tag:blogger.com,1999:blog-7772182113499451603.post3790332484830015765..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: Pills Don't Save Lives - Psychiatrists DoGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-7772182113499451603.post-72393097775666696602013-12-30T14:27:57.194-06:002013-12-30T14:27:57.194-06:00FYI I just got an email today from Takeda on the B...FYI I just got an email today from Takeda on the Brintellix rollout, so maybe they are starting to ramp it up.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-38032530886323260642013-12-27T09:04:56.013-06:002013-12-27T09:04:56.013-06:00this post is very informative....thanks....i value...this post is very informative....thanks....i value your blog and read it regularly....something about this post....your topic...your thinking....your writing...cannot point to anything in particular....but this post was a highlight of my experiences in my reading your blog jamzohttps://www.blogger.com/profile/16938658278079810327noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-15754388820032927802013-12-26T22:01:58.009-06:002013-12-26T22:01:58.009-06:00I remember the reflux drug very well - cisapride o...I remember the reflux drug very well - cisapride or Propulsid.<br /><br />I frequently hear that the addictive properties of medications are rarely explained and I think it is a critical part of informed consent. I am glad you brought up the issue of antidepressant augmentation. I think that anytime there are a number of what appear to be equivalent strategies, it makes sense to review them in terms of relative side effect risk. I generally advise people that the atypical antipsychotic route in the high risk strategy, but that there are risks with the others as well.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-34484358744539999232013-12-26T21:53:16.658-06:002013-12-26T21:53:16.658-06:00I would be shocked if Brintellix was any better th...I would be shocked if Brintellix was any better than anything else but I have been pleasantly surprised by one relatively new drug that just turned generic.<br /><br />I review the available literature, including the descriptions of the syndrome and how much it can vary from person to person and strategies to treat it. I generally advise them that it is an informed consent issue when starting, stopping or cross over tapering SSRIs and SNRIs. I was never formally taught myself as a resident but that was before the days that there were SSRIs. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-10919099025029854582013-12-26T20:20:13.014-06:002013-12-26T20:20:13.014-06:00Of the 5 psychiatrists I have met after I started ...Of the 5 psychiatrists I have met after I started treatment as a teenager for 'situational depression', I think I would be another to say "nobody has ever informed me of the risks or potential side effects". Aside from a gastroenterologist, no other doctor has done so either. He was rather blunt though, he said the 'medical devices come and go, none work" and referring to an old acid reflux drug, he said "killed people". An older Indian-born doctor, he came across as very patient and wise.<br /><br />For the 8 or so years I was treated, I was not able to find a psychiatrist or other physician that was knowledgeable of discontinuing psychotropic drugs (or about drug dependence). As a result, I eventually chose to adopt a tapering schedule I found 'somewhere on the internet' and got off a Benzodiazepine I had been taking for 5 years with only a single followup appointment half-way through a year long taper. The experience was then, and continues to be, somewhat excruciating. I suffered a withdrawal syndrome that has persisted for 2 and a half years now after I stopped the drug. The sum of the experience was rather negative, and I don't think I would be willing to see a psychiatrist again, or encourage anyone else to do so for any reason. The chances of finding a good one who was as knowledgeable as the author of this blog seemed too low to take the risk, and the risk was sometimes extreme. One of my friends wound up on 2 anti-psychotics simultaneously to augment an antidepressant. That could just as easily have been me..<br /><br />Although my story is more complicated, overall 9 years of treatment ultimately caused me 5 years of drug dependence/withdrawal induced disability. Mostly concerning the issues discussed here. I think the approach described could have prevented much of that. <br /><br />Dr. Sandra Steingard, MD, a psychiatrist, more recently wrote an interesting article on tapering patients off anti-psychotic drugs for the website 'madinamerica.com'.<br />http://www.madinamerica.com/2013/11/tapering-neuroleptics-two-year-results/<br />Of the few psychiatrists experienced in withdrawing patients from drugs, I think she might be a valuable resource in that area. She sometimes write guest articles for http://1boringoldman.com, which is run by a retired psychiatrist, Dr. Mickey Nardo. <br /><br />This is an excellent article, thanks.Clarknoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-28473845944693544972013-12-26T19:36:16.806-06:002013-12-26T19:36:16.806-06:00I wrote this: http://psychpracticemd.blogspot.com/...I wrote this: http://psychpracticemd.blogspot.com/2013/10/new-kid-in-town.html<br />about Brintellix, back in October. From what I can tell, it's no better than anything already out there, and probably not as good, and its big claim to fame seems to be that it doesn't impair driving.<br /><br />As a resident, I was never formally taught about how to gently get someone off an SSRI, or SNRI, other than to tell them that they can expect withdrawal symptoms. What do you tell your residents?PsychPracticehttps://www.blogger.com/profile/07071440888782115503noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-48744029985426195192013-12-26T12:07:24.141-06:002013-12-26T12:07:24.141-06:00You may be right. Schatzberg mentioned it in his ...You may be right. Schatzberg mentioned it in his presentation on treating mood disorders at the UW conference last fall by generic name only (vortioxetine). At that time (early October) he said the FDA review was underway and that it potentially had positive cognitive effects. The receptor/reuptake effects were listed as all serotonergic. I think we will start seeing journal ads soon. In order to get some success against the generics, I think newer drugs will either need head to head comparisons or unique additional indications like duloxetine.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-57619867865252874692013-12-26T11:52:45.705-06:002013-12-26T11:52:45.705-06:00Brintellix was approved in October and every psych...Brintellix was approved in October and every psychiatrist I talked to knows nothing about it. This has to be the most subdued release of an antidepressant I can recall I wonder if the pendulum has swung too far the other way.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.com