3 ms·

I recently read a book [0] that made a compelling case that mental health conditions can often be perpetuated, if not created, by the drugs that purport to trea

I recently read a book [0] that made a compelling case that mental health conditions can often be perpetuated, if not created, by the drugs that purport to treat those conditions (the formal term being "iatrogenic" [1]). If true, it's a classic perverse incentive, and a stable closed loop that's good for business and bad for patients, even if the vast majority of practitioners are writing prescriptions in good faith, from a genuine desire to help the afflicted. As a layperson who is suspicious of Big Pharma, I'd be interested to hear other perspectives from those more knowledgable (the book admittedly reinforces my pre-existing opinion!). But however many people are genuinely better off through the use of pharmaceuticals (and I'm sure there are many), I don't think it's controversial to claim that such drugs are often over-prescribed, compared to less profitable solutions (CBT, group therapy, or even basic things like sunshine, movement, and diet). [0] https://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic https://en.wikipedia.org/wiki/Anatomy_of_an_Epidemic [1] https://en.wikipedia.org/wiki/Iatrogenesis https://en.wikipedia.org/wiki/Iatrogenesis

outlace 7y ago
Most anti-depressants are prescribed by general practitioners, not psychiatrists. I've actually this seen interaction before: --- (Generalist) MD: Ok so I'll see you back in 4 weeks to check up on your high blood pressure. Oh um.. you seem a little down today, are you depressed? Patient: Yes, doctor, I've been feeling pretty depressed lately, I ... MD: Ok would you like to try something for that? Patient: Uh ok, sure.. I guess MD: Alright I just wrote you for an anti-depressant, I think that will help. --- That's definitely not an interaction that would happen with a psychiatrist. It is true that psych drugs can cause harm, or do nothing. But I've also seen very dramatic improvements in people's lives from psych drugs, and I think its the fact that enough practitioners see enough of these amazing transformations that it seems like its worth it for some subset of people, and justifies the enterprise. Probably the majority of depression and anxiety we see in modern society is the byproduct of...modern society. Lack of meaningful work and relationships, high work stress, poor physical health and diet, etc. Some of these are the same cause of many cases of high blood pressure and diabetes, but just like with high blood pressure and diabetes, many of those patients just do not have the motivation or desire or ability to make the changes in their lives to improve their physical and mental health. So they want a pill. However, if you go to an inpatient psych hospital, those are mostly people are seriously impaired. Not all of them will benefit from medications, but many will. A bipolar patient may totally throw her life off the rails during a manic episode but can live mania free if on medications. It's just a very messy business. I have seen lots of patients who go from being so impaired they cannot lead a normal life to being fairly function on medications. But also many who get no benefit after many med trials. And others who are possibly worsened by meds. Nonetheless, we're starting to see studies showing that we can predict, based on biological markers, which patients will likely respond to particular treatments. See for example the http://williamspanlab.com/ http://williamspanlab.com/ at Stanford. There they are piloting a study where patients receive a number of biological and symptom-based diagnostic tests, analyzed by predictive algorithms and this analysis is given to the treating physician to help guide treatment. Despite the unsavory history, I really think things are looking up for psychiatry as a field. But surely change will be slow.

outlace 7y ago

Most anti-depressants are prescribed by general practitioners, not psychiatrists. I've actually this seen interaction before: --- (Generalist) MD: Ok so I'll see you back in 4 weeks to check up on your high blood pressure. Oh um.. you seem a little down today, are you depressed? Patient: Yes, doctor, I've been feeling pretty depressed lately, I ... MD: Ok would you like to try something for that? Patient: Uh ok, sure.. I guess MD: Alright I just wrote you for an anti-depressant, I think that will help. --- That's definitely not an interaction that would happen with a psychiatrist. It is true that psych drugs can cause harm, or do nothing. But I've also seen very dramatic improvements in people's lives from psych drugs, and I think its the fact that enough practitioners see enough of these amazing transformations that it seems like its worth it for some subset of people, and justifies the enterprise. Probably the majority of depression and anxiety we see in modern society is the byproduct of...modern society. Lack of meaningful work and relationships, high work stress, poor physical health and diet, etc. Some of these are the same cause of many cases of high blood pressure and diabetes, but just like with high blood pressure and diabetes, many of those patients just do not have the motivation or desire or ability to make the changes in their lives to improve their physical and mental health. So they want a pill. However, if you go to an inpatient psych hospital, those are mostly people are seriously impaired. Not all of them will benefit from medications, but many will. A bipolar patient may totally throw her life off the rails during a manic episode but can live mania free if on medications. It's just a very messy business. I have seen lots of patients who go from being so impaired they cannot lead a normal life to being fairly function on medications. But also many who get no benefit after many med trials. And others who are possibly worsened by meds. Nonetheless, we're starting to see studies showing that we can predict, based on biological markers, which patients will likely respond to particular treatments. See for example the http://williamspanlab.com/ http://williamspanlab.com/ at Stanford. There they are piloting a study where patients receive a number of biological and symptom-based diagnostic tests, analyzed by predictive algorithms and this analysis is given to the treating physician to help guide treatment. Despite the unsavory history, I really think things are looking up for psychiatry as a field. But surely change will be slow.