How often do you see patients influenced/scared by anti-psychiatry movement?

[surftheiop]

Another forum I read has some discussion about SSRI's going and I was shocked to see how many people think psychiatric meds are a giant scam.

Got given tons of links to sites like these

http://www.outlookcities.com/psych/

http://www.outlookcities.com/psych/quackery.htm


If patients come in with information like this what do you do to calm/address their concerns and fears?

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[Regnvejr]

Another forum I read has some discussion about SSRI's going and I was shocked to see how many people think psychiatric meds are a giant scam.

Got given tons of links to sites like these

http://www.outlookcities.com/psych/

http://www.outlookcities.com/psych/quackery.htm


If patients come in with information like this what do you do to calm/address their concerns and fears?

Well, placebo does very well in depression studies

But the reality, as I also explain to my patients is that I have no "safe" meds, that everything I got can have side-effects. But that we generally know those side-effects, and that they also are not that common.

I tell them what they typically can expect if they start meds, and that they likely could get better without meds as well, especially if they go to a therapist, but that medications also often makes the recovery faster and stronger, and that it makes the therapy more effective as well.

In the end, unless the patient is comfortable with the meds and actually benefit from them, there is no reason for them to take them.

I still get about one patient every two month or so with longterm attempts at stabilizing, coming in and telling me that after stopping all meds they're doing much better.

 

[clement]

Another forum I read has some discussion about SSRI's going and I was shocked to see how many people think psychiatric meds are a giant scam.

Got given tons of links to sites like these

http://www.outlookcities.com/psych/

http://www.outlookcities.com/psych/quackery.htm


If patients come in with information like this what do you do to calm/address their concerns and fears?

When I was in undergrad the first physician (ob/gyn) I ever discussed pursuing an interest in psychiatry with replied, "meh, they're just pill pushers."

At the time I found the comment amusing, along the lines of, "Oh derm? If it's dry make it wet, if it's wet make it dry?" Though now I wonder how much of an education pts get these days from general practitioners regarding antidepressants and such?

 

[whopper]

When I was in undergrad the first physician (ob/gyn) I ever discussed pursuing an interest in psychiatry with replied, "meh, they're just pill pushers."

Data shows that PCPs are by far the largest prescribers of psychotropic meds--including Ob-Gyns. Several women use an Ob-Gyn as their PCP.

So he/she ought to condemn his/her own profession as the psychiatry pill pushers before he/she points the finger at us.

It's been my anectdotal experience that the wrong or unnecessary psychotropic medicaiton is prescribed more often by a PCP than a psychiatrist.

Nonetheless, let's take his/her comments at face value. Fine--then be a psychiatrist who is not a pill pusher. After reading Breggin's book Toxic Psychiatry, while I thought he was overboard (and have a large amount of disagreement with his work and his opinions), he did provide me with a strong line that I should never cross--the line of the psychiatrist that just gives pills and doesn't listen and try to understand the root of the problem. I have seen psychiatrists who fit that model.

Getting back to the original question...

I've rarely seen the anti-psychiatry movement affect my practice. I can only remember only two cases where the person demanded to not be on meds due to the anti-psychiatry propaganda.

I'd say about 5% of the patients I've encountered did not want medication, but it was not due to propaganda, but based on an informed decision where that person had the capacity to make the decision and it was based on factual data.

 

[Doc Samson]

Several women use an Ob-Gyn as their PCP.

Perhaps more than that.

 

[Pneumothorax]

A friend of mine saw an elderly patient to whom the psychiatrist recommended SSRIs, and the patient asked, "Are they going to make me want to kill myself?"

Which brings up an interesting topic and a theory of mine. I'm curious what you all have to say about it.

SSRIs (or at least some of them) have the infamous black box warning saying that they may lead to suicidal thoughts etc. People claim it is the SSRI doing this. I don't think that this is the case. I suspect that the suicide cases we are seeing are actually cases of paradoxical suicide. The patient is suicidal, but so depressed that they can't get their act together to do the deed. Once they start recovering, they reach a point where they are still severely depressed, but at the same time have the energy to complete their suicide. These suicides are then said to have been caused by the anti-depressant by the anti-psychiatry crowd. What do you think? Am I corrrect here or way off the mark?

 

[clement]

A friend of mine saw an elderly patient to whom the psychiatrist recommended SSRIs, and the patient asked, "Are they going to make me want to kill myself?"

Which brings up an interesting topic and a theory of mine. I'm curious what you all have to say about it.

SSRIs (or at least some of them) have the infamous black box warning saying that they may lead to suicidal thoughts etc. People claim it is the SSRI doing this. I don't think that this is the case. I suspect that the suicide cases we are seeing are actually cases of paradoxical suicide. The patient is suicidal, but so depressed that they can't get their act together to do the deed. Once they start recovering, they reach a point where they are still severely depressed, but at the same time have the energy to complete their suicide. These suicides are then said to have been caused by the anti-depressant by the anti-psychiatry crowd. What do you think? Am I corrrect here or way off the mark?

Interesting timing. I was just about to ask the same...I'm rotating through internal medicine right now. I admit that I'm sometimes semi-dozing during morning rounds, but I could have sworn our attending (IM) said the other day, "Mr. X is withdrawn and depressed. I'm concerned that if I prescribe anti-depressives he might have enough motivation to kill himself." Say what?

 

[qtpai]

A friend of mine saw an elderly patient to whom the psychiatrist recommended SSRIs, and the patient asked, "Are they going to make me want to kill myself?"

Which brings up an interesting topic and a theory of mine. I'm curious what you all have to say about it.

SSRIs (or at least some of them) have the infamous black box warning saying that they may lead to suicidal thoughts etc. People claim it is the SSRI doing this. I don't think that this is the case. I suspect that the suicide cases we are seeing are actually cases of paradoxical suicide. The patient is suicidal, but so depressed that they can't get their act together to do the deed. Once they start recovering, they reach a point where they are still severely depressed, but at the same time have the energy to complete their suicide. These suicides are then said to have been caused by the anti-depressant by the anti-psychiatry crowd. What do you think? Am I corrrect here or way off the mark?

A study conducted by David Healy, administering SSRIs to healthy volunteers without history of mental illness found that a highly statistically significant number of volunteers became suicidal. Understand, of course, that while Healy is no Szasz, he is considered by many to be something of the respectable representative of anti-psychiatry these days (insofar as anti-psychiatry can be called respectable to psychiatrists). So there's always room to question his study.

 

[Regnvejr]

A study conducted by David Healy, administering SSRIs to healthy volunteers without history of mental illness found that a highly statistically significant number of volunteers became suicidal. Understand, of course, that while Healy is no Szasz, he is considered by many to be something of the respectable representative of anti-psychiatry these days (insofar as anti-psychiatry can be called respectable to psychiatrists). So there's always room to question his study.

The only certain data in that area are on Paxil for adolescents. Which is why we don't give this under 18.

 

[outraged]

No Paxil under 18? It happens!

I was placed on 30 mg Paxil and 2 mg Ativan to take daily when I was 14 by a psychiatrist who met me for 15 minutes. Followups were with his wife who I think was a nurse that was somehow able to prescribe medicines, never saw the psychiatrist again. I now take the same amount of Paxil, plus 50 mg Seroquel for sleep (which I don't need, but a doctor insisted I take--I'm already a zombie), and 4 mg Ativan daily to avoid going into withdrawal symptoms (the doctor says it's not withdrawals, any bad symptoms I would have going down on it means that I am still anxious underneath this fogginess according to him). Psychiatrists are a real brainy bunch! I couldn't even get him to look at the Ashton Manual on which the British National Formulary is based. The psychiatrists I have seen still believe that long term benzodiazepine use can be stopped over the course of several days in a hospital, ignoring evidence that people who do it that way suffer longer protracted withdrawal syndrome and are more likely to continue using benzodiazepines. Well, they don't really ignore the evidence, they don't want to hear about it unless it comes in a pamphlet alongside a buffet spread of fried chicken the drug reps bring in (yes, that's right I can *see* you all stuffing your faces on the Ruby Tuesday's spread, you don't even try to hide it that well).

So no, I'm not anti-psychiatry based on any propaganda--I'm anti-pscyhiatrist because I am an iatrogenic drug addict addicted to a drug more dangerous and more difficult to withdraw from than any other I can think of including all the street drugs I know of, and for which there is no help from the established medical community to withdraw from, and a drug which has caused me to not be able to remember much of my years since I started high school and which i have to take 4 times a day, and which causes me to have to record EVERYTHING, including video recording myself taking my medication because my recall is *that* bad and I truly don't know what I did in the day unless I look back on pictures and video. I have to rest much of the day, the smallest things exhaust me.

You might wonder why I ever saw a psychiatrist if I hate them so much. I was a kid with what I believe was a conversion disorder. I knew I was gay. And I was terrified someone would find out. I wouldn't even let myself think about it. Being gay where I was was worse than being the anti-christ. I was afraid I would raise my hand in school and accidentally blurt out I'm gay and that I would be killed by someone if they knew. You had to know the time and place to know that fear wasn't entirely irrational.

So the psychiatrist was the first person I told. During that 15 minutes he told me never to talk about it until I was in college. That people could get killed for saying stuff like that. Great advice doc!

I'm not looking for help--just pointing out that you don't need a propaganda machine to fuel fears of psychiatry, you all are doing the work of the anti-psychiatry groups all on your own. Again, I am not looking for help. The help comes from other accidental benzo addicts, and people like Professor Heather Ashton. They are the only ones helping. They help each other undo what psychiatry did to them.

So yes, if I am a patient of yours, I will reflect the values of the anti-psychiatry movement, which has nothing to do with the ridiculous and bizarre teachings of scientology, who believe that the evil that lies in psychiatry has existed for billions of years. Their efforts marginalize those who truly want reforms, such as those that exist in Great Britain now, which has done the most work of any country on behalf of those patients prescribed benzodiazepines inappropriately.

 

[Doctor Bagel]

In my neck of the woods pretty much never, which I guess is an upside for being in the middle of the country. There's a general cultural suspicion of psychiatry here, but that's because we're in good ole boy, religious territory. However, no, I've never heard anyone say anything specifically bad about SSRIs or psych meds in general aside from the notion that people who take psych meds should just go to church instead.

 

[Fermata]

In my neck of the woods pretty much never, which I guess is an upside for being in the middle of the country. There's a general cultural suspicion of psychiatry here, but that's because we're in good ole boy, religious territory. However, no, I've never heard anyone say anything specifically bad about SSRIs or psych meds in general aside from the notion that people who take psych meds should just go to church instead.

I'm from the southeast and in both the psych and family medicine settings I've had more patients than I can count bring up the question on their own of increased levels of suicidality with SSRI's.

I also find it interesting, at least in these parts, that various churches with prayer requests will list post-MI, cancer treatment, etc. on their church pamphlets but rarely do you see any of the psych variety.

It dovetails with the "too blessed to be depressed" mantra that I frequently encounter. I'm curious to how prevalent that is in the midwest.

 

[Regnvejr]

I'm from the southeast and in both the psych and family medicine settings I've had more patients than I can count bring up the question on their own of increased levels of suicidality with SSRI's.

I always bring it up. Otherwise, you'll look like you're hiding something.

I also find it interesting, at least in these parts, that various churches with prayer requests will list post-MI, cancer treatment, etc. on their church pamphlets but rarely do you see any of the psych variety.

Still the old ideas of mental illness as a sign of personal failing.

It dovetails with the "too blessed to be depressed" mantra that I frequently encounter. I'm curious to how prevalent that is in the midwest.

In the dry West, there is the cowboy disease: -- If it's not broken or bleeding a lot, you're not sick.