Tuesday, August 20, 2019

Comments by RCHK

Showing 5 of 5 comments.

  • For the record – from a recently trained psychiatrist – neither my medical school nor my psychiatry residency (both mainstream, well-known programs) would have said most of the misinformation that this article claims is taught in medical schools. I don’t know where this author went to medical school, but it certainly does not represent my experience.

    That said, there are definitely people that argue for some of the points who had a voice in our training – eg, in both contexts we read and debated the evidence for and against SSRIs being able to decrease the total suicide rate, or that having a manic response to an antidepressant predicts that on average that person is more likely to benefit from a mood stabilizer than someone who did not have such a response (the practical way to restate the idea that there is underlying bipolarity revealed). We are exposed to a broad range of opinions, however, and encouraged to recognize the conflicting opinions and the presence or absence of evidence for each of them, and to know we’re responsible for making informed decisions ourselves. Which is how I believe it should be.

  • Oops, I’m glad you commented on this, because I should have clarified: the first line treatments for PTSD are *absolutely* talk-therapy.

    Studies of SSRIs and antipsychotics in PTSD have been done, and they have been a mix of no effect and small effects. Studies of psychotherapy (talk therapy) have MUCH better outcomes. Which is why they have been the focus of what is offered veterans by the VA, and are one of the primary indicators discussed in the report.

  • I think this is a completely unfair headline. There is actually a huge amount of data that the treatments being used for PTSD by the VA are effective – a large fraction of it having been done by the VA itself. What this article was saying is that there has not been wholesale tracking of the entire veterans-with-PTSD population *as a whole*, and their clinical change over time, as a QI/research project.

    Now, you can argue that it would be good to track this – and that is what the article is suggesting – but it’s important to realize that (a) this is almost never done in any are of medicine and in any health care delivery system, and (b) it’s not something people are universally for, as there are drawbacks. For example, to track this in a systematic way requires that clinicians standardize their assessment and documentation standards such that it can be processed as a huge data set. Ie, if I’m a VA psychiatrist treating PTSD patients, to make this work well, I have to ask EVERY PATIENT I see to regularly fill out standardized symptom checklists and then I have to manually type them into the computer for other people to process. Even if for any given patient, it may be obvious to us that this is not what would would like to be prioritizing with our limited time together.

  • Respectfully, I think it’s important to note that in general, Chinese medications that affect mental health technically are themselves psychotropic medications – they’re just psychotropic medications with a different kind of evidence base behind them than those that are generally prescribed by Western allopathic doctors. Some of them people may feel have a longer history of use, and that may be comforting. At the same time, there are ways that Western medications are tested that they generally have not been – and at the very least, it’s not always clear that what they have been seen to do in one context and population (eg, China over the past 500 years) is going to predict how they will affect someone in a new context (eg, a modern American who is likely to have a different diet, different lifestyle, different list of health risk factors, and different set of exposures to other medications and toxins from, say, your typical Chinese man from 1800).

    While I (a practicing psychiatrist) have plenty of worries about the short and long term impacts of our most commonly used medications (thus my presence of this webpage), I also have a very healthy respect for – and level of concern about – psychotropic medications that have emerged from other medical traditions. A purified chemical / compound that affects brain function is not something to just assume is safe, wherever it comes from.