Posted by Ritch on August 28, 2002, at 0:36:42
In reply to Re: Dr. Dave - why do you hate this drug? » moxy1000, posted by dr dave on August 27, 2002, at 16:36:52
>.....I am so sick of my patients hoping desparately that a new pill will relieve their misery and then being cruelly disappointed when it doesn't, confirming in their own minds that they will never get better. It is monstrous not to tell people the truth about what they can expect from changing antidepressant - of course sometimes it can be miraculous, but you can't guarantee it and you have to be straight with people about the likelihood of a new antidepressant helping. If people believe they are being put on a far superior drug which is very effective against depression, how do they feel when it doesn't work? Often they will feel that it proves they have an untreatably severe condition, so they lose hope, are more depressed, and question whether it's worth continuing to try to change things.....
>Dr. Dave,
Obviously, you are talking about treatment-resistant unipolar depressive patients who have had at least one or two trials with different antidepressants with little or no success (and understandably yearning for a new "miracle" medication). S-citalopram, possibly, at best, probably offers a very clean (low-SE profile) choice for a clinician seeing a "typical" patient (presenting for the 1st time) with a major depressive episode requiring medical attention. However, there will likely be the occasional treatment-resistant few who might respond well to an antidepressant switch to this medication (and a much "fewer" group-who might respond "miraculously" to this as opposed to s+r-citalopram). The pragmatist part of my thinking, says: "Go ahead and switch them around, play the musical chair game with the AD's, but you will get one or two, here and there, that get well, and that's worth the trials." You talk about "science" being corrupted. I understand your anger about that. So, do we spoil the occasional few for scientific idealism, to save a lot more from being disillusioned by fraudulent capitalistic opiates? Do we.. "let the buyer beware", "keep hope alive", "there's a chance it might work" or decide in advance that a treatment-resistant patient will *likely* not benefit from something new.. so no sense in trying it? What it all boils down to is-what's worse? Risk disillusioning and letting down a patient duped by advertisements from drug companies (when the drug fails to live up to the patient's expectations), or letting down the occasional rare (treatment-resistant) patient who could benefit from the medication.
Mitch
poster:Ritch
thread:109458
URL: http://www.dr-bob.org/babble/20020821/msgs/118010.html