Sunday, July 18, 2010

Letting a General Practitioner prescribe psych meds... like letting an 4-year old-drive an 18-wheeler. Unfortunately many psychiatrists and psych NP's aren't much better, but at least when letting a 14 year-old drive they can at least reach the pedals. There's often still an element of experimentation but they can operate the basic machinery.

I cannot be strong enough in my opposition to GP's prescribing psych meds. GP's are not specialists. As such, they are more likely to rely on "guidelines" from the FDA to prescribe psych meds.

The FDA often says it's just dandy to give a 100 lb woman the same dosages of medications as a 200 lb man. Which in my experience is about as subtle as a stroke.

Additionally, GP's are not generally sitting around reading the latest psychiatry journals, and unfortunately for women with ADHD, whose participation as subjects in research studies is only very recent, that's very bad. We have not been studied, and are treated according to guidelines based on male subjects. Anecdotal evidence seems to suggest that at the very least, female hormones make the experience of ADHD far different at times for men than for women, and that taking that into account may make treatment more effective. However, if even baseline prescribing is clumsy, such subtleties are unlikely to be taken into account.

So not only is allowing GP's to prescribe psych meds just plain crazy, it's also just plain sexist. And by sexist, indeed, I mean institutionally-sanctioned policy that favors one gender over another, passively or otherwise.

Yeah...I went there. And I'm not sorry, because frankly I'm sick and tired of watching people (of both genders) around me get fucked by inelegant prescribers, and watch useful medications get a bad reputation over it.

Medications, prescribed by a psychiatric professional who conscientiously tries to stay current on the subtleties of modern practice, and takes my opinion and knowledge into account, has been an adventure for sure (because of my own biological quirks) but has given me invaluable perspective on what drugs can and can't do, and the ability to make decisions about when and where to use them, to improve the quality of my life.

I will never allow a GP to prescribe psych meds to me without first referring me to a psych provider. Never.


  1. You say it in a way that would get me in trouble as a professional that has to interface with the doctors in town.

    I am jealous.

  2. Singing my song, girl. Sing on!

    And I would go even VERY CAREFUL in your choice of psychiatrist.

    In our local Adult ADHD group, the stories I hear of cockamamie prescribing "methods" just infuriate me. Who the heck are these MDs to treat people's lives so cavalierly? ESPECIALLY when they're paying out of pocket!

    I emphasize "mental health consumerism." Get educated so at least you can know when you're dealing with a bozo. And get support, to know that good results can be had by most people with ADHD, if they proceed according to established protocols.

    Too often, the prescribing stinks, and then the residual symptoms are passed off as the work for therapy or, worse, the limits of treatment.

    Yes, for late-diagnosis adults especially, specialized therapy for ADHD around cognitive-restructuring and developing new habits is often helpful. But too many people stop short on the medical treatment, settling for much less than is possible.

    Thanks for this important message!


  3. MENTAL HEALTH CONSUMERISM! That's a great term Gina.

    I think about this a lot anyway, but I have really thought about it a lot since recently having a conversation with a dear friend, about one of her family members who is clearly struggling with either anxiety or depression or both. Her family member is a talented, smart woman, and deserves a chance at a rich life, but they are afraid for her to turn into a zombie, on psych meds. So...I gave them a pep talk about being "mental health consumers" as you say and exposed myself as an example. I have really worked to educate myself and set up key players in my life who can help advocate for me. Meds aren't the only solution, certainly...but they're such a great tool. Despite my issues with meds in the past year, I'm finally at a place where my life is FAR better then it was before I began any treatment.

    You use the word cavalier, and I couldn't agree more. There is always an element of experimentation involved in taking psychotropic meds...which is precisely why prescribers OWE consumers more attention, more attempt at subtlety...more respect.