Thursday, October 28, 2004

Message from the front lines, #1

A new psychiatrist responds to my post about children and antidepressants:

I think you're right that we don't give our primary care docs proper support. Here in Alabama we have a dire shortage of psychiatrists, even in Birmingham (which has the highest density of shrinks) it is a 2 month waiting period for new patients. The psychiatrists down here are also bad about getting back in touch with their referral sources, and often leave them in the dark about what they are prescribing and why.

I finished my general psychiatry residency in June '04 and have been quite successful in my all outpatient practice so far. I send a thank-you back to my referral sources with my recommendations and treatment plan and this has been very well received. Sometimes it is scary to see how much psychiatry gets practiced in primary care with so little formal training. In a perfect world every case of depression would be treated by a psychiatrist, but the fact is there is not enough of us to see all of them. We need our primary care doctors to feel confident in prescribing antidepressants.

As far as the FDA is concerned, I think the black box warnings are going to kill a lot of teenagers who otherwise would have gotten an effective treatment. I know pediatricians down here that are reluctant to prescribe antidepressants now. Seemingly ignored is the fact that as antidepressant use has increased over time the suicide rate has declined, as well as the fact that in the 4,250 patients in the studies cited by the FDA *no one committed suicide*!

I'm also bothered by the catch phrase "close monitoring" of patients on antidepressants. What the heck is that? Does that mean having every patient I have on an antidepressant leave me a voicemail in the morning letting me know they are still here? Or seeing them back in 4 weeks instead of 3 months? Or insisting that they get psychotherapy every week? I can see the trial lawyers just foaming at the mouth over this one....


6:22 AM
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