Posted by yxibow on December 6, 2006, at 18:34:21
In reply to Re: Are benzos the only drugs that do anything? » yxibow, posted by Quintal on December 6, 2006, at 9:34:11
> > Which I have said before -- but not because of the side effects so much -- protease inhibitors are a real sticky wicket to manage with concomitant depression. They would like to keep their DEA license which allows them to prescribe, pay their malpractice insurance in case someone overdoses on buprenorphine, and generally stay out of the limelight of license auditing of doctors who freely prescribe opiates which while they in the short term help those who have been through a number of medications, are not a part of generalized western psychopharmacological practice.
>
> There was no suggestion on my part they would refuse to prescribe buprenorphine on grounds of side effects. It is the legal status and social stigma attached to opiates that I suspect would deter many pdocs from even thinking about prescribing them.
Which is what I exactly said above. If you don't have a DEA license, you aren't a psychiatrist. You can't practice and you lose the giant amount of money needed for malpractice insurance and your entire livelyhood. Psychiatrists aren't in it all just for the money. Not the good ones. Not the honest ones I've met. And I've met some not so good ones, so I don't believe that everyone out there is practicing as good as they should by any stretch of the imagination.>
> >Thus, this board serves a subset of the community who do not respond to one, but maybe need two or more medications to exist.
>
> Well I've certainly responded to many treatments Jay. The problem has generally been lack of long term efficiency with most drugs besides benzos. It is a very common problem and not only to the people posting on this board. For example, I know of several people that live nearby who have had similar experiences to me. They don't post on websites because they have no access to computers and are not computer literate in any case. Most are middle aged or elderly and living alone.
I can understand that. But this wasn't about computer literacy one way or the other -- you don't have to be computer literate to join mental health support meetings.
> They also have no access to the detailed information we discuss here and no interest in pursuing it. They're working alone in the dark and have no confidence to challenge their GP/pdoc and request alternative meds and treatments unlike most of the people here. In general they trust the medical profession to give them the best treatment and if the almighty Mr.pdoc says this drug works and they suspect it isn't helping them, then they tend to blame themselves - who are they to argue with medical science?
I sense some frustration with past psychiatrists because if my psychiatrist was behaving like "Dr. God" -- and I have encountered doctors of various specialties in life like that, I certainly wouldn't continue a relationship with them.
> There's an old lady that lives a few doors down my street who has been on Prozac 20mg for about 10 years since her husband died. She admits it stopped working soon after she started taking it but is now afraid of talking to her GP about it after being chastised by a locum for requesting another medication. The locum made her feel guilty that she was taking medication at all and from that point she decided to try and make the best of whatever positive effects it still had.
I'm losing the argument on the locum part -- I think that's a britishism. I didn't say everybody had access to the best and brightest -- that wasn't my argument or was any intention of what I was saying was ad hominem.
> She would no doubt be classified as a Prozac responder if her GP was required to produce a report on the efficiency of antidepressants in her patients (as I was bizarrely according to my medical notes, although I felt much worse for having taken it myself).Well, then that GP shouldn't be prescribing psychotropic medications. Frankly I don't think any GP should be, but if they are, if they're they only doctor in a community, they should be taking plenty of CE courses.
> I think it is reasonable to assume there are many more people in a similar position all over the world who are being marked up as treatment responders simply because they are compliant and tell the GP/pdoc mostly what they want to hear.
I can't argue with that statement -- it spells a little bit of frustration and somewhat of an everything or nothing sense that psychiatrists simply check off things neatly on little boxes. There are again, good and not quite so good doctors.
> >And also while we are on the subject of ranting that no drug on the market does anything, I have to say that, with no disrespect to individuals on this board, who have been through tireless trials of medications, we are a special population. This is why we are here. This is why people rant about medications because a number of them are treatment refractory.
>
> I don't think we're ranting that no medication on the market works, rather that there are some very effective drugs even for people who are refractory to first line SSRIs, but access to them seems excessively restricted - as in the case of benzos and stimulants in the UK.
The UK and its restrictions at least in the NHS system on category substances I will agree with you -- it is no accident that the benzo.org site is there but I won't go further into that because there are people here who believe in it and I've been chastised for saying anything.
> There are people posting on this board who are doing very well on their drug regimen, sometimes even on a single medication and have come to tell us the good news. I'm encouraged by their results, so I don't think were necessarily a subset of treatment resistant patients here on psychobabble.
Again, this wasn't a complete and total generalization and if I made it sound so, it wasn't meant to be. What I meant is the argument that in general when I see these threads that all antidepressants are flawed, there is no such thing as transmitter theories, etc, that is equally generalized.
I'd love to hear good news postings, and you're right, some are equally good. But there's always a human tendency that if everything is going smoothly, there's no reason to say anything.
And in response to the other comment
>That is a very, germane and insightful post. I too sincerely believe there are countless numbers of people suffering while on meds, but remaining silent. There are many who are not computer savvy, or who do not have the energy and motivation to tell the world about what they're feeling. Yes, this is a select group of people with problems on this message board, but I honestly feel it represents the tip of an enormous iceberg of people behind the scenes.
I believe that just as there could be this enormous iceberg of people behind the scenes who are suffering in silence, what about the glass half full idea that there are people who have been suffering in silence but now have found the right match and don't need a particular community ?
I think there is a bit of truth to what we all said and I welcome these arguments but not the generalization that "is medicine X" the only thing that does something. Because we're all different. Because there are also treatment regimes that involve things outside of just medication themselves. Like therapy, which is vastly underutilized in this country for certain because of our managed care system, but could equally bring treatment to those, suffering in silence.-- Jay
poster:yxibow
thread:710470
URL: http://www.dr-bob.org/babble/20061206/msgs/710990.html