Re: Anti-depressants
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Thank you for your informative post. It's great to get a different perspective on this issue.
Since you are a doctor and you say that you commonly prescribe a lot of the medications listed in the above post let me ask you a question. Why do family doctors prescribe addictive medications to people who claim they have anxiety and sleep problems? Doesn't this just trade one problem for another?
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Short answer is that I *don't* prescribe recurrent doses of highly addictive meds to people like this.
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Also, Xanax is a drug for SHORT term anxiety? What does that mean exactly? If your anxiety is short term why even treat it with meds?
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I meant that xanax is a short-term solution, sorry I was not clear. To be diagnosed, anxiety by definition must occur for at least two weeks at a time, for a total of 2 months, within the last 6 months time period. It also must have caused significant life changing events to occur, such as missing work, damaged relationships, etc.
My personal take on anxiety disorder is that it should be treated with a 2-pronged attack: meds plus cognitive therapy (ie counseling). Both of these are shown to be effective when used in combination over time, but both take several weeks of use to be effective. Often, people are having severe symptoms of anxiety, to the point they cannot function in their daily life. In those cases, it is justifiable to prescribe a short-term solution to the symptoms, or a stop-gap, however you want to call it. (This is where xanax and others like it may play a role.) In my practice, I never prescribe refills for xanax when treating anxiety, and I only give someone enough for 2-3 weeks use. I also will start them on another, longer-acting med, such as lexapro, celexa, prozac, wellbutrin, etc., and I refer them to some form of cognitive therapy, such a counselor or maybe their pastor, if available. I do all of this at the first or second visit, once I make the diagnosis. I tell them the goal is to use the xanax rarely, and only as a sedative once they are home from a stressful day or if they actually have a panic attack. I let them know it will not be refilled, and that the other med and the counseling will soon take the place of the xanax completely.
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Don't take this personally because it's not intended to be a slam against you. I'm just really perplexed why doctors are so quick to whip out the prescription pad and give people prescriptions for controlled substances. I know a couple people with addictive personalities who have been given endless supplies of ambien and pain medication because they claim they have a bad back or can't sleep. It seems like doctors should interview family members to get a clear sense of the patient and his behaviors before prescribing something as addictive as Ambien. Can you address why doctors wouldn't discuss things with family members before writing out these types of prescriptions including ones for depression?
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I actually don't take this personally, since I think I am not guilty of what you describe.
As you can tell from my above methods, I don't get through an office visit for anxiety (or depression) with any speed or efficiency. It takes time, and it takes a patient with um, well, patience. (sorry) Very often, I get a patient who has been treated elsewhere, and for whatever reason, they were prescribed some happy pills like Xanax, with refills, sometimes for years. They are addicted, and they just want that Rx and to get back to their life. It does not take more than a few minutes of explaining the above to them to see them look annoyed and roll their eyes, and explain to me that the "other stuff" just doesn't work. I am wasting their time and mine, and if I will just write the Rx for them, they will be on their way, thanks. These people leave my office with nothing, and find someone who will write their pills for them.
Many of these folks, believe it or not, have insurance and real jobs, and they keep their appointments every 2-3 months like clockwork. (wonder why?) So, I am losing customers with my approach, some of them very good customers.
I wish it were not so, but I can guess why some docs will be quick to write these meds for even the apparently addicted patients: less time in the office visit, it makes customers happy, and it requires little thought and planning. In short, you can do less work and might make more money anyway.
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