July 24th, 2011 by Harriet Hall, M.D. in Opinion, Research
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Antidepressant drugs have been getting a bad rap in the media. I’ll just give 3 examples:
- On the Today show, prominent medical expert
Tom Cruise told us Brooke Shields shouldn’t have taken these drugs for her postpartum depression.
- In Natural News, “Health Ranger” Mike Adams accused pharmaceutical companies and the FDA of covering up negative information about antidepressants, saying it would be considered criminal activity in any other industry.
- And an article in Newsweek said “Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse.”
Yet psychiatrists are convinced that antidepressants work and are still routinely prescribing them for their patients. Is it all a Big Pharma plot? Who ya gonna believe? Inquiring minds want to know:
- Are antidepressants more effective than placebo?
- Has the efficacy of antidepressants been exaggerated?
- Is psychotherapy a better treatment choice?
The science-based answers to the first two questions are Read more »
*This blog post was originally published at Science-Based Medicine*
July 24th, 2011 by PreparedPatient in Health Tips
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Living Beyond Pain
For people with severe chronic pain like Kelly Young and Teresa Shaffer—both of whom have become patient advocates—coping with agony is a fact of life. Young suffers from rheumatoid arthritis while Shaffer’s pain is linked primarily to another degenerative bone disease.
Chronic pain is one of the most difficult—and common—medical conditions. Estimated to affect 76 million Americans—more than diabetes, cancer and heart disease combined—it accompanies illnesses and injuries ranging from cancer to various forms of arthritis, multiple sclerosis and physical trauma.
Pain is defined as chronic when it persists after an injury or illness has otherwise healed, or when it lasts three months or longer. The experience of pain can vary dramatically, depending in part on whether it is affecting bones, muscles, nerves, joints or skin. Untreated pain can itself become a disease when the brain wrongly signals agony when there is no new injury or discernable other cause. Fibromyalgia—a disease in which pain in joints, muscles and other soft tissues is the primary symptom—is believed to be linked to incorrect signaling in the brain’s pain regions.
Finding a Doctor
The first step to deal with chronic pain is Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
July 16th, 2011 by Dinah Miller, M.D. in Opinion
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Dr. Maureen Goldman talks about self-disclosure for psychiatrists and brings the topic up in the context of Marsha Linehan’s recent announcement that she was treated for a psychiatric disorder as a teenager.
In Clinical Psychiatry News, Dr. Goldman notes:
Psychiatric care and psychotherapy are different from the Alcoholics Anonymous fellowship, where the mutual sharing of personal experience is an integral part of helping people maintain sobriety. I believe that there is middle ground between disclosing personal information and presenting myself as a blank slate. In my practice, I show myself to be a real person. I make mistakes and admit them. I joke about my poor bookkeeping skills and inferior technological skills. I look things up during sessions if necessary, and I tell patients when I need to do research or consult with a colleague. I treat them as real people, too, not just as patients.
I do not, however, share my own story. Mostly, I think that I can help people feel heard, understood, and known, and create a therapeutic plan without personal disclosure. I communicate that “I get it” without being clear that “I really get it.”
I cannot speculate about the motivation behind Dr. Linehan’s decision to allow her mental health history to be chronicled in the New York Times. The story was a very public disclosure, and in that way quite different from a disclosure made in the context of a one-on-one, doctor-patient therapeutic relationship.
We’ve talked in detail about self-disclosure before, and specifically about whether psychiatrists should tell their patients if they’ve suffered from a psychiatric disorder. See Read more »
*This blog post was originally published at Shrink Rap*
April 23rd, 2011 by Steven Roy Daviss, M.D. in Research
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This month’s Psychiatric Times continues the discussion [registration required 🙁 ] about the NY Times article on psychotherapy that Dinah and readers discussed on April 9. This time, our colleague, Ron Pies MD, authored this article which deconstructs the myths perpetrated in the NYT article, which interviewed a med check doctor who found it “sad” that his patients found him to be important to them in their lives (read the article for the full flavor).
I’m glad that Ron pointed out (as we have) that the 2008 Mojtabai and Olfson article — which implied that only 11% of US outpatient psychiatrists provide psychotherapy — was a misleading statistic. Why? Because they did not consider brief psychotherapy sessions (30 minutes or less) to be classified as “psychotherapy” for their session. Thus, a 90807 (45-50 min) is considered psychotherapy, but a 90805 (20-30 min) would not be considered so, even though the AMA’s CPT manual defines it as psychotherapy. Also, brief and supportive forms of psychotherapy are often given even when only a “med check” is billed. Nonetheless, the sound bite from that article has been: “Only 11% of psychiatrists do psychotherapy”. It just ain’t true. As Mark Twain said, “There are three kinds of lies: lies, damned lies and statistics.“—–
*This blog post was originally published at Shrink Rap*
April 13th, 2011 by Dinah Miller, M.D. in Health Tips, Opinion
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This is for Dr. D.
We were having lunch when Dr. D mentioned she wanted to write a book aimed at teaching residents how to
do psychotherapy. It would start with a section on What Makes a Good Therapist? What does she thinks makes a good therapist? Real life experiences which impart an ability to empathize. Do we grow from our own difficulties? More specifically, do we grow in to better therapists? I asked another shrink this, and he said that people like to believe there is some meaning to their suffering, and perhaps it’s nice to believe that if you’ve been stuck suffering, then it makes you a better therapist, but he wasn’t so convinced it was true. Me? I don’t know, maybe. Or maybe not. Personally, I’m fine with the idea of not suffering, at all, ever again, so long as I live.
In residency, I was taught that warmth and empathy are important to being a good therapist. Read more »
*This blog post was originally published at Shrink Rap*
