The Psychiatric “Prescribing Cascade”: A Patient Story


From Lown Institute: “Steve’s story of overprescribing began when he experienced symptoms of depression as an undergraduate and sought psychological help. He was prescribed an SSRI (Zoloft), which led to feelings of apathy and numbness. He also began to experience sexual dysfunction, which is often common in patients who are prescribed antidepressants. In order to treat erectile dysfunction, Steve was prescribed Wellbutrin, another antidepressant. Within a month or two he began to lose motor control of different parts of his body, often causing him to bang his head uncontrollably against the wall. When he confronted his psychiatric nurse practitioner over this traumatic and abnormal side effect, she attributed it to bipolar disorder. ‘She saw the problem as “existing in me” and not an effect of the drugs,’ said Steve.

Additional antipsychotics were prescribed to tame the behavior, but the combinations of, and cross titration between, medications left him feeling more depressed than when he first sought out help. When he would try to stop, he often was left feeling non-functional, in what he described as a vegetative state. The worst to discontinue, in Steve’s experience, were the antidepressants.

For ten years, Steve saw different mental health providers who added medications and changed dosages. At its peak, Steve was taking five different psychiatric medications. When he would tell clinicians about his concerns with the psychiatric medications he was taking, he heard over and over, ‘The medications are safe and the doctors mean well.’ Not one recommended he stop. It wasn’t until Steve was admitted to the hospital for multi-organ failure that a gastroenterologist set him on the path to deprescribe his psychiatric medications.”

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  1. This is a tale of psychiatric ineptitude. No wonder psych patients don’t recover- these alleged professionals didn’t even bother to quantify his level of depression, something a quack like me could get an estimate for in about 20 minutes, using his trusty HOD test during the first contact with an individual.
    I also found those “treatments” pretty ghastly, being addressed to relieving the many side effects of the many prior treatments. I wonder how much money the pharmaceutical companies made off this individual with the medics’ casual attitude toward this alleged treatment.

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  2. ‘The medications are safe and the doctors mean well.’

    Why would they say this?
    a) They don’t care.
    b) Patient is seen as an idiot.
    c) They’re naive, unintelligent and poorly trained.
    d) Defence reaction because they feel caught.
    Any other possibilities?

    “It wasn’t until Steve was admitted to the hospital for multi-organ failure that a gastroenterologist set him on the path to deprescribe his psychiatric medications.”

    Psychiatry seriously damages medicine’s reputation. I wonder why there are no real consequences.

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      • Steve. Maybe you haven’t been following the political screeds, as there’s a powerful right-wing sect that promotes the notion that all human activity should be based on how much income is generated from it by and for involved individuals, themselves (Donald Trump is morally superior to Jesus because he’s a billionaire and Jesus was penniless) and nothing else matters. This may help you understand the psychiatric mentality that passes for therapeutic success- it’s how much revenue your patient generates, not whether or not (s)he returns to anything resembling sanity and usefulness.

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        • I don’t disagree with this at all, in fact, I’ve said the same many times. We’re living in the resurrection of Calvinism – your financial success proves that God is with you. This, however, doesn’t mean that we can’t help each other to deal with the consequences of these destructive postulates, whether in formal or informal ways. Naturally, the psychiatric/psychological industry is an industry and is driven by profits, and that’s the real problem we’re all dealing with.

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