Transcription
So what do I think is the most overrated treatment in Psychiatry? Uh, truthfully, I have to say it's polypharmacy, or it's the act of giving multiple medications at the same time.
Unfortunately, this is a trend that's emerged out of the need to see so many psychiatric patients at once nowadays. It's not uncommon to see, you know, four psychiatric patients in a in a 60-minute slot, especially if you're in some community clinics. Because of that, often times the doctors really don't have time to assess the patients.
So, firstly, you know, you can have a patient coming in there who has psychiatric symptoms due to something totally legitimate that's happening in their life. Maybe it's a breakup, maybe it's a divorce, something like that. And this problem, while it could have been addressed with non-drug means, through support or supportive counseling, because of the lack of services there, often times patients also ask for medications, and doctors want to help, so they prescribe them. So you have this interaction where the doctor doesn't really get to the root cause, and the patient walks out with a medication. And sure, you know, that medication may work for a little bit, but not for everyone, you know. And eventually, after a couple of months, they come back, and the drug, maybe they've adapted to it, maybe they're they're tolerant to it, and and they're still having symptoms. And so now they're on one drug which they've completely adapted to, and they need to go on a higher dose. That plays out a little bit more. They they go up and up on the dose, and then eventually they're they're maxed out on it, and then they jump on another medication. And so you start kind of accumulating them in this way.
What happens also in these settings when we're sort of just churning through medications is I think a lot of doctors really actually miss um psychiatric side effects. And so what is a psychiatric side effect? I think it's something that affects your personality and your mood. You know, sometimes you get a side effect, and it's just like a rash on your hand, and you could walk into a doctor's office and they go, "Hey, do you have any side effects?" and you go, "Yeah, it's right there, you could see it." But the challenge with psychiatric side effects are they affect your brain. Because of that, it's often difficult to perceive them. I mean, you may go into the doctor's office and you may be feeling kind of blunted, out of it, apathetic, or even agitated. But instead of you realizing that a lot of that is coming from your mood and your and the side effects, maybe because of the way the brain works, you've been unable to attribute it as a side effect. And maybe you just think, maybe people are a bit more nasty to you, your wife is like, she's being more defensive, when Maybe you're actually the one who's having problems. And so there's this thing about the way these drugs affect your brain and your mind that that make it really difficult to pick up on those. Really, in like a 15-minute appointment, the doctor's not going to be able to pick up on this if they're not really kind of diving into that, if they're not talking to your spouse. And so sometimes a lot of what I think of as, you know, treatment-resistant depression, you know, patients coming in really blunted, no drive, feeling disconnected. I think a lot of that could be psychiatric side effects which are missed. When that's missed, you know, the doctor just stacks another med on on top of it. Okay, you know, well, treatment-resistant depression, now let's, you know, go and use an antipsychotic. And so you have this kind of cycle that's going on where I think these psychiatric side effects are missed, people becoming tolerant to the medication, and also frankly, the meds can sometimes actually think there's a possibility they may actually make some symptoms worse over time. You know, especially the benzodiazepines make people more anxious in the long run. I think antidepressants, just the normal SSRIs have the possibility of doing that too. And so all of these things are missed and missed, and it just it just becomes a snowball of accumulating medications. Before you know what, patient really sick, maybe they're totally sick just from the medications, and they're getting treatments like ketamine or ECT or TMS, and it just doesn't help them.
So that's what I think of as the most overrated treatment in Psychiatry. You know, when people stack these meds on them, I feel like, you know, the doctors are almost like these mad scientists, and they're just like kind of tweaking all these chemicals and just going, "Oh my God, this is such a mysterious and chronic mental illness." That may be the case, but it's not unless you've really taken the time to really understand the course of the the patient, their history, and and what's been going on with their meds. So, yeah, polypharmacy, stay away.