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shrinkykitten

"...another reason I'm intrigued with the hanged of Salem, especially the women, is that a number of them aroused suspicion in the first place because they were financially independent, or sharp-tongued, or kept to themselves. In other words, they were killed off for the same sort of life I live right now but with longer skirts and fewer cable channels." Sarah Vowell, The partly cloudy patriot.

5.10.2007

Therapy is good for you, and has fewer side effects

There was an article in today's NYT to which I am too lazy to link. It was on the front page though.

It was about the problems of prescribing medications to kids. In particular concerns were raised about off-label prescribing (prescribing meds for things other than the actual intent) and the prescribing of atypicals (like antipsychotics). Part of the issue is that there just is not much (if any) research on the short- and long-term effects of such drugs on kids, yet they are still prescribed in pretty high quantities. Further, the drugs affect everyone differently, and so it is hard to know how one's individual risk for the most severe side effects might be - much less if the drug will even be effective for you.

And, many psychiatrists receive kickbacks from drug companies in terms of free samples, extravagant dinners, trainings, and even money (although not directly for prescribing - some of the people they highlighted got it for running trainings on the drugs).

The article described a pre-pubescent girl who had developed anorexia. The parents took her to a psychiatrist who put her on risperdal (an anti-psychotic, with not insignificant side effects) because it would help her gain weight (it is one of the typically thought of as negative side effects of the drug). And indeed, the girl gained weight - but in 2005 she also developed some sort of nerve thing 9dystonia) in her back that she has to get botox injections for - and that looks to have made her need to hunch over all the time in order to try to alleviate the pain.

This is one of the known side effects of risperdal - it's rare, but still known.

I realize psychiatrists are having an identity crisis of sorts - physicans can prescribe meds, and psychologists, counselors, and social workers can do therapy - so what can they do? What is their niche? They know psych drugs the best, but they are expensive and given that they often only see people for 15 minutes a month, it is hard to feel like you get the best care and that they are really aware of what is going on with you. Also, because they prescribe, that tends to be their focus - find a good medication rather than considering other options. Some do do therapy, but their prices are prohibitive, and some don't get a ton of training in therapy.

It really seems to me that when kids are concerned, therapy should be the first line of defense. The family ought get therapy, if for no other reason than to help them cope with the kid's distress and learn healthier ways of dealing with things, and the kid should get therapy. If and only if that really doesn't help (and it has been given a good chance of helping - not just a few sessions), then perhaps medications should be considered - at low doses, and only ones with good track records of effectiveness.

Parents need to be made better aware of their range of options and the true risks - and they need to be encouraged not the consider the "quick fix" as the best option - and they need to be helped to consider that it may not just be "brain chemicals" and that although the kid is the identified patient*, more may be going on. Thus an approach that takes into consideration a wider constellation of potential precursors or issues will be far more effective.


* typically when parents or a family comes, one person is the "identified patient" which means everyone sees one person as the problem or the one with the problem - yet this is often not the case - that others have problems or are creating problems.

2 Comments:

At 2:03 PM, Blogger k8 said...

While I don't have any medical education, it seems like in almost any situation that trying other options before chemicals would be a good idea. We are such a pill-taking culture, though, that it seems like most people expect to be given a prescription for anything medical, psychological, etc.

 
At 2:53 AM, Blogger Breena Ronan said...

The problem is getting therapy: getting medical coverage, finding a decent therapist, etc.

 

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