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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Uppendown on May 3, 2002, at 12:42:29
Hi Ya'll,
Given all of our individual and collective experiences with all these meds, and the amount of posts about how people are STILL struggling after months and years taking these meds, do you think that meds are over prescribed ? Do you think that well meaning docs, anxious to help their patients, rely on meds before exploring other, non medication options such as psychotherapy? And, what do you think of the "cocktail" approach, where drugs are added to counter-act the negative effects of drugs initially prescribed?
I fully understand that drugs are often required, for a wide variety of reasons, but I'm also VERY concerned that alot of the issues we see P-docs for are created or exacerbated by the very meds we're prescribed.
Just curious about how people here feel and think about that, both generally, as well as how it is relevant to themslves personally. On how the loss of congnitive abilities, weight gain, sexual dysfunction, etc so often associated with these meds has impacted each of us in ways like causing us to isolate, lose jobs, lower our self esteem, etc.. I know this is something a great many of us struggle with..
Best Wishes,
Uppendown
Posted by Geezer on May 3, 2002, at 14:21:47
In reply to Are Meds over prescribed ? , posted by Uppendown on May 3, 2002, at 12:42:29
> Hi Ya'll,
>
> Given all of our individual and collective experiences with all these meds, and the amount of posts about how people are STILL struggling after months and years taking these meds, do you think that meds are over prescribed ? Do you think that well meaning docs, anxious to help their patients, rely on meds before exploring other, non medication options such as psychotherapy? And, what do you think of the "cocktail" approach, where drugs are added to counter-act the negative effects of drugs initially prescribed?
>
> I fully understand that drugs are often required, for a wide variety of reasons, but I'm also VERY concerned that alot of the issues we see P-docs for are created or exacerbated by the very meds we're prescribed.
>
> Just curious about how people here feel and think about that, both generally, as well as how it is relevant to themslves personally. On how the loss of congnitive abilities, weight gain, sexual dysfunction, etc so often associated with these meds has impacted each of us in ways like causing us to isolate, lose jobs, lower our self esteem, etc.. I know this is something a great many of us struggle with..
>
> Best Wishes,
>
> UppendownHi,
My answer to your question - it all depends on an ACCURATE DX. In my case (I am Bipolar II) drugs are the ONLY therapy, primitive as it is. Anything else is complete nonsense.
Geezer
Posted by adamie on May 3, 2002, at 14:55:36
In reply to Are Meds over prescribed ? , posted by Uppendown on May 3, 2002, at 12:42:29
MEDS are not over prescribed. this forum is mainly people who continue to have trouble. most people get the help they need from meds and dont bother posting here because they are too busy living their happy lives.
psychotherapy is over prescribed. it only helps people who are dealign with sadness. it cannot help much if at all when it comes to true mental illness. someone has severe anxiety and panic attacks... they cannot control it... they have something wrong with their brain... talking will Not help. meds are needed. Mental illness is uncontrollable. it is a condition people have no choice but to deal with. therefor meds are needed. just like meds are needed for any other Illness. too many people die because they dont get the rigth treatment. and i am sick of it.
Posted by Uppendown on May 3, 2002, at 15:15:52
In reply to Re: Are Meds over prescribed ? » Uppendown, posted by adamie on May 3, 2002, at 14:55:36
> MEDS are not over prescribed. this forum is mainly people who continue to have trouble. most people get the help they need from meds and dont bother posting here because they are too busy living their happy lives.
>
> psychotherapy is over prescribed. it only helps people who are dealign with sadness. it cannot help much if at all when it comes to true mental illness. someone has severe anxiety and panic attacks... they cannot control it... they have something wrong with their brain... talking will Not help. meds are needed. Mental illness is uncontrollable. it is a condition people have no choice but to deal with. therefor meds are needed. just like meds are needed for any other Illness. too many people die because they dont get the rigth treatment. and i am sick of it.
Hi Adamie, and Geezer,
Hmmm.. Interesting. Just to put this in some kind of perspective, I'm dxed as Bipolar type 1, daily cycler, "psychotic", (meaning I hallucinate virtually constantly..)with PTSD as well. I've done both meds, and psychotherapy, and am currently doing neither. And, for me, I received far more ongoingly useful help with therapy, than I ever did with the meds. Yes, I still cycle.. but I understand what I'm going through, and am able to put it all in a better, more constructive and positive context. Without all the *added* problems that came with the meds, I'm much more able to keep things in a positive light.I just wanted to add this, to say there ARE more than one way to approach these things... I very much understand what you are saying.. I used to say exactly the same thing ! I'm trying to be helpful here!
Best Wishes,
Uppendown
Posted by rainbowlight on May 3, 2002, at 22:23:37
In reply to Are Meds over prescribed ? , posted by Uppendown on May 3, 2002, at 12:42:29
For me personally, I had to weigh the pros and cons. The good benefits outway the side effects and down side of the meds for me. I do have to agree with you though that I think alot of meds are prescribed for the wrong disorders, or for people who truly do need only psychotherapy instead of a med. I certainly would not choose to take an SSRI for mild depression if therapy could fix my problem. I think the drug companies have got the general public believing that popping a Prozac is just as safe as taking an aspirin. Scary!
Posted by Ritch on May 4, 2002, at 11:25:44
In reply to Are Meds over prescribed ? , posted by Uppendown on May 3, 2002, at 12:42:29
> Hi Ya'll,
>
> Given all of our individual and collective experiences with all these meds, and the amount of posts about how people are STILL struggling after months and years taking these meds, do you think that meds are over prescribed ? Do you think that well meaning docs, anxious to help their patients, rely on meds before exploring other, non medication options such as psychotherapy? And, what do you think of the "cocktail" approach, where drugs are added to counter-act the negative effects of drugs initially prescribed?
>
> I fully understand that drugs are often required, for a wide variety of reasons, but I'm also VERY concerned that alot of the issues we see P-docs for are created or exacerbated by the very meds we're prescribed.
>
> Just curious about how people here feel and think about that, both generally, as well as how it is relevant to themslves personally. On how the loss of congnitive abilities, weight gain, sexual dysfunction, etc so often associated with these meds has impacted each of us in ways like causing us to isolate, lose jobs, lower our self esteem, etc.. I know this is something a great many of us struggle with..
>
> Best Wishes,
>
> Uppendown
Hi,I think sometimes we get used to these cocktails and we will still naturally complain because our symptoms aren't completely 100% overcome. However, I think I am much better off now taking low doses of 3-5 meds than I was taking a ton of lithium by itself (and more productive and paying more *taxes*). I personally don't *like* having to take so many pills (and pay for them). I am always looking for some way to simplify my med regime or possibly withdraw a medication if I feel I really don't need it. Also, polypharmacy isn't always due to the side effects of one med necessiating the addition of another. (That makes great ammunition for the antimedication crowd however) I think the bottom line in all of this is just that--the bottom line. The antimed folks are indirectly arguing a moral ideological issue---It's *bad* to take so many medicines, to be so dependent on them, when possibly you could just do therapy (or go to church) and wouldn't need them-what a shame! But IMO, it is employers and insurance companies that are pushing this antimed trend the hardest. It will be a media battle using subtle moral themes instead of presenting good evidence. But, the insurance companies and employers are bleeding red big time on RX meds-no disputing that. So... how are we going to get the *price* down? That's what is really going on IMHO. The "political economy" of the thing is being weighed on the collective social costs versus the collective social benefits of all of this medication. The antimed folks (at root) have in their argument that the costs of all of this medicating greatly outweighs what benefits we are getting from it. So, what side of the "curve" are we on? Would spending *more* on psych meds and medicating more people yield a greater **measurable** collective benefit? It is going to be *voted* on by people where they work. Health insurance premiums and copayments are already going up and those are being passed along to workers. How much more "collectively" are workers going to be willing to pay (in premiums), before they reach a point where they don't feel it is worth it to subsidize other people's meds? So, we are going to get down to "who is going to pay?". Of course, if you are well-off and have an expensive pdoc you will pay for the meds you need yourself and not be impacted that much. The question is--if we cut demand for medications by the masses by cutting off the funding (thru insurance formularies-increased copays,etc.) will be actually be harming people (and society as a whole) because they have barriers to access?
Mitch
Posted by Uppendown on May 5, 2002, at 16:10:55
In reply to Re: Are Meds over prescribed ? » Uppendown, posted by Ritch on May 4, 2002, at 11:25:44
Hi Ritch,
Thanks for replying... and bringing up those points.
I've scanned through the Anti-med stuff, but I've not nearly spent as much time exploring that side of all this, as I have participated on a number of "mental health" message boards, and researched clinical studies for a couple of years now. I'm trying to keep my mind open to as many perspectives as I can.. As I'm sure you know, things in life are rarely either black or white. ;O)
The money side of meds ? Don't get me started on that !! But that industry is much the same as the auto industy, banking, insurance, oil, etc... they do what ever they can to maximize profits... That is the name of the game..
But my real interest, and reason for posting the question in the first place is that in participating and lurking on so many forums, for a pretty long time now.. I've seen quite a few things that they all share. Some are a form of "group dynamic", which has come to interest me.. But there do seem to be a lot of folks who have "life" issues involved. By that, I mean things like relationship, job, economic, school, low self esteem, etc... Things that surely cause upset in their lives, but hardly warrant being put on meds... things that a good councelor or therapist would probably be very good in helping that person develop better perspectives of themselves, and how they interact with their world. I can't tell you how many posts I've read and responded to that fit this description. I believe the is a "similar" thread on this page, " Now I'm Bipolar!". Of course I'm neither a doc, nor know the details of that situation, but it APPEARS to be an example of my very question " Are meds being over-prescribed?" In this case, because of what appears to be a "bad" med reaction, the doc is now mis-diagnosing that individual as bipolar... And if that person wasn't wise enough to question that diagnosis, but instead went along with "Dr. God" ( so many people don't "dare" question their docs..), and as a bipolar, started a med regime that means being medicated 24 hours a day, 7 days a week.. for the rest of their lives! For the sake of discussion, how many *others* are out there who *were* misdiagnosed, and are now on meds believing their "emotional" stuff is a "proof" symptom that the doc was right... don't question their Dx.. and are miserable still because no pill is ever going to "fix" bad relationship skills ! ( For example) But now, on top of their original "problem" of poor self esteem, codependancy, etc.. they now have gained 60 or 100 lbs, can't think clearly, etc, etc, etc... In their now "drugged" state, ( and we've taken enough to know how mind altering and powerful alot of them are..) how many do you think will step back and question their DX at THAT point ??? How many instead will interpret their difficulties as "evidence" that the dx was in fact correct ?? To what extent do forums such as this one essentially "support" being "sick" ?? How many posts have you read of people wishing they were " my old self again" ?? How many of those may in fact be misdiagnosed??
As I said, my concern is sincere... I've personally gone through all the above, and am still looking for answers... I'm only trying to get all of us to think about possibilities... explore ..Best Wishes,
Uppendown
Posted by Ritch on May 5, 2002, at 17:45:23
In reply to Re: Are Meds over prescribed ? Ritch.. , posted by Uppendown on May 5, 2002, at 16:10:55
.........For the sake of discussion, how many *others* are out there who *were* misdiagnosed, and are now on meds believing their "emotional" stuff is a "proof" symptom that the doc was right... don't question their Dx.. and are miserable still because no pill is ever going to "fix" bad relationship skills ! ( For example) But now, on top of their original "problem" of poor self esteem, codependancy, etc.. they now have gained 60 or 100 lbs, can't think clearly, etc, etc, etc... In their now "drugged" state, ( and we've taken enough to know how mind altering and powerful alot of them are..) how many do you think will step back and question their DX at THAT point ??? How many instead will interpret their difficulties as "evidence" that the dx was in fact correct ?? To what extent do forums such as this one essentially "support" being "sick" ?? How many posts have you read of people wishing they were " my old self again" ?? How many of those may in fact be misdiagnosed??
>
>
> As I said, my concern is sincere... I've personally gone through all the above, and am still looking for answers... I'm only trying to get all of us to think about possibilities... explore ..
>
> Best Wishes,
>
> Uppendown
Hi,Some very interesting points you are making there. IMO, psychiatrists do not make the best therapists. I am sure there *are* pdocs which also happen to be outstanding therapists. I have had heard some good stories related to that. However, I tend to believe that is the exception rather than the rule. Perhaps a lot of pdocs "flunk" at therapy because there isn't enough *time*. I honestly believe *any* time period less than 50 minutes is worthless for therapy, and most pdoc visits are 15-30 minutes-just a hunch ("med checks"). Before we got flooded with all of the new pharmaceuticals to tinker with-therapy was very important and that usually was accomplished with clinical psychologists and psychiatric social workers. I am not saying that has come to a stop, it is just that the spotlight has now shifted from therapy to the pdoc because they now have all sorts of new tools in their toolkits which they didn't have before-many of which are quite powerful and helpful. We are just seeing folks with the powerful new tools that don't do therapy very well, and that just highlights the issue even more. I wouldn't want to go back to being "my old self"-NONONO :-) I have put up with my share of horrific driving habits, losing jobs, failing to get thru school, etc., because I went off my meds. I think the phenomena you are trying to address is the notion of a "pill for every problem-no matter how slight". That issue gets real sticky if you include pills for purely "physical" problems which reduce suffering for people that have arthritis-diabetes-heart disease, etc. I still believe that it is all boiling down to $$$. If all of these fancy new pills for everything under the sun were exceptionally cheap, I don't think there would be that much of a controversy. I believe that many in government/politics look at "overmedication" as a danger to society (the economy), precisely because it is too damned expensive..period. All of the baby boomers are beginning to retire and the oft talked about shift from people paying for the benefits and those receiving it is now underway and everybody is trying to cut the costs.
Mitch
Posted by rainbowlight on May 6, 2002, at 1:49:50
In reply to Re: Are Meds over prescribed ? Ritch.. , posted by Uppendown on May 5, 2002, at 16:10:55
Wow, Rich, your post really made me think. I believe it starts with the drug companies. They put the commercials out that make the drugs look like candy. A person who is suffering in their life with depression may feel unable to "fix" their "life" problems, they see the commercial, run to their doctor who then prescribes the drug the patient wants that was seen on the commercial. They end up hating the way the meds make them feel, which in turn, like you said, makes them want their old selves back. They stop the med, return to their old selves, and the cycle starts all over again. It happens everyday. I also see it on many forums on the net. I have had MANY pdocs ask me what med I WANT to be on! Not, what I SHOULD be on. Very scary stuff! I do believe it is a cop-out for some too. They can conveniently blame all the problems they don't feel like fixing on a "mental disorder" they might not even have. I think it gives the rest of us who really DO have mental disorders a bad name. I believe that in General the mental health system in our country is a mess. Personally, in my area, and I live in a very largely populated area of the US that we only have like 2 psychiatric hospitals available, they are very overcrowded and the conditions are less than ideal. You have to beg to get in to get some help, and you have to convince your insurance company that you DO need help so they will pay for it, as if you weren't already stressed out enough! LOL! Well, sorry for the rant, you must have stirred something in me! LOL! You have some great questions!
Posted by Ritch on May 6, 2002, at 11:40:53
In reply to Re: Are Meds over prescribed ? Ritch.. , posted by rainbowlight on May 6, 2002, at 1:49:50
> Wow, Rich, your post really made me think. I believe it starts with the drug companies. They put the commercials out that make the drugs look like candy. A person who is suffering in their life with depression may feel unable to "fix" their "life" problems, they see the commercial, run to their doctor who then prescribes the drug the patient wants that was seen on the commercial. They end up hating the way the meds make them feel, which in turn, like you said, makes them want their old selves back. They stop the med, return to their old selves, and the cycle starts all over again. It happens everyday. I also see it on many forums on the net. I have had MANY pdocs ask me what med I WANT to be on! Not, what I SHOULD be on. Very scary stuff! I do believe it is a cop-out for some too. They can conveniently blame all the problems they don't feel like fixing on a "mental disorder" they might not even have. I think it gives the rest of us who really DO have mental disorders a bad name. I believe that in General the mental health system in our country is a mess. Personally, in my area, and I live in a very largely populated area of the US that we only have like 2 psychiatric hospitals available, they are very overcrowded and the conditions are less than ideal. You have to beg to get in to get some help, and you have to convince your insurance company that you DO need help so they will pay for it, as if you weren't already stressed out enough! LOL! Well, sorry for the rant, you must have stirred something in me! LOL! You have some great questions!
Hi Rainbowlight- thanks for putting your 2cents in. Both "sides" have good arguments, which of course clouds things all the more-but that is what makes it interesting. The part about your doctor asking you what YOU would like to take being scary can also have a very scary flipside. What if your pdoc is very conservative and will not prescribe "off-label", doesn't like polypharmacy, etc, and is not allowing you to realize a potential benefit from new "experimental" medicines because he/she thinks it isn't worth the time (thinks they are most likely ineffective-not worth the hassle-rightly or wrongly)? There *could* be a med you haven't tried that would dramatically improve your symptoms that you haven't tried yet.... So, the 'flip' of that one is: Are we (patient or doctor!) using medication to *avoid* therapy (because we are afraid of it or because it doesn't work!)? Or possibly, are we at a "good as it gets" place, and either we or our pdoc can't see it-so if we can't see it-then we don't ever really begin to *accept* the situation and then work on the non-medication issues,,,,,,"we never get there". I think we are starting to get *there* right now, mainly because there has been a lapse in the amt. of new psych drugs becoming available. We are just coming out from under the avalanche of newer antidepressants/anticonvulsants that have popped up in the last decade and beginning to survey things a little closer. Opinion-wise, I still believe it was a mistake to let RX drugs be advertised on TV. I think it would have been best to let doctors make the judgements (pdocs and GP's), and cross your fingers the doctors you see are reading thier journals (IOW, give a damn) and keeping up with all the research on the medications they have available to prescribe. There is a lot more information on the net than you can get on the tube. Unfortunately, if you can't read well (or just don't want to!), you are going to "listen" to your information and that puts you at a disadvantage. Interesting what you say about being run through the ringer to get help and getting help to pay for psych troubles. It has always been like this. Mental illness is looked at generally as a chronic character flaw, and nobody wants to pay somebody money to beat a dead horse. That is sad, but I am afraid that is more accurate than people would like to admit.Mitch
Posted by Uppendown on May 6, 2002, at 21:38:48
In reply to Re: Are Meds over prescribed ? Ritch.. » rainbowlight, posted by Ritch on May 6, 2002, at 11:40:53
Hey Mitch,
I just wanted to add to what you're talking about... I'm sure you saw the article about the Amer. Psych. Ass. Annual Conference.. where P-docs were resigning at that conference, publicly denouncing the current HMO system that alows them 15 minute visits with their patients.. ( You spoke of this previously..). They said that they didn't spend all those years, getting all that training so that they could become "pill pushers" for the pharmo companies ! They said it was impossible under the current system to do any meaningful therapy, which made that option a non option. It is "pills", or nothing.
And.. I do agree with you about the "cop-out" thing. I don't think the vast majority of folks that are taking meds for things that aren't "mental illness" are even aware of it. I think they truely and honestly are in pain.. I think they are honestly looking for help from "professionals"... but have no idea that the "help" they are getting is mis directed.. that they are being mis-diadnosed... As we have seen even here, recently, patients are being misdiagnosed all the time... and if they aren't educted enough to question the DX.. they get on that med tread mill.. They become card carrying members of "ClubMed" ! LOL!
Just more thoughts... I think this is a serious problem ! Did you, by any chance, see 60 Minutes last night ? They had a story about Breast Cancer, where a doc said they thought *80%* of the people getting treatments for that were getting unneccessary treatment !! Think THAT through! So much unneccessary suffering...
Best Wishes,Uppendown
Posted by Ritch on May 6, 2002, at 23:33:10
In reply to And HMOs help? Ritch.. ;O), posted by Uppendown on May 6, 2002, at 21:38:48
> Hey Mitch,
>
> I just wanted to add to what you're talking about... I'm sure you saw the article about the Amer. Psych. Ass. Annual Conference.. where P-docs were resigning at that conference, publicly denouncing the current HMO system that alows them 15 minute visits with their patients.. ( You spoke of this previously..). They said that they didn't spend all those years, getting all that training so that they could become "pill pushers" for the pharmo companies ! They said it was impossible under the current system to do any meaningful therapy, which made that option a non option. It is "pills", or nothing.
> And.. I do agree with you about the "cop-out" thing. I don't think the vast majority of folks that are taking meds for things that aren't "mental illness" are even aware of it. I think they truely and honestly are in pain.. I think they are honestly looking for help from "professionals"... but have no idea that the "help" they are getting is mis directed.. that they are being mis-diadnosed... As we have seen even here, recently, patients are being misdiagnosed all the time... and if they aren't educted enough to question the DX.. they get on that med tread mill.. They become card carrying members of "ClubMed" ! LOL!
>
>
> Just more thoughts... I think this is a serious problem ! Did you, by any chance, see 60 Minutes last night ? They had a story about Breast Cancer, where a doc said they thought *80%* of the people getting treatments for that were getting unneccessary treatment !! Think THAT through! So much unneccessary suffering...
>
>
> Best Wishes,
>
> UppendownHi,
That is interesting. No, I am unaware what was happening with the APA and pdocs complaining about 15 minute visits and HMO's. Well, historically speaking-that has been what pdocs have been relegated to be-meds folks (in the last 30 years anyhow). Obviously, you probably have two different batches of MD psychiatrists out there. One set is more interested in the psychology and the different therapy strategies to helping patients and the other is more like an internal medicine dude-and is happy to be considered a "psychopharmacologist" instead (give me SPECT scans, charts/input from the psychologist/SW "therapist", and I will make the med decisions in my 15 minute time-frame). I don't see great harm in that really. The tragedy is with the pdoc that spent all that $$$ and *doesn't* want to be a psychopharmacologist, but wants to get the premium daneiro and still do therapy, and is running into all of these barriers. Question is: Does the pdoc that can do all the hurdles and "barrier classes" of med school and be primarily interested in therapy be a truly *superior* therapist than someone who has a Master's in Clinical psychology or Psychiatric Social Work that didn't have to do all of the bio-chem and calculus?? Are they just finding themselves the odd-man out? I don't know.
Mitch
This is the end of the thread.
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