I wanted to title this thread “How do shrinks pick out which dangerous mind-altering drug to give someone?” but that might offend someone.
I was locked up and given Celexa for three days. A drug that makes people suicidal and takes weeks to work. Was it worth destroying 26 years of living clean and sober for that?
The tales I’ve read since then spin my head around. Near as I can figure, doctors keep prescribing different drugs until you get one that might maybe work. It seems like total guesswork, using a mentally ill person as a human guinea pig?
Well, that’s how it works for physical medications, as well… although generally the process isn’t as quick as in House.
The exact protocols will vary by location/organization. Some factors which affect which medication is chosen first and which are tried later include but are not limited to:
patient’s history,
cost,
the doctor’s previous experience with that drug; if a doctor has given a certain scrip to a lot of patients with no ill results, they’ll be less likely to be wary of secondary effects, interactions, etc.
information the doctor has from different sources, which can range from reading its pharmacopea entry to having been invited to a series of medical conferences where every single item handed out (and there were a lot of them) had a certain company’s logo —> the first example is perfectly fine, the second one should be examined with care, but hey doctors are human
I have some experience as a nurse involved previously in prescribing psycho-active medication in the UK. First, if someone is not on such medication (often family doctors prescribe with little solid knowledge before people reach secondary services) we try to avoid using any medication as we know that much of it is only marginally effective and some our definitely counter effective. I have more often had to deal with patients demanding medication than trying to convince them to take it! This is also why there is so much over prescription of anti-depressants in the community.
So let us look at why a professional might suggest, say, an anti-psychotic. A person is physically out of control by either being a threat to others or a threat to themselves; they relate this to ‘voices in their heads’. As practitioners we know that certain medications do dull these voices- sometimes very successfully. Should we prescribe it given its side effects of lethargy and weight gain- who should generally make that decision.
Same with depressive illnesses- we know that anti-depressants are not much use in day to day low mood, but can be very effective with severe depression. Ther is considerable demand from people with moderate depression for anti-depressants- I spent more time trying to advocate against anti-depressants and encourage other methods.
I would argue that many prescribers are open to unfair influence from Big Pharma. I have been around long enough to see four classes of anti-depressants, three classes of anti-psychotics and two classes of anti-anxiety medications introduced as silver bullets with minimal side effects, with such side effects only showing up after half a decade of usage.
The same does go for physical medications. They come into and out of fashion. Having been through the mill with fancy new medications for my own health problems I am now back on a cocktail that was available fifty years ago (3000 years ago in one case) and feel healthier for it!
There are many many things that modern medicine can treat very well. These tend to be things where every human is basically the same when it comes to what’s being treated.
Then there are things where humans vary so wildly and change so much over time and have semi-vague symptoms that trying what’s available until you find something that works is the only choice. I have been on several medicines for depression, and each did something, but none have yet to work 100%. My doctor gave me something that not only helped with depression but also pain because of the nerve damage I suffer. This was not a wild shot in the dark, it was an educated guess based on what the dr knew about the medicines and what she knew about me.
Yes people are human, have biases and prejudices and other flaws. Is this really a surprise? There are going to be problems, mistakes, bad doctors, etc. Especially in a society that values money over everything else, including helping people that need it. Shit like “How do shrinks pick out which dangerous mind-altering drug to give someone?” and “using a mentally ill person as a human guinea pig” is needless hyperbole, and is itself bias and prejudice.
My sister in law is a doctor - the day she realized that all those friendly “medical visitors” are salesmen she was furious. She keeps the family in post-it notes, pens and notebooks, but now she takes anything those guys or their documents say with a big chunk of salt.
I also know several cases (I’m sure nowhere near as many as you’ve encountered) of people, including me, being given a prescription for an anxyolitic when it wasn’t warranted at all. “Gastrenteritis due to stress and over-tiredness” needs bedrest, not being groggy all day!
I said more of an art, not that science and logic were not involved. Getting the treatment right often requires non-scientific input- simple empathy and understanding, getting the mood music right and so on.
Celexa isn’t a drug of abuse, so I would at least suggest that thinking of it as having ‘destroyed 26 yrs of being clean and sober’ isn’t necessary (unless you are blaming it for triggering some sort of relapse?).
In general there are decision-trees for psych meds just like other medical issues, and the further you go the greater the room for disagreement (eg, most psychiatrists might agree the pt needs an anti-psychotic, but disagree as to which specific brand of antipsychotic they’d prescribe). Most PCPs would agree you need an antibiotic (rather than an aspirin) for your pneumonia, but disagree as to which…
We certainly always hear stories like that. I’ve heard a few myself, directly from first-person sources.
Seems like, when you’re down and blue and really looking for some help, the [del]best[/del] least bad thing to do is just suck it up and keep your mouth shut. Barely a notch above barbaric.
Celexa is like the weakest, puniest SSRI out there. Take Paxil then tell me how you feel (especially you males). WebMD lists about 198 side effects (suicidal thoughts is under “rare,” not “common.”). Most people will not experience 1% of these. It can happen but that doesn’t mean the doctors were twirling their moustaches because they knew it was going to happen, the realized it was a possible but rare risk. Many of these are minor. In my experience, the fewer side effects a drug has, the more severe they seem (hello, Stevens–Johnson syndrome).
Pharma influence might be an issue for some, but most psychiatrists I have dealt with would not deal with these people directly. The only time that I realized they were an influence is when one offered me free meds because I was poor (and this was a drug I was already taking, not something pushed on me). Many may be influenced by the popularity of the drug, as every pharmacy likely carries Prozac, but might not carry e.g. Lexapro.
I haven’t watched House that much, but doesn’t he usually have to try many different things first that he’s wrong about (or the hospital doesn’t trust his crazy but true Dx)? And he figures it out before 42 minutes.
Also, how does one get “locked up” if they are not either a potential harm to themselves or a potential harm to others? Suggesting the thoughts thought before the drug.
Celexa has worked wonders on my mother-in-law (93), calming her anxieties so she’s not yelling at the nursing staff anymore. She still bitches about everything, but does it in a calm, quiet voice.
My psychiatrist gave me my first drug (Celexa!) based on several criteria:
newer class of drug with fewer side effects
broad spectrum
low dependency rate
generic easily available and cheap
With a warning that psychiatric drugs are a crapshoot and that we might have to spend a lot of time going from general to specific (Atypicals, MAOIs, etc.).
It’s not so much the drug, it’s the patient. There are different classes of drugs out there and two people taking the same drug can have vastly different effects. I think of it like the doctor has a closet full of pants and you have to try them on one at a time until you find one that fits.