Monday, February 18, 2019

Comments by Catalyzt

Showing 4 of 4 comments.

  • Point taken. I’m talking about psychiatrists who were licensed long before the SSRIs came on the scene. The methodological flaws in the research are not always so easy to see, and if only a small percentage of your caseload used SSRIs– say your caseload is only 15% SSRI, 15% MAOI or tricyclic, 10% mood stabilizer, 10% antipsychotic, and 50% unmedicated who do only talk therapy– it is harder to see the harms of SSRIs. Even if most of your SSRI patients had adverse effects, it could be well-hidden in your drop-outs and transfers. I can easily imagine that it would take a quarter century or so to start connecting the dots, particularly if you’re being bombarded with well-crafted propaganda from companies that you trusted, at least somewhat, in 1980.

    In my Master’s program, I was trained to hunt for logical fallacies and junk science. A few generations ago, I think clinicians were much more naive in this respect.

  • Alto– good to see you again. I remember you well from Boring Old Man, I miss Mickey, Bernard, and the rest of the crew badly, and remember y’all fondly. I like to think things have changed a little bit over the last three or four years, but so sloooowwwwllly. (BTW, I still enjoy visiting your site, though I don’t get over there as often as I should.)

    Recently, I had an appointment with my own neurologist for headaches– Ivy-league educated, very fast and thorough exam, classic 21st century doctor’s appointment. I came prepared with a list of symptoms and history, and she delivered as good an assessment as you could ask for given the time constraints.

    At one point, she asked me if I had tried SSRIs or serotonin agonists. I quickly used my toolkit of coping skills to keep my blood pressure from skyrocketing, and simply asked her, “Why on earth would you use a serotonergic agent? Yeah, the headaches are bad, but serotonin is the most common neurotransmitter, it can show up almost anywhere in the brain, you never know what the hell it will do.”

    I guess I was expecting some kind of an argument. Instead, she just nodded curtly and said something like, “Yeah, I get where you’re coming from. Let’s keep doing what you’re doing for now.”

    Six or seven years ago, I might have gotten some glib neurobabble or a power-point presentation with a graphic of little parachutes making the brave journey through the synaptic gap and huddling together at the receptors. Of course it’s impossible to extrapolate from one person’s experience, but I feel like it’s possible… possible… that at least some junk psych meds are finally becoming a little less popular. And in my own practice, I’ve recently had referrals for clients of all ages, but particularly young people, who were “depressed” (per DSM V) but hadn’t been started on SSRIs– a welcome change since the days of my internship. The patients who haven’t started on SSRIs do seem easier to work with, both in brief and long term modalities of talk therapy. Some of ’em turn on a dime, particularly the kids with no history of major trauma– work through some attachment issues, identify some resources, out the door and back on the road in 12-26 weeks.

    One reason I wish I’d started this career sooner (though it would have been impossible, I was too much of a hothead when I was younger) is that I’d love to see how some of these folks do as they get older. I expect some of them to come back now and then over the next quarter century or so, if I live that long and can keep practicing, but I just have a hunch that the unmedicated ones will only be coming in for a 5-to-26 week tune-up after a major life transition or crisis.

    To be fair, I do see good outcomes for some medicated clients, and a few very favorable long-term prognoses within that group as well… but not nearly as many, and all of them were doing regular weekly therapy well over a year, sometimes over two years.

  • Part of the disconnect between psychologists (or MFTs for that matter) and psychiatrists is that psychologists often see their patients with greater frequency over a longer period of time.

    I know older psychiatrists who actually practice psychotherapy, though they also have patients they see for medication. Generally, they are less aware of adverse effects of medication because many of those effects may manifest well after discharge. As an MFT, I see many patients who have been on SSRIs for many years, and so I see adverse outcomes such as suicidality and withdrawal far more commonly in my practice than my psychiatrist does in his or hers.

    Before I got my license, I think my psychiatrist found my views on SSRIs to be a little hysterical. Now? Not so much. I don’t know a damn thing about his caseload, obviously, but he knows what I have seen and he trusts me, it’s impossible to imagine that his prescribing habits have not changed, though of course he could not tell me if I asked him. Many psychiatrists are actually dedicated healers with a wealth of clinical experience who have been fed the same propaganda their patients have.