tag:blogger.com,1999:blog-26666124.post5907619732853268338..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: Cosmetic Psychopharmacology?Unknownnoreply@blogger.comBlogger70125tag:blogger.com,1999:blog-26666124.post-3499543802345913442013-04-15T15:01:03.203-04:002013-04-15T15:01:03.203-04:00The last one was from EastCoasterThe last one was from EastCoasterEastCoasternoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-64982589579328977422013-04-15T15:00:12.121-04:002013-04-15T15:00:12.121-04:00Dinah -- Thank you for commenting on the Seroquel ...Dinah -- Thank you for commenting on the Seroquel question. I sometimes wonder why more people don't prescribe Benadryl for sleep instead of Seroquel. The Seroquel has the metabolic risks, and it's incredibly expensive.<br /><br />I saw a sleep specialist for what turned out to be sleep hypopnea. The fellow I saw before the attending mentioned to me that there were actual data in support of valerian root.<br /><br />A lot of people don't bring up alternative treatments with their MDs, because they think they'll look nutty, but some have more validity than others. Could be worth discussing when Seroquel is the alternative. Easnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-61526776705491262932013-04-13T12:09:28.993-04:002013-04-13T12:09:28.993-04:00The same doctor that prescribed my son Suboxone, a...The same doctor that prescribed my son Suboxone, also prescribed him xanax. Although I'm sure my son gave the doctor a very convincing "anxiety" story, he had a history of opiate abuse...hence the suboxone! Of course, my son quickly developed a benzo addiction, and died Feb 6, 2013 of a lethal overdose of xanax and heroin.<br /><br />I guess when my son told the doctor "nothing else worked" or that he was feeling "hopeless and suicidal" or he couldn't articulate why it made him feel "calmer", the doctor decided if was OK.<br /><br />Thank you Dr Hassman for taking a stand.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-85837298801407569402013-04-09T15:09:06.793-04:002013-04-09T15:09:06.793-04:00Dr. Hassman,
Many people have found Xrem helpful ...Dr. Hassman,<br /><br />Many people have found Xrem helpful for insomnia. And apparently it provides deep sleep unlike the other insomnia meds.<br /><br />It is also used for narcolepsy<br /><br />So we're going to penalize people from getting treatment that might be beneficial because it has been misused ? That doesn't seem right.<br /><br />Sorry I wasn't clear with the xanax example. The person does not have a history of abuse.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-65793978297554459242013-04-09T13:30:57.296-04:002013-04-09T13:30:57.296-04:00My last comment for this thread:
don't unders...My last comment for this thread:<br /><br />don't understand why it is a shame to closely regulate a drug of serious ramifications like Xyrem--umm, you noted it was the date rape drug, and I'm not sure why people would gravitate to a med that just acts like an anesthetic and knocks you out for 8 hours without any recall; that said, if the prescription dosages minimize that response, well that is good, I guess.<br /><br />People in recovery will tell you the two worst benzos due to the euphoric effects often felt by abusers are, in order, valium and then xanax, so why risk trading one drug of abuse for another, and then further the consequences with long acting metabolite build up that valium can cause? Quite frankly, I am curious why so many colleagues just ignore or rationalize away the frank addiction behaviors that go on with benzo addicts in the office. I ask people to close their eyes and listen to the patient in front of them when they present with their benzo seeking behaviors and tell me they don't envision an alcoholic sitting there. Oh yeah, you're writing the script, that might color the interpretation a bit.<br /><br />You know what, as harsh and unsympathetic this next comment will be, anybody doing honest and consistent recovery work would agree with me: go through benzo withdrawal just once and then think if you want to go back on it again once free of the acute symptoms.<br /><br />That is why this class is such a terrible medication to give to naive, unsuspecting people with a risk for addiction: eventually, EVERYONE will have a moment of withdrawal, and that could be lethal for some. And really, tell me there is no ceiling dose for xanax or klonopin, colleagues, how completely disingenuous a comment/attitude is this!?!?Joel Hassman, MDhttp://cantmedicatelife.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-77045775105469810952013-04-09T12:54:42.785-04:002013-04-09T12:54:42.785-04:00Dr. Hassman, didn't know it took a special lic...Dr. Hassman, didn't know it took a special license to prescribe Xrem. What a shame.<br /><br />I am curious why you would be concerned about someone wanting to abuse valium who wanted to cross taper from Xanax so they could get off of it? Doesn't Xanax have just as much abuse potential if not more due to its short half life?<br /><br />Also, it seems if someone wanted to abuse valium, cross tapering from Xanax wouldn't be exactly an easy to way to do it.<br /><br />You're right though about not prescribing it in the first place. Unfortunately, many of your colleagues aren't heeding your advice and putting people on it in horrific situations regarding getting it off. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-40341821093854307442013-04-09T12:05:35.824-04:002013-04-09T12:05:35.824-04:00Xyrem I assume you mean, sodium oxybate? You need...Xyrem I assume you mean, sodium oxybate? You need to have a special license to write for it. Isn't that making a loud statement why NOT to consider it unless you work in a tertiary care facility?<br /><br />Gee, exchange valium for xanax, not my best recommendation, especially if the reason to taper is abuse/misuse in the first place. Librium is still out there, although not one of my favorites either. Here's an idea that I sense over 75% of prescribing practitioners read as chinese hyroglythics: maybe NOT write for xanax in the first place, consider as a last option for anxiolytic management, especially anyone with a prior substance abuse history irregardless if not alcohol as one substance, write for ativan or klonopin.<br /><br />I plan on writing a post at my blog tonight about the growing disruptions that benzo users create at least at my CMHC. I guess my colleagues left their consciences at home when they write for benzos like pez.<br /><br />Hey, here's a marketing idea, make a pez dispenser for XANAX! <br /><br />Call it the XAN-I-DO !!!Joel Hassman, MDhttp://cantmedicatelife.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-3332427938154314902013-04-09T11:02:57.126-04:002013-04-09T11:02:57.126-04:00Two hypothetical situations for all the medical fo...Two hypothetical situations for all the medical folks on this blog:<br /><br />1. Person with insomnia wants xrem due finding out that it provides deep sleep unlike the other sleep meds. Not concerned about cost.<br /><br />Would you prescribe it? Asking because many physicians wouldn't due to it being the date rape drug.<br /><br />2. Person is having a horrific time getting off of Xanax and would like to cross taper to valium because he/she feels due to its longer half life, it would easier to get off of? Do you prescribe the med? Many psychiatrists would not.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-19376620473123829782013-04-09T09:01:40.949-04:002013-04-09T09:01:40.949-04:00I am not writing checks, the rulers you vote for t...I am not writing checks, the rulers you vote for to stay in office and take your money give it to people who don't need are the ones to ask.<br /><br />Really, how many incumbents in office for more than 10 years have you voted for in the past 20 years? I know I haven't. Incumbency = incompetency.<br /><br />My point if it wasn't clear is that too many people are coming into mental health care to treat their socioeconomic crises. Some will never figure a way out, but some could with a little help. But not from polypharmacy.<br /><br />Yeah, well, truth doesn't pay the bills these days, does it!?Joel Hassman, MDhttp://cantmedicatelife.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-41894135245909589342013-04-09T06:00:19.896-04:002013-04-09T06:00:19.896-04:00All medicines have side effects and physicians sho...All medicines have side effects and physicians should be responsible enough to prescribe these meds to their patients. They must assess the condition of the patient and see to it that the person really needs to take a certain medication and only prescribe the right amount of it. There are a lot of factors that must be considered before giving a person any medications.Davidhttp://proceraavhreviewed.com/noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-14402030329901251082013-04-08T21:53:52.932-04:002013-04-08T21:53:52.932-04:00Love this!
Looking at Dinah's last two ques...Love this! <br /><br />Looking at Dinah's last two questions:<br /><br />1) Is it bad to take a medicine if it makes you more comfortable?<br /><br />2) Is it bad to take a medicine if it makes you more effective?<br /><br />No and no. Isn't that part of the point? Better living through chemistry...<br />Of course risk vs benefit and normal reactions to life vs "abnormal", but we treat symptoms, not diagnoses, right? They may not meet full criteria, but still warrant a medication. And what about that whole part about "significant impairment" in the diagnostic criteria? By whose standards? The provider's or the patient's? What I think is significantly impairing may not be what someone else thinks is. I know this is one area where the subjective nature of our profession comes in to play, but this is where I think stigma also gets fueled - If I think a kid or adult has symptoms of something that warrants a diagnosis and medication, like ADHD, then I'm gonna diagnose and treat. The whole point is to improve functioning, but like someone said earlier - if they only need it for tests, then they don't have it. THAT, I think, would truly be "cosmetic" psychopharmacology. That case is completely different than an anxiolytic/benzo used intermittently and for only certain situations. This is where our clinical judgment kicks in (or at least, its supposed to)- that's why we get paid to see them and make a clinical decision based on our assessment of their specific and individual case, not just a bunch of check boxes for meeting diagnostic criteria. Hell, that's why we have so many people being diagnosed with PTSD at the VA, getting benefits for life, despite their ability to hold down a job or go to college. That's some significant social and occupational functioning, right there ;) ...and a topic for another day.Amandanoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-70234682587759822862013-04-08T19:12:37.314-04:002013-04-08T19:12:37.314-04:00What a great conversation.
Joel, I'd like $25...What a great conversation.<br /><br />Joel, I'd like $25,000 while you're writing the checks.<br /><br />Do we think that psychotropics numb people? Do we think they make them complacent? I don't think that should be a goal of treatment. I believe that with all medication effects, this is person-specific. But many people, like Alison, become more vital and feisty and able to enact plans to achieve goals, when they are better.<br />Complacent should never be a goal.<br /><br />Is it bad to take a medicine if it makes you more comfortable?<br /><br />Is it bad to take a medicine if it makes you more effective?<br />Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-81363520597937858202013-04-08T14:06:46.675-04:002013-04-08T14:06:46.675-04:00by the way, what a hideous joke PAC coverage is fo...by the way, what a hideous joke PAC coverage is for people. Let them access a CMHC and then give them minimal somatic care coverage.<br /><br />It's like that commercial for state farm, when the girl without it asks for her money back gift and a guy appears with a dollar bill on a fishing line, and then he keeps pulling it away from the girl when she tries to take it.<br /><br />This is the sheer cruelty of health care that only PPACA will enhance. Let people have some hope to access the services needed for treatment needs, and then tell them the coverage is inadequate. Oh, and really encourage providers to maximize diagnostic visits and then implement the standards of care.<br /><br />Standards of care, wow, what a misnomer that word takes on now.<br /><br />History does repeat itself, we will be back to basic leeching and skull burr holes in the next 5 or so years, just advanced to what is offered in the previous century, not 300 years ago.<br /><br />We are back to writing for amitriptyline, thorazine, and carbamazepine like it was the 1980s again. You think this is so far from leeching and burr holes!?<br /><br />I kid you not, i have gotten authorization challenges on fluoxetine and alprazolam lately!Joel Hassman, MDhttp://cantmedicatelife.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-59167786112697334712013-04-08T13:46:48.280-04:002013-04-08T13:46:48.280-04:00Another morning of being asked to medicate poverty...Another morning of being asked to medicate poverty. Yes, chronically ill people end up with comorbid socioeconomic strife, but, I firmly believe that close to half of what comes into CMHCs these days is primarily due to the consequences of being in poverty first. And not just financial limitations, but the combination of limits in educational, general resources, and supports from others in the community.<br /><br />So, tell me colleagues, what is this cosmetic medication that will lift the burden of pandemic poverty, I really want to know?<br /><br />All this talk of stimulus monies, I would bet that if you selected for those patients who really showed some responsible insight and judgment and accepted accountability for their actions, (which would dramatically limit the population for this offering) I would bet of the people who got a $20,000 one time offer to help with essential needs like housing, food, and supports to regroup for employment prep, half if not more would not come back for mental health care to the degree chronic patients need the follow up.<br /><br />But, where did those monies go to from Bush and Obama? the very people who didn't need it!<br /><br />And the disingenuous leaders from local, state, and federal levels don't want to acknowledge this.<br /><br />You all keep on believing there are pills to treat your ills. After all, there are dozens of trials of meds to fail first, eh? New CPT codes to continue those q2week med checks, and come May, new DSM 5 codes and diagnoses to legitimize all those visits.<br /><br />And I read at sites in mental health care how people are such fierce advocates for patient care.<br /><br />Really!? With a meds first attitude? Letting patients go months without a therapy or case management follow up visit? Advocacy is about others, not yourself!Joel Hassman, MDhttp://cantmedicatelife.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-12313984478525432932013-04-08T13:23:53.004-04:002013-04-08T13:23:53.004-04:00From harrietmd
My point is that psychiatrists shou...From harrietmd<br />My point is that psychiatrists should not be telling people that their anxieties and depressions are due to their genes and that if their children are unhappy and frightened it is because they have inherited a genetic diiathesis predisposing them to depression.<br />Because it is not a valid scientific argument and for that simple reason alone, we should not be making it.<br />And if people feel suicidal psychiatrists should become involved in exploring and exposing the social system and it's profound stressors as a major reason for these anxieties and for the emoous despair people are experiencing rather than ignoring the entire interface between human beings and the culture they live in as a reason for stress, unhappiness and rage.<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-48897848469604808202013-04-08T11:02:04.527-04:002013-04-08T11:02:04.527-04:00HarrietMD,
Am I to understand that you think I w...HarrietMD, <br /><br />Am I to understand that you think I would be doing more to improve the state of the world if I were suicidal, or so irritable that I had alienated all my friends, or dead, or on welfare and unable to connect with my community, or living with an abusive lover and blaming myself? Because while it’s true that I got more worked up about Things Being Bad when I wasn’t on medication, I couldn’t look after myself or contribute much either and things were getting worse.<br /><br />Now that I have medication, I have full-time work and donate money to social causes. I support people in my immediate network in different ways. I participate in political demonstrations organized by other people. <br /><br />I would be a better person if I would only just be a better person, and I’m not. Still, I’m doing more than I used to and more than I would if I were dead (which is where I was heading). It’s not either/or. <br /><br />Yes, of course, if I had only just been Ghandi I wouldn’t have been suicidal. But just as I’m not Ghandi now, I wasn’t Ghandi then either. So I’m not sure what your point is.Alison Cumminshttps://www.blogger.com/profile/06370841996857073237noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-64090216278629252002013-04-08T10:58:30.228-04:002013-04-08T10:58:30.228-04:00I didn't respond to the Valium scenario until ...I didn't respond to the Valium scenario until now because i just thought it pointless, but, then I thought of a couple of things that make it a bad choice:<br /><br />Why valium and not ativan, which is sorter acting and does not have a euphoric effect, and, does the patient fly just 1 time every year or more, or will this deteriorate to a tablet for flightS a year and then proceed to meds for issues at work, at home, at play?<br /><br />Cosmetic psychopharmacology is a poor term when you step back and think about it, because our job is not to beautify life, but to help patients restore health and function. You might as well write for prn benzos and stimulants if you rationalize a "cosmetic" role for the profession!Joel Hassman, MDhttp://cantmedicatelife.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-49026703755021651612013-04-08T10:51:15.947-04:002013-04-08T10:51:15.947-04:00Mary K,
I have had much worse side effects from th...Mary K,<br />I have had much worse side effects from therapy than from medication. There needs to be a balance of risk and benefit. If someone is functioning well on their own, or if they are not functioning well on their own and feel that therapy is sapping their resources and making things worse, then clearly the balance of risks and benefits is not in favour of therapy. It’s just as irresponsible to suggest that everyone should be in therapy based on the fact that you like it, as to suggest that everyone should take Zoloft based on the fact that I like it. Alison Cumminshttps://www.blogger.com/profile/06370841996857073237noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-52835838342228581612013-04-08T10:25:45.010-04:002013-04-08T10:25:45.010-04:00Again, just to be real clear as my previous post w...Again, just to be real clear as my previous post was written in haste:<br />if most of the people who are seeking treatment for emotional distress of one type or another are actually responding to REAL FEARS rather than FEARS IN THEIR HEAD what should psychiatrists be doing? And are psychiatrists really--professionals that they are and therefore fundamentally embedded within the value system of this culture--any less frightened, and therefore pretending to have an explanatory model and treatment which, like voodoo, makes terrible worries disappear.HarrietMDnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-21100166018318561672013-04-08T10:05:28.969-04:002013-04-08T10:05:28.969-04:00There are many interesting comments to this post, ...There are many interesting comments to this post, but I don't think I saw a single one that involved any level of political analysis. In my opinion, as long as psychiatrists--and everybody else as a matter of fact--do not include in their evaluation and examination of the anxiety and depressive symptoms so prevalent in this culture the reasons for them, any discussion about what is happening is fairly meaningless.<br />The "problem with psychiatry" is that it equates emotional illness with biological illness, with genetic illness rather than with cultural social pressures and stress. In this way, individuals are encouraged to medicate their "symptoms" and to think of themselves as "ill."<br />I do not have any illusions about the suffering that mental illness involves but as psychiatrists (I am one) it used to be our responsibility, and our joy, to examine the complex causes of these phenomena rather than anesthetize people out of their symptoms.<br />We are living in a world very close to annihilating itself--sorry but that is a fact. We are poisoning our own wells, we are committed to resource wars that we pretend are benevolent; our government is lying to us, spying on us, and it is very possible that our children face a future of profound suffering.<br />Why shouldn't we all be depressed--I mean REALLY DEPRESSED. Does that mean that we should all be on antidepressants. Does it mean that we all have emotional illnesses. And does it mean that we should all be put on "medicines" that lessen the pain and the anxiety thus allowing us to do nothing about what we perceive and fear, and want to ignore.<br />If 30 million people in the united states were not on antidepressants because they are profoundly upset, maybe they would be organizing and out in the streets protesting policies that are designed to destroy our society, instead of pretending that they do not know what they do know: we as a culture are in profound trouble.<br />If depression is in any way about "learned helplessness", it is a lesson our society is learning very well. Are medications truly helping us, as a culture, to address reality? Well, it depends which ones.<br />But administering "medications" on masse to ourselves and our children will not solve the real problems that are terrifying us. In the larger sense, if we as psychiatrists have any real wisdom and courage, I believe that we should be helping people to find the courage in themselves to face the genuine causes of their fears.<br />HarrietMDnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-23699830346791058442013-04-08T09:08:20.446-04:002013-04-08T09:08:20.446-04:00Disclaimer: I think EVERYONE should be in talk the...Disclaimer: I think EVERYONE should be in talk therapy. It has virtually no side effects, no one gets enough validation on a regular basis, and none of us gets enough undivided attention from someone who WANTS to listen to us. <br /><br />That said, the patient with profound sadness, the bereaved woman, the Alzheimer's guy, and the man who can't articulate why he wants to take an SSRI again all need to schedule appointments to talk. There is clearly something else going on. <br /><br />The flyer? Yeah. One tab.<br />The college student? Absolutely not.<br /><br />Ambien? No way. Cognitive behavioral therapy for insomnia (CBT-I) is the frontline treatment for primary insomnia, and behavioral modifications must be made (as well as a complete physical to determine any possible underlying medical causes for insomnia). I know Ambien has a low abuse potential, but it frequently gets to the point where patients CAN'T sleep without Ambien---it becomes their medical blankie. In older patients, it can result in falling, which can then result in broken hips and other associated dangers. <br /><br />Seroquel guy? You've got to be kidding. That's like taking a cannon to kill a mouse. He needs CBT-I, too.Mary Knoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-45068305391166378762013-04-08T04:57:28.474-04:002013-04-08T04:57:28.474-04:00i loved the term cosmetic psychopharmacology !!! f...i loved the term cosmetic psychopharmacology !!! first of all it could actually help people in the short term and most importantly de-stigmatize the use of psychmeds! people are doing it anyway in a vulgar unsafe way... kids at big colleges are on ritalin just to go through the exams and so many other things.Anonymoushttps://www.blogger.com/profile/04642090900970853216noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-82231603198961690142013-04-08T00:30:17.609-04:002013-04-08T00:30:17.609-04:00P.S. I recommend reading through this:
http://the...P.S. I recommend reading through this:<br /><br />http://thelastpsychiatrist.com/2006/10/jama_deludes.html<br /><br />The writer is a psychiatrist himself, and his blog is one of the most popular on the 'net.<br /><br />It's a post that illustrates the subtle but very significant deception that real scientists engage in, that prestigious journals publish, that no one gets to comment on except in blog posts. It also happens to deal with antidepressants. I recommend reading it to the end. It's short.mctpshttp://mctps.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-7580295630103459212013-04-08T00:08:18.227-04:002013-04-08T00:08:18.227-04:00"No, they are not simply happy pills. That is..."No, they are not simply happy pills. That is why they don't make happy people even happier."<br /><br />They are supposed to improve mood. Yet everyone seems to accept they don't do that in healthy individuals. I find it hard to believe there is a completely separate mechanism for the improvement of mood in depressed individuals and a completely different one in healthy individuals. Especially given that the only difference between low mood in depressed individuals is that it lasts longer. Think about it. (I'm assuming people think that mood determines motivation, desire to live, and such things, because if they don't, then I don't see why they expect a drug that is supposed to affect mood to fix those things as well.)<br /><br />"http://www.sciencebasedmedicine.org/index.php/study-shows-antidepressants-useless-for-mild-to-moderate-depression-not-exactly/"<br /><br />The writer there says that older antidepressants shouldn't be used to draw conclusions about the efficacy of SSRI's, because the latter are thought to have fewer side effects. Am I hallucinating or is that right? If both types of meds are based on the serotonin hypothesis, then it's not a far fetched idea that if the other are ineffective, then so are the latter.<br /><br />Other than that, I don't care. It's not a study I've ever based any of my conclusions on. It rather looks like it was chosen because it was a relatively easy target. Even then, the debunking that website did wasn't all that hot.<br /><br />Are the other three links more relevant and written with more integrity?mctpshttp://mctps.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-55461883895921853362013-04-07T22:09:55.751-04:002013-04-07T22:09:55.751-04:00@Alison Cummins: there is an old saying that when ...@Alison Cummins: there is an old saying that when you are a hammer everything looks like a nail. One of the dangers of any field is that we see what we know and often think we should double up our efforts doing the same thing when we do not meet with success (this is even true in regard to those people to whom "what they know" is to always do something different). The question you are posing is both complex and intriguing. <br /><br />Dinah and I spoke about this today. I am going to try to write a post on this subject. Stay tuned. You got me thinking. Thank you.jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.com