Psycho-Babble Medication Thread 14266

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Ave. $Cost$ of treating depression

Posted by Diane on October 30, 1999, at 20:09:18

What is the average cost of being on ADs? Ballpark figure.
Including the initial doctor visit & monthly medications.
How many visits does it take to be diagnosed (uni-polar, bi-polar, Dysthymic Disorder,
ADD...etc).

Has anyone taken one of those diagnostic "tests" ?

Symptom Driven Diagnostic System for Primary Care (SDDS-PC)
Primary Care Evaluation of Mental Disorders (PRIME-MD)
Hamilton Rating Scale for Depression (HAM-D)
Montgomery-Asberg Depression Rating Scale (MADRS)
Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R)
Beck Depression Inventory-reported sensitivity of 86%, a specificity of 82%, and a
positive predictive value of 30%.
Zung Self-Rating Depression Scale (SDS)- most widely used screening tool for
depression. About 82% of persons with a Zung
Self-Rating Depression Scale greater than 55 have major depression by DSM-III criteria.

**Is it possible to download any of these "test", fill it out &, send it in prior to first
appointment with Psychiatrist so as to save time?


Thanks
Diane

 

Re: Ave. $Cost$ of treating depression

Posted by torchgrl on October 31, 1999, at 0:59:09

In reply to Ave. $Cost$ of treating depression, posted by Diane on October 30, 1999, at 20:09:18

Sure, I'll jump in on this one with *my* experience... It's kind of difficult to give a general "average cost", as there are so many variables. For one, some people can get by on one drug, some people need one or more others in addition to augment the original. Then there's the fact that most of the older drugs cost quite a bit less than the most recent--I was on Parnate recently for a brief trial, and it would've been about $60 a month for that. When I went back to Wellbutrin, the cheapest price I found was $180 for a month's supply. There are so many different meds people are on, I won't presume to estimate the actual high and low end cost-wise... Oh, and these are American prices. If you can get things in Canada, Mexico, or overseas, I believe it's generally less expensive.

Since I've been paying for my consult visits, it's cost between $80 and $95 a visit. I'm lucky I can do some things over the phone, but have to bite the bullet at least every 6 months or so to make an appearance (I don't have insurance anymore :( )Most cities have clinics you can go to, I think, if you can't afford the usual cost; I just wanted to stay with my original doctor when my insurance ran out. As far as diagnosis goes, I think the psychiatrist should have a pretty good idea of what's going on fairly quickly (i.e. it shouldn't take months of visits before they decide what's going on with you). I'm "fortunate" (and I use the term loosely!) to be pretty much dysthemic with periodic episodes of more major depression, as far as I can tell; I don't *think* I'm at the complex end of the diagnostic scale. So I may have had it easier in that regard... One thing I've learned from reading several message boards is that everyone's had a different experience with this, some much more difficult than others. I think the important thing is to communicate as much as possible with your doctor, and find someone you're comfortable communicating with, so that you can zero in on what needs to be addressed as quickly as possible. I'm sure some things aren't as immediately apparent as others, but I'm not the best person to speak on that topic, as I've been in treatment for depression since I was about 13, so the early days are a blur...
I've never taken any of the tests you mention, although I've heard of many of them. I have to do some of that stuff in conjunction with the med study I've gotten involved in, so may yet have the experience. You can find a few of them at least online; I don't know any sites offhand, but I've had good luck with Yahoo! in finding those sorts of things. I don't know that you'd benefit from arriving at the office with a ream of depression scale results, though. My impression is that the information conveyed by the results is similar to what is discussed during your appointment, anyway, and it's just a more standardized way to look at it. I suppose if you have a severely limited amount of time to talk, they might be helpful...I'm sure there are plenty of people here who know more about this one.

Sorry I couldn't give you more specific answers, but I hope it's been of some help...

 

Re: Ave. $Cost$ of treating depression

Posted by saint james on October 31, 1999, at 1:36:27

In reply to Ave. $Cost$ of treating depression, posted by Diane on October 30, 1999, at 20:09:18

i would say that a doc is going to want to meet
first to do a consult. Some don't use tests at all. (BTW, the DSM is not a test) As AD's take 4 weeks to work; most meet with you after 4 weeks, but tell you to call if there are any problems b4 this. Ask if your doc will do phone calls, many times there is no need to have an apt. when a quick phone call will do. many are willing to change meds over the phone. Once you have found a med that works most want to see you every 3-6 months. Because I am with an HMO I have to go every 3 months but if I saw my doc in private practice I would go twice a year.

Brand meds are very expensive, generics are cheap, so let your doc know if you cannot afford brands. In general generics are as effective as brands, the real question is what will work for you and what the side effects are. You many be on a buget but you neurology does not know this, often !

j

 

Re: Ave. $Cost$ of treating depression

Posted by JohnL on October 31, 1999, at 2:25:20

In reply to Ave. $Cost$ of treating depression, posted by Diane on October 30, 1999, at 20:09:18

Hi Diane. Both my local town family clinic and my counselor have the Beck's test on-hand. From what I've seen it is the most common. Even if you have to fill it out on a visit it only takes about 3 minutes. Answer some simple multiple choice questions. There is a similar test at the site Depression Central. I took that test and brought it in to my pdoc to highhlight for him my most troublesome symptoms. The test helps identify which symptoms are worse than others and can have some influence on drug choice.

My general practitioner charges $50/visit. Usually 20 minutes or so. My pdoc charges $75. Usually half hour. A former pdoc charged $80 for 15 minutes. Ouch! Many will adjust fees on a sliding scale basis according to your income. But you have to ask. They usually won't volunteer that option. My pdoc routinely gives me a prescrip renewable three times. So if I'm tolerating it, I can stay with it for months before another visit. Even then if all is well I can get it renewed with a simple phone call. I usually visit more often when contemplating a switch or an augmentation. I tend to spend a lot of money on frequent visits when I'm having problems with a med.

Generic drugs, like a lot of the tricyclics, are cheap. Most of the others can cost $100 to $200 or more per month. Some are really expensive. Like Buspar. Or Lamictal. Some are dirt cheap. Like Lithium. I think finding a med that fits your side effect profile is the most important thing. That will save cost all the way around in the long run. Poor tolerance will lead to money spent on unused prescrips filling up your med cabinet And frequent visits involving frustration and switching. There are a lot of variables. Treating depression can be fairly cheap or incredibly expensive, depending on all the variables. No easy answer.

One tip though, larger dose pills are usually just slightly more expensive than smaller doses. Sometimes no difference at all. You can save money, and your insurance company will love you, if you get the larger dose and break it in half. For example, I use 7.5mg Remeron for sleep. I got 30 day supply of 30mg pills. I split them in half, then split each half in half with a knife. So for the cost of 30 day prescription I actually have 120 day supply. My local pharmacy has Lamictal at $1.94 for 25mg. 100mg is also $1.94. So why not buy the 100s and break em in four? A caution, can't do it wih Wellbutrin. The inside becomes toxic when exposed to air. For capsules, you can empty contents into juice or water and dose it half glass a day or whatever. That's a common strategy with customizing Prozac doses.

 

Re: Ave. $Cost$ of treating depression

Posted by saint james on October 31, 1999, at 2:42:50

In reply to Re: Ave. $Cost$ of treating depression, posted by JohnL on October 31, 1999, at 2:25:20

many doc's have samples, so ask. They tend to reserve giving samples to those how really can't afford to try something expensive. One doc I saw would give a weeks worth of a new med, so you could see if side effects were managable. That way you did not spend $100 on meds only to find
in 3 days there was no way you could tolerate it.

you can also get meds 4 free if you contact the manufacture directly or go thru www.themedicineprogram.com.

I think John made a good point, that your mental health comes first and cost second. There are lots of ways around the cost if you are on a buget
but you have to ask.

j

 

Re: Ave. $Cost$ of treating depression

Posted by Susan M on October 31, 1999, at 4:16:41

In reply to Re: Ave. $Cost$ of treating depression, posted by JohnL on October 31, 1999, at 2:25:20

> Hi Diane. Both my local town family clinic and my counselor have the Beck's test on-hand. From what I've seen it is the most common. Even if you have to fill it out on a visit it only takes about 3 minutes. Answer some simple multiple choice questions. There is a similar test at the site Depression Central. I took that test and brought it in to my pdoc to highhlight for him my most troublesome symptoms. The test helps identify which symptoms are worse than others and can have some influence on drug choice.
>
> My general practitioner charges $50/visit. Usually 20 minutes or so. My pdoc charges $75. Usually half hour. A former pdoc charged $80 for 15 minutes. Ouch! Many will adjust fees on a sliding scale basis according to your income. But you have to ask. They usually won't volunteer that option. My pdoc routinely gives me a prescrip renewable three times. So if I'm tolerating it, I can stay with it for months before another visit. Even then if all is well I can get it renewed with a simple phone call. I usually visit more often when contemplating a switch or an augmentation. I tend to spend a lot of money on frequent visits when I'm having problems with a med.
>
> Generic drugs, like a lot of the tricyclics, are cheap. Most of the others can cost $100 to $200 or more per month. Some are really expensive. Like Buspar. Or Lamictal. Some are dirt cheap. Like Lithium. I think finding a med that fits your side effect profile is the most important thing. That will save cost all the way around in the long run. Poor tolerance will lead to money spent on unused prescrips filling up your med cabinet And frequent visits involving frustration and switching. There are a lot of variables. Treating depression can be fairly cheap or incredibly expensive, depending on all the variables. No easy answer.
>
> One tip though, larger dose pills are usually just slightly more expensive than smaller doses. Sometimes no difference at all. You can save money, and your insurance company will love you, if you get the larger dose and break it in half. For example, I use 7.5mg Remeron for sleep. I got 30 day supply of 30mg pills. I split them in half, then split each half in half with a knife. So for the cost of 30 day prescription I actually have 120 day supply. My local pharmacy has Lamictal at $1.94 for 25mg. 100mg is also $1.94. So why not buy the 100s and break em in four? A caution, can't do it wih Wellbutrin. The inside becomes toxic when exposed to air. For capsules, you can empty contents into juice or water and dose it half glass a day or whatever. That's a common strategy with customizing Prozac doses.
>

Isn`t it just the Sustained Release Wellbutrin that you can`t break in half? My doctor told me to break the regular Wellbutrin and build up the dose very slowly as I have a lot pf trouble tolerating meds. I hope this is right!

 

Re: Ave. $Cost$ of NOT treating depression

Posted by Racer on October 31, 1999, at 11:42:37

In reply to Ave. $Cost$ of treating depression, posted by Diane on October 30, 1999, at 20:09:18

This is another important factor in the equation. Don't forget the cost of leaving major depression untreated.

For example, employment problems, health problems, loss of energy and motivation, loss of apetite, loss of interest, lack of social interaction, etc. These all have a cost, too, and in some cases can have an actual dollar value assigned to them. For example, think about someone who misses work an average of 3 days a month because of depression. Aside from the very real danger of losing one's job, there's a cost to the company, a cost in reduced wages, an intangible cost in loss of trust among coworkers who try to take up the slack, and so on.

So, while it's expensive to treat depression, in my case about $10.50 per day (thank goodness for compassion programs!), there's another cost to lack of treatment which should also be taken into account.

Good luck to you.

 

Re: Ave. $Cost$ of NOT treating depression

Posted by Abby on October 31, 1999, at 18:53:54

In reply to Re: Ave. $Cost$ of NOT treating depression, posted by Racer on October 31, 1999, at 11:42:37

Zoloft is particularly good that way. Split 100mg instead of using the 50s. I just got a prescription of 50s filled to add an extra 25mg, but I think that I would have preferred to get 100 and use a pill cutter.

Are you in Boston? I think that a study i being done right now with Prozac. Everyone gets 4 weeks worth, and then some people get a placebo, but if they relapse, or don't respond to Prozac, they are given more drugs.

Look at Dr. Ivan's page.

Abby

 

Re: Ave. $Cost$ of NOT treating depression

Posted by S. Suggs on November 1, 1999, at 5:05:33

In reply to Re: Ave. $Cost$ of NOT treating depression, posted by Abby on October 31, 1999, at 18:53:54

In regards to the generic meds, yes, you do save money in regards to brand name. However, what the pharmacy does is mark up their cost on generics on a much higher percentage basis, vs. the mark up on the brand. Ex. Some of your top selling meds (Prozac, zoloft....) are sold just above cost, possibly below, as a lost leader to draw in the floor traffic to sell food and other items. Why are most pharmacies located in the back of the store....so you will have to walk past the merchandise on the way in. On the receipt, the drug store will always tell you how much you saved. While this is true, it would really shock them to ask how much they made. Despite new technology in pharmaceuticals, the money to be made for the pharmacy is on the generics. They are banking on the fact that most people do not know this.

I like to use a book called the Physician's Generics. Similar to a PDR, but with all of the direct cost for the pharmacy. I have no problem with free enterprise, but if I may save myself some $, I'll do it. It will list brand (if available) and all generics with the number of tablets/pills in each container, and as mentioned, the direct cost. It really has been a life send. Cost around 70.00. You can probably find one on the net.

Blessings,


S. Suggs

 

Re:Thank you all

Posted by Diane on November 1, 1999, at 15:58:18

In reply to Re: Ave. $Cost$ of treating depression, posted by JohnL on October 31, 1999, at 2:25:20

Looks like I'm going to have to apply for state med insurance.


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