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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Ann Marie T. on May 28, 2004, at 8:11:55
Hi I'm new. And REALLY angry after realizing that I've been going through zoloft withdrawl. Now for a psych patient I've been pretty compliant with my medications over the years. BUT pdocs all know that psych patients have a low compliance with meds as a group. It is part of the disease AND a perfectly natural response to feeling pefectly healthy for a long time and continuing to take meds everyday. So....here's why I'm mad....why aren't the pdocs telling people about the symptoms you can have when you come off an SSRI? Shouldn't patients have the right to know all of the benefits and risks of a treatment? In fact I believe that's called INFORMED CONSENT and I believe it's the law (I may be wrong on this).
Any thoughts?
Could it be that they are in denial or are we deliberately being mislead?
Posted by Racer on May 28, 2004, at 8:39:42
In reply to What is wrong with the pdocs?, posted by Ann Marie T. on May 28, 2004, at 8:11:55
I think there are a number of factors at work here. For one thing, the clinical trials are so short, that withdrawal effects after long term treatment probably wouldn't show up. It's only after years of clinical use that doctors really start to learn about things like withdrawal, and they've got to make a big effort to keep up or they won't find out about that sort of thing.
Also, doctors in general -- including veterinarians, I've talked to mine about this -- have to protect themselves emotionally from their patients. This is true of the psychiatrists as well as the oncologists and cariologists. It's not only the death of their patient they need to insulate themselves from, although that's bad enough, but the effects of the treatment on a patient. In the case of psychopharmacologists, think of how difficult it must be for them to prescribe drugs to their patients, knowing that the same drugs that may improve the one aspect of their lives will also devastate the life the drugs make possible? A pdoc prescribing a drug that will improve depression has to face the fact that that same drug also puts the patient at much higher risk of obesity with all its attentdant health problems, reduced productivity if it's one of the more sedating drugs, long term gastrointestinal problems, and a wicked withdrawal when the medication is stopped. What's that line from the Hippocratic Oath? "First, do no harm?" These doctors are prescribing drugs they know will cause discomfort to their patients, but these drugs are all they have to work with. If all you have is a claw hammer, everything starts to look like a three penny nail.
Personally, I think a lot of the problem is those doctors who resolve this for themselves by distancing themselves so much that they can't offer true compassion anymore. These are the drugs they have, so these drugs are good enough and the patient is being unreasonable to complain about, say, anorgasmia when at least the patient wants to have sex again. They'll tell patients, "Just put up with the shaking hands and jerking arms from the medication" without stopping to think of how they would feel losing control of their own bodies that way. On the one hand, they have to stifle their empathy in order to function and survive. On the other hand, though, it means that they do a real disservice to their patients, who are likely to be most vulnerable to begin with.
I'm sorry you're having withdrawal troubles. I hope the discomfort eases soon for you.
Posted by Buckeye Fan on May 28, 2004, at 9:25:52
In reply to I don't think it's deliberate, posted by Racer on May 28, 2004, at 8:39:42
Good post Racer.
Some of my thoughts are...
Too many patients
No other alternative really offered by their
medical training"Distancing" is the term used to describe the
human reaction to trying to mentally seperate
one's self from a bothersome unsolvable
problem.And of course, as you said...we are in the age
of Lawsuits, Malpractice and vunerability to
Physicians in general.I know it may sound like I am defending them...
but I am really just trying to help us all
inderstand the Why's of Physcician Behavior.Buckeye Fan
Posted by amdew717 on May 28, 2004, at 12:12:45
In reply to I don't think it's deliberate, posted by Racer on May 28, 2004, at 8:39:42
> Personally, I think a lot of the problem is those doctors who resolve this for themselves by distancing themselves so much that they can't offer true compassion anymore. These are the drugs they have, so these drugs are good enough and the patient is being unreasonable to complain about, say, anorgasmia when at least the patient wants to have sex again. They'll tell patients, "Just put up with the shaking hands and jerking arms from the medication" without stopping to think of how they would feel losing control of their own bodies that way. On the one hand, they have to stifle their empathy in order to function and survive. On the other hand, though, it means that they do a real disservice to their patients, who are likely to be most vulnerable to begin with.
>I think I finally hit a nerve with my pdoc yesterday while discussing side-effects when I simply said, "you have no idea what it's like to be in my shoes." All he could say was, "that's true," and nothing else. That's really different for him...he's usually so defensive, and had been up to that point in the discussion. He had been saying how we're very limited with the drugs we can try on me because of my low tolerance for side-effects...as though that's my fault.
Thanks for your post,
Jim
Posted by Ann Marie T. on May 28, 2004, at 13:11:55
In reply to What is wrong with the pdocs?, posted by Ann Marie T. on May 28, 2004, at 8:11:55
Thanks for your views, guys. I never thought of it from that perspective.... I'm still a little annoyed with my pdoc, but at least I think he's not trying to screw me to get Pfizer to give him a free vacation to Hawaii...
Thanks again
Posted by AntiTrust on May 28, 2004, at 20:35:33
In reply to What is wrong with the pdocs?, posted by Ann Marie T. on May 28, 2004, at 8:11:55
all i can give for advice is ASK ASK ASK ASK and then ASK some more questions-ask for handouts,pamphlets websites etc.
Posted by Viridis on May 29, 2004, at 2:12:35
In reply to What is wrong with the pdocs?, posted by Ann Marie T. on May 28, 2004, at 8:11:55
I don't think that this attitude is completely universal, although I've seen it often enough -- more with GPs, though. My current pdoc is very upfront about the possible side effects of meds, has taken antidepressants himself, and has related the side effects that he experienced to me. He's very cautious in dosing, and actually believes it when I say that I had a bad reaction to a drug.
He seems very informed about this; for example, he estimates that more than 60% of his patients on SSRIs experience sexual dysfunction, and works hard to achieve a dose that helps without impairing everyday activities. But the bottom line is that his first responsibility is to get extreme states of mind under control, then he works with the patient to try to achieve a normal life.
There's a wide range of meds out there already, with more appearing all the time, and there really are doctors who recognize that no one med fits all. I think that the best doctors are simply frustrated by the unpredictability of individual reaction and the lack of tests (but try hard to find the best fit), and the average doctors just stick to a standard set of drugs that insulates them from liability and matches the patient's insurance plan.
Posted by Tony C. on May 29, 2004, at 7:48:57
In reply to What is wrong with the pdocs?, posted by Ann Marie T. on May 28, 2004, at 8:11:55
You know Doctors are not GOD. I am a 7 year Serzone user, and when I have reduced Serzone my taste was altered, my leg numb, aches like the FLU x 20 - I mean My eyes would barely turn after a 25% reduction for only 5 days, and one of the Best Psych Docs in my Area, said "OH IF I WERE YOU I WOULD TAKE IT BACK UP, ACTUALLY INCREASE IT 100 MORE MG. IT IS YOUR DEPRESSION RETURNING" Sorry Doc, you have let me down bigtime, what I experienced was NOT Depression it was the beginning of a CRUEL Withdrawal, that got worse as each day passed with no hope of let up. My Gosh, if I quit cold Turkey or ran out I tremble to think what would happen. HEY DOCTORS THESE DRUGS CAUSE WITHDRAWAL BIGTIME !!! Someone please educate these doctors !!! OH BY THE WAY, MOST DOCTORS THINK YOUR IMAGINING THE SYMPTOMS !!!
Posted by Bill LL on June 1, 2004, at 9:08:58
In reply to What is wrong with the pdocs?, posted by Ann Marie T. on May 28, 2004, at 8:11:55
I think that the docs themselves are not very familiar with withdrawal side effects for a couple of reasons.
It's not in the drug company literature. The drug companies know about the problem but don't want to advertise it. They don't feel compelled to advertise it because withdrawal effects do not occur during the clinical trials since they are of such short duration.
Pdocs might only have a few patients on any given drug. When a patient withdraws, he might lose contact with the patient. Oftentimes, a patient will stop seeing the pdoc, and start having the primary doc do the prescribing.
I have heard that taking Prozac during withdrawal from Effexor will work very well. I'm guessing that Prozac may also help with withdrawal from Lexapro, Zoloft or other SSRI's.
This is the end of the thread.
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