[madisgram]

i feel this article is most beneficial for those of us on meds for MI. just me, anything short of my pdoc prescribing my meds can lead to problems. i know some people have no recourse but to see a gp, etc. but have known multiple people who have also gone this route with less than helpful results. this article may be helpful for those who question the benefits of seeing a pdoc for meds.

by Jory Goodman, M.D.
DONT! That's my opinion in a word. Don't. Politely, please don't.
I'll make note again that 70% to 80% of psychotropic medication is prescribed by non-psychiatrist's: internists, pediatricians, gynecologists, family practitioners, dermatologists, nurse practitioners and physicians assistants. Just about everybody with a medical degree of some sort is much more ready to prescribe psych meds than to make a referral to a psychiatrist. No, not everybody, just most. Otherwise those percentages would be different.

.....
Certainly there are some quite capable internists and pediatricians who are
quite adept at psychiatric diagnosis and 1st tier psychopharmacology. Similarly there are some quite capable internists and pediatricians who won't go anywhere near psych meds and insist upon psychiatric consultations. The problem is that virtually all non-psychiatrists get all of their psychopharmacology “training” from pharmaceutical representatives who meet with them for a few minutes, bring them lunch, then leave samples and brochures. Not to say that many of these capable physicians haven't done some continuing education on psychiatry and psychopharmacology but how much is enough.

http://www.psychologytoday.com/blog/...-psychiatrists

[splitimage]

I know I don't want anyone but a psychiatrist playing with my brain and my meds, and both my family Dr., and my addictions Dr. have said that they won't touch prescribing for me - I'm too complicated.

I'm just lucky that I have a super psychiatrist under publicly funded healthcare.

splitimage

[amandalouise]

Originally Posted by madisgram

i feel this article is most beneficial for those of us on meds for MI. just me, anything short of my pdoc prescribing my meds can lead to problems. i know some people have no recourse but to see a gp, etc. but have known multiple people who have also gone this route with less than helpful results. this article may be helpful for those who question the benefits of seeing a pdoc for meds. http://www.psychologytoday.com/blog/...-psychiatrists

thanks for the article. when I read these things I try to keep in mind that what is written is the viewpoints of the author , how and what the author of the articles wants to put in. they dont always reflect what is 100% true and doesnt always reflect what each and every medical and mental health provider believes. example a psychiatrist I had the chance to meet at a seminar here in NY had been quoted in psychology today and a few newspapers. during the seminar he addressed what was quoted about him and his views. He had to clarify quite a bit because the author of the article took what he said out of context of what the actual conversation was, which totally changed what the psychiatrist was saying about the topic. i was totally shocked at how much difference there was in the articles vs the actual meaning and psychiatric view this psychiatrist had, not that it was bad, not in a long run, just that the article lead people to believe one thing when there was so much more and such a difference behind the actual psychiatrist and his views on the topic.

now in my personal treatments I have had both good and bad medical doctors, good and bad psychiatrists, and good and bad prescribing habits of both medical and psychiatric treatment providers,

for me the key isnt whether, a psychiatrist is better at prescribing psychotropic medications because here in the USA both are equally qualified as in state mandates, state requirements, state licensing, state evaluations for receiving their qualifications for prescribing medications. I checked on thiese criteria both for my job and for my own treatment well being.

for me the key is remembering each person has their own way they react to treatment providers, treatment plans and treatment medications.

I feel that to get the right treatment provider and right treatment plans, right medication, right dosage takes

time with checking out that treatment provider, treatment plan and medication,

the client matching their self, or those they are in charge of, up with the right treatment provider (medical or mental) for their needs and wants

the client working with the treatment providers with 100% honesty that includes not hiding symptoms, reactions whether they are positive or negative ones.

I have found when I or others that I know follow these things we have positive outcomes and positive progress, whether the treatment providers that are prescribing the medications are medical doctors or psychiatrists,

[lizardlady]

Excellent advice Madisgram.

My primary care prescribed a medication for my fibro that impacts serotonin levels. I wasn't sure I should take it because I'm on an SSRI so I asked my pdoc. He told me I should absolutely NOT take the fibro med due to interaction with the SSRI. When I told my primary care what he said she didn't understand what the problem was.

[elliemay]

I think MDs are the best choice for medications simply because that's basically all they do, day in and day out.

I think it provides a wealth of experience that the good ones can really use to help their patients.

THat's not to say that a general practioner can't do psych meds, of course they can and do - sometimes with very good results. There are protocols for these meds that are implemented in standard general medicine.

Overall though, I would be hesitant to accept these kinds of meds from a GP, but that's just me.

I was getting anti-dep. for many yrs. on and off from my GP until I was given Paxil which sent me through the roof and to the darkest place I had ever been.I'll leave the details out. It was at that point when I told her what happened that she asked me if I might be bipolar. It took another 10 yrs. for me to go and get help and the correct dx. I know that this is not an unusual situation.

I feel really strongly about this. And came to understand it the hard way. I was originally misdiagnosed by a GP, and mismedicated accordingly. It was 3 years of hell before I truly understood that she was in over her head. And worse, she "felt comfortable" prescribing psych meds. So many psychological things are very complicated. How on earth could someone who needs to keep on up with everything keep on top of such an intricate specialty?

And then there's just the general problem of not acknowledging the complexities of mental issues and forging ahead like it's no big deal, and requires only the most cursory of diagnostics. For example... my GP just quickly ran down "the list" and prescribed. Her "screening" for BP? THREE WORDS. "So, no highs?" I thought she was talking about drugs, and was in no state of mind to even realize that that wasn't it. So guess who got put on straight ADs? Let the chaos begin. And boy did they taking me for a ride! I responded in a BIG way by the SECOND DAY. If she'd known anything, she'd have recognized that as a BIG clue. Before you know it, I'm dancing on the countertops cleaning the cabinets in the middle of the night, singing at the top of my lungs to the radio and shouting out, "OMG! They've got my whole college record collection!" Alternate this with suicidal depressions complete with physical hallucinations (being pushed into traffic). Could BP be more obvious? Apparently not. She just kept adding more, changing dosages, never acknowleging she was out of her depth. It damn near cost me my life.

You might wonder why I never made the connection. A) I really knew nothing of BP, so it never even occured to me to think of it. B) All my prior symptoms had been going on for soooo long, to me they were "normal", no matter how messed up they obviously were, I had no insight. So having this go into over-drive felt more like a personal failing on my part. I'm "obviously" a hopeless case, so just be patient and let her keep trying, right? FINALLY (when the physical hallucinations were going on), I thought, "Something is majorly ****** up here." Asked for a Pdoc recommendation. My proper dx could hardly have been easier for the Pdoc. A history of over 25 years worth of completely obvious classic textbook symptoms, that anyone who knew anything about BP would easily recognize. Clear cut. It wasn't even complicated. Sooooo, my point is, with that obvious of a case, the GP had not a clue, what of more complicated cases?! I shudder to think.

I realize there are situations where there's not much choice, but, I can't stress strongly enough... proceed with extreme caution.

(Yup, roxiesmom... the darkest places EVER. And that's saying something. And darkest wasn't even the physical hallucinations -- it was just that they were so bizarre it got my attention.)

[arcangel]

What a perfect world it would be if everyone had access to a "pdoc" and a "T" and we all had "treatment teams."
Unfortunately it isn't a perfect world and we don't all have access to that level of health care.

[Open Eyes]

Well, it is important to do your best to make sure you have a physical if you can, even check your heart. I just saw a commercial with a woman talking about years of addressing what was called an anxiety disorder which was not true, she had a heart condition and had minor surgery and no more anxiety.

Regular GPs dont really understand psychological issues and psychiatrists are not GP's either. So if one can do their best to check their health and if that is clear also see a pdoc.

Pesonally I was misdiagnosed both by a gyno and a psychiatrist and a therapist.
It sure can get frustrating.

Open Eyes

[venusss]

Originally Posted by arcangel

What a perfect world it would be if everyone had access to a "pdoc" and a "T" and we all had "treatment teams."
Unfortunately it isn't a perfect world and we don't all have access to that level of health care.

well, there are times when no treatment is better than bad treatment, imho.

[Perna]

I know many drugs have the potential to become "psychotropic" what with adverse side effects and interactions with other drugs, etc. There's so much about drugs that is particular to a person, no one can know its effect until a person takes it; look at the opposite reactions one can have to some OTC and general "cold" medicines, some get sleepy and some get revved up. Until drugs get more "specific" on what/how they treat, it's pretty much a crap-shoot at times?

[arcangel]

Originally Posted by VenusHalley

well, there are times when no treatment is better than bad treatment, imho.

After reading hundreds of posts from members here w/ a full array of treatment options at their disposal I'd have to agree w/ you, based on empirical evidence. Still I'd rather take my chances. According to the CDC, about 100,000 people die each year in the USA from hospital-acquired infections, but if I had a ruptured appendix or an aneurysm I'd take the risk of being hospitalized.
That's under "normal" (for me) circumstances. The way I feel right now I'd just say que sera sera...

[Willcat]

Originally Posted by arcangel

What a perfect world it would be if everyone had access to a "pdoc" and a "T" and we all had "treatment teams."
Unfortunately it isn't a perfect world and we don't all have access to that level of health care.

When I had no insurance (no job too) and no government disability insurance funds, I had to rely on a county program where I could see a GP doctor only. I needed urgent psych care and I do not think I could wait until I received some benefits to see a Psych doc.

The GP doc did give me just a few psych med's (older generic) ones that helped me manage until I could go through the process of getting government disability benefits.

I do agree seeing a pdoc is best for psych issues. but I feel its better to get medical psych care from a GP doc than wait (sometimes a long wait) until a pdoc can be made available.

I totally get that it's not always all that possible. I was fortunate at the time to have insurance through (now) ex. But now I am in much different position (no insurance, no work, no regular doctor, no dentist... you get the picture) and another possibility I'd like to mention is PMHNPs (Psychiatric and Mental Health Nurse Practioners). They not only can prescribe meds, they also do therapy. And specialized training in their schooling specialization. Psych stuff! Since this is their specialization, what sorts of advancements are they going to keep up with? Psych stuff. To me it is a 'two-fer'. Being able to do both meds and therapy through one person is very nice, not to mention less expensive.