psychiatrists and medication

if you take medication or are thinking about it, i’d suggest you make your way over to shrink wrap, where dinah, a psychiatrist, has a fabulous post on how she goes about prescribing medication.

here’s an excerpt:

1) past history of response. if the patient says, oh, yeah, six years ago i felt this way, i took paxil for six months and that helped a lot and i didn’t have any side effects, then paxil it is.

the path changes if the story is that the medication didn’t work or had side effects.

2) family history of response. this is the patient’s first episode, but mom swears by wellbutrin, it’s helped her when nothing else would.

3) patient preference. he’s here because his best friend took celexa and became a new and wonderful person. i have no idea what friend’s diagnosis is or why celexa was chosen for friend, but if there isn’t a contra-indication, then i might as well honor a patient’s wishes and there’s some power to believing something will help.

4) other medical issues. i don’t start with meds that interact with what the patient’s already on.

6) my best guess at the side effect profile, for better or for worse. really, this is a guess. i actually hate this issue because patients often worry about side effects they never get, but okay, if someone is agitated, i might start something i think of as being more calming.

can i say a word about weight gain as a side effect? some patients refuse any medication that’s been associated with this. but clearly … there are people who don’t gain weight on medicines that are said to cause weight gain, just like there are people who don’t get better with anti-anythings. people respond to meds differently.

the biggest point i see here is that dinah doesn’t immediately say, “depression? wellbutrin!” she actually looks at the person and his/her situation first, and then makes a recommendation.

you’d hope every psychiatrist was like that. unfortunately, that hasn’t been my experience. in fact, when i was working in social services, i had a little project trying to find at least a handful of respectful, client-oriented psychiatrists to refer clients to here in the vancouver area. i found one who took new clients. and then he retired.

what do you think, people? any good experiences with psychiatrists? would love to hear them.

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