Thoughts on a quote from a Dr. Raison CNN article?

[surftheiop]

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For people who don't know, CNN has a "Ask the Experts" series in their health section. The mental health expert is psychiatrist Charles Raison from Emory.

Here is a quote from a recent response to a question, and I'm curious what you all think


"These are dark days for psychiatry. Recent studies have suggested that the medications upon which much of the field is built are not as effective as we once thought and have more side effects, some of them ominous.
And we've had almost no luck discovering agents that are either safer or more effective than what we've already got on tap.
We've discovered a lot about pathways in the brain and body that promote depression, but we've been so unsuccessful at bringing this basic knowledge to the clinic that many of the largest pharmaceutical companies have abandoned the pursuit of new psychotropic agents."


http://www.cnn.com/2011/HEALTH/expert.q.a/09/27/ketamine.depression.raison/index.html

 

[OldPsychDoc]

The media is SO poor at portraying complex issues in anything except the most simplistic, binary sound bites.

Is it true we don't know everything?
Is it true our medications don't "cure" the illness they treat?
Yes and yes.

But are these "dark days"?
Should we just fold the enterprise and walk away? Hell no.

Ask your patients.
You make a difference in their lives, dammit.

 

[zenman]

For people who don't know, CNN has a "Ask the Experts" series in their health section. The mental health expert is psychiatrist Charles Raison from Emory.

Here is a quote from a recent response to a question, and I'm curious what you all think


"These are dark days for psychiatry. Recent studies have suggested that the medications upon which much of the field is built are not as effective as we once thought and have more side effects, some of them ominous.
And we've had almost no luck discovering agents that are either safer or more effective than what we've already got on tap.
We've discovered a lot about pathways in the brain and body that promote depression, but we've been so unsuccessful at bringing this basic knowledge to the clinic that many of the largest pharmaceutical companies have abandoned the pursuit of new psychotropic agents."


http://www.cnn.com/2011/HEALTH/expert.q.a/09/27/ketamine.depression.raison/index.html

As long as the world is screwed up (and we have politicians) you're safe. Plus we hypothesize about which brain pathway is doing what. Then we hypothesize which med might work. So, what's the problem? Maybe we have to be artists working with science.

 

[surftheiop]

Also if anyone finds it interesting, the rest of the article is about how he thinks IV ketamine is going to be used more widely in the coming years.

 

[F0nzie]

Hey if Ketamine fixes your cognitive distortions by helping you dissociate into wonderland go for it. However, I know Tom Cruise wouldn't approve, so I have my reservations.

But in all seriousness, as physicians shouldn't we be relieving human pain and suffering? Can we empathize with someone who is chronically depressed and living a miserable existence?

 

[nitemagi]

Hey if Ketamine fixes your cognitive distortions by helping you dissociate into wonderland go for it. However, I know Tom Cruise wouldn't approve, so I have my reservations.

But in all seriousness, as physicians shouldn't we be relieving human pain and suffering? Can we empathize with someone who is chronically depressed and living a miserable existence?

No. No empathy allowed. 😉

 

[kugel]

No. No empathy allowed. 😉

I see what you mean, nitemagi. In fact, I often feel much the same way. When I start feeling like that.....
ARRRGGHH!

NO.....EMPATHY.......ALLOWED!
must.....remove.....emotion.....chip....

aaaaahhhh. There. That feels b...
actually, it doesn't feel at all.
Success!!

 

[whopper]

I do believe that some research avenues are reaching or are on the track to see foreseeble endpoints, but there's so many other good things going on. I heard a lecture from a prominent psychiatrist (nuts, forgot his name) where he mentioned that there's so many SSRIs on the market, and several are so cheap, that it's created a disincentive from pharm companies to want to develop more.

Despite the above, I believe there's a lot to be optimistic about. I don't know if the good doctor's comments were taken out of context. Perhaps he was speaking more from a research perspective. For example, the introduction of $4/month SSRIs has been a boon for many, even with insurance. I see Risperdal possibly further decreasing in price, and the ability to choose from several atypicals certainly has improved the quality of life of several patients I've seen.

I'd say it was darker days when all you had to choose from was Risperdal or Zyprexa for an antipsychotic. I've had several patients where both caused serious harm to the quality of life but they did fine on Geodon or Abilify.

More research is being done into hopefully detecting schizophrenia in the prodrome stage. This will hopefully lead to treatment at that point and possilby even complete prevention of schizophrenia in some patients.

I think I'll stop myself now because it's obvious that there's a lot of reason to see reason for more advancement. As for the studies pointing to psychotropics not being as effective and having more side effects than we previously thought? Good. Wouldn't it be a good thing to find out the truth? I'd say that's more along the area of enlightment than darkness.

 

[digitlnoize]

Whenever people say psych meds don't work, I just want to show them a video of a schizophrenic patient on meds and off meds. Did these "doctors" not rotate on an inpatient psych unit?

 

[billypilgrim37]

Most "psych patients" most doctors see are not "psych patients." They're "troublesome primary care patients." We don't have a pill for being annoying and clingy and demanding.

Well, Xanax and Seroquel, but we are all part of a global conspiracy to deprive patients from these life saving treatments.

 

[UrshumMurshum]

I'm not a professional, but I do believe that in the future some type of stem cell therapy will be used for psychiatric medicine. Stem cells are proving viable in regrowing neurons in a variety of neurological disorders such as parkinsons disease and stroke. With the ability to regenerate neurons, it might one day be possible to give the neurons that got killed off in the neurodevelopment of the infant and child that is hypothesized to produce a variety of mental illnesses.

But of course, it will have to be done in China 😉

 

[sunlioness]

Actually, after the week I'm having I think the best way we're going to fix people is to end poverty and make sure everyone has a job. I've seen so many patients this week with depressive and anxiety symptoms secondary to fruitless job searches and dwindling bank accounts. Of course then we'd still have the truly mentally ill and the malingerers, so I'm not worried about job security.

 

[F0nzie]

Actually, after the week I'm having I think the best way we're going to fix people is to end poverty and make sure everyone has a job. I've seen so many patients this week with depressive and anxiety symptoms secondary to fruitless job searches and dwindling bank accounts. Of course then we'd still have the truly mentally ill and the malingerers, so I'm not worried about job security.

Maybe going back to an older model where psych wards were attached to farm colonies so that patients can engage in occupational therapy- give them wages, a sense of self-efficacy, and the opportunity to feel like productive members of society. Instead of our current model where we have them eating macaroni and cheese and watching TV all day. We really foster a sick society. Underlying it all, I believe, is a strong sense of entitlement- that some how basic crops, food, water, electricity, and televisions have somehow been made available by rubbing two sticks together.

 

[Ibid]

Maybe going back to an older model where psych wards were attached to farm colonies so that patients can engage in occupational therapy- give them wages, a sense of self-efficacy, and the opportunity to feel like productive members of society.

The trouble is that those places were horrible. They were violent malevolent places that were a living hell. They attracted nasty evil staff who abused people in every way you can think of. And part of society is the last thing people were. They were totally apart forgotten about with no way out. Basically they were slave camps. Be honest you wouldn't want that sort of life for yourself or any member of your family.

It's easy to be romantic about a system if you have not seen it first hand but the record if you look for it is clear. They were irredeamably nasty places.

Sure a culture was lost when they shut. But a culture was lost when slave plantations became a thing of the past. We don't mourn the loss of that culture.

The biggest misunderstanding about these places is that they were asylum from the community. They were not. With the best genuine intentions of the time they were asylum from the poor house/work house (or US equivalent) because the workhouse was clearly not the right place for them. Especially children. Work houses have been replaced by the welfare state so people no longer need asylum in that sense.

Instead of our current model where we have them eating macaroni and cheese and watching TV all day.

The biggest problem here is lack of expectations for people, although of course that is not the whole story. People live down to what is expected of them.

We really foster a sick society. Underlying it all, I believe, is a strong sense of entitlement- that some how basic crops, food, water, electricity, and televisions have somehow been made available by rubbing two sticks together.

Very true but it cuts both ways. If everyone didn't feel so entitled to avoid paying tax by various means, legitimate and foul, then most western countries wouldn't have to pay for our lifestyles by raising cash in the market place. How about doing away with that sense of entitlement to not pay tax if at all possible?

Most welfare claims by a huge margin are legitimate and when they are not we huff and puff about people cheating the system. All the while tax "cheats" well they get called clever. The military, police, fire department and so on don't pay for themselves.

Like I say it cuts both ways.

 

[F0nzie]

This type of black and white thinking is exactly why our system is messed up.

 

[Ibid]

This type of black and white thinking is exactly why our system is messed up.

So you would be happy to see your own mother living out her life in one of these farming communites? Come on be serious....nothing black and white about my post. Maybe you are just a big fan of tax avoidance. Plenty of people are, prone to it myself to be honest but it is no different to claiming benefit that under the rules one is entitled to. Not so much black and white as pot calls kettle black imo.

 

[Ibid]

Actually, after the week I'm having I think the best way we're going to fix people is to end poverty and make sure everyone has a job. I've seen so many patients this week with depressive and anxiety symptoms secondary to fruitless job searches and dwindling bank accounts. Of course then we'd still have the truly mentally ill and the malingerers, so I'm not worried about job security.

If only there was an easy way to make people believe that they were capable of work (even if you have to redefine work) and that they would be better off in everyway by taking part.

imo there is a "job" for everyone. I met a receptionist the other day who had quadriplegia and had great difficulty speaking as well. The work space was not even that well adapted to be honest. I felt about as small as I have ever felt.

 

[sunlioness]

The people I was referring to are not people who need or believe they need disability. They are people who are currently unemployed, have been job-searching for months and not finding anything. People who need or think they need disability are another issue, but I'm seeing people who never would have seen a psychiatrist if the economy weren't so bad right now. (Most of these are on the charity care program that my employer runs.)

 

[LizzytheShrink]

No. No empathy allowed. 😉

EMPATHY is crucial. SYMPATHY violates boundaries and ruins the doctor-patient dynamic.

This person quoted in the original post sounds fringe-y to me. I don't get it... many medical fields are the same. I agree with one of the posters that said that psychiatry is more art than science.

Bottom line is, our patients get better. When I did ECT, it was so rewarding to see thier progress. But yeah, who knows why it works? In my world, where I read the results of research, and don't actually do the research, efficacy is king. Sure, patients rarely get cured, but diabetics don't... cardiac patients don't...

Dark days, bah.

IV ketamine, huh? Not something I'd sign up for anytime soon. 😱

 

[surftheiop]

Maybe going back to an older model where psych wards were attached to farm colonies so that patients can engage in occupational therapy- give them wages, a sense of self-efficacy, and the opportunity to feel like productive members of society. Instead of our current model where we have them eating macaroni and cheese and watching TV all day. We really foster a sick society. Underlying it all, I believe, is a strong sense of entitlement- that some how basic crops, food, water, electricity, and televisions have somehow been made available by rubbing two sticks together.

At the same time you got tons of MDs thinking they are entitled to drive brand new BMWs and have 2 vacation houses because they were born into a successful family that paved their way to a prestigious career. Then they look at their patients and think "this person could be me if they weren't lazy"

I came from a middle class family where money was never a real concern (from 50k to 90k combined income) and everything I needed to be successful was just handed to me. I can tell you for sure I haven't worked harder in life or medschool than folks born into rough neighbors have to work just to survive. Not sure I can feel too entitled to luxury cars when really the only thing I did was get lucky in the parent lottery.

 

[notdeadyet]

I came from a middle class family where money was never a real concern (from 50k to 90k combined income) and everything I needed to be successful was just handed to me. I can tell you for sure I haven't worked harder in life or medschool than folks born into rough neighbors have to work just to survive.

Just so the thread doesn't veer dangerously into stereotyping, the data's pretty clear that those with jobs in higher income brackets tend to work more hours than those with jobs in lower income brackets. That's largely because you get more incentive to work more hours in higher paying jobs.

There are folks who work two jobs in the projects to give their kids get a better break than they did and there are also those sit on the stoops and figure out welfare fraud schemes. There are folks who slave away 90 hours a week as attorney's so that they can retire early or give their kids opportunities they didn't have and there are those who count the interest on their inheritance and lead a life of hedonistic decadence. No income bracket has the copyright on nobility. Assuming that someone works their fingers to the bone because they're poor is as stereotypical as assuming he's lazy.

 

[surftheiop]

Just so the thread doesn't veer dangerously into stereotyping, the data's pretty clear that those with jobs in higher income brackets tend to work more hours than those with jobs in lower income brackets. That's largely because you get more incentive to work more hours in higher paying jobs.

There are folks who work two jobs in the projects to give their kids get a better break than they did and there are also those sit on the stoops and figure out welfare fraud schemes. There are folks who slave away 90 hours a week as attorney's so that they can retire early or give their kids opportunities they didn't have and there are those who count the interest on their inheritance and lead a life of hedonistic decadence. No income bracket has the copyright on nobility. Assuming that someone works their fingers to the bone because they're poor is as stereotypical as assuming he's lazy.

I agree, I wasn't trying to claim that poor people work harder at their jobs than people of means.

But I think its also narrow sighted just to look at hours at the workplace. Poor people have to do a lot of extra work outside the job that can take a toll. I can't imagine having to waste 2-3+ hours a day riding different buses to get to work, when I can hop in my car and drive somewhere in 20 minutes. Or if someone in my family got sick, a parent could take the day off no problem and not have to worry about not being able to pay the rent due to lost wages, etc.

That being said, this doesn't have anything to do with the thread or this forum so I won't derail my initial post any further.