Prescriptions for psychiatric problems on the rise

[Doctor Strange]

I read the book years before the film was made. And I went on a high school trip to see the stage version at the old Mercer Arts Center (near NYU) in NYC in 1971. The play was great - like the book and film.

Many people aren't even aware that there was a theatrical adaptation before the film; in the original Broadway production, Kirk Douglas played McMurphy and Gene Wilder played Billy Bibbit. And it was written by Dale (Man of La Mancha) Wasserman!

http://en.wikipedia.org/wiki/One_Flew_Over_the_Cuckoo's_Nest_(play)

 

[ButteMT61]

... In some ways, there are far more eyes on her drug use than there would have been in the Golden Age (multiple doctors, pharmacists, and her health insurance) rather than a single doctor and a pharmacist, but all these people are far less invested in her overall care. If anything, one would think that somebody who reviews her claims (and is in charge of payout) would flag it and stop paying...

Exactly! There literally is no "care" in healthcare today. And nobody will flag this unless the profits are less than the paperwork. So your aunt can continue merrily along. I'm not being insensitive - maybe it's what keeps her going. I know a few people like that, and honestly, if they're functional and happy, then so be it. Assuming no harm is coming to her in a physiological and/or mental health sense.

 

[1961MJS]

Hi

My Dad has been in bad health for a couple of years, finally dying in mid-August at 92. Mom is only 80, and was staying up pretty much 24/7 to make sure he was o.k. When he finally went to a nursing home, an emergency room doctor put Mom on Xanax, 4 a day. She took two before deciding that wasn't going to work. She took the first at bedtime, woke up at 10 am, took her "missed" 8 AM pill and slept until 4 PM.

I think that the insurance companies are shying away from operations if possible now. If a pill works, then you'll be fine (and out of their hair), it it doesn't work, they have several thousand more pills to try....

Later

 

[shopgirl61]

I see this as very relevant to noting that "progress" and our current culture is obviously not doing so great, whether it's bought doctors, crooked salesmen or an increasingly "nervous" population. I don't have the stats but I don't know if so many people used to take psychotropic meds.

Your question adds to the conversation...how?

We have a 125 year old pharmacy in town that has been in its original building since the 30s complete with an upper floor that has many medicine bottles
and the likes on display, believe me when I say that what people took back in the day was far more potent than today's. its just that there is mass marketing methods now that garner the attention of patients.

 

[V.C. Brunswick]

This is enough to make one become a Scientologist. I won't digress but I think they've hit the nail on the head in their view toward psychiatry.

 

[Hawkcigar]

I work in a hospital pharmacy and supervise a staff of approximately 50 people. My specialty is compounding of drugs that are not commercially available and I have developed a couple of definite opinions over the years.

I think the increase in pharmaceutical advertising is absolutely to blame for the increase of psych drugs. The industry has convinced us that we should all be happy all the time. If you're not happy then there's something wrong and you'd better ask you doctor for that Prozac script. Patients see these commercials on TV and demand to their physician they get the latest super pill they saw while watching Grey's Anatomy. We've lost sight of the fact that life is made up of a lot of ups and downs and it's ok to be sad or depressed occasionally. I'm obviously not referring to those who suffer from true clinical depression.

Luckily, my hospital has pretty much banned drug reps from roaming through the clinics unattended. All the drug reps have to register with the compliance office and we don't allow the distribution of samples. Back in the old days it would be nothing for a drug rep to spend a few hundred $ for lunch. Thankfully those days are coming to an end, at least at my particular hospital.

 

[PrettySquareGal]

The industry has convinced us that we should all be happy all the time. If you're not happy then there's something wrong and you'd better ask you doctor for that Prozac script.

I couldn't agree more!

 

[Connery]

In my experience, a good physician generally does not dole out prescription medication like a "Pez" dispenser. There are protocols to follow and if this is a Primary Care Physician he usually refers the patient to a specialist. There are many reasons for this, not the least of which is a concern for a medical malpractice lawsuit.

 

[sheeplady]

Well, I think it's important to note that psychiatric illness is a huge category that (I personally think) is lumped together set of illnesses. I think someday we're going to find out is really several very different sets of illness. We put them together because a person's mental state is outside of normal, and it is kind of like creating a category of physical illness based upon symptoms rather than the cause, because we still don't understand the cause. We know that in many cases the brain chemistry is different, but what causes this difference? Why do some treatments work for some but not for others?

Think about it for a second- we've got personality disorders, schizoprenia, and depression in one over-arching category of "psych illness." Those illnesses (if you've ever known someone with them) are as different as night and day. Even clinical depression can have many different causes- those that have life triggering events and those that don't- which suggests different avenues of treatment.

We don't lump physical illnesses together- there is no "physical illness" department at a hospital or a "physcial illness doctor" who specializes in cancer and heart disease; because even though all those can make your left arm hurt, they are very different diseases with very different treatments and causes.

 

[LizzieMaine]

In my experience, a good physician generally does not dole out prescription medication like a "Pez" dispenser. There are protocols to follow and if this is a Primary Care Physician he usually refers the patient to a specialist. There are many reasons for this, not the least of which is a concern for a medical malpractice lawsuit.

That's the thing -- we're expected to assume that all doctors are "good doctors." But as with any profession there are good doctors and mediocre doctors and money-grubbing hacks. But for some reason coming out and saying that about the medical profession is unacceptable -- which is unfortunate, because what do you spend your money on that's more important than your health?

 

[Connery]

That's the thing -- we're expected to assume that all doctors are "good doctors." But as with any profession there are good doctors and mediocre doctors and money-grubbing hacks. But for some reason coming out and saying that about the medical profession is unacceptable -- which is unfortunate, because what do you spend your money on that's more important than your health?

I agree with you LizzieMaine and there is nothing wrong with that assumption. However, I also have to take the responsibility to research the doctor that I planning to use; that means get references from people I trust and referrals from those in the medical profession. Also, if I have a question...ask it for heaven's sake. That "halo" surrounding a physician's head is long gone and been replaced by a level of expectation that they perform as "good doctors" in a professional manner, in all respects.

 

[amador]

No halo here. I thought I would chime in from the inside. I see a great many patients that WANT a drug to fix something quickly and without effort. Common examples are smoking, obesity, depression, anxiety, chronic pain. I can tell patients to stop smoking which will clear up MOST cases of bronchitis, sinusitis, asthma, coronary heart disease and lots more. Eat less and MOST arthtitis, low back pain, cardiovasular disease, diabetes and others will either get better or go away. MOST epression and anxiety are circumstantial and temporary can be helped with nonmedical counseling or just emotional support from friends and family. Note that I said MOST.
Patients seem to want a quick and easy fix, and the pharmacutical companies are in a position to provide SOMETHING. That SOMETHING is a pill, placebo effect is about 38%. That means that if I give you ANYTHING including a suger pill 38% of you will get better. If you don't then there may be something that needs further attention.
If a smoker thinks he has a sinus infection and demands an antibiotic and I tell him that he does NOT have a sinus infection and he needs to stop smoking and does not need an antibiotic he will not come back. He will seek a Doctor who will give him his antibiotic and not hassel him about his smoking. Same with obesity, depression, anxiety etc.
Back in the Golden Era there were fewer drugs and people just endured until whatever they had would either get better or worse. If worse to the Doctor. There are no easy answers and no simple solutions.

 

[Edward]

I'm a very grateful recipient of the NHS's aid in my own struggle with mental illness. Fortunately, although I suffered from it for years before diagnosis (never occurred to me to go - I thought I was just a moody bugger! It was when I started losing time that scared me into it) my depression never got so all-consuming that it left me totally unable to function, nor did it (as the danger can be) evolve into bipolar. I came pretty damn close to a total breakdown a couple of times, though. I'm certain that there are many people who are palmed off with some pills; my doctors however were great, and in addition to carefully prescribed medication as and when (I'll probably be on and off that for the rest of my days) I had a course of therapy. Cynical as I was before I went, that was an enormous help in equipping me to deal with the condition, knowing when I need to address things or even go back on the meds for a bit. Back in the 40s, I'd have been dead or in an institution by now I have no doubt. Glad to live in an era where the stigma of mental illness is - rightly - finally beginning to fade.

 

[PrettySquareGal]

No halo here. I thought I would chime in from the inside. I see a great many patients that WANT a drug to fix something quickly and without effort. Common examples are smoking, obesity, depression, anxiety, chronic pain. I can tell patients to stop smoking which will clear up MOST cases of bronchitis, sinusitis, asthma, coronary heart disease and lots more. Eat less and MOST arthtitis, low back pain, cardiovasular disease, diabetes and others will either get better or go away. MOST epression and anxiety are circumstantial and temporary can be helped with nonmedical counseling or just emotional support from friends and family. Note that I said MOST.
Patients seem to want a quick and easy fix, and the pharmacutical companies are in a position to provide SOMETHING. That SOMETHING is a pill, placebo effect is about 38%. That means that if I give you ANYTHING including a suger pill 38% of you will get better. If you don't then there may be something that needs further attention.
If a smoker thinks he has a sinus infection and demands an antibiotic and I tell him that he does NOT have a sinus infection and he needs to stop smoking and does not need an antibiotic he will not come back. He will seek a Doctor who will give him his antibiotic and not hassel him about his smoking. Same with obesity, depression, anxiety etc.
Back in the Golden Era there were fewer drugs and people just endured until whatever they had would either get better or worse. If worse to the Doctor. There are no easy answers and no simple solutions.

That was also my experience when I used to work as a counselor.

 

[amador]

Glad to hear you are doing well Edward. The treatment you got is the way that I treat as well. Usually I will assess for urgent or emergent issues. If none, then a detailed evaluation by psychologist or psychiatrist and tests to determine if there are any physiological or medical causes. Usually he second evaluation will tease out any underlying disorder and either addressing the medical issues or initiating medications. Medications nowadays are much more subtle than they were back in the 30's 40's. Quick acting medications to handle urgent or emergent psych issues are available. More modern medications take some time to have an effect so... a short course of quick acting medications while waiting for the slower onset meds. Meanwhile "the talking cure" has to be ongoing. Studies have shown that both medications AND counseling are more effective than either alone.
Most people want to feel better TODAY and older medications will do that. So it is easier and less expensive to go that way. People don't want to spill their guts to a stranger in order to feel better so they start to demand the short acting immediate effect medications, leads to dependance and addiction. No easy answers, no simple solutions, everybody is unique, that's why it's called Practicing Medicine. The more you practice the better you get at it.

 

[davidraphael]

I'm a very grateful recipient of the NHS's aid in my own struggle with mental illness.

I'm glad to hear you're doing better and that you had a positive experience with the NHS. I suffered from panic disorder and depression (and related physical conditions). I ended up at my doctor at 8am one morning telling him that I genuinely didn't know how I was going to get through the day.
I was given a small handful of valium and offered a counsellor....but there was a minimum 10 month waiting list. (that's the NHS for you! I still remember the old NHS joke that there are 12 month waiting lists for abortions)

I was told to go on holiday - "somewhere warm and sunny"...

...And this is where it gets funny in a blackly amusing way....

I decided to go to Egypt. After a couple of days, just after I left Hatshepsut’s Temple, terrorists killed dozens of tourists. We were soon thereafter escorted out of the country under military escort.
I was an absolute wreck. Some holiday. Worse than before I had left!
I didn't even get my money back!
And when I returned I found out that my landlord had decided to kick me out!

Great year, that was....

I eventually learned to control the panic disorder with meditation. I do periodically suffer from depression, but to my shame I haven't dealt with it properly yet.

I live in Germany now and I have to say, generally, I'm pleased that I don't have to deal with the NHS. Healthcare on the continent is far superior by a long long way.