After 20yrs of providing outpatient mental health services in an extremely underserved rural portion of Northern Minnesota, perhaps like Rip Van Winkle, I have finally started to make a major change in my practice patterns. I have enjoyed thoroughly the daily clinical work, but possibly like Bill Murray in the movie Ground Hogs Day, there has been very little variation and even less networking with other providers in my region of the State. Increasingly, I have been moving into the direction of the “pdoc” & med checker….a model Managed Care seems to prefer, as well as BigPharma. Thanx to some stellar input from other experts around the globe via Twitter, in particular, I have become increasingly aware of the need to be like my online superstars – a Serious Skeptic, particularly regarding the feedback from drug reps, Industry Sponsored Speakers, Industry funded CMEs, etc. Some of the biggest names in psychiatry today have been department heads who promote Branded products without disclosing the huge sums of money they have received from whatever Company they are promoting. Ghostwritten articles, Journal Supplements with misinformation, have gotten out of control. Thanks to the links provided to me by other Professionals and Patient Advocates, I was, and continue to receive, alarming and eye-opening facts that have led to me spend so much of my clinical work, now attempting to reduce the polypharmacy regimines of many. I consult with a large number of children and adolescents. The pattern is far too predictable. Initially, an unruly child will be labeled as ADHD and prescribed a direct stimulant. Family Dynamics and NeuroPsych issues often not addressed. If the child continues to be disruptive, the meds are increased and often augmented. A child psychiatrist will often then add an antipsychotic and the child is diagnosed as Bipolar with ADHD, as well as Oppositional Defiant Disorder. In recent years, family docs and Nurse Practitioners begin to follow the same prescribing patterns. As for the antidepressants, for over a decade, I have cautioned via my website about ‘discontinuation syndromes’ – particularly from Paxil, Luvox, and Effexor – shortest half life – so quickly wear off with a single missed daily dosage. For Adult, many a Vacation of a Lifetime has been ruined due to not being informed about the withdrawal effects. For the child or adolescent, in a Foster Home or Residential placement, many a home visit has been disaster because their meds were not send with them or they failed to take them once home for a weekend. (With the short acting, symptoms of panic, crying, insomnia, and extreme irritability sets in within 24 hrs after a missed dosage. Tragically, the conclusion is made that the patient needs more time in placement and no connection is made to the drug discontinuation) At the next review or court hearing, the Judges typically go with the recommendation that another 6-12 months is needed with out of home placement. I could ramble on for hours regarding all the short and long term side effects from these potent, often prescribed off label agents. Last week the NYT published a video about antipsychotics for disruptive children and hopefully parents will become much more skeptical. Often “The doctor does not know best” BigPharma is only driven – like BigTobacco-to expand their market shares and keep the shareholders happy. Several “Me Too” SGAs (2d generation antipsychotics) have been launched in the USA with very similar metabolic side effects, leading to childhood obesity, diabetes, increased Prolactin (which causes breast enlargement and leakage even in young boys – Seach YouTube). Long term effects are unknown in the young, but hyperProlactinemia leads to a number of serious conditions such as osteoporosis. Parents, Guardians, Teachers, and not Drug Reps must step in and protect their children and themselves. These same drugs (risperidone, for example) should not be used in nursing homes with dementia patients as they increase risk of Stroke and Heart Attacks in the Elderly…..yet the nursing homes and Assisted Living dwellings continue to utilize frequent SGA,s in spite the Black Box Warnings on the package insert demanded by the FDA.
So for this Rip Van Winkle Shrink, my 20 years in the isolation of my office is up at the end of this month. No Drug Reps, No “Free Samples” and I will once again consult by leaving the comfort of my office, and visit the children, adolescents, and adults in their own settings. Meanwhile,I will hope to continue to receive incredible updated information from advocate Bloggers, Pharmalot, PharmaGossip, Fierce Pharma, Carlat Blog,Soulful Sepulcher and so many other informed and skeptical of BigPharma contacts via the internet.
Great Child who did not wish to have her picture taken.
It’s a shame that you’re so far away from Lindsay, Stephany’s daughter… She thinks very quickly, from what I can tell – Stephany once wrote that Lindsay used to complain that people (on the TV and radio), were wishing her harm. I think that she applied her knowledge of language (which was very good, as I understand it), and applied it almost mathematically.
A more detailed understanding of how she came to the conclusions that she did, I cannot supply, because I’ve never had the opportunity to look at a piece of “free writing” that she’s done, and ask her about it. But there’s no question that she’s extraordinarily bright, in my mind.
How we mean the words that we use is irrelevant, unless we’re prepared to clarify our meaning to those who have not understood us. I guess that that’s the message I take from Lindsay’s experience.
Matt
great post, dr brandsford. as the director of the largest support group in the philly area for folks w/mood disorders & their loved ones, i can honestly say i sacrificed my kidneys while running the group. in less than a year i will need either a transplant or dialysis. the amazing thing, tho, is that when i went off lithium, which i’d been on for 16 yrs, my bipolar I had disappeared. i just read robt whitaker’s painstakingly researched ‘anatomy of an epidemic ‘ and have had my eyes opened about long-term harm. right on, dr b, with no drug reps allowed in your office.
So many patients who initially benefited greatly from Lithium Carbonate, are now gradually finding out they are in Chronic Renal Failure – that it is irreversible, and often after 20+years of ongoing Rx. They had their serum creatinines monitored and the BUNs, but at some point renal toxicity seems to set in. Switch to Valproate and the concern becomes potential Liver Failure, possible pancreatitis, alopecia, weight gain, ? increase in Polycystic Ovarian Cysts, etc. Then the Second generation antipsychotics are promoted so heavily by the BigPharma with all the problems related to metabolic syndrome. I can not currently think of a safe, long term Bipolar med…….tend to use targeted use rather than continuous use. Always amazed how well many patients with BSD can become at looking for triggers for relapse and setting up a safe plan with friends and family to prevent relapse. dlb
Dr. Bransford,
Has no one ever improved on this medications in your experience?
The difficulty is deciding what “impovement” is expected and at what price in terms of short and long term side effects. Risperidone and all other SGA will reduce disruptive behaviors, but also create major metabolic changes – particularly in child and adolescents……….If you wish to have the child “behave”, the first and second generation antipsychotics will sedate the child. but at the expense of Movement Disorders with first generation, and metabolic disorders with second generation – such as risperidone, Abilify, Seroquel, Zyprexa, clozapine, asenipine, ziprazidone, and iloperidone. Yes, the meds can alter behaviors, but the neurophysiological effects can be damaging & irreversible. I see far too many obese child, now with diabetes, and hyperprolactinemia – particularly with risperidone…having profound effects on the pituitary gland. Tragic results can occur with prescribers uninformed and believing the BigPharma companies in terms of their misinformation regarding safety. I strongly believe there are non-medication interventions that are far too often overlooked & are effective, safe, and beneficial. Temple Grandin PhD gives a great lecture that is on DVD entitled and “How I See It” in which she addresses Autism and Aspergers with a fair discussion re: meds, as well as a plethora of other treatment modalities. I strongly recommend viewing it.
Dr. Bransford,
I look forward to the day when psychiatrists take this to a higher level, by holding to the following:
1) No psych drugs for children – period.
2) No psych drugs for elderly – period.
3) Adults, by informed consent only…. This includes information on the harm from the long-term use of drugs, particularly, antipsychotics, long periods of time, and/or cocktail form.
4) No psychiatric “treatment” of any kind by force, without due process of law – period.
Psychiatry has a long way to go….
Every psychiatrist should know about the dangers that come with the long-term use of psychiatric drugs, and be able to inform their patients on how to taper OFF psychiatric drugs – slowly and safely…
Must-read links for any psychiatrist -
http://discoverandrecover.wordpress.com/warning/
You and your colleagues have light-years to go.
I applaud you for taking a few baby-steps, and encourage you to do more… to lead!
Your “profession” has lost its way!
Passionately,
Duane Sherry, M.S.
Dr. Bransford,
You and your colleagues need to stop drugging children…. especially foster care, Medicaid kids… like candy you and your colleagues pass out prescription rx drugs to them….
From the website Psychiatrist, Peter Breggin, M.D. -
http://breggin.com/index.php?option=com_content&task=view&id=38
A moratorium on the drugging of young kids… Then, maybe your “profession” will be seen as “doing no harm.”
Duane
Dr. Bransford,
One last comment….
This is an absolute must-read for any of you docs who are interested in doing right by children, and right by the law…
Medicaid Fraud Initiative Against the Psychiatric Drugging of Children and Youth -
http://psychrights.org/education/ModelQuiTam/ModelQuiTam.htm
The work of Attorney Jim Gottstein (above) kinda says it all….
Take a look at it, and see if you reach the same conclusion.
Psychiatrist are not above the law.
Duane Sherry, M.S.
drbransfordmd wrote:
“The difficulty is deciding what “impovement” is expected…”
It’s a good point, and my apologies for butting in.
One could argue that potentially there is an issue to be addressed, even ahead of the one you mention, and that is having a patient acknowledge that there is a problem that needs to be addressed. If one cannot reach agreement on that, then there is little hope of improvement. I think what I’m trying to say is that one has to be clear that one’s own view as to whether there is anything wrong has to be validated by the patient’s, and vice versa (ie, a patient may perceive an issue, which one regards as completely normal, and explicable by known phenomena – eg, while they may think they’re going mad, they may be in an environment where the use of double binds, perhaps in the form of ultimatums, is commonplace, and extremely damaging).
Matt
Dr. Bransford,
I apologize for using the term “you and your colleagues” – rather than “psychiatry”….
Only you know what type of treatment you provide children, and I should not have assumed otherwise.
Duane