Medication and intern content?

[serimeri]

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Hi all,

Getting ready to start intern year...was wondering what do you guys recommend as a resource for tapering SSRI's, dosages, etc.?

I know the pharmacology but I suck with dosing!

Thanks

 

[heyjack70]

Stahl's medication book, the prescribers guide is good. Supplement with epocrates and uptodate's online drug reference.

 

[wolfvgang22]

Sheldon Preskorns quick reference for depression is good

 

[serimeri]

thanks all. Hopefully program will give me Stahl book! 🙂

I'm also hoping I'll get some teaching on this tapering stuff. I've seen so many disasters in my PCP office for FM rotations as an MS3.

For instance, one doctor would just hand out fluoxetine for someone who just had minor mood symptoms. Didn't even check to see that they were already on Adderall XR, and it could be anxiety. I hate this societies view on just curing everything with a pill, unless we get ready to tackle our issues, we'll just be creating a polypharmaceutical mess!

 

[Psychobabbling]

Maudsley (spelling?) has a really nice pharm book. Used in the UK more I think. Really good book, better than stahl in some regards imo

 

[serimeri]

Maudsley (spelling?) has a really nice pharm book. Used in the UK more I think. Really good book, better than stahl in some regards imo

Can i get it as a pocketbook?

I honestly struggle with formulating my assessment and plan sometimes. I feel like I should have gotten my plan mastered as a med student, but I still struggle sometimes.

The dosing also gets me. I don't know what doses to administer. Epocrates is so-so for that but in my experience, physicians use their own intuition rather than what epocrates says

 

[psych md jd]

Tried and true advice: start low, go slow.

 

[smalltownpsych]

thanks all. Hopefully program will give me Stahl book! 🙂

I'm also hoping I'll get some teaching on this tapering stuff. I've seen so many disasters in my PCP office for FM rotations as an MS3.

For instance, one doctor would just hand out fluoxetine for someone who just had minor mood symptoms. Didn't even check to see that they were already on Adderall XR, and it could be anxiety. I hate this societies view on just curing everything with a pill, unless we get ready to tackle our issues, we'll just be creating a polypharmaceutical mess!

I think it can be helpful to remember that medications can reduce symptoms, at times, and this can help our patients, but they will not change unhealthy behavior and relationship patterns or even just plain bad decision making. "I didn't like my boss so I quit my job." As you have already seen, chasing symptoms with medications can lead to quite a merry-go-round especially when we start to add in medications to treat side effects of other medications that may or may not be working. Add in the placebo effect and you can see that you have your work cut out for you!

 

[Doctor Bagel]

So an unfortunate thing to know is that there aren't really clear, evidence-based, super specific guidelines on tapering for lots of our medications. You can look up things, but you'll find lots of people deviate from what you look up with good reason (at least based on clinical experience). There are lots of reasonable ways to taper, titrate and do cross-tapers and few specific clear published guidelines beyond "taper slowly" or whatever.

 

[nitemagi]

I think it can be helpful to remember that medications can reduce symptoms, at times, and this can help our patients, but they will not change unhealthy behavior and relationship patterns or even just plain bad decision making. "I didn't like my boss so I quit my job." As you have already seen, chasing symptoms with medications can lead to quite a merry-go-round especially when we start to add in medications to treat side effects of other medications that may or may not be working. Add in the placebo effect and you can see that you have your work cut out for you!

I agree with this, mostly. Sometimes symptoms can elicit a response pattern from family members/others that maintain the problem. Interrupting the reinforcement cycle with medications can at times reorganize the system. In strategic therapy they refer to it as a "second order change."

 

[smalltownpsych]

I agree with this, mostly. Sometimes symptoms can elicit a response pattern from family members/others that maintain the problem. Interrupting the reinforcement cycle with medications can at times reorganize the system. In strategic therapy they refer to it as a "second order change."

True that, and I was thinking about that as I was posting but not sure how to communicate concisely so left it for you to add.
Here is a good example: family system organized around mom being helplessly depressed, she takes medication that is effective and begins acting more confidently, the rest of system changes in how they interact with her. Sometimes in a beneficial way and sometimes counter.

 

[Shikima]

Here's a tip; Educate that there is no magic pill and the medications won't tie into the instant gratification that people are seeking.