Posted by mtdewcmu on July 13, 2011, at 0:07:54
In reply to Re: Peter Kramer - mixed feelings, posted by joe schmoe on July 12, 2011, at 22:35:55
> I read a lot of bad logic in those articles, but this statement takes the cake:
>
> "I believe doctors should be prohibited from prescribing psychoactive drugs off-label, just as companies are prohibited from marketing them off-label."
>
> As if any company is going to spend hundreds of millions to get an already approved drug, approved for something else, just in time for it to go off-patent (or worse, if it is already out of patent). Such a ridiculous rule would keep effective drugs forever out of the reach of patients, if the (extremely expensive and time consuming) initial studies for a particular use did not cover something the drug was later found to effectively treat. What rubbish.
>Actually, that sounded like a good idea to me. But you also raise a good point. Maybe doctors could be allowed to prescribe a drug off-label after the patent has expired, or after some set number of years. Keep in mind that if doctors were required to prescribe "on-label," the drug companies would have an incentive to get new drugs approved for the widest possible range of conditions. Right now there is little incentive to get an antidepressant approved for, say, GAD, when it can just be prescribed off-label. Older drugs could be grandfathered in.
> I wish I could inflict my pre-treatment brain chemistry on some of these authors and then watch them try to get through life without drug treatment.
>Some psych drugs undeniably work, and I don't think Marcia Angell is saying they don't. For instance, I don't think anyone doubts that lithium works for bipolar disorder. But if you're talking about SSRIs, how can you be sure that the drug cured you and you didn't just get better on your own?
> Imagine if this paragraph was about the invention of penicillin, not prozac:
>There is an important difference here. Penicillin can be proven to work better than supportive care in double-blind studies. Prozac can't.
One part of her article that raised questions in my mind that she didn't answer was the part about the exploding number of diagnoses in the DSM. Just because the diagnoses exist on paper doesn't mean that psychiatrists are going out of their way to find people to pin them on. Virtually anyone that walks into a psychiatrist's office can walk out with a prescription for antidepressants. Most of the dubious diagnoses in the DSM are not things that require heavy-duty drugs, they'll probably be treated with antidepressants. It doesn't follow automatically that just because there are more diagnostic categories that patients will be treated with more or heavier drugs.
I have a complex inferiority.
Rx: 40mg citalopram, 30mg d-amphetamine, 15mg mirtazapine, 300mg bupropion
Dx: ADHD (inattentive subtype), depression
poster:mtdewcmu
thread:990777
URL: http://www.dr-bob.org/babble/20110630/msgs/990885.html