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A Tragic Lesson
Why hasn't there been more of a backlash, or concerns raised, among doctors that this might lead to overmedication or improper medication of patients?
I think that is starting to happen. But doctors are under pressure. Managed care came along at the same time [as the ads], and they are under pressure to process a lot of patients each day. It's easier to write a prescription and send patients on their way. And it's tricky referring people for proper mental-health treatment. Cognitive behavioral therapy can be very effective for mild to moderate depression, but psychotherapists aren't very good at marketing themselves. A busy PCP is not likely to know offhand an appropriate psychotherapist. Prescribing the drug can be the path of least resistance. But the critical issue with the Ledger case, and others, is follow-up.
Are there other lessons we can draw from Ledger's tragic death?
I would just say that when multiple drugs are involved, the interactions and full clinical picture need to be closely monitored by a single person, and it should be an expert in that area--a psychiatrist, for example, when psychiatric drugs are involved. And, in addition, to the ongoing follow-up, they should also be looking at the underlying issues. I doubt that Heath Ledger was seeing a therapist, but clearly he had sleep and anxiety problems. Most people taking those drugs are not seeing a therapist; they are taking the drugs in isolation. So even though the drugs can be effective, the patients are not addressing the underlying issues.
Why don't more doctors prescribe therapy?
For patients, it's hard work and it's painful and time consuming. It's logistically a lot more difficult than going to a pharmacy and picking up a prescription. There are homework assignments. You often keep a journal. It's work, and it's not fun. The other piece is that insurance companies have favored drug treatment over referrals for therapy. And [the therapy] involves looking at things in a more complex way. Change is a complex, protracted process [and our] culture is impatient with that. We like to get the quick fix and be on our way.
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Member Comments
Posted By: docktorb@aol.com @ 04/21/2008 12:23:59 PM
Comment: Heath Ledger was both over and undermedicated. His last interview was almost certain evidence of a cyclothymic/bipolar problem. It's strange to me that the psychiatry professor didn't say anything about that.
That would go against his antimedicine theory. Yes,too many medicines are being given, but in Heath Ledger's case the right medicine, a mood stabilizer, was not prscribed. A primary care doctor should know to screen for that, but with the government and insurance companies push for assembly line medicine, it's not surprising that it was missed. As a primary care physician, I frequuently am reluctant to send a patient to a psychiatrist as the commentator suggests. In our area they tend to add a medicine at every visit instead of changing to an effective one. Children are often on five or six medicines when the do better when changed to one mood stabilizer and perhaps an anti depressant.
It is possible that Ledger refused a mood stabilizer, opting for the bandaid treatment with valium like drugs. These give immediate relief but don't treat the underlying condition. Things usually get worse over the long haul as in Ledger's case. It's easy to see a desperate in amanic insomnia taking more and more drugs to get to sleep. Finally it's enough to puy you in a permanent sleep. As many as one in thirty people has bipolar or it's milder cousin, cyclothymic disorder. This is extremely common in actors and other creative people. They tend to be the movers and shakers of the world. Think Alexander the Great, Teddy Roosevelt,Ted Turner, Van Gogh, Jim Bakker. They get things done but are at risk of getting carried away. It's only a little exageration to say these people either become millionaires, go to prison, or both. It must be controled to get the maximum benefit without the harmful results. This does involve counseling, education, and yes, mood stabilizers at the lowest effective dose. A knowledgible primary care physician is essential to manageing this condition through it's fluctuating stages.
Posted By: docktorb@aol.com @ 04/21/2008 12:22:55 PM
Comment: Heath Ledger was both over and undermedicated. His last interview was almost certain evidence of a cyclothymic/bipolar problem. It's strange to me that the psychiatry professor didn't say anything about that.
That would go against his antimedicine theory. Yes,too many medicines are being given, but in Heath Ledger's case the right medicine, a mood stabilizer, was not prscribed. A primary care doctor should know to screen for that, but with the government and insurance companies push for assembly line medicine, it's not surprising that it was missed. As a primary care physician, I frequuently am reluctant to send a patient to a psychiatrist as the commentator suggests. In our area they tend to add a medicine at every visit instead of changing to an effective one. Children are often on five or six medicines when the do better when changed to one mood stabilizer and perhaps an anti depressant.
It is possible that Ledger refused a mood stabilizer, opting for the bandaid treatment with valium like drugs. These give immediate relief but don't treat the underlying condition. Things usually get worse over the long haul as in Ledger's case. It's easy to see a desperate in amanic insomnia taking more and more drugs to get to sleep. Finally it's enough to puy you in a permanent sleep. As many as one in thirty people has bipolar or it's milder cousin, cyclothymic disorder. This is extremely common in actors and other creative people. They tend to be the movers and shakers of the world. Think Alexander the Great, Teddy Roosevelt,Ted Turner, Van Gogh, Jim Bakker. They get things done but are at risk of getting carried away. It's only a little exageration to say these people either become millionaires, go to prison, or both. It must be controled to get the maximum benefit without the harmful results. This does involve counseling, education, and yes, mood stabilizers at the lowest effective dose. A knowledgible primary care physician is essential to manageing this condition through it's fluctuating stages.
Posted By: the.cheshire @ 02/22/2008 3:42:09 AM
Comment: I doubt very much if poverty was 'the biggest cause' or even a factor in Heath Ledger's death. The use of the word "then" for "than" makes me doubt your professionalism, but I do agree that drugs make people "do strange and terrible things they would regret forever"--if they ever get off of them and get back to a mental state where they can regret them. I agree with this because that's exactly what happened to me.
I was prescribed Paxil and Xanax and Trazodone all at the same time. When I complained to my Dr. that I was getting worse instead of better, he increased the dosage. How was that supposed to help?
TV commercials for drugs clearly tell of side-effects and negative results, which the doctors should, but usually don't. When you fill a prescription, the drug store staples a sheet of paper with the side effects written on it, so that is no excuse for patients wanting the drugs anyway, unless they can't read (closed captioning) or hear--yet there were other side effects from the drugs I took that I experienced, that weren't anywhere on the papers or in the doctor's mouth, that I actually had to search the internet to find.
People already on drugs don't mind being put on more drugs. It's like using peroxide to pre-soften resistant hair so that it will "take" more peroxide hair color-- one drug conditions the patient to accept more with no concern for the side effects or damage they can cause.
Aren't doctors to drug companies what mechanics are to parts companies? It's sad the way things are and it's sad that Heath is dead. I think it boils down to one thing. When it comes to what happens to the people taking their prescriptions, the doctors and the drug companies simply do-- not-- care--.