The WELL: inkwell.vue.378: Gary Greenberg, Manufacturing Depression

#178: Gary Greenberg (gberg) Wed 13 Oct 10 07:38

Wed, 13 Oct 2010 07:38:00 PDT

And even when they do recommend or insist on therapy, psychiatrists can be awfully naive about the effects of their prescriptions.

Case in point: 60-year-old man, retired successful businessman, getting divorced, divorce rancor at about a 6 or 7 on a scale of 1-10, worst feature being that he and wife are still living together (house is big enough to accommodate). He's listless and fatigued, an little bored and restless, not going out much, napping a lot, avoiding friends and other pleasurable activities, melancholy although not tearful--in short, a textbook case of depression. Psychiatrist decides to put him on Ritalin, because the thing he talks the most about is his malaise. Stuff perks him right up, he starts going out, is less morose, more engaged, etc.

It's a good outcome in many ways, although important to remember that Benzedrine was once the drug of choice for depression, and stimulants have a way of losing effectiveness on mood. But he avoided the side effects of antidepressants, got immediate results, and won't have to worry about antidepressant withdrawal.

But she told him that the reason she gave him the Ritalin is that he has adult ADHD. As proof, she gave him one of those 15-item scales they're so fond of. Now, I've seen this guy on and off for a long time, and it never crossed my mind that he had ADHD. He's been steadily employed, built a successful business, but not the kind that relies on quick hits and fast sales--a slow and steady buildup in a business that requires long-term client relationships and lots of concentrated work--been faithful in his marriage, etc., etc. He's got a lot of interests, and many irons in the fire, which is probably why he tested the way he did, but the guy just doesn't fit the profile.

Being the drug libertarian that I am, I have no objection to the prescription. But that doesn't mean the prescription is not a problem--or, to be more precise that the diagnosis is not a problem, and perhaps a worse problem than "masking his symptoms" or whatever. His diagnosis now has him thinking that he's got ADHD, and that this is why he was suffering. This diagnosis will change his experience of his life, the way he understands himself, and how he approaches therapy. The most underrated side effect of all. [Read entire topic]

#177: Mark McDonough (mcdee) Wed 13 Oct 10 04:39

Wed, 13 Oct 2010 04:39:00 PDT

Well at least those of us who read before you scribbled finally know what happened to Judge Crater! [Read entire topic]

#176: Linda Castellani (castle) Tue 12 Oct 10 23:36

Tue, 12 Oct 2010 23:36:00 PDT

I had to scribble. Forgot that I was in a publicly-viewable conference. [Read entire topic]

#175: Idea Hamster On Speed (randomize27) Tue 12 Oct 10 22:48

Tue, 12 Oct 2010 22:48:00 PDT

Oh, a permanent imbalance is a whole 'nother critter...but anything that can be dealt with by therapy instead of meds, I'll take the therapy, hard and fast, rather than drug myself into someone else. [Read entire topic]

#174: Linda Castellani (castle) Tue 12 Oct 10 19:50

Tue, 12 Oct 2010 19:50:00 PDT

<scribbled by castle Tue 12 Oct 10 23:35> [Read entire topic]

#173: Gary Greenberg (gberg) Tue 12 Oct 10 17:19

Tue, 12 Oct 2010 17:19:00 PDT

Around here (Eastern CT) that's pretty much par for the course. The only followup is the one to the psychiatrist to make sure the drugs are working. Fewer and fewer psychiatrists place much stock in therapy, except for the assembly line CBT version, and often that's just lip service. [Read entire topic]

#172: paralyzed by a question like that (debunix) Tue 12 Oct 10 15:07

Tue, 12 Oct 2010 15:07:00 PDT

I recently had the mother of a patient get really angry with me that I would not give her a new prescription to continue a psychiatric med a psychiatrist started her on *without* arranging any ongoing followup/counseling with any sort of mental health practitioner.

Always have to wonder if the family misunderstood, hard to believe a psychiatrist would start it without even the *intention* of followup, but still, all too common that patients get the drugs without counseling, even kids. Yikes. [Read entire topic]

#171: uber-muso hipster hyperbole (pjm) Tue 12 Oct 10 14:53

Tue, 12 Oct 2010 14:53:00 PDT

Painting over is a real problem if we are to live authentic lives, I agree. A percentage of people, though, have genuine chemical imbalances in their brains that cannot be fully changed by therapy and action. Sometimes brain chemistry needs to be augmented on a long term basis. [Read entire topic]

#170: Idea Hamster On Speed (randomize27) Tue 12 Oct 10 14:14

Tue, 12 Oct 2010 14:14:00 PDT

That's very true. And there are therapy methods to do that. But, just drug-and-go is only covering up the problem, not fixing it, or preparing to fix it.

Had a girlfriend once, she started having panic attacks, went on Xanax and Prozac, changed her personality, killed her sex drive, and she was still having debilitating panic attacks four years later, before...well, I broke contacts with her 3 years after we broke up, though we'd been friends for those 3 years.

Me, had a robbery a hair over 4 years ago that triggered debilitating panic attacks. Got therapy, didn't take any drug courses, dealt with it, and while I still have an occasional panic attack, haven't had a debilitating one in years.

Where she painted it over, I immediately got to work on the scaffolding and braces. Still could throw on some paint, but it's good enough now, why bother? [Read entire topic]

#169: uber-muso hipster hyperbole (pjm) Tue 12 Oct 10 11:10

Tue, 12 Oct 2010 11:10:00 PDT

Sometimes you have to put put in braces and scaffolding before you can fix the building. [Read entire topic]