4 ms·

That's possible but it's an awful lot of speculation. She also might have had lots of patients who did so well on SSRIs they stopped seeing her and just had the

That's possible but it's an awful lot of speculation. She also might have had lots of patients who did so well on SSRIs they stopped seeing her and just had their GP prescribe the medication from then on. Or all her patients might have overdosed on an unrelated drug and died. You can come up with lots of scenarios other than the most likely one. But this: > They would have discontinued the medication, terminated the doctor patient relationship, then waited for things to "go back to normal" when they were off the drug but found it never did. is not the way a good psychiatry practice (like the one I frequent, IMO) is designed to work. You try a lot of different things and you see what works. You're told upfront that this is part of the process and that if you don't like a medication, you don't have to keep taking it, and you should tell the doctor why and what you're open to trying next. I tried buspirone (which I still take), duloxetine (intolerable GI side effects; didn't take for long enough to experience anything sexual), and bupropion (too stimulating, not right for my condition) before I settled on citalopram. I had been specifically avoiding citalopram because I was scared of it, and I feel a little foolish for that now. So I think your scenario is unlikely in my case. I can't speak for other doctors.

staticman2 5y ago
You don't have to keep taking the drug, I agree. But the doctor will give you another instead, and if the dysfunction continues it will be assumed to be a "temporary" symptom of the subsequent drug like it was with the old drug. You won't go "cold turkey" to see if things go back to normal unless you fire the psychiatrist because frankly, in America at least, psychiatrists are pill pushers and, unless you are wealthy and will pay out of pocket, you will only get insurance covered talk therapy with a cheaper psychologist or social worker. Psychiatrist are often only there for quick discussions about medication. The time intensive talk therapy is done by someone less expensive. In my area psychiatrist will often partner with therapy practices and only handle the drug side of things. If someone stops taking drugs, there would be no reason to see the psychiatrist.
- ivraatiems 5y ago
  > You won't go "cold turkey" to see if things go back to normal unless you fire the psychiatrist because frankly, in America at least, psychiatrists are pill pushers and, unless you are wealthy and will pay out of pocket, you will only get insurance covered therapy with a cheaper psychologist or social worker. This is just not my experience, sorry. Perhaps this is true of the majority and I got lucky, or perhaps you have had some very negative experiences worth sharing, but I have never felt pressured to do anything I didn't want to do. After I tried duloxetine, I waited several months before trying anything again (except the buspirone which, as I mentioned, I'd been on the whole time). I met with my psychiatrist regularly during that time. It was all covered by insurance. In fact, going directly from one SSRI to another without cross-tapering is not standard practice and can be quite debilitating. If your physician did this to you, they were not doing their job correctly. > Psychiatrist are only there for quick discussions about medication. The time intensive talk therapy is done by someone less expensive. True, but not really relevant, I think. If medication is what you want, a psychiatrist is who you should have. Choosing the right one can be a challenge, I agree, but that doesn't make their profession not valuable.
  - staticman2 5y ago
    I meant cold turkey as a synonym for no longer on drugs, I should have phrased it differently. I never said psychiatrists pressure patients. I said they only treat patients on drugs. If the patient decides to go off drugs that's the natural end of the relationship. You replied and said you saw a psychiatrist when you were still on a anxiety drug and the insurance paid for it. Well, of course they did, you were taking a drug. You are correct that some patients could stop taking an SSRI and still see a psychiatrist. I'm also correct that many patients who have gone off the drug to see if the sexual dysfunction stops will probably no longer be making appointments with the psychiatrist. What would be the point? If they want to talk to someone that's what therapists are for.
    - ivraatiems 5y ago
      > You replied and said you saw a psychiatrist when you were still on a anxiety drug and the insurance paid for it. Well, of course they did, you were taking a drug. The insurance company doesn't know what you are discussing in your sessions and isn't going to let you see or not see a specialist just based on whether they prescribe you meds. That's not how it works - or not how it should be working if your insurer is acting appropriately. I also saw this psychiatrist a couple of times before taking anything. I didn't walk out of my first session with a prescription for buspirone. > I never said psychiatrists pressure patients. I said they only treat patients on drugs. If the patient decides to go off drugs that's the natural end of the relationship. It is, but that doesn't mean you just immediately stop seeing them and never communicate again. That's not how it works - with a good psychiatrist at a good practice. You taper off, verify the taper worked and you have no further issues, and then stop seeing them if you want. > I'm also correct that many patients who have gone off the drug to see if the sexual dysfunction stops will probably no longer be making appointments with the psychiatrist. What would be the point? If they want to talk to someone that's what therapists are for. You need to provide some data for this assertion if you are going to keep making it. The point is that the psychiatrist, as the person overseeing your care, is the person you would naturally tell about a problem you were having. I don't think "go off the drug and just stop talking to the doctor" is the normal behavior, I think it's more like "tell the doctor you're going off the drug, confirm you went off the drug, the doctor asks if you want to try another drug, you say no, and then you stop talking to the doctor." I'm sure some people do just stop taking whatever they're taking and never speak to their doctor's office again - but most practices are set up to prevent that, because you'd have to actually cancel an appointment and ignore phone calls in order to get to that point. Doctors hate risk by and large, and letting patients randomly discontinue drugs with no supervision is not something they generally want to incentivize.

staticman2 5y ago

You don't have to keep taking the drug, I agree. But the doctor will give you another instead, and if the dysfunction continues it will be assumed to be a "temporary" symptom of the subsequent drug like it was with the old drug. You won't go "cold turkey" to see if things go back to normal unless you fire the psychiatrist because frankly, in America at least, psychiatrists are pill pushers and, unless you are wealthy and will pay out of pocket, you will only get insurance covered talk therapy with a cheaper psychologist or social worker. Psychiatrist are often only there for quick discussions about medication. The time intensive talk therapy is done by someone less expensive. In my area psychiatrist will often partner with therapy practices and only handle the drug side of things. If someone stops taking drugs, there would be no reason to see the psychiatrist.

ivraatiems 5y ago
> You won't go "cold turkey" to see if things go back to normal unless you fire the psychiatrist because frankly, in America at least, psychiatrists are pill pushers and, unless you are wealthy and will pay out of pocket, you will only get insurance covered therapy with a cheaper psychologist or social worker. This is just not my experience, sorry. Perhaps this is true of the majority and I got lucky, or perhaps you have had some very negative experiences worth sharing, but I have never felt pressured to do anything I didn't want to do. After I tried duloxetine, I waited several months before trying anything again (except the buspirone which, as I mentioned, I'd been on the whole time). I met with my psychiatrist regularly during that time. It was all covered by insurance. In fact, going directly from one SSRI to another without cross-tapering is not standard practice and can be quite debilitating. If your physician did this to you, they were not doing their job correctly. > Psychiatrist are only there for quick discussions about medication. The time intensive talk therapy is done by someone less expensive. True, but not really relevant, I think. If medication is what you want, a psychiatrist is who you should have. Choosing the right one can be a challenge, I agree, but that doesn't make their profession not valuable.
- staticman2 5y ago
  I meant cold turkey as a synonym for no longer on drugs, I should have phrased it differently. I never said psychiatrists pressure patients. I said they only treat patients on drugs. If the patient decides to go off drugs that's the natural end of the relationship. You replied and said you saw a psychiatrist when you were still on a anxiety drug and the insurance paid for it. Well, of course they did, you were taking a drug. You are correct that some patients could stop taking an SSRI and still see a psychiatrist. I'm also correct that many patients who have gone off the drug to see if the sexual dysfunction stops will probably no longer be making appointments with the psychiatrist. What would be the point? If they want to talk to someone that's what therapists are for.
  - ivraatiems 5y ago
    > You replied and said you saw a psychiatrist when you were still on a anxiety drug and the insurance paid for it. Well, of course they did, you were taking a drug. The insurance company doesn't know what you are discussing in your sessions and isn't going to let you see or not see a specialist just based on whether they prescribe you meds. That's not how it works - or not how it should be working if your insurer is acting appropriately. I also saw this psychiatrist a couple of times before taking anything. I didn't walk out of my first session with a prescription for buspirone. > I never said psychiatrists pressure patients. I said they only treat patients on drugs. If the patient decides to go off drugs that's the natural end of the relationship. It is, but that doesn't mean you just immediately stop seeing them and never communicate again. That's not how it works - with a good psychiatrist at a good practice. You taper off, verify the taper worked and you have no further issues, and then stop seeing them if you want. > I'm also correct that many patients who have gone off the drug to see if the sexual dysfunction stops will probably no longer be making appointments with the psychiatrist. What would be the point? If they want to talk to someone that's what therapists are for. You need to provide some data for this assertion if you are going to keep making it. The point is that the psychiatrist, as the person overseeing your care, is the person you would naturally tell about a problem you were having. I don't think "go off the drug and just stop talking to the doctor" is the normal behavior, I think it's more like "tell the doctor you're going off the drug, confirm you went off the drug, the doctor asks if you want to try another drug, you say no, and then you stop talking to the doctor." I'm sure some people do just stop taking whatever they're taking and never speak to their doctor's office again - but most practices are set up to prevent that, because you'd have to actually cancel an appointment and ignore phone calls in order to get to that point. Doctors hate risk by and large, and letting patients randomly discontinue drugs with no supervision is not something they generally want to incentivize.