The Medical Thread

[cheerfulgreek]

Close to 10% of men and women in America are now taking drugs to combat depression. At one time this was a rare condition, but now it's become so common. I subscribe to "Scientific American Mind" magazine and I was reading this article on depression. It was saying that in the past three generations, increasing numbers of Americans have been prescribed antidepressants. In many cases, such prescriptions are the only mental health care the patients receive. One cause of the rise in antidepressant use is that many doctors combine conventional sadness as from the loss of a loved one or a life changing event such as a divorce with the more serious condition of clinical depression. Also, a second contributing factor, is a change in the standard diagnostic guide which caused many milder mental ailments to fall under "disorder" which I think would be considered kind of a neutral label. That could be anything. It was saying that a clinically depressed person may not be able to drag her/himself out of bed. I just wonder why it has gotten so bad, and how does medication really stop this problem?

[SoEnchanting]

Originally Posted by BigRedBeta

Did you ever figure out where your attending went?

What interests you about Surg and Family? Do you have an interest in eventually ending up in a rural community?

When do you start putting together your 4th year schedules? Are you going to try to do a surgery sub-I? Any away rotations? Anything you're REALLY excited to do for a month?

No, sorry I stopped working with him before I got to ask him! I'm with a new attending now after they found out I wasn't getting that much inpatient experience. I'm with a doc now who's triple boarded in Medicine/Critical Care/Pulmonology. Wowsers!

I have things that I love about both FM and Surgery. I like the continuity and relationships that are formed with patients in FM, but I think the OR and procedures in general are fun. I don't like that FM is all outpatient (I get bored doing one thing or being in one place for too long), but I hate surgeons' hours... especially if I have any hopes of having a life/family outside of medicine one day.

We're in the process of putting together our schedules now, focusing mostly on the few required 4th year rotations. Our sub-I's and electives will be scheduled within the next month or two. And of course, no away rotations want to hear from you until the summer. I'm not sure what sub-I's I'll do next summer/fall, but I'm avoiding surgery until I'm pretty sure that's what I want to do. I have been so indecisive lately. I don't know what I want to do when 3rd year ends! It seems like this point in life has come rather quickly - so many decisions to make in a short period of time...

[SoEnchanting]

Originally Posted by cheerfulgreek

Close to 10% of men and women in America are now taking drugs to combat depression. At one time this was a rare condition, but now it's become so common. I subscribe to "Scientific American Mind" magazine and I was reading this article on depression. It was saying that in the past three generations, increasing numbers of Americans have been prescribed antidepressants. In many cases, such prescriptions are the only mental health care the patients receive. One cause of the rise in antidepressant use is that many doctors combine conventional sadness as from the loss of a loved one or a life changing event such as a divorce with the more serious condition of clinical depression. Also, a second contributing factor, is a change in the standard diagnostic guide which caused many milder mental ailments to fall under "disorder" which I think would be considered kind of a neutral label. That could be anything. It was saying that a clinically depressed person may not be able to drag her/himself out of bed. I just wonder why it has gotten so bad, and how does medication really stop this problem?

This is an interesting topic, cheerfulgreek. SoEnchanting's opinion is that the rise in the incidence of depression is a result of a combination of things - people are more willing to talk about it and doctors have a plethora of good antidepressants to throw at you than in generations past.

[AKA_Monet]

Originally Posted by cheerfulgreek

Close to 10% of men and women in America are now taking drugs to combat depression. At one time this was a rare condition, but now it's become so common. I subscribe to "Scientific American Mind" magazine and I was reading this article on depression. It was saying that in the past three generations, increasing numbers of Americans have been prescribed antidepressants. In many cases, such prescriptions are the only mental health care the patients receive. One cause of the rise in antidepressant use is that many doctors combine conventional sadness as from the loss of a loved one or a life changing event such as a divorce with the more serious condition of clinical depression. Also, a second contributing factor, is a change in the standard diagnostic guide which caused many milder mental ailments to fall under "disorder" which I think would be considered kind of a neutral label. That could be anything. It was saying that a clinically depressed person may not be able to drag her/himself out of bed. I just wonder why it has gotten so bad, and how does medication really stop this problem?

I agree with what was said before. Also the issue is what neurotransmitter systems are active during times of stress. The issue is some clinical depressions are due to chemical imbalances. I would say ~25%, roughly 75% have environmental cues due to circumstances. The combination of both: chemical imbalances with stressful environments causes the misjudgments of healthy responses to conflicts.

I don't think depression has gotten worse or situations for depression are worse, I think there is increased reporting. Moreover, most depressive episodes are considered reason to arrest, making the treatment absent and worse.

Medication used solely alone does not treat depression. Dr. David Burns one of the foremost psychiatrists on depression and bipolar disorders states it MUST be in combination with various talk therapies and/or mindfulness trainings. Cognitive is the best therapy with medication treatment. Mindfulness with yoga breath and exercises seems to have good preliminary responses at this time.

40 years ago, most people attended church to get that meditative experience. However, now, there are a variety of practices and quite a few people are cynical. That does not negate the importance of some "spiritual/soul" work to ease the neurohormones involved in the stress response.

[cheerfulgreek]

Well, if statistics are correct then there's a very good chance that many patients have no psychiactric diagnosis. A study of antidepressant use in private health insurance plans found that over 40% of those who had been prescribed antidepressants had no psychiatric diagnosis or any mental health care beyond the prescription of the drug. No, the medications don't cure depression, but honestly how many people who are on these prescription drugs are really depressed? How many people are depressed and don't know it, and are not on any kind of prescription drugs?

I do think people are more willing to talk about it now than they were in the very distant past, but I think some of the prescription drugs are unnecessary based on what I said earlier in this post.

[AKA_Monet]

Originally Posted by cheerfulgreek

Well, if statistics are correct then there's a very good chance that many patients have no psychiactric diagnosis. A study of antidepressant use in private health insurance plans found that over 40% of those who had been prescribed antidepressants had no psychiatric diagnosis or any mental health care beyond the prescription of the drug. No, the medications don't cure depression, but honestly how many people who are on these prescription drugs are really depressed? How many people are depressed and don't know it, and are not on any kind of prescription drugs?

I do think people are more willing to talk about it now than they were in the very distant past, but I think some of the prescription drugs are unnecessary based on what I said earlier in this post.

Well, it was sometime in the late 1970's when hospitalization was no longer enforced on any unwilling adult unless police became involved... I remember President Reagan signing that decree and a whole bunch of people with true disorders were put out on the street. They became the bums and homeless. But by the time the police were involved, the person has allegedly committed a crime, i.e. assault, robbery, carrying a weapon to cause bodily harm, etc.

Zyban et al. is used to help people to stop smoking. So if that drug was included, that is why they might be saying massive increases in anti-depressants.

Also, when Prozac was admitted to the formulary, Eli Lilly did attempt to stop the selling of the nutritional supplement L-Tryptophan saying it caused a rare eosinophilia. But many drugs cause odd side-effects, including Prozac, which has more dangerous ones and that is why Pharma started making extended release tabs. Tryptophan has repeated shown to have better effects than Prozac or Wellbutrin.

I think we see new drug systems to treat psychotropic conditions or mental conditions without the full knowledge of neurology or biochemical genetics that are in play to developing the "true" mental disorders. However, I would rather someone with Schizo-affective disorder be treated with Olazapine, anyday...

I am not following your concern: Is your thinking that there is something wrong with people globally? Or how come the poorest of the poor do not suffer from depression? Or you were merely shocked at the number of US citizens using (abusing) antidepressants? Let's not talk about the amount of antidepressent drugs in flushed down the toilet and may be in our drinking water...

I can tell you that very few people actively do have bipolar I or II and are NOT medicated, and had no idea they have it. Some depression and bipolars do correlate with type 2 diabetes development. The research as to why is sketchy at best.

[BigRedBeta]

Why do you think you have lupus?

If you truly do have lupus, then a physician can provide treatment that will greatly improve your condition and make you feel a lot better. Given the significant progression of the disease, the medications can prevent a number of the eventual complications the lupus causes.

[AKA_Monet]

Originally Posted by BigRedBeta

Why do you think you have lupus?

If you truly do have lupus, then a physician can provide treatment that will greatly improve your condition and make you feel a lot better. Given the significant progression of the disease, the medications can prevent a number of the eventual complications the lupus causes.

At bolded: be careful, wait until you have a license before dispensing medical information!!! It's the new rule on GC!!! Forget the fact that you may have primary experience treating said patients or research on said illness, but, remember to add your disclaimer!!!

I just reposted your second paragraph because I thought it was awesome!!! Very succinct Dr.!!!

[BigRedBeta]

Originally Posted by AKA_Monet

At bolded: be careful, wait until you have a license before dispensing medical information!!! It's the new rule on GC!!! Forget the fact that you may have primary experience treating said patients or research on said illness, but, remember to add your disclaimer!!!

How silly of me to forget that!

I saw that other thread once, then never looked at it again...it's amazing to me that I've been on GC for almost 6 1/2 years now and managed to avoid most of the major arguments that have arisen here.

[cheerfulgreek]

Originally Posted by РrettyВoy

Can any of you guys help me? I think I have lupus, but I really don't want to go to the doctor.

lol lol lol

Just so you guys know this isn't the real PrettyBoy. It's a troll and he's been going from thread to thread causing problems. The real PrettyBoy has over 1000 posts and has a join date in October.

[cheerfulgreek]

Originally Posted by AKA_Monet

Well, it was sometime in the late 1970's when hospitalization was no longer enforced on any unwilling adult unless police became involved... I remember President Reagan signing that decree and a whole bunch of people with true disorders were put out on the street. They became the bums and homeless. But by the time the police were involved, the person has allegedly committed a crime, i.e. assault, robbery, carrying a weapon to cause bodily harm, etc.

Zyban et al. is used to help people to stop smoking. So if that drug was included, that is why they might be saying massive increases in anti-depressants.

Also, when Prozac was admitted to the formulary, Eli Lilly did attempt to stop the selling of the nutritional supplement L-Tryptophan saying it caused a rare eosinophilia. But many drugs cause odd side-effects, including Prozac, which has more dangerous ones and that is why Pharma started making extended release tabs. Tryptophan has repeated shown to have better effects than Prozac or Wellbutrin.

I think we see new drug systems to treat psychotropic conditions or mental conditions without the full knowledge of neurology or biochemical genetics that are in play to developing the "true" mental disorders. However, I would rather someone with Schizo-affective disorder be treated with Olazapine, anyday...

I am not following your concern: Is your thinking that there is something wrong with people globally? Or how come the poorest of the poor do not suffer from depression? Or you were merely shocked at the number of US citizens using (abusing) antidepressants? Let's not talk about the amount of antidepressent drugs in flushed down the toilet and may be in our drinking water...

I can tell you that very few people actively do have bipolar I or II and are NOT medicated, and had no idea they have it. Some depression and bipolars do correlate with type 2 diabetes development. The research as to why is sketchy at best.

My concern is I don't think the patients who are being prescribed the drugs are actually depressed. I think a lot of it is to make large profits. I mean c'mon think about it.

Some of the things you were posting about took place in the 70s and 80s, but what I think modern psychiatry has done is to confuse the two. Depression and depression. I know that sounds crazy but I couldn't think of a better way to word it. It's kind of like a creation of depression, so pharmaceutical and other health care companies are more into making profits from health rather than contributing to it. Did I lose you here? Basically they're telling patients they're depressed and they're not.

Seriously, there's probably about one in four people who appear to be depressed and is treated as such, but in reality the patient is pretty much dealing with the aftermath of a recent blow, like the end of a marriage, or the loss of a job or something related to those things.

[AKA_Monet]

Originally Posted by cheerfulgreek

My concern is I don't think the patients who are being prescribed the drugs are actually depressed. I think a lot of it is to make large profits. I mean c'mon think about it.

Some of the things you were posting about took place in the 70s and 80s, but what I think modern psychiatry has done is to confuse the two. Depression and depression. I know that sounds crazy but I couldn't think of a better way to word it. It's kind of like a creation of depression, so pharmaceutical and other health care companies are more into making profits from health rather than contributing to it. Did I lose you here? Basically they're telling patients they're depressed and they're not.

Seriously, there's probably about one in four people who appear to be depressed and is treated as such, but in reality the patient is pretty much dealing with the aftermath of a recent blow, like the end of a marriage, or the loss of a job or something related to those things.

Well, I am not going to "argue" (in a good productive way) whether some people are hypochondriacs that feel that popping pills will make them feel better...

However, many of these drugs used to treat depression (Major Clinical, and/or biopolar I or II, with psychotic episodes) according to the exact definitions of the DSM, MD Consult and Online consult schedules with full case conference review, are legit for the treatment of this illness... That is why psychiatrists are scheduled to prescribe these medications, rather than a GP or Family Doctor...

I know a Family Doc, Internal Med doc or a GP is not going to want the DEA asking questions as to why they prescribed one too many antidepressants without a mental eval referral...

But, that does not go to say that a FEW shrinks are not prescribing random chit...

However, underlying crap that people have in general may get uncovered through traumatic incidences. You never know what the "triggers" are in adults. It is my understanding that "triggers" are well studied in abused (physically, verbally and sexually) children... But, by the time an adult has some issues that never happened as a child, the ability for "brain plasticity" is amenable? I dunno? But that's how it was explained to me... Like negotiation skills are better as one ages...


Also, you need to start practicing appropriate medical terminology here... It is easier to practice with us than with your attending... Don't get busted like my husband did in vet school when he did not go thru the entire list of differentials - he just said the 3-4 top things and what would help the sick animal...

[cheerfulgreek]

Originally Posted by AKA_Monet

Well, I am not going to "argue" (in a good productive way) whether some people are hypochondriacs that feel that popping pills will make them feel better...

However, many of these drugs used to treat depression (Major Clinical, and/or biopolar I or II, with psychotic episodes) according to the exact definitions of the DSM, MD Consult and Online consult schedules with full case conference review, are legit for the treatment of this illness... That is why psychiatrists are scheduled to prescribe these medications, rather than a GP or Family Doctor...

I know a Family Doc, Internal Med doc or a GP is not going to want the DEA asking questions as to why they prescribed one too many antidepressants without a mental eval referral...

But, that does not go to say that a FEW shrinks are not prescribing random chit...

However, underlying crap that people have in general may get uncovered through traumatic incidences. You never know what the "triggers" are in adults. It is my understanding that "triggers" are well studied in abused (physically, verbally and sexually) children... But, by the time an adult has some issues that never happened as a child, the ability for "brain plasticity" is amenable? I dunno? But that's how it was explained to me... Like negotiation skills are better as one ages...


Also, you need to start practicing appropriate medical terminology here... It is easier to practice with us than with your attending... Don't get busted like my husband did in vet school when he did not go thru the entire list of differentials - he just said the 3-4 top things and what would help the sick animal...

Fudge!!!! I can't believe I have to type this all over again. My post didn't get posted.

Who said I was arguing? lol at the popping pills to feel better.

I'm not saying anything to negate the DSM. Infact each successive edition of the DSM has proclaimed an increasing number of diagnoses that cover a large number of human behaviors. The 1st DSM published covered over 150 diagnoses, the next over 350 and so on. I think the next one is supposedly scheduled for 2011, and the number will only increase.

AKA_Monet, I'm not arguing with you, infact I agree with most of what you posted, but I'm just saying in contrast to the DSM manuals, large percentages of people with a severe and persistent mental illness get no care whatsoever. The majority of those with a diagnosable mental disorder are not receiving treatment.

Also, studies have shown that about 42-50% of people with a serious mental illness were receiving no treatment for their conditions. I also read that a seperate study published in 2002 found that of those in the U.S. receiving treatment for a serious mental illness, only 40% were receiving what is considered minimally adequate treatment. Out of all those with serious mental disorders, then, only 15% were getting the high quality care they needed. This goes back to my earlier post about profits vs. actual health care. I'm not negating anything you've said, but I still believe the profits are overshadowing the care that is really needed for serious mentally ill patients.

lol at your husband. May I ask what happened to him for taking short cuts?

[AKA_Monet]

Originally Posted by cheerfulgreek

Who said I was arguing? lol at the popping pills to feel better.

I'm not saying anything to negate the DSM. Infact each successive edition of the DSM has proclaimed an increasing number of diagnoses that cover a large number of human behaviors. The 1st DSM published covered over 150 diagnoses, the next over 350 and so on. I think the next one is supposedly scheduled for 2011, and the number will only increase.

AKA_Monet, I'm not arguing with you, infact I agree with most of what you posted, but I'm just saying in contrast to the DSM manuals, large percentages of people with a severe and persistent mental illness get no care whatsoever. The majority of those with a diagnosable mental disorder are not receiving treatment.

Also, studies have shown that about 42-50% of people with a serious mental illness were receiving no treatment for their conditions. I also read that a seperate study published in 2002 found that of those in the U.S. receiving treatment for a serious mental illness, only 40% were receiving what is considered minimally adequate treatment. Out of all those with serious mental disorders, then, only 15% were getting the high quality care they needed. This goes back to my earlier post about profits vs. actual health care. I'm not negating anything you've said, but I still believe the profits are overshadowing the care that is really needed for serious mentally ill patients.

lol at your husband. May I ask what happened to him for taking short cuts?

When I say "argue", I mean this...

I probably should say "discuss" as the appropriate terminology... What we are trying to do is persuade each other of our concepts to learn what is really going on here. We are not yet in debate...

@bolded: With these comments, I agree with you, most people fail to get adequate mental health care, if at all.

The profits from Big Pharma probably overshadowing appropriate care of these patients. What I am saying is that there has been a shift in mental health care from talk therapy to that of the concrete, biological, evidence based neurochemical provable... The two should be working together because in mental illnesses 1) quite a few people are born with imbalances; and 2) learning, environment and nurturing as well as personality development play a huge role into someone's behavior.

The drug treatment and efficacy should be used on someone who cannot sift through a difficulty, BUT more importantly, that person should undergo somekind of talk treatment to validate and confirm societal standards on civil behavior...

Long time ago, a child acting out in a public setting was unheard of and a parent could physically discipline their child, publicly, if they wanted to.

Today, a child can act out in a public setting, no one will say anything, and clients are disturbed. It has caused some places of business not to allow children into the establishments. The parent usually takes the child to the restroom and resolves the issue, what some would say placating...

No one questions how it might damage the psyche on one identifying boundaries on this growing child. If a child has a predisposition to ADHD, will adderall, ritalin or whatever treatment really enable child to be functional in behavior?

But without treatment, that child would be lost to the system of violent outbursts and uneducated due to behavioral problems.

What to do...

Then we haven't gotten to appropriate diagnosis...

[darling1]

your discussion has been wonderful. the dialogue has been on point. from personal experience, the benefit of proper medication and talk therapy does help in the treatment of mental illness. there are many people who do not have the benefit of both whether it's accessibility or cost, OR even culture, which plays a huge role in proper treatment.

i hope this type of discussion continues.