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Saving Yourself from the Sins of Psychopharmacology – Part 1
Natasha Tracy offers some suggestions about how patients and doctors can work together to correct the sins of psychopharmacology.
Last week I wrote about the seven sins of psychopharmacology as identified by a few doctors. Identifying problems is, of course, the first step in finding solutions and I certainly respect doctors for taking this step. However, as patients, we can’t wait for doctors to fix their own problems. We need to find ways to protect ourselves from these problems as well.
Sin: Poor diagnostic evaluation
Fix: A better understanding between patient and doctor
Doctors make diagnoses for all kinds of reasons and while I’d like to tell you they’re all based on science, of course, they are not. However, I think it’s reasonable to assume that any diagnosis be backed up by some science as represented in the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic manual that is used by all doctors throughout the U.S. and Canada. And if a doctor gives you a diagnosis, it should be found in that book. And if they give you a diagnosis, your symptoms should be found under the diagnostic criteria of that illness.
But the only way for a patient to know exactly what diagnosis they have and how the doctor came to that conclusion is to ask. So, for example, if a doctor diagnoses you with depression but you think you might have bipolar disorder you might ask, “On what information are you basing the diagnosis of depression?” And then you might follow that up by, “What about the following information . . . how does that fit in?”
This gives the doctor the opportunity to explain your diagnosis and their rationale. And better yet, it gives you a chance to disagree with whatever they are basing the diagnosis on, if, indeed, you feel the information is incorrect.
Sin: Dosage and duration errors
Fix: Slow and steady wins the race
It is my opinion that doctors mishandle dosage and duration of medication for two reasons:
- They are trying to help, often to relieve suffering as fast as possible.
- It’s more convenient for them.
In my opinion, while the goals of the doctor may (or may not) be laudable, allowing the patient, side effects, and therapeutic effects to drive dosage and duration makes more sense. For example, it’s critical that patients be forthcoming about how a medication is affecting them and when a patient comes in and complains of side effects, that is not the moment to push the dosage or even abandon the trial. That may be the moment when waiting is the most appropriate thing.
No one likes to be told to “wait and see” but that’s the only way you can find out if the side effects will go away with time and whether that amount of medication might produce useful effects. By pushing the dose, you may increase the chance of a positive effect sooner, but you also likely increase the side effects which will decrease medication compliance. Essentially, in an attempt to relieve suffering, you sabotage treatment.
By listening to the patient and slowing down medication changes, doctors can increase the chances of an effective medication trial and decrease the chances that a patient will simply stop taking the medication because it’s more trouble than it’s worth.
Fix: Questioning use of multiple medications and ceasing those that are not useful
If a patient is doing poorly, it is not uncommon to add a medication in the hopes of augmenting the current medication. This is ok and often clinical experience backs up the use of this practice. However, the problem with this is that people rarely question whether the original medication serves any useful purpose.
For example, if a person is really depressed, a doctor may add a second antidepressant of a different class, not wanting to immediately remove the original medication for fear of patient decline before the second medication has a chance to work. This is understandable. But it’s reasonable to question whether the original medication should be continued once the new medication is on-board.
Similarly, when a doctor takes on a new patient, he or she often simply adds to the cocktail a person is taking rather than trying to create a new treatment plan entirely. This practice can increase side effects and doesn’t necessarily benefit the patient therapeutically.
Check back next Wednesday for the second part of how to save yourself from the sins of psychopharmacology.