The responsibility of prescription

Nothingcompares

Half listening to LiveLine (Joe duffy show) about a woman that was prescribed a highly addictive anti-depressant when she was feeling a bit down and is apparently now reliant on this medication. She was never told of the addictive nature of the drug or that it would be a long term thing. My question is

When you go to the doctor and they write you a prescription should you be:

querying exactly what it is and what it will do?
just leave it to their judgement and do it?
query the pharmacist?

My name is URL

I'm not a medical person, but imo it's up to the individual to read up on what's been prescribed and raise any issues with their GP

The woman wasn't told about the addictive nature of the drug.. does that mean she didn't read the literature that came with the meds? And when she realised she had become addicted did she tell her GP or just presume it would pass?

PhysiologyRocks

My doctor always tells me these things anyway.

Nothingcompares

My name is URL wrote: »

I'm not a medical person, but imo it's up to the individual to read up on what's been prescribed and raise any issues with their GP

The woman wasn't told about the addictive nature of the drug.. does that mean she didn't read the literature that came with the meds? And when she realised she had become addicted did she tell her GP or just presume it would pass?

Basically my underrstanding is, she turned up at the GP. Said I'm feeling a bit down. The GP prescribed this anti-depressant for 3 months. She came back 3 months later and said she's grand. GP said you have to continue taking these indefinitely. This was a shock to her.

deepimpact

what was the anti-depressant they were discussing?

imported_guy

ok im not a doctor but here it goes.

- she could be using the wrong dosage
- alot of meds have reactions, people are allergic and etc etc
- she probably did not consult her doctor after feeling a little better, and thought oh well im feeling nice, i'll keep on taking it.
- how did she get more prescriptions for it?, if she is addicted why did the doctor keep prescribing it

as for the thread title, the issue of responsibility needs to be adressed

one day i didnt feel like going to college (i had a math test), i asked my dad to write me a doctor's note (hes a doctor), he did it the note said i had 2 episodes of vomiting and it had went away without any medication or some bs like that (well i was faking it), and i got off the hook and was awarded the marks for that test in college (without having to sit the test, it got averaged on the other tests), and the next day my morals kick in... and i was wondering what any other doctor would have done

i heard about doctors in america who take out prescription meds (like ones used to treat ADD) and sell them on the black market, and they are used to make meth and all that crap. and lets not even talk about people addicted to morphine and where they get their prescriptions from


so let me break it down and paint the big picture

why did the doctor keep prescribing the med?

sam34

i didnt hear the show.

but, there is no "highly addictive" anti-depressant.

it's one of the greatest myths out there about anti-depressants.

some anti-depressants do cause discontinuation/withdrawal effects, but this does notr mean they are addictive.

addiction implies tolerance, where you need ever increasing doses to achieve the required effect. this is simply not the case with antidepressants.

sam34

imported_guy wrote: »

how did she get more prescriptions for it?, if she is addicted why did the doctor keep prescribing it

there is the harm reduction principle - most commonly associated with methadone prescribing, whereby it is considered better to have someone taking methadone and being monitored by a clinic, or using clean needles for their heroin, rather than shooting up with shared dirty needles.
sometimes appropriate prescribing and management requires ongoing prescriptions of addictive drugs.

imported_guy wrote: »

one day i didnt feel like going to college (i had a math test), i asked my dad to write me a doctor's note, he did it (well i was faking it), and i got off the hook and was awarded the marks for that test in college (without having to sit the test, it got averaged on the other tests), and the next day my morals kick in... and i was wondering what any other doctor would have done

to be honest, that was highly irresponsible and unethical of your father.

imported_guy

to be honest, that was highly irresponsible and unethical of your father.

well lets not go there, we have all faked a stomach ache at some point in our life i just did it in college.

there is the harm reduction principle - most commonly associated with methadone prescribing, whereby it is considered better to have someone taking methadone and being monitored by a clinic, or using clean needles for their heroin, rather than shooting up with shared dirty needles.
sometimes appropriate prescribing and management requires ongoing prescriptions of addictive drugs.

yeah i heard about the heroin thing in some countries eg. norway where you can ask for clean needles when you drop off your old one for addicts and alot of places they even monitor it so they dont OD (i'd rather see rehabs trust me)

and comming back on topic, we dont know what type of drug is being prescribed, my dad says if it is methadone then all patients should have a pretreatment ECG to measure qtc interval and a follow up ECG within 30 days and each year. If the methadone dosage is greater than 100 mg/day, or if patients have unexplained syncope or seizures, additional ECG is recommended, but he says he has never treated anyone for depression lol and thats what he remembers.

sam34

imported_guy wrote: »

well lets not go there, we have all faked a stomach ache at some point in our life i just did it in college..

well, faking a stomach ache is one thing. a doctor falsely certifying a family member as ill to avoid an exam is anotehr thing entirely.

imported_guy wrote: »

and comming back on topic, we dont know what type of drug is being prescribed, my dad says if it is methadone then all patients should have a pretreatment ECG to measure qtc interval and a follow up ECG within 30 days and each year. If the methadone dosage is greater than 100 mg/day, or if patients have unexplained syncope or seizures, additional ECG is recommended, but he says he has never treated anyone for depression lol and thats what he remembers.

well, we can be pretty certain that the drug in question here isnt methadone. firstly, its not a treatment for depression.
and anyway, my point was that anti-depressants are not addictive.

i mentioned methadone in response to your question about why addictive drugs might be prescribed on an ongoing basis.

Carsinian Thau

sam34 wrote: »

well, faking a stomach ache is one thing. a doctor falsely certifying a family member as ill to avoid an exam is anotehr thing entirely.

+1.

frodi

Drug on show was paroxetine, brand name seroxat.

I heard the start and got bored after 5 mins or so

angeldelight

Nothingcompares wrote: »

Basically my underrstanding is, she turned up at the GP. Said I'm feeling a bit down. The GP prescribed this anti-depressant for 3 months. She came back 3 months later and said she's grand. GP said you have to continue taking these indefinitely. This was a shock to her.

In fairness the GP should have explained more to her.... with depression there are different phases of treatment. The acute phase lasts in and around 6-10 weeks of treatment. After this the symptoms of depression should be under control. Then continuation phase (4-9 months) to restore prior level of functioning and eliminate any residual symptoms. This is at the same dose as the acute phase. SOME people will also require maintenance (12-36 months) which can, in certain individuals, reduce recurrence by up to two thirds.

As already stated anti-depressants are not addictive.

*My reference for the above are Compass Thereapeutic Guidelines on managing Depression in Adults

tallaght01

A) her doc won't have told her that the anti-depressant was highly addictive, because it's not.

There's often a HUGE discrepancy between the patient's version and the doctor's version of the story. Only difference is the doc isn't allowed to go on radio to defend his/herself.

I've been in a situation as a very junior doc where I was in the room as my reg and consultant told a lady that her son was going to die. About 6 weeks later she's sprawled across the paper telling the world about how no-one explained anything to her, and she was expecting to go home a few days after admission.

GER12

The discussion on lifeline yesterday was in relation to an expert they had on talking about the side-affects of seroxat - which is an anti-depressant drug. The expert was talking about the risk of miscarriage, foetal abnormalities and dependancy in patients who use of seroxat. People phoned in to say that they were in child bearing age - and when they attended their GP - they were prescribed seroxat but they werent told of the risks.

Before prescribing any pharmaceutical substance it is the doctors responsibility to fully explain all facts about the medication including any potential risks involved. I was listening to Lifeline today - and other persons were phoning in about the state of mental health services - and the fact that when they went to their GP or psyhiatrist they were far to quick to prescribe medication rather than offer therapeutic access to a psychologist. Mental health services in Ireland are still quite undeveloped - services are currently based on a medical model of thinking where the focus is primarily on medication and hospitalisation - and compliance by the patient!!

Nothingcompares

sam34 wrote: »

i didnt hear the show.

but, there is no "highly addictive" anti-depressant.

it's one of the greatest myths out there about anti-depressants.

some anti-depressants do cause discontinuation/withdrawal effects, but this does notr mean they are addictive.

addiction implies tolerance, where you need ever increasing doses to achieve the required effect. this is simply not the case with antidepressants.

i took addictive to mean habit-forming and 'intolerable withdrawal symptoms' to cause habit

sam34

GER12 wrote: »

I was listening to Lifeline today - and other persons were phoning in about the state of mental health services - and the fact that when they went to their GP or psyhiatrist they were far to quick to prescribe medication rather than offer therapeutic access to a psychologist. Mental health services in Ireland are still quite undeveloped - services are currently based on a medical model of thinking where the focus is primarily on medication and hospitalisation - and compliance by the patient!!

define "far too quick" to prescribe?

how can a lay person know when a doctor should prescribe?

just because a person feels a dcoctor was wrong, does not necessarily mean that is the case.

furthermore, there are relatively few psychologists available through the public services, so the option is very often not there for the GP or psychiatrist to refer to a psychologist.

shock horror :eek: doctors prescribe medication!!
newsflash - this is what tehy are trained to do.
GPs and psychiatrists are not counsellors, psychologists, therapists, social workers or anything else.

they are doctors.
they are qualified to prescribe, that is their remit. nobody else on the multi-disciplinary team can prescribe.

and whats teh issue with expecting a patient to comply?
there is a huge drive among advocacy services to stop calling psychiatric patients "patients" and to call tehm "service users", which they feel implies more active involvement in their own care, which involves taking some responsibility and adhering to agreed treatment plans.

sam34

Nothingcompares wrote: »

i took addictive to mean habit-forming and 'intolerable withdrawal symptoms' to cause habit

i see what you're getting at.

but for a substance to be addictive, it has to cause craving and tolerance, among other things.

the anti-depressants dont do this.

yes, thay cause withdrawal symptoms, which can be extremely unpleasant, but they dont cause cravings and you dont get tolerant to them.

GER12

sam34 wrote: »

define "far too quick" to prescribe?

how can a lay person know when a doctor should prescribe?

just because a person feels a dcoctor was wrong, does not necessarily mean that is the case.

furthermore, there are relatively few psychologists available through the public services, so the option is very often not there for the GP or psychiatrist to refer to a psychologist.

shock horror :eek: doctors prescribe medication!!
newsflash - this is what tehy are trained to do.
GPs and psychiatrists are not counsellors, psychologists, therapists, social workers or anything else.

they are doctors.
they are qualified to prescribe, that is their remit. nobody else on the multi-disciplinary team can prescribe.

and whats teh issue with expecting a patient to comply?
there is a huge drive among advocacy services to stop calling psychiatric patients "patients" and to call tehm "service users", which they feel implies more active involvement in their own care, which involves taking some responsibility and adhering to agreed treatment plans.

Doctors duty is not only to prescribe - they are also there to listen to the patient and refer to the most appropriate professional if the situation warrants it. There's complete different philosophies between the medical and social model of thinking. If a patient goes to the GP telling them that they are feeling depressed and cannot sleep - is it the answer after a ten minute consultation to prescribe anti-depressants or sleeping tablets or does a doctor not have a clinical responsibility to talk to the patient and to try to establish why that person is feeling the way they are. I understand that doctors and particularly GP's may be overloaded in terms of their workload - but that is no excuse - and having the benefit to draw from being both a "service user" and professional from that area I have seen first hand situations where doctors are too keen to prescribe too readily anti-depressants.... and for what reason... simply because the doctor hadnt got the time to listen and didnt know dont know what else to do. Thank god I had the necessary knowledge and professional background to voice my own opinion on what I needed and also to exert my rights. As for what is the big issue around compliance - doctors are not always right - paternalistic viewpoints of the patient must always comply are very much outdated modes of thinking in modern medical practice in Europe - medical treatment is and should be a partnership - and there is also such a thing as autonomy and self-determination ie. to determine what is in my own medical interest or unlike all other patients do people who experience mental health difficulties not have that basic human right. You are however right about the lack of multi-disciplinary care in Ireland and particularly the shortage of psychologists both within both General Practice and Psychiatry - that situation exists in mental health services policy and other elements of Irelands health services....

sam34

GER12 wrote: »

Doctors duty is not only to prescribe - they are also there to listen to the patient and refer to the most appropriate professional if the situation warrants it. There's complete different philosophies between the medical and social model of thinking. If a patient goes to the GP telling them that they are feeling depressed and cannot sleep - is it the answer after a ten minute consultation to prescribe anti-depressants or sleeping tablets or does a doctor not have a clinical responsibility to talk to the patient and to try to establish why that person is feeling the way they are. I understand that doctors and particularly GP's may be overloaded in terms of their workload - but that is no excuse - and having the benefit to draw from being both a "service user" and professional from that area I have seen first hand situations where doctors are too keen to prescribe too readily anti-depressants.... and for what reason... simply because the doctor hadnt got the time to listen and didnt know dont know what else to do. Thank god I had the necessary knowledge and professional background to voice my own opinion on what I needed and also to exert my rights. As for what is the big issue around compliance - doctors are not always right - paternalistic viewpoints of the patient must always comply are very much outdated modes of thinking in modern medical practice in Europe - medical treatment is and should be a partnership - and there is also such a thing as autonomy and self-determination ie. to determine what is in my own medical interest or unlike all other patients do people who experience mental health difficulties not have that basic human right. You are however right about the lack of multi-disciplinary care in Ireland and particularly the shortage of psychologists both within both General Practice and Psychiatry - that situation exists in mental health services policy and other elements of Irelands health services....

if somoene presents to a gp with symptoms of depression, and the GP offers them a treatment for that depression, i dont see how that can be castigated.

now, of course GPs should listen to the patient and try and establish the roots of it, BUT, as i said above, there is s limit to what the GP can do here.. they cannot offer brief counselling, because they are not counsellors or psychologists.

more often than not, they cant refer to a psychologist, because teh access isnt there.

lets look at an analogy form general medicine.
if a GP sees someone with hypertension and wants them to take meds as well as adopt lifestyle changes such as dietary modifications.
but, there is no dietician available.

so, what should teh GP do? either do what he can do to combat the problem, which is prescribe the meds, or not prescribe them and give some dietary advice but not as full and detailed as what would be given by a dietician, because thats not what the GP is?

if teh GPs were leaving depressed patients out there with no meds, and on enormous waiting lists for psychologists, there would be an outcry as to how they were being forgotten about and denied treatment.

im well aware of the issues around paternalism and autonomy in medical and psychiatric practice.

the doctor is not always right, noone is infallible.

most psychiatric practices now have careplans which the patient is involved in drawing up, and often cosigns, to indicate their active participation in their care.

compliance does not have to be a passive thing, and for any treatment t be a success, be it meds or a psychological intervention, the patient has to comply. you wont get far with cbt if the patient isnt doing the homework set, just as you wont get far with meds if theyre sitting in the kitchen press.

GER12

sam34 wrote: »

if somoene presents to a gp with symptoms of depression, and the GP offers them a treatment for that depression, i dont see how that can be castigated.

now, of course GPs should listen to the patient and try and establish the roots of it, BUT, as i said above, there is s limit to what the GP can do here.. they cannot offer brief counselling, because they are not counsellors or psychologists.

more often than not, they cant refer to a psychologist, because teh access isnt there.

lets look at an analogy form general medicine.
if a GP sees someone with hypertension and wants them to take meds as well as adopt lifestyle changes such as dietary modifications.
but, there is no dietician available.

so, what should teh GP do? either do what he can do to combat the problem, which is prescribe the meds, or not prescribe them and give some dietary advice but not as full and detailed as what would be given by a dietician, because thats not what the GP is?

if teh GPs were leaving depressed patients out there with no meds, and on enormous waiting lists for psychologists, there would be an outcry as to how they were being forgotten about and denied treatment.

im well aware of the issues around paternalism and autonomy in medical and psychiatric practice.

the doctor is not always right, noone is infallible.

most psychiatric practices now have careplans which the patient is involved in drawing up, and often cosigns, to indicate their active participation in their care.

compliance does not have to be a passive thing, and for any treatment t be a success, be it meds or a psychological intervention, the patient has to comply. you wont get far with cbt if the patient isnt doing the homework set, just as you wont get far with meds if theyre sitting in the kitchen press.

There is nothing wrong with a GP or psychiatrist prescribing seroxat for instance for depression.... once that they obtain a full case workup and establish whether they are prescribing because their is an identified medical need and the treatment has in empirical literature known efficicacy, or are these scripts being written to mask other deficits in health services ie. service user unable access to support services. Person assaulted - presenting sequelae PTSD - yet psych team misdiagnosed. Meds were prescribed by psych's.... yet these meds have no known efficacy in the treatment of PTSD. Person tried to obtain access to psychotherapy - despite a statutory entitlement that person was told she wasnt entitled to it. That person then had to take a two year case to the ombudsman and that case highlighted maladministration and was necessary to bring about statutory compliance with legislation. In my experience mental health services are far more advanced in the UK.