Bob–

An encounter from this week:

I saw a 24 year-old theater actress who was started on Lexapro nine months ago for a one-time “panic attack” and has gained sixty pounds since.  This is extremely distressing to her as her physical appearance and fitness is essential to her job.  She suspected the weight gain was being caused by the medicine, and so she went to her prescribing family doctor and he said that, no, it wasn’t from the Lexapro.  She couldn’t account for any other lifestyle changes that would cause such dramatic weight gain.  He checked her thyroid and said it was fine, and so he told her to exercise more and eat less.

At a subsequent visit, she asked him straight-up if she could stop the medicine, and he said no, because it was working so well to control her panic attacks that she should stay on it at least a year and maybe indefinitely.  He reassured her it was a very safe medicine and it was not causing her any side effects.  She tried to stop it on her own anyway, and after three days without it felt dizzy and then had a horrible panic attack.  This confirmed to her that he was right:  she had a disease and needed the drug.

Later, she told him she couldn’t concentrate anymore (unable to memorize lines), and he diagnosed her with ADD and started her on a stimulant.  In all of this, he never recommended any remedies for her mood or thought disturbances except drugs.  She lost a little of the weight after starting the stimulant and found she could concentrate better, but started having insomnia.  So he started her on Ambien.  It worked to help her sleep, but the daytime fogginess got worse, so he increased her to the maximum dose of the stimulant.  At this point, she became frustrated that he wasn’t really listening to her, sick of taking pills, but she didn’t know where else to turn.

A friend recommended that she try a new doctor, so she happened to come see me, not knowing anything about my take on mental health alternatives.  When she saw me, she was disheveled and tearful.  She now carried the diagnosis of three diseases (panic disorder, ADD, and insomnia), was taking three medications, had become suddenly obese, and most distressingly, was feeling mentally worse than ever.  She said she felt like her head was in a fog all the time.  Her panic attacks had returned along with chest pain, she couldn’t concentrate, she was moody and volatile, she couldn’t sleep at night, and the theater manager told her she had to figure out what was wrong soon or she would lose her job.  She didn’t know what was wrong with her, but felt like in a year her life had fallen completely apart.

After a long discussion and a medical evaluation, I told her that I was worried that all of her problems had been caused or worsened by the medications, and that we seriously needed to consider coming off of them.  We came up with a plan to taper over the next three months, one medicine at a time, supplementing with lifestyle changes, acupuncture and counseling.  We’ll hope for the best for her.

So the questions I ask are these:  why did her primary care doctor, who I assume had the best of intentions and did not intend to harm this young woman, jump to the conclusion that she needed drugs after she had one panic attack?  Why did he not question the need for the medicine once she started showing such known side effects?   Why did he continue diagnosing her with more diseases and adding more drugs?   Why is there no safety net to catch patients like this, who are being slowly drowned by the system, or to catch recklessly prescribing physicians?

I was fired from my employed position last year in part because I had started cautiously helping patients withdraw from drugs that seemed to be hurting them.  The hospital was concerned that my methods fell outside of the standard of care, could be harmful to patients, and thus did not represent the hospital’s interests well.  But do you think this patient’s original doctor will ever be questioned by any employer or licensing board for diagnosing and prescribing with such abandon?  No, he won’t be.  You would think it would be in the best interest of her insurance company to ask this question:  “How come this previously healthy, active young woman, in the course of nine months, now requires three medications at over $200/month, in addition to multiple office visits and blood testing?”

In short, why do we primary care doctors, who prescribe over 75% of psychiatric drugs in America, practice the way we do?

In my next letter, I’m going to offer an answer to this by offering examples of recent “Continuing Medical Education” activities that I have received, which are thinly disguised, unchallenged propaganda for the biomedical model, all coming from expert psychiatrists who have multiple ties to drug companies.

Best regards,

Mark

Editor’s note: These letters are selected from an exchange that Dr. Foster and Robert Whitaker have had since he read Anatomy of an Epidemic. They describe his interactions with his patients, and his changing thoughts about the prescribing of psychiatric medications. In all of these letters, the specific patient situations he describes are real, but all identifying characteristics have been altered or obscured, or permission has been sought, in order to protect patient privacy.