NYT article: Antipsychotics

[DynamicDidactic]

Advertisement - Members don't see this ad

Nice article in the Times
http://www.nytimes.com/2012/09/25/h...n-in-the-use-of-antipsychotic-drugs.html?_r=2

 

[roubs]

A study last year found that 21.3 percent of visits to a psychiatrist for treatment of an anxiety disorder in 2007 resulted in a prescription for an antipsychotic, up from 10.6 percent in 1996.

I'll admit I was surprised to learn that 1 out of 5 people going in for an anxiety disorder end up with an antipsychotic. Maybe I shouldn't have been surprised.

 

[syzergy]

We just talked about psychoses in our psychopathology course. I had no idea Abilify was an antipsychotic. I see commercials for it all the time and I just thought it was a different type of antidepressant.

 

[Iwillheal]

Yeah, it's an atypical antipsychotic. I hate the commercials. And what a dumb name. What's next, calling a hemorrhoid cream, "Poopify"? At some point they were running ninety seconds long ads for it like three or four times an hour on...CW I believe...and so while watching a movie I ended up exposed to it over ten times. The commercials for these kinds of drugs are almost always the same: sickeningly sweet disembodied female voice talking over a minute long dumb cartoon or happy/peaceful people going about their daily activities. So you watch a smiling cartoon character walk carelessly about, petting a cartoon pet dog perhaps, as you hear the voice start listing the side effects..."extreme high blood sugar has been reported which can cause coma or death...."

 

[Pragma]

I'll admit I was surprised to learn that 1 out of 5 people going in for an anxiety disorder end up with an antipsychotic. Maybe I shouldn't have been surprised.

Probably seroquel, at least that is my initial thought. Lots of people get that instead of benzos if they have a substance use history too.

 

[cara susanna]

YES, one of my biggest pet peeves is abilify being marketed an anti-depressant.

 

[Doctor Eliza]

We don't want to throw out the baby with the bathwater though. I have had more than one client (and even a family member) have an amazing response to the addition of abilify (after attempting several SSRI's SNRI's and TCA's) for their unipolar, non-psychotic depression. Just because it is likely over-rx'd doesn't mean that the creation of such medications hasn't been extremely helpful if not life-saving for some.

Of course, good for some is not good for all. Careful thought needs to be given when rx'ing any med, in particular ones with serious side effects when something else might do the job. Further, serious medications like these need to be rx'd by psychiatrists and not GP's. A huge pet peeve of mine is that GP's often have a poor understanding of their own limitations here. Recently, I encouraged a parent to talk to their kid's pediatrician about the possibility of an ADHD med. She came back with an rx for Depakote!! The pediatrician told mom that it was a medication that had been around for a long time and was good for mood issues (the child indicated that she was sad because school was hard).

Best,
Dr. E

 

[Iwillheal]

We don't want to throw out the baby with the bathwater though. I have had more than one client (and even a family member) have an amazing response to the addition of abilify (after attempting several SSRI's SNRI's and TCA's) for their unipolar, non-psychotic depression. Just because it is likely over-rx'd doesn't mean that the creation of such medications hasn't been extremely helpful if not life-saving for some...

Yes, I also agree that it is helpful in a number of cases as an augmenting agent or in particular kinds of depression, like ones with significant agitation or psychotic features (obviously).

But my personal issue is people committing the fallacy that just because X improves symptom Y, then X is the way to go. That's only one side of the coin. The other side is what else also works. Changes in lifestyle? Psychotherapy? And let's not forget the side effects of antipsychotics either (I guess this is a coin with three sides).

I have a very limited experience but in the hospital I work couple of times a week, I see far too many people who want a quick and painless solution to complex problems that require effort, commitment, and lifestyle changes. I don't blame people for wanting that, but I do think practitioners who know better but go along with it are doing everybody a disservice. If you don't want to take the time to persuade people that the easiest way out of pain is often times not the best way forward, then you're in the wrong business. <b>
The commercials say "ask your doctor." What some psychiatrists are telling patients is not the whole truth.

 

[AnnoyedByFreud]

Yes, I also agree that it is helpful in a number of cases as an augmenting agent or in particular kinds of depression, like ones with significant agitation or psychotic features (obviously).

But my personal issue is people committing the fallacy that just because X improves symptom Y, then X is the way to go. That's only one side of the coin. The other side is what else also works. Changes in lifestyle? Psychotherapy? And let's not forget the side effects of antipsychotics either (I guess this is a coin with three sides).

I have a very limited experience but in the hospital I work couple of times a week, I see far too many people who want a quick and painless solution to complex problems that require effort, commitment, and lifestyle changes. I don't blame people for wanting that, but I do think practitioners who know better but go along with it are doing everybody a disservice. If you don't want to take the time to persuade people that the easiest way out of pain is often times not the best way forward, then you're in the wrong business. <b>
The commercials say "ask your doctor." What some psychiatrists are telling patients is not the whole truth.

I think it's important to realize that the majority of people who are prescribing psych meds are GPs and are not specialists (psychiatrists, etc.) and that can cause some real problems. I am currently at a community health clinic that has a huge behavioral health component to it, since they cater to homeless individuals. A lot of the clients have serious psychotic and mood problems and many of them are on antipsychotics. I was really shocked to hear that there are no psychiatric providers at this site - no psychiatrists, psych NPs, etc. It's all primary care providers who are doing the med management for very complex psych problems. Granted, it's a free clinic for the homeless, so it might be that they can't attract a psychiatric specialist, but I was still appalled to hear this.

 

[DynamicDidactic]

sometimes it seems that psychopharm is the modern version of lobotomy or ECT. Meaning, lets just throw all different types of meds at anyone with a problem b/c we have nothing better and it seems to do something. I think 50 years from now we will look back and be appalled at how we used certain meds.

the serotonin model of depression is losing steam as the empirical literature progresses. It makes logical sense that throwing an atypical antipsychotic on anyone will do something. Whether the effects are indeed due to the medication or are in response to a placebo process is another question.

I will add that I am in favor of psychiatric medication, just the ones that actually help without significant adverse side effects.

 

[roubs]

Probably seroquel, at least that is my initial thought. Lots of people get that instead of benzos if they have a substance use history too.

Also occurred to me that a subset could be people with PTSD, seems like medically they often adopt an "all of the above" strategy there.

 

[paramour]

We don't want to throw out the baby with the bathwater though. I have had more than one client (and even a family member) have an amazing response to the addition of abilify (after attempting several SSRI's SNRI's and TCA's) for their unipolar, non-psychotic depression. Just because it is likely over-rx'd doesn't mean that the creation of such medications hasn't been extremely helpful if not life-saving for some.

Of course, good for some is not good for all. Careful thought needs to be given when rx'ing any med, in particular ones with serious side effects when something else might do the job. Further, serious medications like these need to be rx'd by psychiatrists and not GP's. A huge pet peeve of mine is that GP's often have a poor understanding of their own limitations here. Recently, I encouraged a parent to talk to their kid's pediatrician about the possibility of an ADHD med. She came back with an rx for Depakote!! The pediatrician told mom that it was a medication that had been around for a long time and was good for mood issues (the child indicated that she was sad because school was hard).

Best,
Dr. E

I've recently seen lots of children/adolescents on Depakote!

With one, I got a bit of a chuckle at reading "Depakote sprinkles at morning" with breakfast (in addition to their dosages at lunch and dinner AND their other meds...).

I can see the new cereal commercials now: "It's new and improved--Fruit Loops with Depakote sprinkles!"

Yikes!

 

[Buzzwordsoldier]

But my personal issue is people committing the fallacy that just because X improves symptom Y, then X is the way to go. That's only one side of the coin. The other side is what else also works. Changes in lifestyle? Psychotherapy? And let's not forget the side effects of antipsychotics either (I guess this is a coin with three sides).

I have a very limited experience but in the hospital I work couple of times a week, I see far too many people who want a quick and painless solution to complex problems that require effort, commitment, and lifestyle changes. I don't blame people for wanting that, but I do think practitioners who know better but go along with it are doing everybody a disservice. If you don't want to take the time to persuade people that the easiest way out of pain is often times not the best way forward, then you're in the wrong business. <b>
The commercials say "ask your doctor." What some psychiatrists are telling patients is not the whole truth.

Hip hip. But I'd challenge you to consider whether practitioners who "go along with it" can honestly be said to "know better" -- not everyone who is called to this work comes ready willing and able to marry their practice to critical social analysis.