Psychopharmacology/Advanced Practice Psychology

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DynamicDidactic said:
It is an empirical question which fields are worse or better.
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This is a tautology. Your question cannot be answered without RxP, which requires support to allowing testing. Not that this matters because it was already studied in 1997 with favorable results.
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AcronymAllergy said:
Compounded by the fact that psychologists are fewer in number to begin with than pretty much all other mental health and healthcare professions, as best I can recall.
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True, but I can say with some confidence that participation rates in state and national Orgs are markedly worse amongst counselors and social workers. I think the entire ACA (national counseling org) budget was maybe a quarter of APA’s the last time I compared them, but that was a couple of years ago.
 
AcronymAllergy said:
My take is that we probably need to do both simultaneously, in terms of expanding/protecting scope of practice and addressing the issues in our field. Some issues I don't think will ever go away (e.g., there are plenty of physicians, nurses, and other healthcare professionals who adhere to pseudoscientific treatments and methods). Some issues are more prevalent in psychology than medicine (e.g., predatory training programs), but I think if we focus on addressing those problems at the expense of expanding/protecting scope of practice (even if not to RxP, to at least focus on improved reimbursement for psychological services, ability to use H&M codes, inclusion in the Medicare definition of physician, etc.), we run a very real risk of becoming non-viable as a profession.
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R. Matey said:
True, but I can say with some confidence that participation rates in state and national Orgs are markedly worse amongst counselors and social workers. I think the entire ACA (national counseling org) budget was maybe a quarter of APA’s the last time I compared them, but that was a couple of years ago.
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To be fair, APA also represents a broader profession, including a lot of non-licensable branches of psychology, like social, I/O, developmental, animal behavior, etc., whereas pretty much everyone ACA represents are either clinicians or counselor educators who train clinicians.
 
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futureapppsy2 said:
To be fair, APA also represents a broader profession, including a lot of non-licensable branches of psychology, like social, I/O, developmental, animal behavior, etc., whereas pretty much everyone ACA represents are either clinicians or counselor educators who train clinicians.
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Maybe, but the context of the comment was related to healthcare advocacy, which I imagine is mostly unique to clinicians. It would be interesting to compare practitioner-to-practitioner across fields though I'd maintain that social workers and counselors have less extra cash to fork out for a professional org membership.

Edit: Also, I'm less sure that the non-licensable subfields account for 3/4s of APA's budget considering licensable degrees make up the greatest share of the membership. At least, that's my understanding.
 
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R. Matey said:
Maybe, but the context of the comment was related to healthcare advocacy, which I imagine is mostly unique to clinicians.
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Fair, but keep in mind that not all of APA's resources are going to things related to clinical practice or clinicians. I definitely agree that APA is the strong org overall, though.
 
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futureapppsy2 said:
Fair, but keep in mind that not all of APA's resources are going to things related to clinical practice or clinicians. I definitely agree that APA is the strong org overall, though.
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It's a good point, but I guess I was assuming that APS swallowed up the lion's share of the non-practice interests in psych.
 
For those of you who have completed a MSCP program, what was the experience like navigating the course work and clinical rotations while maintaining your clinical role/private practice? Strongly considering completing one the accredited programs.
 
msc545 said:
This may be changing, but many Psychiatrists are poorly trained in psychodiagnostics and therapy, and tend to "shotgun" patients with additional meds when one or two don't work. Many cannot do therapy at all because they were never trained in it and believe that meds can (or should) solve all problems. Psychologists have broader training, and with appropriate additional training can do a better job of overall care including the use of meds.
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I believe this to be largely true. Like many professions, there are good and bad in all professions, but an advantage of RxP training for psychologists I believe is our far superior diagnostic skills. Quite frequently I see a bad/incorrect diagnosis, and that can really shape treatment away from what is actually needed. Also, the willingness to STOP medications and not just add to a medication list.
 
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Therapist4Chnge said:
I believe this to be largely true. Like many professions, there are good and bad in all professions, but an advantage of RxP training for psychologists I believe is our far superior diagnostic skills. Quite frequently I see a bad/incorrect diagnosis, and that can really shape treatment away from what is actually needed. Also, the willingness to STOP medications and not just add to a medication list.
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Stopping medication is to some extent like admitting you made a mistake - something a lot of Psychiatrists and other Physicians have trouble doing.
 
msc545 said:
Stopping medication is to some extent like admitting you made a mistake - something a lot of Psychiatrists and other Physicians have trouble doing.
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No, it isn’t. It is a common aspect of pharmacotherapy that medications do not have the intended effect or result in problematic/intolerable side effects. When that’s the case, the appropriate course of action is to discontinue the medication and, typically, try another viable option.

Agreed that medications are often not discontinued when they should be, but stopping an ineffective/intolerable medication is in no way acknowledging you made a mistake. It’s appropriate, responsible, competent practice.
 
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medium rare said:
No, it isn’t. It is a common aspect of pharmacotherapy that medications do not have the intended effect or result in problematic/intolerable side effects. When that’s the case, the appropriate course of action is to discontinue the medication and, typically, try another viable option.

Agreed that medications are often not discontinued when they should be, but stopping an ineffective/intolerable medication is in no way acknowledging you made a mistake. It’s appropriate, responsible, competent practice.
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I agree with all that you said. However, no matter how appropriate stopping the medication is, I believe that there is also a tinge of failure on the part of the prescriber associated with stopping it, and that tinge is the unstated reason that many meds that should be stopped are not, or are stopped late, or in some cases increased in response to complaints about lack of efficacy, or combined with other meds but not discontinued.

I know that there are valid reasons for taking all of the actions I have mentioned, and you of course know that there are invalid reasons as well. Valid and invalid reasons are often combined in all choices we make.

Our unconscious acts silently but decisively.
 
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medium rare said:
No, it isn’t. It is a common aspect of pharmacotherapy that medications do not have the intended effect or result in problematic/intolerable side effects. When that’s the case, the appropriate course of action is to discontinue the medication and, typically, try another viable option.

Agreed that medications are often not discontinued when they should be, but stopping an ineffective/intolerable medication is in no way acknowledging you made a mistake. It’s appropriate, responsible, competent practice.
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I have no issues stopping a med. Everyone reacts differently to them
 
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Heist said:
I have no issues stopping a med. Everyone reacts differently to them
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Please kindly explain the practice of increasing the dose of a med that is already causing side effects in an attempt to increase efficacy, and also explain the practice of combining incompatible meds in the same patient instead of first stopping the one that isn't working well or at all. I have seen both of these situations far too often.

You may not do any of this, but others do.
 
msc545 said:
Please kindly explain the practice of increasing the dose of a med that is already causing side effects in an attempt to increase efficacy, and also explain the practice of combining incompatible meds in the same patient instead of first stopping the one that isn't working well or at all. I have seen both of these situations far too often.

You may not do any of this, but others do.
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Trazodone is usually increased for its side effect of sedation. Incompetence is seen in ALL fields and I’m sure there are plenty of stories to go around. That does not mean we should accept incompetence when it’s detrimental to patients. A question I have for you is how did you respond when you saw or were informed of these issues? It seems specialists don’t like communicating with each other for whatever reason. I’ve had plenty of situations where a patient didn’t tell me or forgot to share some concerns and later shared it with their therapist. Therapist communicated it with me and it got addressed.

One issue that does happen is where some prescribers treat psychopharmacology as an art and don’t pay attention to the evidence of research. Anecdotally, I’ve cleaned up messes from psychiatrists, psychologists, PCPs, NPs, other random specialists. There are issues in all fields is my point and there is no one “superior” field.
 
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UTsksk said:
Trazodone is usually increased for its side effect of sedation. Incompetence is seen in ALL fields and I’m sure there are plenty of stories to go around. That does not mean we should accept incompetence when it’s detrimental to patients. A question I have for you is how did you respond when you saw or were informed of these issues? It seems specialists don’t like communicating with each other for whatever reason. I’ve had plenty of situations where a patient didn’t tell me or forgot to share some concerns and later shared it with their therapist. Therapist communicated it with me and it got addressed.

One issue that does happen is where some prescribers treat psychopharmacology as an art and don’t pay attention to the evidence of research. Anecdotally, I’ve cleaned up messes from psychiatrists, psychologists, PCPs, NPs, other random specialists. There are issues in all fields is my point and there is no one “superior” field.
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Answering a question with a question generally mean you have no answers to my questions.
 
msc545 said:
Please kindly explain the practice of increasing the dose of a med that is already causing side effects in an attempt to increase efficacy, and also explain the practice of combining incompatible meds in the same patient instead of first stopping the one that isn't working well or at all. I have seen both of these situations far too often.

You may not do any of this, but others do.
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Clinical effects often are not linearly related to medication dose. This is because most psychotropic medications act at multiple CNS receptors, with differing affinities.

For example, trazodone and mirtazapine are both antidepressants with sedating properties that saturate at relatively low doses. This is because the medications have high affinities for histamine receptors, which are responsible for the sedating effects. At higher doses, receptors for which the drugs have lower overall affinities start to be affected. In particular, dopamine and norepinephrine receptor activation can have activating effects that override the sedating effects of the saturated histamine receptors, resulting in less sedation at higher doses. See



For example, see below for Table 3 from the second reference above, listing receptor occupancy rates at different doses of trazodone. Histamine H1 receptors are already 84% blockaded at the 50 mg dose. Dopamine and norepi transporters are minimally saturated at this dose (10% and 14%), where as by 150 mg they are 25 and 33% saturated respectively, and would go higher at more depression-relevant doses like 200-300 mg/d (not included in this table).
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This is why these medications are used at low doses for sleep (7.5 mg for mirtazapine and 25-100 mg for trazodone) but require higher doses (15-45 mirtazapine and 200+ for trazodone), at which they may instead be activating, to be effective for depression.

Also, I'm not sure what you consider 'incompatible,' and personally I always strive for monotherapy when possible, but in many cases it really isn't possible or appropriate. For example, individuals with bipolar disorder who are currently depressed generally shouldn't be treated with an antidepressant alone because it can precipitate mania. In some cases they can be managed by monotherapy with a mood stabilizer that has relatively better efficacy for depression, such as lamotrigine; but many bipolar patients won't respond to this, and will require both the antidepressant to treat the depressive episode and a mood stabilizer to prevent the antidepressant from flipping them into mania.
 
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tr said:
Clinical effects often are not linearly related to medication dose. This is because most psychotropic medications act at multiple CNS receptors, with differing affinities.

For example, trazodone and mirtazapine are both antidepressants with sedating properties that saturate at relatively low doses. This is because the medications have high affinities for histamine receptors, which are responsible for the sedating effects. At higher doses, receptors for which the drugs have lower overall affinities start to be affected. In particular, dopamine and norepinephrine receptor activation can have activating effects that override the sedating effects of the saturated histamine receptors, resulting in less sedation at higher doses. See



For example, see below for Table 3 from the second reference above, listing receptor occupancy rates at different doses of trazodone. Histamine H1 receptors are already 84% blockaded at the 50 mg dose. Dopamine and norepi transporters are minimally saturated at this dose (10% and 14%), where as by 150 mg they are 25 and 33% saturated respectively, and would go higher at more depression-relevant doses like 200-300 mg/d (not included in this table).
View attachment 367551

This is why these medications are used at low doses for sleep (7.5 mg for mirtazapine and 25-100 mg for trazodone) but require higher doses (15-45 mirtazapine and 200+ for trazodone), at which they may instead be activating, to be effective for depression.

Also, I'm not sure what you consider 'incompatible,' and personally I always strive for monotherapy when possible, but in many cases it really isn't possible or appropriate. For example, individuals with bipolar disorder who are currently depressed generally shouldn't be treated with an antidepressant alone because it can precipitate mania. In some cases they can be managed by monotherapy with a mood stabilizer that has relatively better efficacy for depression, such as lamotrigine; but many bipolar patients won't respond to this, and will require both the antidepressant to treat the depressive episode and a mood stabilizer to prevent the antidepressant from flipping them into mania.
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This post demonstrates why I want my patients to see psychiatrists rather than NPs.
 
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tr said:
Clinical effects often are not linearly related to medication dose. This is because most psychotropic medications act at multiple CNS receptors, with differing affinities.

For example, trazodone and mirtazapine are both antidepressants with sedating properties that saturate at relatively low doses. This is because the medications have high affinities for histamine receptors, which are responsible for the sedating effects. At higher doses, receptors for which the drugs have lower overall affinities start to be affected. In particular, dopamine and norepinephrine receptor activation can have activating effects that override the sedating effects of the saturated histamine receptors, resulting in less sedation at higher doses. See



For example, see below for Table 3 from the second reference above, listing receptor occupancy rates at different doses of trazodone. Histamine H1 receptors are already 84% blockaded at the 50 mg dose. Dopamine and norepi transporters are minimally saturated at this dose (10% and 14%), where as by 150 mg they are 25 and 33% saturated respectively, and would go higher at more depression-relevant doses like 200-300 mg/d (not included in this table).
View attachment 367551

This is why these medications are used at low doses for sleep (7.5 mg for mirtazapine and 25-100 mg for trazodone) but require higher doses (15-45 mirtazapine and 200+ for trazodone), at which they may instead be activating, to be effective for depression.

Also, I'm not sure what you consider 'incompatible,' and personally I always strive for monotherapy when possible, but in many cases it really isn't possible or appropriate. For example, individuals with bipolar disorder who are currently depressed generally shouldn't be treated with an antidepressant alone because it can precipitate mania. In some cases they can be managed by monotherapy with a mood stabilizer that has relatively better efficacy for depression, such as lamotrigine; but many bipolar patients won't respond to this, and will require both the antidepressant to treat the depressive episode and a mood stabilizer to prevent the antidepressant from flipping them into mania.
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I definitely understand the reason(s) for increasing medication and I appreciate your discussion of these - however, my original question was "Please kindly explain the practice of increasing the dose of a med that is already causing side effects in an attempt to increase efficacy". I don't think your explanation addressed this scenario specifically, and it is one I have unfortunately seen far too often.

As for my use of the term "incompatible", what I meant was the situation in which two medications interact to produce unwanted side effects that would presumably not occur in the presence of only one of them. I can understand why this might not be completely foreseeable, but I cannot see why a practitioner would choose not to remedy it. Again, I have seen this too many times.
 
msc545 said:
I definitely understand the reason(s) for increasing medication and I appreciate your discussion of these - however, my original question was "Please kindly explain the practice of increasing the dose of a med that is already causing side effects in an attempt to increase efficacy". I don't think your explanation addressed this scenario specifically, and it is one I have unfortunately seen far too often.
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I'm obviously not acquainted with the specific cases you have in mind, but in the example case of the two meds I mentioned, if the unwanted side effect was sedation, then increasing the dose might actually improve the issue.

Some side effects are also transient. GI upset with SSRI initiation is extremely common but also quite transient, typically lasting a few days, in rare cases up to several weeks. I normally start quite low and advise people to wait until the nausea subsides before increasing the dose, but if nobody ever increased an SSRI beyond the point that caused initiation nausea, there would be a lot of undertreatment happening.

msc545 said:
As for my use of the term "incompatible", what I meant was the situation in which two medications interact to produce unwanted side effects that would presumably not occur in the presence of only one of them. I can understand why this might not be completely foreseeable, but I cannot see why a practitioner would choose not to remedy it. Again, I have seen this too many times.
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I certainly can't speak for anyone else's practice habits, but the balance between side effects and efficacy is always an individual decision. I have definitely had patients choose to continue taking a given medication through side effects that I personally would have considered intolerable, because they felt the benefits were worth it. Unless the side effect in question is an active health threat, this is a personal choice.
 
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medium rare said:
Some of us psych NPs are aware of this as well.
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Of course, and some psychiatrists are idiots despite making it through med school and residency. Overlapping distributions. Still haven‘t run into a highly competent Psych NP in the real world, but then again you are a psychologist so a little different dynamic at play. 😁
 
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tr said:
I'm obviously not acquainted with the specific cases you have in mind, but in the example case of the two meds I mentioned, if the unwanted side effect was sedation, then increasing the dose might actually improve the issue.

Some side effects are also transient. GI upset with SSRI initiation is extremely common but also quite transient, typically lasting a few days, in rare cases up to several weeks. I normally start quite low and advise people to wait until the nausea subsides before increasing the dose, but if nobody ever increased an SSRI beyond the point that caused initiation nausea, there would be a lot of undertreatment happening.


I certainly can't speak for anyone else's practice habits, but the balance between side effects and efficacy is always an individual decision. I have definitely had patients choose to continue taking a given medication through side effects that I personally would have considered intolerable, because they felt the benefits were worth it. Unless the side effect in question is an active health threat, this is a personal choice.
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Thanks for the detailed information and the discussion.
 
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It has been several years since I have looked into MSCP programs. Do folks have a sense of the most reputable programs for this currently? Any reputable remote programs for those unable to relocate?
 
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Harry3990 said:
It has been several years since I have looked into MSCP programs. Do folks have a sense of the most reputable programs for this currently? Any reputable remote programs for those unable to relocate?
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www.apa.org

Prescriptive Authority Program Designation

Programs currently or recently undergoing the review process for prescriptive authority program designation, designated programs, status definitions such as under review, designated and application voluntarily withdrawn, and designation fees.
www.apa.org www.apa.org

Personally, I think I'd only think about FDU or NMSU.
 
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WisNeuro said:
www.apa.org

Prescriptive Authority Program Designation

Programs currently or recently undergoing the review process for prescriptive authority program designation, designated programs, status definitions such as under review, designated and application voluntarily withdrawn, and designation fees.
www.apa.org www.apa.org

Personally, I think I'd only think about FDU or NMSU.
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Second FDU and NMSU. Pass on the others. Idaho State may have a decent program but I’m not familiar with their specifics.
 
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Is Illinois currently the only state that accepts RxP applicants who enrolled and completed their MSCP while concurrently being enrolled in their doctoral program? I was wondering if this route can be used for RxP applicants in the 5 other states or if they require the MSCP to be completed as a postdoc. Also for those who have been part of selection teams for internship and postdoc sites, would students, especially neuro focused, who have completed this route really stand out when applying for internships and postdocs? I know that TCSPP is the only program out there that offers the simultaneous enrollment route . Any thoughts or input about obtaining the MSCP while being enrolled in your doctoral program?
 
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Long answer: This came up years ago (15+ years) and I'm not sure there has been a definitive answer; you'll likely have to ask each state licensing board individually. Back when I did my training (brick & mortar, not online), we were able to take the classes if we had advanced standing in our doctoral program, though we had a mix of existing providers and a handful of current doctoral students. I took my pharma classes years 3, 4, & 5 of my doctoral training, then went on internship. I had to get my hours in (a degree requirement, diff from hours towards licensure for RxP) after my fellowship years. I don't see a feasible way to pursue your hours until you are at least independently licensed as a psychologist. From a logistics perspective, taking pharma classes and trying to finish my doctoral degree was brutal.

Short answer: Talk to each state licensing board individually.
 
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NeuroHooper said:
Is Illinois currently the only state that accepts RxP applicants who enrolled and completed their MSCP while concurrently being enrolled in their doctoral program? I was wondering if this route can be used for RxP applicants in the 5 other states or if they require the MSCP to be completed as a postdoc. Also for those who have been part of selection teams for internship and postdoc sites, would students, especially neuro focused, who have completed this route really stand out when applying for internships and postdocs? I know that TCSPP is the only program out there that offers the simultaneous enrollment route . Any thoughts or input about obtaining the MSCP while being enrolled in your doctoral program?
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I second everything T4C has said. The only way to know for sure is to check each state's requirements and then just ask their board.

As for internship/postdoc selection, for me personally, it wouldn't move the needle one way or another (i.e., I wouldn't view it as a significant positive or negative). If the person hadn't had formal neuroanatomy coursework otherwise, I might view the psychopharm training as at least somewhat compensatory for that.
 
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NeuroHooper said:
Is Illinois currently the only state that accepts RxP applicants who enrolled and completed their MSCP while concurrently being enrolled in their doctoral program? I was wondering if this route can be used for RxP applicants in the 5 other states or if they require the MSCP to be completed as a postdoc. Also for those who have been part of selection teams for internship and postdoc sites, would students, especially neuro focused, who have completed this route really stand out when applying for internships and postdocs? I know that TCSPP is the only program out there that offers the simultaneous enrollment route . Any thoughts or input about obtaining the MSCP while being enrolled in your doctoral program?
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1) If you are going to stay in IL, then get the MSCP now. Coordination of the rotations will be easier while you are in an academic setting. Setting yourself up for future jobs is easier.

2) If you are unsure if you are going to stay in IL, then do not get an MSCP until you're settled in an RxP state.

3) LA might accept the TCSPP. NM will probably not. IL will. ID has a reciprocity clause, which you might be able to use after you get an IL RxP license. IA is too early to tell.

4) Early career, Neuropsych pays slightly less than RxP (i.e., $130k <$197k). The midcareer neuropsych salaries reported by Sweet are equivalent to the salaries reported by RxP psychologists.

5) Because there are fewer RxP psychologists than neuropsychologists, most places would look at the qualifications, and want you to work as a prescriber. That is something to consider.

6) If you watch the history of psychology, the people who come early to new practice areas make money.
 
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Therapist4Chnge said:
Long answer: This came up years ago (15+ years) and I'm not sure there has been a definitive answer; you'll likely have to ask each state licensing board individually. Back when I did my training (brick & mortar, not online), we were able to take the classes if we had advanced standing in our doctoral program, though we had a mix of existing providers and a handful of current doctoral students. I took my pharma classes years 3, 4, & 5 of my doctoral training, then went on internship. I had to get my hours in (a degree requirement, diff from hours towards licensure for RxP) after my fellowship years. I don't see a feasible way to pursue your hours until you are at least independently licensed as a psychologist. From a logistics perspective, taking pharma classes and trying to finish my doctoral degree was brutal.

Short answer: Talk to each state licensing board individually.
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I see now, I’ll make sure to reach out to other states to see how they would go about it. Thank you!

AcronymAllergy said:
I second everything T4C has said. The only way to know for sure is to check each state's requirements and then just ask their board.

As for internship/postdoc selection, for me personally, it wouldn't move the needle one way or another (i.e., I wouldn't view it as a significant positive or negative). If the person hadn't had formal neuroanatomy coursework otherwise, I might view the psychopharm training as at least somewhat compensatory for that.
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Thank you! My program has pretty in-depth specializations so I’m taking plenty of courses like neuroscience, neuroanatomy, behavioral neuropsych, etc so maybe it wouldn’t be as impactful as I thought completing it as a student.

PsyDr said:
1) If you are going to stay in IL, then get the MSCP now. Coordination of the rotations will be easier while you are in an academic setting. Setting yourself up for future jobs is easier.

2) If you are unsure if you are going to stay in IL, then do not get an MSCP until you're settled in an RxP state.

3) LA might accept the TCSPP. NM will probably not. IL will. ID has a reciprocity clause, which you might be able to use after you get an IL RxP license. IA is too early to tell.

4) Early career, Neuropsych pays slightly less than RxP (i.e., $130k
5) Because there are fewer RxP psychologists than neuropsychologists, most places would look at the qualifications, and want you to work as a prescriber. That is something to consider.

6) If you watch the history of psychology, the people who come early to new practice areas make money.
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These are all great points. I’ll have to keep all those in mind if I choose to take the RxP route. I’m not sure what state I’ll settle down in yet. And I really enjoy neuropsych so I’m not sure I’d want to give that up to mainly prescribe, though I’m sure there are ways to work around both.


Thanks all you for the insight and advice!
 
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Hi! Curious to hear from folks licensed in their states with prescriptive authority. About to begin a program, and in looking at states to get licensed in, many require basic sciences to be completed (Illinois, specifically). Can anyone speak to the Colorado statutes that state basic sciences must be completed prior to or as part of their psychopharmacology program?
 
The solid RxP psychopharm programs will incorporate the basic science requirements into their curriculum. I’m not sure what Colorado is doing for a locally-based training program, but I would recommend the RxP programs at New Mexico State and Farleigh Dickinson Universities.
 
dutch2020 said:
Hi! Curious to hear from folks licensed in their states with prescriptive authority. About to begin a program, and in looking at states to get licensed in, many require basic sciences to be completed (Illinois, specifically). Can anyone speak to the Colorado statutes that state basic sciences must be completed prior to or as part of their psychopharmacology program?
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All the APA designated programs cover basic sciences as you need them to competently prescribe. I believe Illinois is the only state that requires applicants to have completed some undergrad courses related to bio, chem, and human anatomy and physiology, not to the extent of pre-med prerequisites but similar. I could be wrong, but doing a quick look over the Colorado bill, it seems like you just need to have completed your doctoral program in psychology, your MSCP, pass the PEP, and complete the required supervised experience.
 
WisNeuro said:
Anyone want to snag me the following article and PM me it? :)

Examining psychologist prescriptive authority as a cost-effective strategy for reducing suicide rates.​


APA PsycNet

psycnet.apa.org psycnet.apa.org
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I, unfortunately, cannot get access to the article at the moment. HOWEVER,

Color me skeptical. How does RxP reduce suicide despite, generally, the lack of support for meds in treating suicide (and even some evidence indicating an increase in suicide rates)?
 
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DynamicDidactic said:
I, unfortunately, cannot get access to the article at the moment. HOWEVER,

Color me skeptical. How does RxP reduce suicide despite, generally, the lack of support for meds in treating suicide (and even some evidence indicating an increase in suicide rates)?
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Yeah, there's a lot this person isn't controlling for.
 
Looks like the CPA may be proposing a bill in the next year or so as they started a fundraising drive. It’s been some time since their last attempt. I’m sure a win in California would do wonders for the movement as a whole.

Not sure how well it’ll do though, pretty sure the AMA and California psychiatrists will do whatever they can to stop it from passing.
 
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DynamicDidactic said:
I, unfortunately, cannot get access to the article at the moment. HOWEVER,

Color me skeptical. How does RxP reduce suicide despite, generally, the lack of support for meds in treating suicide (and even some evidence indicating an increase in suicide rates)?
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Because it’s more about money than it is about helping people or society. The best con is when the shill is suffering and desperate. We have so much of this going on right now it is staggering isn’t there some evidence that a purposeful or meaningful life reduces risk and isn’t that what we are getting less of? A big reason I don’t pursue RxP and I practice in a state with it, is because I prefer to think psychotherapy and other psychosocial interventions guided by psychological principles are more effective.
 
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smalltownpsych said:
Because it’s more about money than it is about helping people or society. The best con is when the shill is suffering and desperate. We have so much of this going on right now it is staggering isn’t there some evidence that a purposeful or meaningful life reduces risk and isn’t that what we are getting less of? A big reason I don’t pursue RxP and I practice in a state with it, is because I prefer to think psychotherapy and other psychosocial interventions guided by psychological principles are more effective.
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Since you employ a nurse practitioner for med management: is that more about money than effectiveness?
 
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PsyDr said:
Since you employ a nurse practitioner for med management: is that more about money than effectiveness?
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Just to be clear, I am not anti medications and for many of my patients who skew towards the more severe they are an important part of the treatment. I also want to make money, but at the same time it can be a distorting or corrosive force. I don’t pretend to be a saint. 😁
I am a firm believer that it is more often both/and as opposed to either/or.
 
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