December 19, 2016
A recently published meta-analysis of over 3000 studies suggested that switching antidepressants after the first drug doesn’t produce the desired results is not better than staying the course and/or exploring options other than trying a different drug. This is a very interesting finding as most prescribing clinicians tend to give one antidepressant a “trial” of about 6-12 weeks. If things aren’t better then often scrap that medication and start another 6-12 week trial of another one. The authors of this article reviewed 3234 relevant studies and concluded that it is generally wiser to explore alternatives other than a medication change.
December 13, 2016
A recent research letter, published by JAMA, reported that one out of six American adults take at least one psychiatric medication. As a clinical psychologist I understand the benefits of non-medical treatments for psychiatric illness, but that doesn’t mean I don’t appreciate appropriate use of psychiatric meds. In fact, I refer a significant number of my patients to their primary care providers or to psychiatrists for medications, and I often make suggestions to the prescribing professionals about which medication I believe would work best for the referred patient. Nearly every time I do this, however, I have a long discussion with my patient about what it means to be on a psychiatric medication, and what it doesn’t mean. I almost always say something like, “several of your friends and several of your coworkers are on [psychiatric] meds… but they just haven’t told you,” in an effort to communicate how prevalent they are. This letter drives that point home really nicely.
But what I really like about the letter is that it also talks about how some medications are not be prescribed appropriately. Two classes of drugs that are most frequently mis-prescribed are benzodiazapines (e.g., Ativan, Xanax) and sedative/hypnotics (e.g., Ambien), which are supposed to be used short-term, not for months or years at a time.