Someone I know who has long suffered from serious anxiety is currently on Xanax, Atarax, Klonopin, Inderal, and an SSRI.
What's behind this overmedication – four different drugs (not the SSRI), each of which is intended to treat that anxiety – is how mental health treatment has evolved over the past decades.
Where I had a psychiatrist from the get-go in 1977 (after I recovered from the first of four episodes of major depression) whom I saw once a week for talk therapy and who prescribed medication, my friend has a psychologist who delivers psychotherapy and a psychiatrist who works with the psychologist and prescribes medication – no talk with my friend: the psychiatrist works with the psychologist and selects medications based on their consensus.
Over the years, what with changes in both psychologists and psychiatrists, my friend has accumulated a collection of medications which results in her being forced to figure out each time she's anxious what particular drug(s) she should take at that moment.
This is not the way.
There's almost no chance she'll ever be able to get off this array of mind-altering drugs as long as she's under the care of this – or any – combined pair of doctors.
Sad, insightful and true
ReplyDeleteI agree that this is not the way. Back in the 80s, in the state hospital where I worked, pharmacists attended most treatment team meetings and the issue of polypharmacy was nearly always part of the discussion. When I returned to that kind of work in the 90s, the word polypharmacy was no longer being used, but justification for using more than one medication to treat the same symptoms was just part of what was expected. Given the severity of the symptoms of our patients, having two antipsychotics (and very rarely three) prescribed was not uncommon, but certainly not for the majority. Failed attempts at monotherapy were always part of the documentation in these instances. I think that in the absence of a professional using monotherapy as a standard for prescribing, your friend is stuck with asking, by herself, for a reasoned answer to whether one med will do the job. I also want to add that you were very fortunate to find a psychiatrist who had also been trained in psychotherapy. I believe that is extraordinarily rare.
ReplyDeleteMy psychiatrist trained in the early 1980s, when psychotherapy was a major part of residency training. Your best bet, all other things being equal, is to find an old psychiatrist who is still practicing. From Perplexity Pro: "----------------- M.D. is a psychiatrist practicing in Charlottesville, Virginia. According to Healthgrades, he is 71 years old, and he has been licensed to practice medicine in Virginia since 1983 — over 45 years of active clinical practice, per the Virginia Board of Medicine."
Delete