Teachers CANNOT prescribe Ritalin, or any other drug. I was on Ritalin until a few years ago. It has nothing to do with “over-medicating”.
And again, I am NOT saying that medication is for everyone. Just that for some of us, it works-and I resent the HELL out of people who claim I’m just popping pills so I don’t have to deal with life.
:rolleyes:
Let’s see, I spent this morning seeing 12 patients in a psychiatric clinic.
I referred 4 people for CBT, and offered it to several more who didn’t feel well enough for it.
I decreased meds and increased meds, I changed meds because they weren’t working, but I also stopped meds and discharged people because they’re now well.
I suggested everyone get help from the voluntary sector (Relate, Women’s Aid, Samaritans, Women’s Forum, Men’s Advisory Services, Rape Crisis Centre etc).
I got one person a social worker, another an occupational therapist and a third a community psychiatric nurse. I offered addiction sevices to someone else.
I had one person thank me for the opportunity to talk, and another thank me for starting the meds which have helped him cope with some fairly horrendous family issues.
I gave someone the first opportunity they’ve had to talk about a serious suicide attempt without judgement.
I didn’t admit anyone to hospital or treat anyone against their will.
Some people want medications, some people don’t, just as some people are willing to attend CBT or psychotherapy and some aren’t. Generally, they get to choose whether or not they’ll take meds, and what they’re willing to take. I very, very rarely impose treatment on in-patients, and can’t impose it on outpatients against their wishes.
AHunter3-You make a lot of very good points.
Competency requires that a person is able to weigh up information in order to give a decision, and to do this they must believe the information provided is true.
If someone is frankly psychotic or manic, their mental illness, and lack of insight into it, may render them unable to weigh up any information in order to make decisions.
If someone is psychotic and believes that I am an agent of Satan and that everything I say is a lie, they cannot believe any information I give them is true, so cannot be competent to make complex healthcare decisions based on any information I have provided them.
If someone has barricaded themself in a building with a firearm after making several phonecalls to their psychiatric team requesting help before they kill themselves and they then refuse to come into hospital voluntarily because they want to complete a suicide, I don’t have a lot of options left other than detention against their will in order to prevent them from killing themself.
If someone is manic and has spent thousands of pounds in a day, is found partially clothed on the roof of a high building stating that they can fly, hasn’t slept or eaten in days and exhibits sexually disinhibited behaviour, while being adamant that they’re feeling fantastic and there is nothing wrong with them, I don’t have a lot of options other than to detain them in hospital for their own safety.
Their bodies, their lives, their choices…up to a very clearly defined point.
Ya know, when I was first put into the nut house, I was very opposed to meds. And to shock therapy (ECT), for that matter. Heck, I was opposed to the nut house, period.
I didn’t like the meds, the first one they put me on caused a huge reaction that made every muscle in my body tense up to the point where I thought my spine would snap, and the others left me drugged and groggy.
Now, this was some time ago, so the main drug of choice was thorazine … not the greatest drug. But after while, I realized that being in a big barracks with a host of other very, very damaged and demented individuals would be a whole lot worse without thorazine …
And I actually saw electric shock do some good … it’s not a pretty picture, and not the first treatment to try, but they were actually able to use ECT to reach some people that were way, way out in space, and bring them back at least to near earth orbit …
For me, ianzin, I find your stance puzzling. First, I don’t understand your thoughts about the “real” person. Is the “real” person the guy who was so profoundly disturbed that he hadn’t said a word for months, just sat and stared at the wall … or is the “real” person the same guy after ECT who could at least talk about what was going on in his head? Until you can give me a clear answer to that question, I can’t really speak to your point about the “real” person.
For me, the treatment guidelines are real, real simple - whatever works. I’ve seen mental problems up close and personal, and it’s ugly. If they can be fixed with ECT, or with witch doctors chanting, or with Paxil, with psychotherapy, or religion, or group hugs, or with some combination of all of the above, I don’t care. Whatever works.
Finally, ianzin, I agree with you that depending on drugs is not the ideal result, and that they are often overprescribed. However, for many people, drugs may be better than the other available options (which often include things like suicide, job loss, destroyed relationships, and divorce).
w.
Kurt Vonnegut, Breakfast of Champions
Bathroom wall, circa 1971
Unless I’ve substantially misunderstood, SSRIs do not stimulate the brain at all, they inhibit the re-uptake of the neurotransmitter Serotonin meaning that more of it is around longer, and it’s the presence of the Serotonin the helps modulate mood. SSRIs won’t help much if there is an actual lack of Serotonin produced (as opposed to a lower sensitivity to it), or if the mood issues are not related to Serotonin levels at all, so I wouldn’t be at all surprised if some of the people taking them are getting little or no benefit beyond a placebo effect.
I’d also note, from a purely personal perspective, that before going onto an SSRI 18 months ago – something I was quite resistant to beginning-- there were some days where I couldn’t have mustered a positive thought to save myself. 
Before agreeing to meds I had seen therapists of various flavours – and got the most / best experience from seeing a neuropsychologist – being a techy person I want to know how it works. 
Positive thought, physical activity, and the bio-chemical effects of these were an important part of what we discussed.
Although I started the SSRI for depression, the most obvious effect (to both me and others), has been a substantial lessening of anxiety.
I still have bad days. I still get bouts of depression. SSRIs will not stop you being sad. But… the lessening of anxiety (for me at least) makes it possible to break a depression cycle – such as get up and do something active to pro-actively alter my chemistry – rather than obsessing on the not-positive thoughts that really aren’t helping. I can do something positive to change my mood rather than being caught in a black spiral that I couldn’t manage to break.
The teachers will suggest a kid for seeing a doctor about getting Ritalin. They are not qualified to make the diagnosis yet they have an air of awareness that makes people follow along. My son was on Ritalin when he was young. It was because a friend of my wife suggested it. She was a nurse and she suggested a doctor. I was repulsed by the doctor. My wife thought she was great. He spent about 5 years on it until he said no more.
I don’t know if someone has already addressed this, but in case you didn’t realize it, drugs for which the exact mechanism of action is still unknown are used in every field of medicine. To go with historical examples, sulpha drugs and penicillin were used to cure bacterial diseases long before it was known how exactly they killed bacteria. If we waited to determine mechanisms before we started treating, thousands of people would have died. Exendin, Metformin, and TZDs are three different diabetes drugs for which action was unknown (and is still being determined) but have proved to be useful in controlling blood sugar. You can’t disregard empirical evidence just because it’s empirical.
That’s funny - I thought you were arguing on behalf of faith.
I fought this battle for most of my adult life (once I was aware of the existence of anti-depressants and other psychopharmaceuticals) with my mother and other relatives. My mother was never officially diagnosed as bipolar but I have no doubt that she was; she had every symptom associated with it on both ends (the mania/exuberance and, worse, the depressive). My sister (who has similar tendencies but not as pronounced) has wondered aloud before “How did she live for as long as she did without an occasional field trip to the noodle factory?” (My brother and my 85 year old aunt actually gave her the answer I wouldn’t voice and I was surprised it was that obvious: “because she had Jon to run interference for her when she was cuckoo for Coacoa puffs”.)
Anyway, I lobbied her for years to take anti-depressants or stabilizers. I started them myself to combat unipolar depression (I have mild bipolar disorder myself, but depression was what I sought treatment for more than my manias) and I could tell from personal experience that (after, admittedly, some initial changes and some side effects that dissipated in time)- they work. It doesn’t make you into a Disney themedark dancer singing duets with animated redbirds, but it definitely takes the edge off the lows and the highs; if a manic episode is akin to riding bareback on a wild rampaging boar the medication changes it to riding a saddled domesticated hog (still not pleasant but no tusks and not quite as furious or easily spooked) while the lows go from wanting to burrow into the core of the Earth if you could find the ambition and energy and just lying there til volcanic fumes put you to sleep forever and flames consume you, to just wanting to go sit in the closet once in a while.)
Anyway, I begged her to take medication. I told her she didn’t have to go to a psychiatrist, her medical doctor could supply it (which she well knew, since ironically she worked for the last 15 years of her career at a large mental health center), but nope. “Those things CHANGE YOU!” (True- that’s the whole fucking piont.) “They have SIDE EFFECTS!” (True- but nothing like the side effects of getting mad and shooting firearms in the living room or tossing an ignited barbecue grill through a porch screen [which can burn your hands] or the side effects on your children when you lock yourself in a bathroom with a pistol and tell them to call the paramedics then go outside until they arrive or the insomnia that comes of having to wrestle a .38 away from your mother’s hand so she won’t kill herself.)
And she actually said “This is who I am.” I quoted her own father to her, who when told that of a neighbor he was mad at (“Oh Mustang, that’s just how Preacher is”) responded “Then fuck who Preacher is! That’s not an excuse!”
Anyway, my mother was an intelligent, warm, loving, wonderful, funny, charming, talented, giving, incredible human being, who happened to share brainspace with an out of control rampaging demonic bitch. Medication may not have exorcised the roommate but it would at least have made it stay in the back of the house most of the time so that her children wouldn’t have the fish hook feelings* they have when thinking of her.
Anyway, she’s the most extreme case in my life, but I have other relatives and I’ve had friends who wouldn’t hear of changing themselves. They seem to regard psychotropics as somewhere between pot and a hallucinogen that’s going to leave them a zombie (possibly because when you work in mental health so many who take the meds are zombies, but that’s usually because their particular illness is so extreme that it’s necessary or because they have brain damage that caused their illness which also zombies them or other reasons; the difference in a person who suffers from depression and a person who’s been in mental health centers for 10 years is the difference in a guy with a football knee injury from 20 years ago and a guy in a wheelchair.) These drugs are not panaceas and the same one doesn’t always work the same for two people, but as somebody who’s experienced life on them and off of them (off of them both before and since my diagnosis) I’ll tell you flatly that I’m never going to go off of them again, because to paraphrase what Pearl Bailey said about rich and poor “I’ve been medicated and I’ve been unmedicated and I like medicated”.
I was reading part of the new (final?) Kurt Vonnegut book, which contains a long preface by his son. Per his son (the physician Mark of Eden Express fame) KV could not stand the thought of psychotropic medications because they might make him not-depressed and not-bitter and not-consumed-with-anger, and if he lost the depression/bitterness/anger he wouldn’t (in his opinion) be able to write anything worth reading, and that would make him more depressed than before. (It’s the “I hate Brussel sprouts and I’m glad because if I didn’t hate them then I’d like them and if I liked them I’d eat them and then I’d puke because I hate them” circular reasoning fallacy, but you can understand it a tad.) Vonnegut was a loving father in that he truly adored his children, but he was also (per his son and one of his daughters) petulant, thin-skinned, tyrannical, verbally abusive, worrisome, irrational, and argumentative- in other words he could be totally charming and wonderful or a first order total pain in the ass to be around- but thereagain, the effects of his maladies on his wives and family and other people and the occasional lapses into problem drinking and suicidal despair bothered him far less than the notion he might be happy but unremarkable and “not as nature made him”. It was very familiar. (IIRC- it’s been a long time since I read the book- in Eden Express, written almost 40 years ago, in Mark Vonnegut’s own psychotic episode he became convinced his father had killed himself, which his children had lived in terror of since childhood.)
*Last quote on that page: *My feelings for you, Hank, are like a big bowl of -
fish hooks. I can’t just pick up one up at a time. I pick one up and they all come, so I just had to leave 'em alone. *
Sampiro, I think you said it better than I ever could.
Please consider the possibility that her low self-esteem may be a result of her depression rather than the cause of it.
Fear Itself, thanks for the update on placebos. I just don’t know how they can be considered placebos if they have active ingredients, but it’s not something that I am current on.
I have trouble with this one only because when I am under the influence of full-blown depression, I don’t have control of positive thoughts. If I just have the blues or I feel sad, then I can put on the right music and do something about it. But the illness depression is a whole lot of other things in addition to feeling overwhelmingly sad. I can’t think straight or concentrate. My speech is slowed and I have trouble finishing sentences. I walk more slowly. I sleep all the time – even when I take provigil. I don’t have any energy. I will go without food rather than make myself something to eat.
I’ve said this before, but it is like being wrapped in cotton batting. Or maybe you’ve had those nightmares where you can barely move your limbs?
And I caught all sorts of hell for the medicine I was taking. The irony was that most of it was from my step-daughter who was also suffering from depression and threatening to harm herself. But she kept saying that I wasn’t depressed, she was. She couldn’t see the obvious because her own judgment was impaired by depression and probably could have benefitted from medication.