Posted by Quintal on October 7, 2007, at 18:51:19
In reply to Re: Rimonabant - New Appetite Suppressant, posted by James_glasgow on October 6, 2007, at 13:43:35
Hi James,
I understand where you're coming from. I gained a lot of weight on a combo of SSRI and clonazepam, at my heaviest I weighed about 14 stone, but I have a small frame.
>My experience of psychiatry in the UK is one of "its not the drugs, you just are greedy",
We both know they tend to increase appetite and alter metabolism. It's really frustrating to be on the receiving end of this, but I do think you're likely to hear this from some psychiatrists in the US too, especially if they're poorly trained and on a budget.
>"it is the drugs but we cant do anything about it",
I think this could be true, up to a point.
>"it is the drugs, we will change it to another (often of the same class) and see what happens" (even after many goes they dont seem to learn that doing this does not work)
Yeah, that's frustrating too. I have to say that this seems to be true of psychiatry worldwide. There are many people here from all corners of the globe that have been through the book, and nothing seems to work very well. I think we're really very lucky to have this safety net. It was only after being deprived of it that I learned its true value. I guess this could be part and parcel of psychiatry still being in its infancy.
>However, look around this board and you will see it is common practice in the US. This also goes for topiramate and just about anything you can think of that would assist side effects, modafanil, orlistat, amantadine with the exception being the use of procyclidine.
Yes, and I think that's likely because the private sector is a buyer's market. The Americans who are dependent on public welfare of some sort, a bit like our NHS, tend to be more limited in their options. In both countries the patient can buy private healthcare if they can afford it, and private healthcare practitioners can afford to indulge their patients. Public healthcare practitioners have to be more practical and realistic wherever they are in the world. I can see how 'additional extras' like bupropion might seem extravagant to the doctor on a tight budget, when weight can allegedly be reduced by diet and exercise alone. I can see why a doctor might feel pressured into telling you >"its not the drugs, you just are greedy"< even if I don't agree with it. It gets you out the door with minimal expense. It's a whole different ballgame if you profit from the consultation and the prescription. Different priorities. I wish it weren't as cold and clinical as that, and I know there are exceptions, but still that's how the world works, for better or worse. I've been on the receiving end of it myself, and I empathize with others who are in the same position.
I notice that many people in the US have trouble getting MAOIs because 'they're too old and dangerous', all the usual tricks that we have to put up with. And the great fear of prescribing pain meds in the US - contrast that with the Great British benzo inquisition. Every medical system has its own little quirks. Still they do lumber on, somewhat blindly it seems at times, but at least we have the advantage of being able to apply a little steering in our own cases.
This is why I was so shocked that rimonabant was marketed first in the UK, big market share an appetite suppressant would have and all. Now it seems rimonabant may not be entirely fit for human consumption. Oh well...
Q
poster:Quintal
thread:786700
URL: http://www.dr-bob.org/babble/20070929/msgs/787678.html