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Author Topic: Drugs are scary.
Bob the Lawyer
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"According to the website for Strattera, trials have only been done on Child and Adult ADHD. But that doesn't mean a doctor can't prescribe it for you for that diagnosis if they think it is right for you."

While it's late and I don't desperately want to get into this, you have know idea how annoying this is from the perspective of big pharma. You know that what you're designing the drug to do isn't necessarily how it will be used. Doctors aren't pharmacists, sometimes I think they forget that.

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mackillian
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Exercise is wonderful for mental health [Big Grin]

As well as a good diet and good sleep.

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rivka
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mack, that happened to you, too?! [Eek!]
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mackillian
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mmm. using strattera like that would bug me...but I haven't even looked at the biochemistry of how typical OCD medications help and how strattera differs.

But to test it--you need to do controlled clinical trials.

But some medications for mood stabilizers ARE used off-label.

Lamictal was just approved last July for use as a mood stabilizer in bipolar disorders--and I'd started taking it in June.

This is most common with anti-seizure meds. Depakote is one that is approved as well.

But the others...trileptal, tegretol, topamax, gabitril...still off-label.

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Eljin
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quote:
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I feel that everyone wants the "quick fix", so they come up with these personality disorders, then prescribe behavior changing drugs.
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I understand that you feel this way, but I'm curious as to the thought process which lead you there. Why do you believe this? Specifially, what are your reasons for believing this to be more than just a possibility, but rather an established fact?

(Thanks. Honest questions, I promise -- I'm interested. )

I think the main reason I feel this way is the family and community I live in and have lived in my entire life are very big on taking personal responsibility. I come from a very conservative and religious background, and I've always been taught that one should do the best with what they have. There are also quite a few students at my school who use ADD as an excuse for any bad behavior, as if it were a crippling disease, and they were completely unable to make any choices for themselves. Before very recently, there was no medication for ADD, and people still survived. My HB teacher this year, who has been teaching at the school for at least 20 years, very obviously has ADD. This is not to say that all cases are made up; I do realize that there are many identifiable imbalances in the brain. It's just been my experience that human beings in general want that "quick fix", which usually doesn't fix the problem, just the symptoms (I'm not talking medically here, I'm talking universally)

Not sure how much sense that made, but you said you wanted my thought process, so I gave it as best I could. My logic usually makes some fairly random seeming jumps that I don't always understand completely, so I hope that all hangs together well enough.

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mackillian
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rivka--which?

(GET ON AIM)

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ClaudiaTherese
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Eljin, I'd definitely agree with you that it is possible both to have a treatable mental illness and to be a real jerk. They are certainly not mutually exclusive!

Thanks for your honesty. I have a different take on this, but I was mainly curious to learn where you were coming from, and I appreciate the explanation.

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mackillian
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Eljin--that's what I do for my work, in part.

I work with kids with mental illnesses in terms of managing their symptoms and resulting behaviors in the community. That while they do have a mental illness, be it ADHD, depression, bipolar, what have you, that is no excuse for misbehavior. But it takes a different type of behavioral management system and some damn good accountability for behavior for those kids.

Mental illness isn't an excuse for bad behavior. But it doesn't discount the actual illness's existence, either.

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ClaudiaTherese
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Yeah. What mack said. [Wink]

[I love it when she does that.]

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pH
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mack: Well, my psych at home...the one I refuse to speak to anymore....once mentioned adderall for ocd. But he never got around to trying it with me; apparently, it has worked in the past, as I said, on rare occasions.
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rivka
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mack, the kidney/bathtub thing. [Wink]

Can't -- am trying to help a child with homework he doesn't think he can do. [Wall Bash]

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mackillian
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pH--hmm. makes me curious, that's for sure.

rivka--tell him he just can't. I'll take care of the rest. [Wink]

CT: *blush*

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rivka
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Tried that, mack. Didn't work. The coaxing is working -- almost done with this page. *phew!*
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mackillian
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cattle...prod...
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ClaudiaTherese
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Be strong, rivka.

*sends the good vibes

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rivka
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I try to save that for getting him out of bed in the morning. [Big Grin]
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mackillian
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[ROFL]
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Jill
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I asked my therapist about this today, and she said that one theory is that when people are depressed, they generally lack energy. When they start a new antidepressant medication, they have a lot more energy, and therefore some of them will use that energy to actually DO something about their depression... i.e., commit suicide. Note that most antidepressants don't take effect for a few weeks, so the most dangerous time is right after someone starts one.
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Alucard...
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Sorry I entered the fray late. A few points from a pharmacy perspective:

I have been a pharmacist for 8 years, and I have never had a patient commit suicide because of an adverse drug reaction to something like Paxil. I have dispensed SSRIs: like Paxil, Prozac, etc THOUSANDS of times, and I must tell you very honestly that the world is definitely a better place because of modern pharmaceuticals.

I have seen drugs pulled off the market in the United States for fewer than 40 deaths nationwide, Baycol and Rezulin to name a few. Now similarly, Prozac had this type of negative press in its early years, and the sensationalism was hard to fight through for me professionally.

Strangely enough, the Church of Scientology was found to have masterminded a huge anti-Prozac press campaign that evolved into a multi-headed beast that still surfaces its head to this day. I also believe that Eli Lilly, the makers of Evista (osteoporosis drug) at least had an indirect hand in discrediting Premarin as an unsafe drug. Why? Many patients were switched to Evista.

Ask yourself who has the most to gain by some of the sensationalized ads you see concerning pharmaceuticals, then ask someone you trust what they believe to be the crux of the matter. In the case of Paxil, I would cry and console any of my patients' families that suffered a tragedy like the one listed in this article. The pain and suffering you read is obviously real. Also keep in mind that the FDA is not pulling these drugs off the market, but they are recommending that certain SSRIs are not to be prescribed for adolescents under 18. This is a very important distinction. If you are very Darwinian, you might consider 40 deaths compared to MILLIONS of patients who benefit from a drug acceptable. Think in terms of cancer drugs: if you had a 50/50 chance of surviving cancer, but a drug could make that chance of survival 90/10, would you risk it, even though 40 patients died out of thousands because of liver toxicity? I would! However, the FDA does not work under these terms. A drug will be pulled off the market, in many cases VOLUNTARILY by the manufacturer, with the FDA overseeing the process. Paxil and other SSRIs will NOT be pulled from the market. This should alleviate the fear of pharmacueticals for some people.

However, I remember being 18 once and I can attest to the turbulent and emotional time that it was for me personally. I cannot pretend to think that these potent pharmaceuticals have no adverse effects at all, however, for every 1 adverse reaction, there are 99 positive ones. I just hope professionally and personally, that no one is permanently injured or hurt while trying to find the right drug.

Let me also say this: If diabetes medicine seemed frightening to you, would you not take it and let diabetes run its course? Seems foolish doesn't it? If your body NEEDS insulin but you are afraid of needles, will you willingly let your disease progress until it kills you?

I hope not, but I know people like this. As mac and CT and others are illustrating, some psychololgical disorders are a chemical imbalance of neurotransmitters, just like the body not having enough of a hormone like insulin.

However, experts may give the false assumption that they know everything about the brain and how it works. Wrong. As vast as our knowledge has become and the subtle differences between pharmaceuticals, there is still a 3-week period in which doctors tell their patients to "try" a new drug.

This makes NO SENSE in a pharmacokinetic sense. Without going through the boring mathematics of it, dosing of a drug once a day should reach steady-state blood plasma levels in about 5 doses. So on paper, with the purity of mathematics to support it, taking a drug for a week should ellicit some positive or negative response. However, the brain is still a mystery and takes as long as 3 WEEKS to illicit a response to some drugs. What does this mean?

For someone who is suicidal, they may be prescribed and antidepressant, a SSRI, like Paxil. If this is not working, or is causing side-effects, this patient may have to battle suicidal depression another 3 weeks with no benefits from pharmacotherapy.

As eluded to, these 3 weeks can be a dangerous time, and as much supportive therapy as can be given will make all the difference.

Remember, drug therapy is only one facet of therapy. I do not believe by any stretch of the imagination that simply taking a pill will solve all problems. Psychotherapy and counseling also play an integral role in treating suicidal tendencies. Communication also plays a HUGE role. We see this break down where the patient in the above example did not want to continue Paxil, so the doctor doubles it. This is a tough call for the casual observer to make judgement on. In many cases, the prescriber is justified. However as many Jatraqueros have mentioned, they knew when a drug was not working probperly and procedded to discontinue the medication promptly.

What does all this mean in summary? If you believe that your current medication is not working properly, check with your doctor. If you do not want to take the medication, then tell the doctor exactly that and ask what else can be taken to replace the discontinued medication.

HOWEVER!

Please do not stop medication without informing your doctor. Keep your doctor in the loop and let them help you make an informed decision. If you are not satisfied with the decision, get a second opinion.

I must say that working with drugs all around me all day long that drugs are not scary.

People are scary!

Hope this helps!

P.S. I cannot recall Depakote having a black box warning of any kind. The most recent black box warning has been for Serzone. I expect one for Zyprexa soon as well, and as far as Serzone is concerned, it has been pulled off the market in Europe for liver toxicty associted with long-term therapy. This may happen in the US as well, so Serzone should be reserved for last-line therapy.

[ March 24, 2004, 05:42 AM: Message edited by: Alucard... ]

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ClaudiaTherese
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(Is there any other place like Hatrack? Bravo, Alucard, and thanks. [Smile] )
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Valentine014
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I can't seem to find any information regarding the reason I stated earlier, but I do know for a fact that it has been black boxed for hepatotoxicity.
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ClaudiaTherese
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Valentine, I'll try to look around later.

( [Wave] [Smile] )

[ March 24, 2004, 09:06 AM: Message edited by: ClaudiaTherese ]

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Tiger Eye
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quote:
These medications SAVE LIVES. And even more often, make life worth living.

yah. i'm living proof. i'd be in trouble without my meds.
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imogen
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On a slight tangent / back to the first pageishness...

Looking back on this thread - something that strikes me is the issue of the amount that antidepressants/ADHD drugs are overprescribed.

Let me qualify here. I do not think that antidepressants or any other drugs to correct disorders are not necessary in many cases. I've seen a lot of first hand cases where those drugs have helped immensely.

Mack, I've read how happy you are this year with your medications working out, and I don't doubt for a second that these medications have been fantastic for you.

But I also have a mother who is a GP, and a couple of friends who got prescribed various drugs that, in hindsight, they didn't need. My mother sees the over-prescription of such drugs as a big problem.

In Australia, at least, it seems some (not all!) doctors are more willing to write out a script then spend some more time with their patient and maybe refer them to other services.

And now we (in Australian primary schools) are starting to see a trend that way with kids as well - it's easier to give them ADHD medication than try more time consuming ways of getting them focussed and interested. Which I think is very worrying.

[ March 24, 2004, 09:29 AM: Message edited by: imogen ]

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UofUlawguy
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I have a question for all you super-knowledgeable people. Is there any indication that the kinds of disorders we've been talking about (depression, ADHD, bipolar, others?) are more common now than they were in the past? The fact that they are being diagnosed and treated so much seems to surprise a lot of people, and in some cases make them wonder if the phenomenon is real. Others, who believe the disorders are real and as prevalent as they seem, start to see conspiracies re: chemical/industrial/pollution-related harms related to modern life that former generations didn't have to deal with.

So, were people of the 19th century and before plagued by these disorders as much as we are today?

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pH
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Honestly, I think they were just as prevelant...but not as easily recognized. I mean, treatment for mental disorders used to consist of basically taking a chunk out of your brain or shocking the crap out of you.

I think they're _overdiagnosed_ today, but I don't think they're any more common.

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Shigosei
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Bit of a tangent here: Has anyone had a medication quit working after a few years? Did you switch to another one or increase the dose?
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MrSquicky
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Many people seem to think that a mental illness is either biologically caused or it isn't. Also, they seem to think that the only way to fix a biological-based illness is through biological (usually pharmacological) intervention. Except in rare cases, neither of these are true.

For one thing, most major mental illnesses are most likely a combination of biological predisposition and environmental factors. There are very few places where we've concluded that something is purely biological. When someone gets depressed, it is likely that they have brain chemistry abnormalities that are contributing to this, but there are also usually environmental things that are also fueling this state, and some of these factors are the person's way of thinking about things. Also, it is likely that in some cases, a depresssed person may not have a biological cause for their problems and it's mainly their own way of thinking about things that is the cause.

Here's the thing though. We don't know what the case is. Furthermore, from a therapeutic standpoint, we don't really care. It's not a therapist's job to necessarily determine cause except where it leads to a more effective treatment. It is certainly not a therapist's job to blame someone, to say that it's their fault that they have a mental disorder. That's for ignorant people and talk radio hosts to do. A therapist should be concerned almost exclusively on what's going to make their client function better and remain functioning better.

A person with problems caused by brain chemistry abnormalities doesn't necessarily need to be treated by fixing these abnormalities with drugs. In many cases, talking cures can fix this problem. Likewise, people with non-biomed problems can still have these problems fixed or at least covered by drugs. Just because a problem is caused one way, doesn't mean that it can only be dealt with in that dimension.

The analogy I like to use for mental illness is of someone struggling with a weight. It's bearing them down and you want to help them. Utlimately, you want the person to become strong enough to handle this weaight and other weights that come along, but yelling at them that it's their fault that they are not strong enough to lift this one is not a step along this road. Even if it is true (and what arrogance to assume that you can know that it is), you're not helping them either get over this weight or become stronger. You're just distancing yourself from your own projected weakness. You're job is to try and help them, by lessening the weight or helping them lift or teaching them a better strategy to lift the weight. Also, some weights are going to be too heavy, not matter how hard you try. That's when you just have to try to get rid of it and keep it away.

I think we overproscribe drugs to deal with psychological illnesses and that this is both an indicator and a cause of some big problems in our society. In many cases, drugs are by no means the most effective treatment, neither in the short term or the long term. What they often are, however, is the easiest way of dealing with someone who isn't acting the way you want them to. Also, on the part of the person taking the drugs, they are the easiest way of "dealing" with their problems. However, much of the time, all their doing is blocking the symptoms without doing anything about the problem itself.

pooka brought up the recent findings that exercise is an effective treament for certain types of depression. According to studies I've read, it works even better when treating childhood ADHD. The problem - well besides it not working in all cases - is that it's much more effort to get kids to exercise than it is to have them pop a pill. Also, it's more threatening to acknowledge that kids don't pay attention in school because the school system is extremely poorly set up in terms of getting and keeping kids attention. It's better to blame the children than ourselves, and it's even easier to blame some sort of chemical problem than the kids.

Popping pills, even when this treats the syptoms without many adverse side effects, rarely works in a long term view. As soon as the person stops taking the pills or acclimates to them, the problem is often going to return. Generally, at best, they can clear the ground of threats for the "real" therapy to work. That is, teaching coping strategies and helping with lifestyle changes and psychological growth.

This thinking, however, is not inline with the high value that our culture places on comfort based individualism. People don't want to accept that their thinking is at least partially the cause of their problems. They also don't want to go through the difficult process of reworking the way they think about things. It's much easier to deflect the responsiblity and say that it's because of brain chemicals and there's nothing I can do about it. They don't want to hear that even if it is caused by brain chemicals, that doesn't mean they can't do anything about it other than popping pills.

On the other side of the aisle, people who want to distance themselves from people with mental illnesses put the blame completely on a lock of will. In this thinking, people who have a mental illnesses are just weak, whining individuals who are looking for an easy escape from their problems. That this is in a very mild form true doesn't help this type of thinking. The people who think this way rarely want to recognize that, not only are there psychological illnesses that are pretty much beyond people's control, but that people, themselves included, rarely ever have even a majority of control over their mental state. Not only do they yell at the people trying to lick that bruden, but they're jumping up and down on it to make it heavier.

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MrSquicky
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UofU,
Comparing across time periods is a really imprecise thing. We're lacking reliable data and a basis for comparison. There's really no way of knowing.

However, we do have access to comtemporary cross-cultural comparisons of the prevalence of mental disorders. As this as our basis, America compares extremely poorly on many of the neuroses, such as depression, ADHD, and anxiety disorders.

It's important to acknowledge the possible sources for this other than the "weakness in society" one that people immediately jump to. For example, American's have a significantly different diet than other countries. Also, there is in general more and different types of pollution (according to some current thinking this is a possible cause for the ADHD) here than elsewhere.

However, I'm a social/personality guy, so I'm predisposed that it is mainly due to the structure of our society and also because these disorders are masked by the deprivations in the other societies that we're talking about.

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MrSquicky
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As I'm in a ranting mood right now, I'd like to point out that the single best thing we can do to improve both the mental and physical health of our country is to strongly encourage exercise. The big problem with this, other than the reluctance of the population to do it, is that it doesn't make anyone any money. It's free and it's the universal magic bullet. This is one of the main reasons why I support nationalized health care in theory, because then we can use interventions that really work rather than ones that are good for the economy or at least drug companies.
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Tiger Eye
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UofUlawguy,

i was watching the news and they had a story that talked about the increase in diagnosing children with mental 'problems' (bipolar, ADHD, etc.) over the past few years. however, i dont remember it proving whether it was the children that were changing, or the process of diagnosis.

my guess would be a combination.

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sndrake
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I think these things go on a continuum from "difference" to "disorder/disease" and interact heavily with social and environmental factors.

I've dealt with it somewhat on my own. At time in my life (none recently), I've been in situations where I was given a screening test for depression and met borderline conditions for very mild depression. Recently, I've learned that this is no surprise - part of whatever happens with hydrocephalus seems to leave a lot of us predisposed to depression, so it's probably biochemical/structural in origin.

My own education, assertiveness and a cooperative professsional led to a polite decline of a medication offer. (I have a lot of atypical reactions to different meds)

When I feel it's an issue, I know what to do. For the level of depression that I get, a regimen of regular exercise, decent diet, and paying attention to my sleep kicks my own system into gear. What you do does effect your internal chemistry - in my case there was a clear choice to be made.

I also have some features that overlap with ADD, but heck, I have features that overlap with Aspergers, too. For me, I'm not sure what medication would do for or to me. And I'm comfortable enough not to want to mess with it.

But that's the point, I think. If things aren't working - the whole risk/benefit analysis begins to look very different. Like when I have an approaching migraine and reach for the medication with all the grim warnings on it. [Angst]

Every time. [Smile]

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Alucard...
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I have in my hand the Package Insert for Depakote. It is black-boxed for Hepatotoxicity, Teratogenicity (spina bifida especially), and Pancreatitis. Thanks for making me look it up and I apologize for not knowing this. I SHOULD have known this (flogs self with spatula on the knuckles).

I have done continuing education on ADHD and ADD and I was surprised by the meta-analysis of the population treated with drugs like Ritalin or Strattera.

This news is alarming and very unexpected, but the study found that only 30-50% of patients that could be diagnosed with ADD/ADHD are treated pharmacologically. What this means is that the reasearchers of the study extrapolated, with very scientific methods, how many patients are treated, how many go untreated, and how many go undiagnosed. I am the biggest skeptic in the world and I can't help but do what I do professionally and be shocked by how much pshychotropic medicine I dispense. Numbers don't lie, people do. I just hope that the companies that make drugs for ADD/ADHD are not manipulating the data for further sell their products.

I especially liked the idea to exercise. I miss gym class. I beleive that if more companies and employers offered pre-work calesthenics, that more and more people would want to participate. However, in the real world, this would give employees more opportunuties to gain workers compensation claims and sit at home.

I also liked the comments that there is more than one way to solve a medical condition. Basically, pharmacotherapy is only one facet of total health care. I would also caution strongly the use of common sense. Magnet therapy, reflexology, and other quack sciences are just that. Don't make me quote PT Barnum on this issue...

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Alucard...
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I also forgot to mention one other important factoid. For those of you who believe that drugs are overused for psychological disorders in general, you are wrong. Before the advent of benzodiazepines (Valium-like drugs) and antidepressants, many of these patients were institutionalized. The ones left untreated generally became ostracized from "normal"society as insane. What this means is that with the advent of modern pharmaceuticals, studies have shown that as much as 20% of today's society would be intitutionalized if treated under guidelines a hundred years ago. Just where are you going to put all these people? That is why TOTAL therapy is so important when facing a psycholical condition. Drugs are only a small but important part of therapy. I believe that psychoanalysis and pshychology are also big components. Most importantly, I believe that a certain amount of self-discovery and self-analysis have to occur to allow healing. Only then can someone have the courage to fight their condition and find ways to live with it.
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MrSquicky
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Alucard,
But it's entirely possible that drugs are both over-prescribed and under-prescribed at the same time. Just because there are a lot of people who aren't getting treated at all doesn't change the fact (well, not a fact as much as an opinion on my part) that there are many people who are being mistreated by either being treated solely pharmocologically or being given drugs when other therapies would be much more effective.

It is possible to both overserve and underserve the same community. In fact, I'd say it's pretty much inevitable.

[ March 25, 2004, 12:58 PM: Message edited by: MrSquicky ]

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Alucard...
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I agree wholeheartedly. In fact, I would rather see drugs underused than overused if I had to choose, but I always strive to aid in a patients optimal therapy, finding that happy medium.

Personally, I hate to take my cholesterol medicine, and do take vitamins, although I wish I were not relying on either.

So, essentially, I agree.

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