Thursday, November 13, 2008

It Could Happen To You, Too


ClinkShrink and Roy would like me to shut up already. One more thought, and then I will, I promise. I know, I'm getting everyone stirred up about the question of whether docs respect when patients say they have side effects from meds. It's an issue that's come up over and over on Shrink Rap.

So Anonymous (one of the many) wrote as a comment:

Maybe if psychiatrists put themselves on meds as this doctor did with Wellbutrin, your perspective would change. After she suffered horrific side effects and withdrawal symptoms, she is a lot more empathetic when her patients complain about side effects.

Thank you, Anonymous, for the comment-- it's a topic I've been wanting to write about for a long time and you've provided a spring board.

So when people have a problem or a solution, it's normal to think that other people might have the same reactions. Many of the anti-anti-depressant (or anti-AnyDrug) comments on the internet have the overtone that these medicines hurt me, they should be banned, or no one should take them. I'm an offender: if you tell me you have back pain, I'll be the first to ramble about how my back spasms have been totally cured by swimming (sub-text: swimming might fix you, too).

Psych meds: They work for some people. They don't work for some people. Some people have side effects. Some people don't. It's quite clear that many people simply don't tolerate them. And I do believe that some docs don't 'believe' their patients when they describe unusual side effects or reactions or that they may believe the patient but respond in a way that feels dismissive to the patient. I also know that I sometimes wonder if a side effect is from a medication or from something else (another illness, another medication, something else going on at the same time) . I see a fair number of people who return and say "I didn't like how I felt and I stopped taking that stuff" and usually that means that trial of that particular medication is over. I also see a fair number of people who say medication helps and they've had no side effects from it, at all. Or medication doesn't help and they have no side effects from it-- it's feels like they are taking a sugar pill.

So the idea that shrinks should try taking an antidepressant so they can empathize with the patient's response -- there is one important assumption here: That the shrink would have side effects! What if the doc, any given doc, goes on Wellbutrin like the doc in the article and unlike that doc, doesn't have any side effects? By this logic, wouldn't that make them less empathic? Huh, that stuff is hell on you, can't be, I tried it myself and I was fine. By the same token, if the doc pops a pill and has awful side effects, might the doc never be willing to give it to anyone? After all, it caused awful things to happen, and might the doc therefore deny a certain treatment to his patients who might benefit from it? I think such things happen all the time: doctors are human, it's hard to ignore your own experiences, especially the extreme ones.

I'll shut up now.