Posted by detroitpistons on June 15, 2010, at 17:21:34
In reply to Re: Drug Holiday?, posted by Humanpdr on June 15, 2010, at 16:04:12
Totally agree...I had a doctor who wouldn't prescribe me Dexedrine instead of Adderall, but he didn't really give a good explanation of why. I think it had to do with Dexedrine having a bad stigma a long time ago because it was probably abused a lot (maybe even by med students in the 70's!). However, I think that more and more doctors are going back to it for people who don't prefer the peripheral nervous system stimulation from the L-amphetamine.
I only know basic chemistry and basic biochemistry, but even with that level of knowledge, I can still figure out that out of the 4 salts in Adderall, the D-amphetamine is still the majority component (roughly 75 percent?). I tried to nicely explain that to him, using more of a questioning tone so that he didn't feel like I was lecturing him. I said something to the effect of, "But doesn't Adderall have largely the same active ingredient as Dexedrine?" He still wouldn't prescribe it to me. If anything, I would think that Adderall has more abuse potential than plain old D-amphetamine because of the stimulating effects of the levo enantiomer...I don't know.
Psychiatrists need to be intimately familiar with the chemistry of the brain, but a lot of this just comes down to a doctor's interest in the field, work ethic, time constraints, etc. If you're a psychiatrist, you need to keep up with the research, read papers, read journals, etc, perhaps even more than other specialists.
Regarding psychotropic drug discontinuation, I don't think most psychiatrists have any clue as to what's going on in the brain. Some doctors still don't take withdrawal very seriously. I've seen studies that indicated physiological changes such as reduced cerebral blood volume...Bottom line, they have to have a pretty good knowledge of organic chemistry, neurology and pharmacology, and many of them don't.
I hate to keep using ADHD stimulants as examples (the same ideas apply across the board), but some doctors now prefer to prescribe Vyvanse for ADHD patients who previously took Adderall (or Dex) successfully. Why? Is there actually a therapeutic benefit or are they just "going with the flow" and listening to the drug reps too much? I just don't think that a lot of people, including doctors, are putting 2 and 2 together. My doctor wanted to get me on Vyvanse, which is hilarious to me because he wouldn't prescribe me Dexedrine, which is essentially the exact same drug!!! Unbelievable.
If you have a patient who has been compliant with Adderall or Dex for a long time and isn't an abuser, then why spend the extra money and switch to Vyvanse? Cost is a big issue to me because I don't have insurance. Unless I'm missing something here, Vyvanse is simply D-amphetamine/Dexedrine attached to an L-lysine molecule so that it has to be metabolized by the liver. Is there really any therapeutic benefit to that other than the fact that you can't crush it up and snort it? What you have left after Vyvanse is metabolized is still pure D-amphetamine, right?!! I mean, this drug has been around since 1887 and it's still being patented!! First it was with Adderall and now it's Vyvanse. This is a perfect example of the "patent extender" drugs that are reformulations of an old drug.
Anyways, I got off on a tangent there, but my main point is just that my doctor really made me question the depth of his knowledge because he didn't seem to understand some pretty basic concepts.
> I absolutely think psychiatrists should have more extensive psychopharmacology/neurology training. The problem is that in medical school, 99 percent of the material is basic physiology/anatomy etc. Little time is spent exclusively on psychopharmacology, and psychiatry is definately a neglected field, both by big pharma and medical training.
>
> That being said, my psychiatrist is awesome. He and I discuss complex pharmacology and approach my anxiety/depression from a very analytical/empirical POV, which I love bc I'm a neuroscience and Chem dual major at my university. But there are SO MANY ignorant MDs who know literally only undegrad intro psychology level material when it comes to psychopharmacology.
poster:detroitpistons
thread:948597
URL: http://www.dr-bob.org/babble/20100615/msgs/951165.html