Posted by viridis on October 22, 2002, at 23:26:06
In reply to Re: Does Wellbutrin have any antianxiety propertie » viridis, posted by Squiggles on October 22, 2002, at 11:28:47
Hi Squiggles,
I agree that doctors deal with life-threatening conditions of all sorts, and so many may put conditions like anxiety and depression low on the priority list (even though for some, these conditions can be life-threatening too). And I realize that, by definition, a GP can't be an expert in everything.
Several things particularly bothered me in this case. I went in reasonably well-educated, with an understanding of Wellbutrin's mechanism of action and the knowledge that it might exacerbate anxiety. He dismissed this from the beginning, and prescribed a large dose (450 mg/day to start), which I questioned given my history of severe anxiety problems. His response was that either it works or does nothing, so just take it and see what happens. When I asked the pharmacist if this was a normal dose, she said it was definitely at the high end, and typically a dose someone would titrate up to gradually. She called the doctor, who said he'd intended to write 150 mg to start (although we had discussed this just a couple of hours before). So, I tried 150 mg and can't imagine what would have happened at 450.
When I reported my response, he said it had to be my imagination, and that what I really needed was therapy. So, there are several problems here. I wasn't pushy or arrogant at any point, yet the doctor completely brushed off my questions, even though I explained the basis for my concerns from the start. And, the idea that all of my problems could be addressed by therapy shows a fundamental lack of understanding of mental health problems (I've had plenty of therapy, by the way, and the last two therapists I saw wound up telling me that I was quite sane and obviously had a biological problem that would require medication). I also wasn't impressed by the assertion that he'd "intended" to prescribe a lower dose, when we'd just finished discussing whether 450 mg was too high.
Anyway, things have turned out alright with the help of an excellent psychiatrist who I found on my own (I asked the GP for a referral to a psychiatrist, but he said he didn't know of any -- I'm in a large metropolitan area and the one I'm seeing is a few minutes' drive from the GP's office).
I think I'm fairly well informed, so I shudder to think what many people, especially those totally crippled by mental illness, must experience. I hope that with the growing awareness that mental conditions are medical conditions, family doctors will begin to become more informed. And you're right -- maybe we will see more education of doctors in the area of psychopharmacology. There's certainly a market for people with those skills, and my impression is that the stigma associated with treatment of these conditions is diminishing.
I'm not sure doing it through the drug companies is the best strategy, though. Although I don't buy into the "evil pharmaceutical empire" viewpoint, it would be pretty hard to avoid a totally unbiased education from people who are being paid to market their company's latest and greatest AD, etc.
All the best,
Viridis
poster:viridis
thread:124426
URL: http://www.dr-bob.org/babble/20021019/msgs/124800.html