about everything that could give one a buzz.
This type of person is a sort of lay-pharmacologist — someone who knows not only how each drug made someone feel, but sometimes even about class of drug and mechanism of action. Of course, this type of expert would seldom know terribly much about what the FDA thought or felt about these drugs. “I heard it works pretty well and faster than anything on depression,” he said, “and I am kind of depressed and the standard antidepressants, the crap like Prozac and Zoloft aren’t worth taking and don’t do anything. But they say that stuff works fast on depression.”
Yes, he knew his stuff so well that he may even have read some kind of FDA reports or something. Still, ketamine is not the kind of thing you can dish out in a county clinic in Noplace, California. If you want something exotic, try a university psychiatry or pharmacology department, or call or email the National Institutes of Health. I could offer the standard stuff, but not ketamine. Not me, not there.
“I wants me some of them-there antidepressant pills.”
He was a 47 year old good old boy of the sort I had treated in Oklahoma and other rural parts west –a real cowboy. He had herded animals and done the rodeo and all of that.
No, he had never seen a psychiatrist before, ever. He had been out crying on the front porch, and it was a next door neighbor who had somehow convinced him that there were medications and he did not have to tell his whole life story to get pills. Well, maybe that would work with a general practitioner, but he was not only disappointed but also angry that it was plainly NOT going to work with me. Figuring he had been had, he broke down and told me the story. I could understand at once why he had been reluctant to get into this, for we went through half a box of Kleenex while he gave me a plot that was worthy of a tear-jerky country song. Read more on A Cowboy’s Lesson — Antidepressants Won’t Work Well With Alcohol…
Eli Lilly gets credit for being economically savvy and the first out of the chute.
Cymbalta (duloxetine) is a much awaited antidepressant that is supposed to be effective especially on the bodily aspects of depression. Those pesky aches and pains that are associated with depression in one form or another.
People may look at the complex before they look at the obvious — which is a faster answer and closer to the truth. I happened to be talking and I found three more yesterday. Women. Young, intelligent, and attractive women, who did not have and did not want boyfriends. All three were part of the mental health treatment establishment.
The first time I discovered one of those was some years ago, a few cities ago, and she was a very clever and very talented psychiatric nurse. She loved her profession, and took good care of people. She loved nature and animals and plants. I believe her to have been quite attractive. She had been turning down dates because she would rather go to her gardening clubs or whatever.
She had also said, without tears or depression, that she expected she would always be alone, would move into the home for old nurses when she was old enough, and die there. She had been on Prozac for about three years. There were a few problems with this. First, nobody had ever talked to her about getting OFF Prozac. They said she might as well stay on it, since life was that good.
Actually, I have looked at data for depressed folks of varying ages. Sure, there is a risk of side effects, but nobody seems to care. I cannot remember, off the top of my head, seeing data about the recurrence of depression that suggested anybody needed to stay on antidepressants permanently.
Certainly, nobody under, say, 55 or so. And she was plenty under. I mean, there are things you can do to lessen the chance of recurrent depression — psychotherapy, even reading books. And there is the whole question of getting someone off SSRIs. I have had patients who claim it is impossible. I’ve had people come to me because the withdrawal effects were horrendous. Yet I have taken people off easily and (reasonably) quickly with natural substance regimens. It’s not impossible – you just have to know how.
That eliminates many of my colleagues. Or perhaps they keep their patients on prescription drugs to insure their return and a steady cash-flow. Naw – doctors wouldn’t do THAT!
There is another problem. There are drug side effects we know little about or may find hard to measure. I remember from my days doing clinical trials that at one time, shortly before I left the business, someone adopted a “uniform” side effect reporting system. The trouble with that was trying to fill in the blanks for the questions on the form when the patient is saying things that do not fit in the blanks.
Every one of these mental health professional women had been put on Prozac when it came out, because of the safety and efficacy. I remember, collecting data, one of the first people I gave Prozac to during clinical trials before that drug was on the market. She told me that she “felt like a zombie” and that she missed having the full amplitude of emotional expression. She missed crying at the movies, something she had genuinely enjoyed. Said she had a feeling of euphoria afterwards — a feeling of euphoria she really enjoyed. Try fitting that one on a uniform side-effects reporting system.
The three women I met yesterday are unlikely to get off their Prozac. They stood in wide-eyed disbelief of my assertions. Of course, they had just met me and know little about who I really am. Besides, people seem to have trouble taking advice for which they aren’t paying. I just reminded them as I remind patients that taking any medication is a choice, and reporting what is going on to a doctor is always a good idea.
If any of these intelligent and well-insured women had gone to a therapist, they could have ended up with some kind of verbally analytic procedure, which obviously would not help. Or maybe they would be referred for some hormone supplementation, which has biologic risks of its own. Big ones, like — cancer.
Worse yet, I’ve met two psychiatrists in my 30 years of practice who gave everybody electric shock treatment. Everybody! The first person in whom I suspected a real lack of sex interest had changed her life — the psychiatric nurse — did finally get off her Prozac. If she had any recurrent depression problems, I do not know about them.
She had a date within two weeks, and last I heard, was dating many interesting men, looking for a best boyfriend.
I am convinced that we are looking at a Prozac side effect that the system has made it impossible to measure. We probably have at least a little of the same side effect with similar drugs in the same class – such as Paxil and Zoloft. Maybe others, too.
The psychiatric nurse easily agreed her general quality of life had been diminished while she was on Prozac. She was too undepressed to notice. When she got off the drug, she suddenly noticed.
Getting a drug past the FDA takes some studies on how it gets into the body and the like. Nobody ever seems very worried about getting off a psychiatric drug. That’s been the focus of my private practice for at least the past five or six years.
For the individual, the effect is pretty evident even though I only have one clear cut example. What about the species? Is this just one of several steps driving humans to …. extinction? People change as time passes. What affected you in the past may have gone away – as many illnesses seem to do.
Spending your lifetime on a drug when you no longer need it is tragic. Or having your quality of life changed because of the way a drug reacts in your body – instead of seeking alternatives to control your problems.
I think it is worthwhile for anybody on a psychotropic drug to ask how their life has changed since they have been on a prescription medicine. We researchers have been limited to collecting information on side effects that the FDA and/or drug companies “let” us.
So don’t look toward the government or the drug companies for help.
She was 28 and pretty and sweet and came in for depression. It was only systematic questioning that confirmed she was manic-depressive. Actually her next-door neighbor had seen a television show on manic-depression and had made the diagnosis a couple of years before, long before this woman had ever seen a psychiatrist. Her episodes had curiously enough been regarded more as amusing than as dangerous, so nobody had ever done anything about treatment.
By the time I knew anything about her, she had already had one child, and was pregnant with her second.I always believe in coordinating forces with the obstetrician/gynecologist when caring for a pregnant woman.I rarely get phone calls returned, but this is the way it should be, especially if someone has brought up the question of psychotropic drugs. She had never seen a doctor; her first child, and this one, had been delivered by a nurse practitioner midwife. The one thing I am absolutely sure this woman did better than any physician (except me) is answer phone calls. She was obviously thumbing through the old chart on the other end of the line when she told me: “After the birth of her last child she ran after her husband with a kitchen knife. She destroyed a bunch of stuff in the house. We did not know whether or not to believe the husband. After all, he had a serious history of drug abuse. They were sent to counseling; there is nothing more in the notes.”
It took all I had to keep from yelling into the phone at the top of my lungs. Read more on “Postpartum Psychosis”…
She said she was depressed and anxious. She was 38, large, and animated, with almost glazed over excited eyes, and talking a mile a minute.
Every person who tells me he or she is depressed gets asked the necessary questions to determine if he or she has manic-depressive illness, otherwise known as bipolar illness. The only way to determine this that I know about is by asking. Nobody who is depressed and comes in for treatment of same is going to spontaneously volunteer the info I need to make the diagnosis. Read more on Bipolar Could Be Misdiagnosed As Depression…
He was a pale faced, somewhat overweight 50 year old with a tired demeanor. He had a treatment resistant depression and I had asked his primary care physician to run some tests. He complained of not just lower back pain, but pain in all his joints, and I wanted to rule out autoimmune illness; things like rheumatoid arthritis, or even lupus. I also told him to review his pain meds with the doctor.
He claimed 8 months of sobriety from what had once been a pretty heavy alcohol habit. Who knows what is real or true? He had told me he had a couple “little relapses,” not unexpected in that sort of problem.
“The doctor says I am an addict and I am going to die from my pain meds, because I take too much of them. I told him if he would give me better ones or stronger ones, I would not have to take so much. It is his fault. I really hurt.” Read more on Death By Pain Pills…
The current litany is “The economy is bad and I need more money just to get by.” Patients tell me they are about to get evicted or starve to death. I know nothing about benefits or their politics, except that governmental entities have no money either and this route is harder.
A lot of people seem to think that their lives would be better if they were plugged into a job that fit them as well as a plaster cast fits a fracture. But instead, they usually tell me there are no jobs at all. I try to slip in a little bit of useful advice, but obviously personal experience is limited. I don’t even have a really good answer for the patients who say “you have a job. Lucky you. You can’t understand what I am going through.”
There are patients who amaze me with their resourcefulness. Mostly, the manics or hypomanics; depressed people seem more likely to get “stuck.” Read more on Brainpower Helps In Hard Times…
He looked different from most of the depressed patients that walk into a psychiatric clinic. He was 24, thin and spare. His hair was longer than average and hung loosely over his brow, his clothes were black and macabre –what the young folks call “Goth”. That style makes everyone look depressed, but I could tell his depression ran deeper than fashion styles.
He was actually a handsome young man, and he had sensibly avoided the face and body piercings that Goths favor. He was open about his choice of lifestyle, relishing his chance to educate me. But while he was talking, I could see he was so depressed, he could have been the poster child for the diagnostic manual.
But something more was going on here. He told me that he had adopted the Goth look at age 13; that nothing else could express how he felt about life — or rather, how he didn’t feel. Read more on What If Life Is Not Worth Living?…