Tuesday, August 17, 2010

Scared of psychiatry? I was too.

Seriously, where does the time go? Today I just finished my very last day on my psych rotation. The shelf exam is Friday and then I get to start neurology! By no means am I planning on going into psychiatry, but I loved learning about it because it is:

a) so controversial
b) so prevalent
c) so gosh darn interesting
d) so heartbreaking
e) so challenging
f) so cushy (meaning, the work days are short and sweet)

I've never met more people scared of using psychiatric medications. I think it's natural to be scared of drugs that act primarily in the brain. Heck, I think it's natural to be scared of prescription drugs, period. And to be sure, a lot of the old drugs could kill you in overdose (although, most drugs can do that if you mix them right). Plus there is plenty of pop culture about "anti-psychotics" and "tranquilizers" and other things that will "fry your brain." The multi-billion dollar drug industry is also not really helping things with its pretty advertising followed by ads parading as "public service announcements" for lawyers who can get you compensation for drugs with "evil" side effects. Bottom line: it's confusing.

But if I learned anything on this rotation, and in med school in general, it's that prescription drugs are necessary--life-saving even--for many, many people. Even the psychiatric drugs. Especially the psychiatric drugs. If you've ever seen a child with severe ADHD, you realize that this disorder could literally sabotage his whole education and development if the proper treatment isn't started. For those who think medicating their kids is for the birds, "treatment" is not just drugs. Treatment for these kids is holisitc, or should be if the parents are on board. It includes not only a psychiatrist, but therapists, parenting classes, behavioral planning and changes in the home structure, dietary changes, and teachers. I'm all for alternate therapies including diet, exercise, and behavioral therapy, but sometimes it isn't enough, and the best thing a parent can do for their child is accept a diagnosis and work with the entire team to implement care on all levels--including drug therapy. I can't tell you how frustrating it is to work with parents and patients who put ultimatums on their treatment. For example, they'll say they'll do "anything" but try a stimulant for their child. Or, they'll allow an anti-depressant, but "no more than 10mg." Honestly, why do we even go to medical school if parents and patients are just going to tell us exactly how they want their child or themselves treated? And I'm not talking about advocacy. I think every patient and parent has a right to advocate for their child and for their own healthcare. Truly, studies show that when patients are in charge of their health, they are more compliant and heal faster. But advocating for yourself crosses a line at the point where the recommendation/opinion of the health care professional no longer matters.

I'll get off my soapbox. I just want people to really think before they judge about things like whether diagnoses such as ADHD even exist, or whether psych meds are a bunch of hooey. It's so easy to jump to conclusions and so hard to actually dig through the reserach. Guess what? Most good doctors have dug through the research.

So what have I learned? ADHD is real. So is depression, and anxiety, and psychosis, for that matter. When people suffer from psychiatric illness it is not their fault. People with depression can't just, "snap out of it." Drugs help--help a lot of people actually--and it isn't a sign of weakness if someone needs and anti-depressant or almost any other kind of psych drug. Also, psychotherapy works and it's also not a sign of weakness if you need to see a therapist. Or if you need to be hospitalized. Psych diseases are just like other medical problems, our culture has just bent them out of shape in weird ways so that we get scared when a family member or loved one has a diagnosable psych illness. So get the facts. Advocate. And don't be scared. Psychiatristis are some of the nicest people I have ever met.