Saturday, March 20, 2010

Rerun: Meds in Our Treatment - How Does Smart Factor In?

I've been running a long series of posts on diagnosis and misdiagnosis. The following, on treatment, is from June of last year. You make the connection ....

"How well have your meds worked for you?" I asked you in a poll I ran here through the month of May. Of the 168 who responded, only 14 percent of you answered, "very well." In other words, only a small percentage of you thought your meds worked like gang-busters. The overwhelming rest of you had reservations.

Thirty-six percent of you - about one-third - responded, "conditionally well." In other words, your meds may not be perfect but they were meeting your expectations. When you add in the "very well" group, fully half you reported satisfactory results with your meds.

So, can we put a positive spin on the results? Hold that thought.

One in five of you (19 percent) told me that your meds were "rather problematic." In other words, you're not happy with your meds, but you are experiencing some benefit.

Nearly one in five (17 percent) responded that your meds were "very problematic" and 11 percent told me your meds were "a complete disaster." Added together, nearly one-third of you have given an unambiguous thumbs down to your meds.

So, how do we interpret the results? Keep in mind this is hardly a scientific survey. Let's go negative, first:

The fact that more than eight in ten of you reported that your meds are not working "very well" - for whatever reasons - speaks volumes. Add to that the fact that the "complete disaster" group is running in a virtual dead heat with the "very well" group and we are talking very low levels of customer satisfaction.

In other words, if meds were automobiles, car makers like General Motors would be in bankruptcy. Wait, let me rephrase that. Uh, never mind ...

Now let's go positive. This means first seeing possibilities in the "rather problematic" grouping. Suppose, for instance, half of you in this group were to graduate to "conditionally well." Then 60 percent of you - nearly two thirds - would at least be reasonably satisfied with your meds. Suppose we could get similar conversion rates from the "very problematic" and "complete disaster" groups. Then three-quarters of you would be happy customers.

How is that possible?

The meds are constant in this equation. The two variables are you and your psychiatrist. First imagine a smart patient working with a smart psychiatrist. Now picture a naive patient placing his or her trust in a lazy psychiatrist. Are we likely to see dramatically different outcomes? I rest my case.

Okay, one example: You come to your psychiatrist depressed. He diagnoses you with clinical depression. The antidepressant doesn't work. In fact, it makes you feel worse. The psychiatrist tries you on another antidepressant, then another. You are starting to feel like you are crawling out of your skin.

Then your psychiatrist gets a bright idea - or rather a thought implanted in him by a drug rep the day before. Based on his conversation with someone way too dumb to get into med school in the first place but attractive enough to take up a career in modeling (whether male or female), he now decides that the answer to your problem is an atypical antipsychotic to kickstart the antidepressant.

A smart psychiatrist will know exactly the right situation to make this call, but in your case would probably never have to make it. Instead, after not getting a good result with your second antidepressant, she - the smart psychiatrist, that is - would probably revisit the diagnosis. It could turn out - on further enquiry - that you have bipolar or something in the bipolar spectrum. So she takes you off the antidepressant and puts you on a mood stabilizer.

If the mood stabilizer works, your "complete disaster" scenario has been turned around. Maybe not all the way. In all likelihood, in fact, you still have a long way to go. But now, at least, you are in a position to learn more, to move up to from being a naive patient to a smart one.

What a difference "smart" makes in the equation.


Karen Vaughan said...

What I like about Chinese medicine is that the diseases are broken down into patterns, then the herbal prescriptions are individualized to the strengths and weaknesses of the patient. Bipolar for instance has about five patterns ranging from phlegm harassing the heart (lithium dries phlegm) to liver yang rising. Since the prescriptions have been around for a millennia or so, the proportions have been worked out and so have the energetics.

And the western meds don't address the underlying condition where the neurotransmitters can't make it through the cell membranes. With the change in Omega 6 to Omega 3s from 2/1 to 30/1 the lipid layer around the cell has become stiffer. Bipolar has been treated with fish oil alone.

And as the soil has become depleted of minerals, only seaweed eaters have enough magnesium, lithium and other minerals for the enzymatic reactions to get through the gates in the cell membrane. Bipolar is also treated with lithium or magnesium alone.

And we won't get into the lack of Vitamin D- we evolved with 25,000 iu daily from the sun but now get a few hundred. Put all that together with a genetic predisposition and you get a prescription for disaster, rarely addressed by western meds.

John McManamy said...

Hey, Karen. And what I hate about psychiatry is that very little of this stuff is addressed. You very rarely find any seminars pertaining to this at psych conferences. Please keep filling us in.

Karen Vaughan said...

I have a good article on how to support brain function that discusses this. Go here and scroll down to Simple Ways to Support Brain Function.

John McManamy said...

Hey, Karen. Excellent advice. I very much look forward to checking out your website.