Posted by yxibow on February 3, 2007, at 0:17:15
In reply to Re: Atypicals for anxiety?))yxibow, posted by mindevolution on February 2, 2007, at 23:29:28
> I backed up my generalisations with valid arguments and links to research which is all anyone can do.
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> On the other hand I questioned you about some of the generalisations you made about the suicide risk for unmedicated people with schizophrenia, and you have not backed up any of your generalisations at all.
I can attempt to back that up and argue with journals, but the fact is that for acute suicidality in schizophreniform disorders or for that matter in any disorder, an antipsychotic ranks up there with Lithium in its capability to stop a person from harming themselves in a 72 hour or 14 day hold if it is warranted that the patient cannot yet handle release. The latter is more rare and often consumers are tossed back into the community and their illnesses come right back and something awful happens, or they become part of the walking wounded homeless, untreated, all too visible in a certain city near where I live.
I can also back up a study in the BJP that did an extensive study of TD in Zyprexa vs Haldol and came up with an average rate of 2.66% and a yearly average of 0.52%http://bjp.rcpsych.org/cgi/content/abstract/174/1/23
If we extrapolate further, Seroquel has an even lower potential of TD.
There also was another study recently that compared all atypicals and found that the rate of TD was around 2% give or take, which is a lot better than most of the typicals that preceded them. Yes, there was a study, the CATIE study that said that the effectiveness was not very different, but where's the humanity? Agents like Zyprexa and Seroquel, with all their unfortunate lipid profile issues, have far less EPS than the phenothiazines and others that were compared with.
> > This doesn't mean that I don't think that one shouldn't start with something less than a neuroleptic for anxiety disorders, but sometimes complex situations may warrant something more. I fully agree that both SSRIs and benzodiazepines have safer side effect profiles for the most part when used as directed.
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> glad to hear it!I never disagreed there...
> > We don't know the relationship that a consumer has with their provider -- we can make suggestions, we can yell all sorts of opinions about medication, but the sanctity of a doctor-patient relationship is something that the unlicensed individual without a medical degree I don't think should be throwing the baby out with the bathwater.
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> > Not quite yet. Not without really knowing the person at hand and not with a casual find-another-provider so you can go shop for medications. Maybe there's a reason why the doctor is doing what he is doing. And maybe there isnt a good one.
> I can see that point, however, from reading posts on this board it becomes very apparent that all too often people trust their doctors, who in return lead them towards highly risky and toxic medications without pointing out such risks to the patientl; meaning the patient is denied informed consent. the moment this happens, the relationship is over in my book. taking their business elsewhere is the only remedy a patient has in such a circumstance.
I agree with the model of informed consent -- don't get me wrong, I had a psychiatrist in college who I did not like, frankly I think she just hated people who read the PDR and happened also to be male. (I'm not a misogynist, this just seemed to be a sense that I got that as sole controlled substance provider -- nurse practitioners could provide other substances, college mental health was ran as her own fiefdom.) And yes, I was offered olanzapine even though I knew of the possibility, however small, that TD could occur and I was not at that level of anxiety. And I didn't take it.This doctor was also a benzophobe and before I knew well about the dangers of quitting cold turkey, I quit Tranxene only to have scalp muscle spasms. I was given back only half the dose. If I was not poo-pood by the paltry student urgent care clinic (and this is a top tier University in the US with a medical school of shining reputation), I would not have ongoing spasms today.
If I knew then what I know now I would have gone to the off-campus doctor they were all too happy to consolidate to an on campus doctor and an on-campus therapist (who I respected much and got along with unlike the doctor) and gotten my Tranxene back at its level until it could have been properly reduced.
> > Some people can't manage without any medications. The ideal situation of course would be to manage a situation with various types of therapy alone, but we know that depressive and anxiety disorders work best with a combination of both and here we're talking about someone with concomitant illnesses. It is always best to have the MED (minimum effective dose) of any medication and I think any rational psychiatrist/psychopharmacologist would agree so.
>
> well sure, the meds carry the most risk, so the lowest risk alternative is non med treatments, then if these don't work by themselves, a combination of therapy + meds.
I would have to somewhat disagree -- I think that combining first line choices with therapy would work better, but you're entitled to your opinion. If more "harsh" medications are needed, however one wants to describe that, it should also be under informed consent. MDD doesn't respond very well just to therapy alone, it is a consuming disorder, I can tell you.
> however, all too often docs recommend the most risky meds first, like an AP for anxiety, what was he thinking?! a good doctor in my view starts with the lowest risk meds, and then gradually tries progressively more risky alternatives, with the highest risk alternative being the last medication to be suggested, keeping the patient informed all the while. good doctors that operate like this are extremely rare in my experience. for anxiety, I can think of at least 10 different meds that could be tried ahead of an AP with significantly lower risk.
Well I can think of a number of benzodiazepines that could work and possibly some other AEDs, that's true. I never said antipsychotics are a first line defense, except in some complex bipolar cases when there is a clear line that mania is occurring, and sure, even then lithium and other choices are available but don't always work.
> > It is my opinion that I feel a general sense of loathing all medications coming from your opinions which is your perogative, but there are people on here who have gone through dozens of trials to find the right mixture for their respective situations and I think that also needs to be respected.
> I am not against medication in any way, however, due to the current drug approval process, even if one reads all the drug company research, I think we do not get the objective data we need to make truly objective informed decisions. How does a patient know when they go to a doctor that APs are extremely toxic and benzos are much safer and are approved for anxiety without coming to a board like this one? Are they supposed to blindly trust their doctor, or should they be given as much information as they need to make their decisions? How do they even know if they have a good doctor?
I think they should be given as much information as they need to make their decisions. But it goes further as we have a rubber stamp and out the door model of health care in the US. We have large numbers of patients and no universal health care. HMOs have dictated this cycle for years and fortunately we have the Mental Health Parity Act now, but even it doesn't cover the things that should really be part of a treatment program.
> One idea of mine is to have a central register of drug toxicity, so that every medication is given a toxicity rating for its recommended dose range out of 1000 based on independent government (not drug company) sponsored trials. Patients and doctors can both refer to the register as one way of objectively identifying the relative risks of medication alternatives.
However paltry it is, there is an adverse reporting system in the US in the Stage IV (marketing) of a medication and some drugs have been pulled because of numerous reported cases.
Well every substance out there that has a CAS number is given an MSDS rating actually. We know the LD50 in rats and mice and sometimes dogs -- mice may seem miniscule but they serve a valuable purpose as a number of their responses to medication mimic a human response. Would you really want to be a lab mice in the first stage of drug trials for toxicity before it is given to "healthy" humans in Stage I?
The government does sponsor drug trials to the tune of millions of dollars a year, they can be looked up on government web sites at the NIH, etc. But like it or lump it, sans advertising, it takes millions of dollars to produce the "right" compound, and that money can't come from thin air.
I mean I could rant that the US could spend more money on education and health care than on military forays, but we would get into an Iraq argument and everyone has a different opinion (I support the troops, but I think there has been great mismanagement to say an understatement, of things.)
poster:yxibow
thread:728141
URL: http://www.dr-bob.org/babble/20070201/msgs/729252.html