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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by crabcakebenny on July 27, 2016, at 13:04:11
Let me preface this post by stating it's all just my opinion, and the last thing I want is to invalidate others' experiences or dissuade people from taking a drug which might work for their issues.
I completely understand that for a good slice of people, such as those experiencing hellish psychosis or intense mania, these can be indispensable drugs. However, what I will never understand is the ubiquitous practice of prescribing these drugs for more "vanilla" psychiatric states, such as depression or anxiety disorders. My concern primarily revolves around EPS/Tardive Dyskinesia, which seem to transcend the general "side-effect" profile and cross a border which seems to signify some sort of toxicity or insult to the nervous system.
I'm aware this is a pro-medication forum, and I am pro-medication. I just don't understand why APs are prescribed so heavily where they aren't indicated. Every pdoc that I visit insists on trying an atypical, and I have to explain to them I'm just not comfortable. This often marks the end of our relationship ("I'm sorry then, I can't help you.").
I've only had markedly negative experiences on APs, and I'm wondering what dynamic is responsible for doctors narrowly focusing on these drugs.
Posted by jonhed on July 27, 2016, at 13:58:27
In reply to Why do doctors push antipsychotics so hard?, posted by crabcakebenny on July 27, 2016, at 13:04:11
I feel the same way. Back in 2010 in sweden, everyone was getting quetiapine for insomnia, depression, anxiety, psychosis, restlessness and a lot of other symptoms that are not indicated for it.
That has me wondering why some doctors are so negative about prescribing other medications off label, when AP/AAPs are prescribed off label all the time(!).Like, why can't i get 20mg of ritalin for my anhedonia, but can easily get 600mg of quetiapine or 30mg of olanzapine for it.
You know, big pharma, big money.
In sweden we have a "book" about all the substances that exist in sweden, and now, this year, quetiapine has SEVERAL black box warnings for tardive dyskinesia and other horrible side effects that you get encouraged to seek immediate/acute help for if you get these side effects.
Back in 2010 when i was on a sh*t load of antipsychotics and had such extreme side effects, no doctor believed me because it wasn't written in that book back then.
Oh, sorry i can't talk about this, i get so angry.
I'm sorry. I have to breath for a while.
I know what you mean though, i'm pro medicine to but this is b*llsh*t.
Thank you for bringing this up. Cause it all comes down to money. Nothing, and i mean nothing else than money.
Posted by Christ_empowered on July 27, 2016, at 14:23:20
In reply to Re: Why do doctors push antipsychotics so hard?, posted by jonhed on July 27, 2016, at 13:58:27
its...$$$. There's Big Pharma pushing them hard, with industry-sponsored studies for everything. Helps anxiety?!? Yeah, OK...like that's a huge revelation. So does Thorazine...I'm not signing up for that one.
Benzo prescribing waxes and wanes, and there's all sorts of variables that go into it (your social class, the doctor's age, your gender, your location, etc.) that have nothing to do with your problems. If you do get a BZD Rx, the choice of BZD is often dictated by trends more than...science, solid data, etc.
Then...there's the kind of doc you're seeing. Community mental health where I am...BZD are generally a no go. I mean, I see now that it happens, just...not often. I think they use Klonopin almost exclusively because the other ones might make somebody feel good or something. I dunno.
But, yeah, a private practice doc is probably more willing, a cash only doc is usually even more willing, and croakers in shady parts of town will often hand out xanax at the drop of a hat.
And...your history. Drinking, drugs, family history..employment status, age, etc. etc. etc. Many docs also give more freely to women. I'm male, and female docs would give me uppers and downers, but the male docs were really strict and...I bailed on them, lol.
Some states now have triplicate forms for BZD drugs. Weirdly enough, I read that docs in those states are prescribing more meprobamate and bringing back some of the less fun barbiturates (phenobarbital...how retro...). Again, that has nothing to do with you, your problems, you life, etc...its just some DEA stuff docs often don't wanna deal with.
And...AP/AAP drugs are not only non-addictive, very few people even much care for them. No street value, no "fun," etc. Sometimes, I think a lot of shrinks would rather us be docile and zombified than let anybody feel any drug induced euphoria...e-v-e-r.
Oh, yeah, and...shrinks rarely take their pills and potions. Odds are pretty good they wouldn't take most things they prescribe their patients, especially the AP/AAP drugs. They know quite well that these drugs can cause all kinds of problems, including dysphoria, but...that's the patients, not them. Oh well.
Posted by crabcakebenny on July 27, 2016, at 16:25:06
In reply to Re: Why do doctors push antipsychotics so hard?, posted by jonhed on July 27, 2016, at 13:58:27
> I feel the same way. Back in 2010 in sweden, everyone was getting quetiapine for insomnia, depression, anxiety, psychosis, restlessness and a lot of other symptoms that are not indicated for it.
> That has me wondering why some doctors are so negative about prescribing other medications off label, when AP/AAPs are prescribed off label all the time(!).
>
> Like, why can't i get 20mg of ritalin for my anhedonia, but can easily get 600mg of quetiapine or 30mg of olanzapine for it.
>
> You know, big pharma, big money.
>
> In sweden we have a "book" about all the substances that exist in sweden, and now, this year, quetiapine has SEVERAL black box warnings for tardive dyskinesia and other horrible side effects that you get encouraged to seek immediate/acute help for if you get these side effects.
>
> Back in 2010 when i was on a sh*t load of antipsychotics and had such extreme side effects, no doctor believed me because it wasn't written in that book back then.
>
> Oh, sorry i can't talk about this, i get so angry.
>
> I'm sorry. I have to breath for a while.
>
> I know what you mean though, i'm pro medicine to but this is b*llsh*t.
>
> Thank you for bringing this up. Cause it all comes down to money. Nothing, and i mean nothing else than money.
I definitely relate to resenting the people who prescribed me that sh*t, but it really just makes me unhappy to dwell on it. I've tried to forgive them, or at least not think about it.IMO this really emphasizes the need to research and be selective with who you're paying to handle your meds. It's discouraging to think that there are physicians who would rather receive some underhand cash from pharma to promote their drug than to apply critical thinking and explore what works best for each individual. I'd also like to think doctors would be more risk-taking in Europe, rather than being like "Oh, here's some Zyprexa.", with stuff like Tianeptine and Agomelatine being prescribed over there.
Posted by jonhed on July 27, 2016, at 18:32:37
In reply to Re: Why do doctors push antipsychotics so hard?, posted by crabcakebenny on July 27, 2016, at 16:25:06
It makes me unhappy as well, but it's hard to not think about it sometimes..
Yeah maybe they are, i live in sweden and the doctors are very experimental here because of the consistent(?) salary the doctors get. (They have a maximum and minimum wage they get. But they also get provision for prescribing x many, lets say, methylphenidate pills to. The only thing that is good with most countries in europe is that we never have to care about the cost of any drug. It's equal cheap to buy aspirin as abilify, there is no difference, and when you have paid 2800kr (220 dollars) in one year for medicines, everything become free. Even 10000 pills of rexulti is free, cause we have something called "högkostnadsskydd" it's like an insurance every citizen are born with, that makes you only pay 220 dollars per year at most for medicines. That makes it easier for doctors to choose more freely with the dosages, because everyone can afford it. we don't have sample packs here, you get a script for 100 pills at the time, and if you can't tolerate them, you go to the pharmacy and return it and they dispose them in a eco friendly way. But it's equal corrupt anyway, cause everyone wants to make money.)
But.... Many are paid here to unfortunately. So don't think to high about europe!
Sorry for the lecture in swedish politics.
Posted by rjlockhart37 on July 27, 2016, at 20:11:53
In reply to Why do doctors push antipsychotics so hard?, posted by crabcakebenny on July 27, 2016, at 13:04:11
quick awnser : because they have low potential for abuse, they improve behaviormal problems, reduce aggression, seem to be a non-risk form for a benzo
if benzo's didnt have the catagory of it's abuse potential, they would be in favor by doctors more....but still think about it, antipsychotics can be addicting because if you don't have them, you have withdrawl and they have use to use benzo's to ease it, but they don't have the pleasure of relieving anxiety like benzo's do.....like taking a valium or a xanax can be like having a drink, you feel relaxed and back down to earth
Posted by Phillipa on July 27, 2016, at 22:25:28
In reply to Re: Why do doctors push antipsychotics so hard?, posted by jonhed on July 27, 2016, at 18:32:37
I take both valium & xanax have for many years. My Pdoc knows I don't abuse them and knows that older folks should not take antipsychotics. Fear of falls a big deal Phillipa
Posted by SLS on July 27, 2016, at 23:24:59
In reply to Re: Why do doctors push antipsychotics so hard?, posted by Phillipa on July 27, 2016, at 22:25:28
> Fear of falls a big deal
My grandmother's life was cut short when she fell down some steps as the result of taking Dalmane (flurazepam) every day. She broke her hip as a result, and deteriorated quickly. It is not an unusual story.
- Scott
Posted by shadowtom2 on August 1, 2016, at 18:30:35
In reply to Why do doctors push antipsychotics so hard?, posted by crabcakebenny on July 27, 2016, at 13:04:11
Along the lines of what others here have written, I think that the reasons why doctors prescribe antipsychotics as often as they do to alleviate mental states that involve neither psychosis nor mania come down to pharmaceutical company marketing more than anything else. Now, it's obvious that it's in the interests of pharmaceutical companies that are selling patented medicines to promote these medications over other treatments (pharmaceutical and otherwise) that might, in some cases, actually be better choices for some people. But I think that some might be surprised by the lengths that those in the pharmaceutical industry go through to influence prescribing decisions. I came across an article yesterday that was written by a woman who's worked both as a pharmacist and as a medical science liaison for a major pharmaceutical company, and the article described how pharmaceutical companies attempt to influence the prescribing decisions that doctors make by targeting those doctors who are considered to be "key opinion leaders" in their fields. You might be interested in reading it. Here's a link:
http://www.madinamerica.com/2016/07/did-i-choose-the-wrong-profession/
Tom (the former Tomatheus)
Posted by SLS on August 1, 2016, at 18:44:53
In reply to Re: Why do doctors push antipsychotics so hard?, posted by shadowtom2 on August 1, 2016, at 18:30:35
Tomatheus?
You sound different for some reason.
- Scott
Posted by shadowtom2 on August 1, 2016, at 19:29:52
In reply to Re: Why do doctors push antipsychotics so hard? » shadowtom2, posted by SLS on August 1, 2016, at 18:44:53
Well, without question, what I wrote in the post that I just made to this thread is, at least in some ways, more critical of psychiatry than what I've written in most of my older Psycho-Babble posts. But as I wrote not all that long ago under my Tomatheus username, my participation on this board and on all of Psycho-Babble at this point is on a limited basis, as I definitely don't think that I have as many positive things to say about medications as I used to. That's not to say that I no longer think that psychiatric medications play a useful role (and sometimes a very central role) in alleviating the symptoms of various mental health conditions or that I won't ever mention the benefits of psychiatric medications when others here with mental health conditions ask questions about medications that they're taking or thinking of taking. If I have something to share that I think that somebody else might find to be helpful, then I intend to share it, whether it's something that might be in line with the views of a majority of psychiatrists, or whether it's something different. The post that I just made here does seem to fall into the "something different" category, but that's not to say that that will be the case for all (or even necessarily most) of what I'll be posting here going forward.
Tom
Posted by SLS on August 1, 2016, at 23:35:50
In reply to Re: Why do doctors push antipsychotics so hard? » SLS, posted by shadowtom2 on August 1, 2016, at 19:29:52
Hi Tom.
> Well, without question, what I wrote in the post that I just made to this thread is, at least in some ways, more critical of psychiatry than what I've written in most of my older Psycho-Babble posts. But as I wrote not all that long ago under my Tomatheus username, my participation on this board and on all of Psycho-Babble at this point is on a limited basis, as I definitely don't think that I have as many positive things to say about medications as I used to. That's not to say that I no longer think that psychiatric medications play a useful role (and sometimes a very central role) in alleviating the symptoms of various mental health conditions or that I won't ever mention the benefits of psychiatric medications when others here with mental health conditions ask questions about medications that they're taking or thinking of taking. If I have something to share that I think that somebody else might find to be helpful, then I intend to share it, whether it's something that might be in line with the views of a majority of psychiatrists, or whether it's something different. The post that I just made here does seem to fall into the "something different" category, but that's not to say that that will be the case for all (or even necessarily most) of what I'll be posting here going forward.
I am positive that I will learn more from you if you post here than if you don't post here.
I hope you are doing well and that your new treatment regimes prove to be robustly effective.
Best regards,
Scott
Posted by shadowtom2 on August 2, 2016, at 1:27:55
In reply to Re: Why do doctors push antipsychotics so hard? » shadowtom2, posted by SLS on August 1, 2016, at 23:35:50
Thank you for your words of support, Scott. I hope that your current treatments are also serving you well and that any changes that might be made to your regimen going forward will be of benefit to you.
I'm thinking that there's enough of a chance that I might post an update on my treatment before too much longer. These days, I prefer to hold off on writing about strong responses that I have to treatment until I have some reason to think that such responses will persist over a relatively long period of time. So, I'm waiting for now, but as I said, perhaps I'll post a treatment update before too long.
Tom
Posted by SLS on August 2, 2016, at 5:51:05
In reply to Re: Why do doctors push antipsychotics so hard? » SLS, posted by shadowtom2 on August 2, 2016, at 1:27:55
> Thank you for your words of support, Scott. I hope that your current treatments are also serving you well and that any changes that might be made to your regimen going forward will be of benefit to you.
Thank you, Tom.
> I'm thinking that there's enough of a chance that I might post an update on my treatment before too much longer. These days, I prefer to hold off on writing about strong responses that I have to treatment until I have some reason to think that such responses will persist over a relatively long period of time.
Yes. I do this, too.
> So, I'm waiting for now, but as I said, perhaps I'll post a treatment update before too long.
I truly hope that we can see a positive update from you soon.
Take care of yourself (I know you always do).
- Scott
Posted by SLS on August 2, 2016, at 6:26:02
In reply to Why do doctors push antipsychotics so hard?, posted by crabcakebenny on July 27, 2016, at 13:04:11
I'm sorry you have had such bad experiences with "antipsychotics". I guess there is some property in common that these drugs possess that your brain very much dislikes. Maybe there is a clue in their somewhere.
I placed quotation marks around the word "antipsychotics" to emphasize that the newer neuroleptic drugs have properties in addition to dopamine D2 receptor antagonism. They vary from drug to drug. Most are serotonin 5-HT2 antagonists. Some are 5-HT1a partial agonists. Some are D2/D3 partial agonists. Others are 5-HT7 antagonists. Others are D4 antagonists. Still others are norepinephrine reuptake inhitors. Because these modern neuroleptics have such an array of mechanisms, researchers and clinicians found that they treat things other than schizoid and manic illnesses. These include depression, bipolar depression, borderline personality disorder, pervasive development disorders, tics, Tourettes Syndrome, severe nausea, and even hiccups. Hopefully, drugs can designed to strip the D2 antagonism and leave the other therapeutic properties to treat variety of mental illnesses.
Actually, there is one drug that has been around for many years that is a pure 5-HT2a/b/c antagonist. It seems to work as an adjunct to other drugs to treat an array of neurobiological illnesses. It is known as ritanserin. Unfortunately, it has been around *too* long. It is no longer under patent, and no drug company will spend the money to develop it for medical conditions. For now, it is confined to experimental laboratories. The other thing is that, by itself as monotherapy, it doesn't do much. It needs to be combined with other things. Ritanserin is a good drug without an indication.
In summation, "antipsychotics" are nothing more than chemical compounds that work to treat psychotic disorders in addition to other disorders; much like "antidepressants" treat depression in addition to OCD, ADD/ADHD, GAD, social anxiety, panic disorders, incontinence, and chronic pain disorders.
- Scott
Posted by Tabitha on August 2, 2016, at 12:57:07
In reply to Re: Why do doctors push antipsychotics so hard?, posted by shadowtom2 on August 1, 2016, at 18:30:35
> I came across an article yesterday that was written by a woman who's worked both as a pharmacist and as a medical science liaison for a major pharmaceutical company, and the article described how pharmaceutical companies attempt to influence the prescribing decisions that doctors make by targeting those doctors who are considered to be "key opinion leaders" in their fields. You might be interested in reading it. Here's a link:
>
> http://www.madinamerica.com/2016/07/did-i-choose-the-wrong-profession/It's really unfortunate that those tactics are used and I don't doubt that they influence prescribing trends. I'd like to see regulation and/or standards of professional ethics create some push-back.
I had a head-desk moment at the end of that article though. She leaps from seeing that the pharmaceutical industry is inefficient and borderline corrupt, to counselling people to replace their medications with "the healing powers of food, sunlight, exercise, sleep, and community." As if a healthy lifestyle will eliminate that pesky bipolar disorder, OCD, GAD, etc.
Maybe it's a generational thing. She can't recall the days when people lived healthy lifestyles yet still suffered from untreated mental illness.
Posted by shadowtom2 on August 2, 2016, at 18:48:40
In reply to Re: Why do doctors push antipsychotics so hard?, posted by Tabitha on August 2, 2016, at 12:57:07
Thank you for your comment, Tabitha. I think that you made a number of good points, and I too tend to think that at least for many patients with mental health conditions, making lifestyle changes alone without utilizing other interventions that are indicated to help alleviate the symptoms that those with mental conditions struggle with will likely only help so much to resolve such symptoms. That's not to say that I find making healthy lifestyle choices to be a bad idea or that I think that making healthy choices with respect to things like food, sunlight, exercise, sleep, and community isn't something that can lead to improvements in a person's mental well being. Making good choices in all of these areas, I think, has the potential to improve the mental health of some individuals, even if the evidence to support their use as treatments for full-fledged mental health conditions might not necessarily (at least in all cases) be conclusive.
Still though, the idea that making healthy lifestyle choices might somehow be something that patients with mental health conditions should do instead of taking medications that they are benefiting from doesn't seem to be at all sensible to me. I'm all for increasing the number of treatment interventions for mental health conditions, especially when such interventions have a large body of evidence to support their use, and especially for patients who've tried using more established treatments without success. And I also think that making healthy lifestyle choices can be a good thing for everyone, including those who are taking medications and/or participating in talk therapy for a mental health condition and benefiting from such treatments. To me, when a person with a mental health condition makes healthy lifestyle choices along with utilizing any other treatment interventions that the person in question finds to be beneficial, that makes sense. However, suggesting that making healthy lifestyle choices should serve as a replacement of sorts for a medication regimen that's helping to alleviate the symptoms of a person's mental health condition doesn't seem like a good idea to me.
Tom
This is the end of the thread.
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