Saturday, September 29, 2007

What have I always said, class?

"Um, that the revolution is coming?"

"No justice, no peace?"

"That you really need a diet Coke and a cigarette?"

No, no, no. You haven't been paying attention. Or've been paying TOO MUCH attention. Anyhow, what's I've always said is: There are usually simpler and better ways to help people than by handing out prescription drugs like Rush Limbaugh on Halloween ("Oh, you're a scaaary monster! Have a Percocet. And you're a typical yuppie blue-state voter--have a handful of OxyContin, sweetheart, I like your style.") Not just pain meds, either--in fact, I think there's probably a tendency by most general practitioners to underprescribe narcotic analgesia (unless you're like my primary care doc, who offered me a script for Tylenol 3 when I came in with a small abcess in an embarrassing location. No, dude, it doesn't hurt that bad, I just didn't want it to spread and start eating away my entire ass. My gluteal real estate is already prime; there's not a whole lot of it, supply and demand, see?). I'm talking about the everyday drugs, the 'lifestyle' drugs if you will. The statins for cholesterol, the antihypertensives (ie, blood pressure meds), the "mood brighteners" prescribed for people who aren't clinically depressed, exactly, but who feel that something has gone wrong in their lives and are consumed by a basic feeling of...not being all they could be. Perhaps--and I'm going out on a limb here--that's because they're NOT being all they could be. Maybe they work long hours at a job they hate and have no time or energy for doing the things they love, like spending time with family, painting, gardening. Maybe they're not doing the most basic things to take care of themselves physically and emotionally--they live on coffee, soda, vending machine crap at work, and fast food on the way home; they don't have time to exercise or get enough sleep but manage to watch three hours of reality TV a night; they have friends, but they spend more time discussing the lives of distant celebrities and non-existent television characters than the vagaries of their OWN existences. So, tip: before you start slinging the Zoloft and Celexa, or badgering your doctor to do same, give exercise, healthy eating, sufficient sleep and relaxation techniques a try. Lifestyle interventions: maybe difficult, but essentially free. Drugs: easy as hell, but upwards of $150 per prescription. That's per month, son. And while exercise, sleep, etc. have no negative side effects, drugs do, and furthermore a lot of these compounds just haven't been around long enough for us to know what happens (in the long term) to people who take them. Not to mention that a lot of drug companies conceal study results that show drugs are...ahem...less efficient than they might want people to believe, or that there are side effects that most people would consider intolerable.

Zyprexa, for example, is an antipsychotic that the folks at the eating disorders treatment center were really jazzed about; I was prescribed it once, but d/c ed it as soon as I was discharged. They liked it in part because it chills you out, and a lot of anorexics are high-strung folks with sleep disorders. Secondly, it is well known for its hunger-inducing and weight-increasing effects. It's not unusual for Zyprexa to plump someone up to the tune of 40 pounds. From a clinical perspective, in this very particular environment, those might be selling points (or an anorexic patient suddenly confronted by weight gain and/or rabid hunger could turn bulimic or redouble her efforts to resist food because the underlying emotional issues haven't been adequately addressed...but hey, insurance companies look at weight gain, not at quality of life!). It's good for treating obsessive thoughts, too, or so the manufacturers say; anything from OCD to psychotic delusions to the anorexic litany of calories in/calories out. In the general population, though--ie, people who aren't initiating treatment 30 pounds underweight--that kind of weight gain can cause real problems, up to and including what a lot of patients I see call "the diabetes." Not to mention the inability to find cute halter tops in the summer. Yet somehow the diabetes/crazy weight gain connection didn't get much press until Zyprexa had been on the market for a while. I shouldn't say "much press;" it still hasn't gotten much press, to be frank. Last time I saw The Psychiatrist and told her the new antidepressant (rhymes with Beffexor) was making me lose weight--and oh, by the way, my sleep cycle has gone to hell, but at least I'm catching up on the 2 am Golden Girls reruns--she said, "Hey, let's try Zyprexa." There was a brief conversation in which I expressed my desire not to take antipsychotics, especially not one that makes you "fat and sleepy," and in which she told me she didn't think I was psychotic, and hey, why didn't I take 5 months worth of samples and give it a try--no obligation, as they say on infomercials. So I got a little baggie of samples and a pamphlet called "Building a new life" or something similar, which really should have been called "Platitudes and Stock Photographs of Smiling People and Birds and Stuff."

That said, there are people who need drugs to function. Most psychotics, for example, or people with severe and intractible depression, or some other psychological disorder of a crippling nature. That's why I want to be psychiatrist and not a psychologist or art therapist or social worker: I want to be able to prescribe the drugs (though I know there have been rumblings about giving psychologists with PhDs prescribing privileges; that's a whole different post). And I loved my, uh, Boloft for years, and my Bepakote has been a godsend. They're not lifestyle drugs for some people; they're fixing a neurological/chemical dysfunction that has very real potential to kill (30% of folks with schizophrenia attempt suicide at least once, and 10% finish the job eventually; about 18% of bipolar people kill themselves; 15% of people with anorexia die of their disease). I'm not a drug-hater by any means--they aren't bad in themselves (well, except cyanide, and a few others...the ones that hang around street corners after dark, stealing cars and whatnot...). It's the responsibility of doctor and patient to use them judiciously and correctly.

1 comment:

john said...

Yet another of these anti-psychotics, Beroquel, has a very similar effect to Zyprexa. My family physician, worrying that I was a psycho, prescribed Beroquel telling me that it was a sleeping medication.

I, of course, researched the drug in my Facts and Comparisons, only to find that the bitch had lied to me and prescribed an anti-psychotic that specializes in the treatment of bipolar disorder. A little more research, and I self-diagnosed myself with bipolar disorder and took the meds. Not six weeks later, and I had gained 65 pounds. What the fuck? Hello, depression. Hello, suicidal thoughts. I was now a cow who slept well at night and rarely did things to hurt myself.

The trade-off was not worth it. So, I stopped taking the meds. Cold turkey.

I now rely on the stimulating effects of Bellbutrin. And I don't trust my physician.

Not sure why I shared this. But I liked the post. And it's a topic few people know much about.