How Doctors Can Sabotage Psychiatric Medication Treatment
Recently, I was talking with someone on Twitter and she was concerned about the side effects of psychiatric medication X. I asked her what her starting dose was for the psych medication and she said 15 mg. Now, I’m not a doctor, but I can tell you two things:
- That is ridiculous.
- That will certainly make the patient stop the medication early due to side effects and never even find out if it works.
Psychiatric Medication Starting Doses
There are two psychiatric medication starting doses – the one given by the drug company and the reasonable one. Sometimes they are the same, but often they aren’t. I’m honestly not sure why drug manufacturers insist on being so aggressive in their starting dosages but I suspect it has to do with the fact that they want their medications to work sooner and thus look better in studies. If I gradually increase a medication over three weeks that cuts into the time we have to study the medication at a full dosage (when it will likely work). And in all honesty, many medications take far more than three weeks to safely get on.
And 15 mg for medication X is aggressive even by manufacture standards (which recommends between 10 mg and 15 mg). It is not at all reasonable unless the person is in a hospital or acutely psychotic or suicidal. And it most especially isn’t appropriate for a person already concerned about side effects.
Doctors Sabotage Patients
So the way I see it is this doctor is sabotaging his patient. He’s prescribing a starting dose that she likely won’t tolerate, she will, quite reasonably, want off the medication, and neither one of them will ever know whether the medication would have been useful. And I can attest to the fact that this can be a very useful medication when used properly.
And this angers to me to no end because it gives patient the experience that medications are “bad” due to the severe side effects and “don’t work” due to the fact that they don’t stay on them long enough to find out.
And what really ticks me off is that it doesn’t have to be this way.
Mental Health Medications – Low and Slow
I said in my last article the way to start a medication is to start on an extremely low dose and very slowly increase it. And that is the best advice anyone taking medication can hear (if you ask me). Sure, it might not work, you still might find too many side effects or the medication might not work for you but at least that way you can give it a fighting chance.
And I know, it’s impossible for the average person to know what a reasonable starting dose is. After all, 15 mg seems low. But all I can recommend is telling your doctor that you are very sensitive to medication and you would like to start on the smallest dose possible. Because it’s easy to increase the dose is you find there are no side effects, it’s really difficult to lower the dose once you already have a prescription in-hand.
So don’t let your doctor sabotage your medication trial. You deserve an easier way onto medications and you deserve a less painful experience. Speak up for yourself. It might be the only way that will happen. (A good indicator of a low starting dosage is looking at the lowest dosage the manufacturer makes.)
(Obviously, good doctors, particularly psychiatrists, know what a good starting dose is but someone who doesn’t treat your type of illness, or use that type of drug, every day will likely just go with whatever the manufacture suggests, which is generally where the problem is.)
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Tracy, N. (2012, April 26). How Doctors Can Sabotage Psychiatric Medication Treatment, HealthyPlace. Retrieved on 2023, May 31 from https://www.healthyplace.com/blogs/breakingbipolar/2012/04/how-doctors-can-sabotage-medication-treatment
Author: Natasha Tracy
Certain ailments can be modulated with drugs with apparantly no understanding of the process such as drugs reducing the hearing of voices but recent evidence points to abnormalities as being structural based within the brain with chemical drugs having no effect. This makes sense because the brain is not just a soup of neurotransmitters but structures such as fixed neurons. It also would make sense that depression is a chemical imbalance and can be treated with drugs if that's your thing but schizophrenia cannot be corrected at a fundamental level with drugs because that disorder is structurally bases. A lot of reatment is about politics and money and not about the health of the person. You can cry to the heavens all you want about these pills being magical but magic they are not. Mental illness in the old village days before dungeons existed was probably understood in terms of behavior of the person much better than today when all we do is sedate the disturbed and make their lives shallow.
Thank-you. That is very kind.
- Natasha Tracy
*Great* blog. Really , *really* well informed/informing, engaged and engaging, and fiercely intelligent and thoughtful.
I love it.
Medication of psychiatric illnesses, as primary treatment option of any psychiatric entities exhibits many contradictory issues for both: psychiatrist and their patients. These misunderstandings, on the other side causes numerous side effect that lead to interruption of prescription medication from respective psychiatric patient. Your recommendation of low and slow administration of psychopharmacologic medication indicates as useful and critical aspect of psychiatric treatment. But, the individual tolerance is specific and most important aspect of this crucial psychiatric treatment approaching procedure. The negligence of this suggestion essentially damage therapeutic process with numerous bad consequences for courses and definitive outcome of pertaining disease. In order to avoid this bad prognosis of psychiatric diseases, it should to create a constructive and confidence therapeutic milieu between doctors and their patients.This mean to explore all problems and difficulties that occur along medication. To achieve this fruitful therapeutic target, it ought to be honest and empathic toward patient with mentally problems. The same is value for patient, whose compliance is deeply depended to their sense of self respect and self-confidence.
Please don't name-call. It doesn't help anyone.
Summer you are nutz stop trying to prove it to everyone....but you are entitled to your shortsightedness I mean opinion
All psychiatrists are cold-blooded sadists who wish to harm people. Stay away from them. They have never done anyone any good, and neither have psychogenic drugs. It's all a smokescreen created by drug companies. ALL psychogenic drugs cause heart, brain and liver damage, most often irreversible. All mental illness is manufactured by psychiatrists and drug companies. The only effective therapy is psychotherapy from a PSYCHOLOGIST, not a psychiatrist. Psychologists are actually trained in psychology, whereas psychiatrists are only trained in neurology, unless you live in New Brunswick, where most have no university education.
I have been on many different meds to treat my BP2 and witht he exception if one NP all my drs. Have started me at high dosages with the exception of Lamictal which they followed the traditional low dosage until my dosage was reached. I don't know if it is because I have been on A/D for a while and mood stabilizers but the standard like I got last night when my p-doc switched my med was its an SSRI so it doesn't really make a difference your just switching one out so just stop one and start this it's the equivalent dose almost but a different drug. My understanding because I research the crap out of everything is that they aren't all the same that's why there are different SSRI (same idea) different structure how it's made.
Doctors are in a class by them selves
Low and slow is traditional and BEST practice, as among all the unknowns for side effects for a given patient, the most predictable trends are these: side effects are worst at higher doses, AND worst at the very beginning of treatment. Thus starting high dose maximizes the risk of side effects, and thus of destroying motivation for treatment, especially when the benefits lag the adverse effects - quite common.
Insurance pressure, with reduced lengths of stay, largely explain this otherwise obviously poor practice: we take more chances inpatient because the extra staff monitoring keeps it safe, albiet unpleasant and largely counterproductive. Most clinicians I work with keep this practice to an absolute minimum, as it accomplishes little and makes for unnecessary suffering and non-adherence and readmissions. I generally encourage patients to insist on low initial doses, and often give partial doses to those who request it. What is right stays right, even when it becomes less convenient or lucrative, and no one saves money over time with poor clinical practice. Stupid is as stupid does, yes? We often see such with insurance, sadly.