Anti-depressants - stay on em, quit?

[Guest Raidne]

I want to be 100% serious for a minute. I read hundreds of pages of medical records every day. I read everything from doctors choosing certain courses of treatments because the patient didn't report certain symptoms that I can see the patient reported to other doctors to "oops, we operated on the wrong vertebrae." Most commonly what I see is doctors choosing courses of treatment based on the information previously provided by the patient without reviewing the options with the patient and eliciting additional relevant information. There is, in medicine, not always one obvious course of treatment, but an array of options. Your doctor chooses the best option. If you don't ask, they generally won't tell you (1) that there are other options and (2) why they are choosing the one that they are choosing.

If I'm drafting a will, I don't think it's responsible to make decisions for the client. You tell the client the options, counsel them, and then let them make the decisions. Doctors are no different, we shouldn't treat them as such, and it's irresponsible to your own health to do so. From what I see, day in and day out, over and over, Deathwalker's approach will absolutely yield better health care results than Kal's "doctor is God" approach.

You absolutely should listen to your doctor and make decisions with your doctor - just don't let your doctor make decisions for you. Your doctor is one person with hundreds of patients - insisting on interaction leads to more relevant information for your doctor. However, in order to have that conversation, you need to be thoughtful and informed on your condition yourself. Make no mistake - you pay for health care. It's probably worth doing at least the amount of research you'd do to buy a flat-screen TV, no?

Having said that, don't go anywhere on the internet. As far as generally available medical information online, we generally use nih.gov here at my office. For instance, here's the NIH booklet on depression: http://www.nimh.nih.gov/health/publications/depression/index.shtml

I guess it's kind of ironic, but IMO, Kal's POV is the one truly harmful thing that's actually been said in this thread, and not to an insignificant degree. I'm not going to say that I'm not somewhat enjoying calling him out because I think he was being a jerk in the first place, but mostly I just feel that it's really important to avoid this approach in the interest of your own health.

[Kalbear]

Wait - you are really stating that talking to your doctor is harmful? Or do you think that not taking the advise of random strangers on the Internet is harmful? Those are the two things I suggested - to talk to a doctor and not take the advice of people on the Internet that don't know you or anything about you. I never suggested that you only follow your doctors orders or only do what they state no matter what.

You really believe that this is actually bad advice, don't you? Heh. Okay, so be it. Good luck taking your life choice advice from random strangers then.

[Kalbear]

To put it back on nuke, deathstalker and raidne apparently believe that it is less harmful for a person with a diagnosed mental illness who is off their medication to listen to strangers on a fantasy message board for their medical decisions over talking with a doctor, and that this will yield better results.

And both have admitted that they disfavor and distrust doctor opinion.

Sounds legit to me.

[Aemon Stark]

I want to be 100% serious for a minute. I read hundreds of pages of medical records every day. I read everything from doctors choosing certain courses of treatments because the patient didn't report certain symptoms that I can see the patient reported to other doctors to "oops, we operated on the wrong vertebrae." Most commonly what I see is doctors choosing courses of treatment based on the information previously provided by the patient without reviewing the options with the patient and eliciting additional relevant information. There is, in medicine, not always one obvious course of treatment, but an array of options. Your doctor chooses the best option. If you don't ask, they generally won't tell you (1) that there are other options and (2) why they are choosing the one that they are choosing.

Why is it that you think reviewing medical records - those submitted for legal review anyway, hardly representative of ideal practice - gives you such a particular insight into the practice of medicine that you can make these kinds of claims? First, you are reviewing only that which is documented, which in many cases will not include extended discussions about treatment options (if any) - and patients say different things in different situations all the time. History-taking is an art not an exact science and patients do not always volunteer information even on direct questions. To take one example, I've had one guy claim he had no major health problems and no prior surgeries... but who had stents and a pacemaker which hadn't been interrogated in over 2 years. We wouldn't have gotten that info if it hadn't been an exceptional long and thorough first visit for primary care.

Second, there is frequently an obvious course of treatment and there are extensive guidelines for common conditions defining treatment protocols and "first-line" approaches. There is frequently not an "array" of options, though as ever you can choose to "watch and wait" rather than proceeding with some drug or surgical therapy. Admittedly this is a bit different in psychiatry, where there are classes of essentially identical drugs which differ mainly in side-effect profiles, and so it is particularly important for the physician to work with the patient to get the best result.

If I'm drafting a will, I don't think it's responsible to make decisions for the client. You tell the client the options, counsel them, and then let them make the decisions. Doctors are no different, we shouldn't treat them as such, and it's irresponsible to your own health to do so. From what I see, day in and day out, over and over, Deathwalker's approach will absolutely yield better health care results than Kal's "doctor is God" approach.

Patients who do (reasonable) research and take an active interest in their treatment are always easier to work with and do everyone involved a great service. However, I hardly think that deciding on terms of a will is comparable to deciding the best approach to moderate mitral regurgitation or lymphoma or cerebral aneurysms or sepsis. And at the primary care level, there are evidence-based guidelines which define the appropriate therapy for hypertension, type II diabetes, etc.

You absolutely should listen to your doctor and make decisions with your doctor - just don't let your doctor make decisions for you. Your doctor is one person with hundreds of patients - insisting on interaction leads to more relevant information for your doctor. However, in order to have that conversation, you need to be thoughtful and informed on your condition yourself. Make no mistake - you pay for health care. It's probably worth doing at least the amount of research you'd do to buy a flat-screen TV, no?

Doing research is helpful, sometimes, and I always attempt to provide direction to appropriate resources. However, you can give all the papers and pamphlets in the world to a mother of a child with ITP, and she still might not know what a platelet is the next day.

Having said that, don't go anywhere on the internet. As far as generally available medical information online, we generally use nih.gov here at my office. For instance, here's the NIH booklet on depression: http://www.nimh.nih.gov/health/publications/depression/index.shtml I guess it's kind of ironic, but IMO, Kal's POV is the one truly harmful thing that's actually been said in this thread, and not to an insignificant degree. I'm not going to say that I'm not somewhat enjoying calling him out because I think he was being a jerk in the first place, but mostly I just feel that it's really important to avoid this approach in the interest of your own health.

UpToDate (http://www.uptodate.com/index) is pretty much the gold-standard and has a fairly extensive free section too. (Depression treatment article http://www.uptodate.com/contents/patient-information-depression-treatment-options-for-adults-beyond-the-basics?source=search_result&search=depression&selectedTitle=2%7E68]here) Unfortunately the full version is quite expensive and probably well above the right level in complexity.

[Nukelavee]

It's not a binary kind of thing, tho.

Just like you state you aren't saying only take a doctor's orders, or that they are all knowing, most of us aren't going to ignore the doctor, automatically, in favour of things we read on the boards.

Besides, for this topic, it can hardly be said it's random people. If nothing else, my decision to start the topic was based upon knowing there are a number of people here who do have experience with depression, and the effects of the medications involved.

As well, one thing I've learned over the last 5 years is that feed back from my peers has been as big a factor in dealing with depression as the meds or my doctors, and that, really, I needed input from both groups. If you haven't been there, with any kind of issue that has similar ways of treatment, it's easy to overlook just how important it is to hear those anecdotes and experiences, because you never know when somebody is going to use exactly the right language to let you make a connection you really need to.

[Sci-2]

I feel like people are taking what Raidne is saying to an illogical extreme, though I don't being a doctor is like being a lawyer and its flawed to draw an analogy between them. (For one thing I suspect we'll have AIs for a good deal of legal work, given time.)

I've definitely had experiences with doctors who are basically assholes trying to get their money and get me through the door, but that's what a second opinion is for.

I think a better way to look at this is you should, to an extent, trust your intuition as well when choosing which docs you interact with and not take any one doc as the word of God.

[Robin Of House Hill]

Perhaps Kalbear will understand better with this anecdotal information.

My provider under Medicare and supplemental insurance is Kaiser-Permanente. I chose them because they are convenient to public transportation and everything is under one roof. I don't normally seek medical assistance, but in January of 2011 after suffering terrible pain in both shoulders, I reluctantly scheduled an appointment. The first doctors I saw prescribed an anti-inflammatory, but were much more concerned with my blood pressure. Fine, now, I take blood pressure medication. They also wanted to do some lab work. Fine, I was already there, so why not. Then they told me I had hypothyroidism and prescribed more medication. Well, I hadn't noticed any ill effects from low thyroid output, but fine, I took those pills as well. After a couple of months, they concluded I'd torn the rotator cuff tendons in both shoulders. Aside from a couple of cortisone injections, my only options were to live with the pain until the tendons slowly healed or have surgery. I decided to tough it out. In June of 2011, I got an appointment with my primary care physician because I was experiencing episodes of rapid, irregular heartbeats. The doctor listened to my heart and said everything sounded normal and suggested that more exercise would help keep the pulse rate down. Over the next month the rapid pulse, irregular heartbeat worsened. I requested and got a new primary care physician. I saw that doctor and his first statement was a guess that the thyroid medication dosage was to high. The lab confirmed that he was right. Fine, he reduced the dosage. That brought the pulse rate down, but didn't address the irregular rhythm.. Recently, I went in on short notice because of swelling at the base of my big toe. This doctor correctly diagnosed it as in inflamed bunion, and not gout or pseudo-gout. But she noted some swelling in my legs, which though I'd pointed out had occurred in the past if my sodium intake got too high and that it would subside if my diet got more reasonable. Since doctors never listen to such things, when said by patients, she scheduled me for for an echo-cardiogram so they could see how my heart was working mechanically. Fine, so I'll go. After almost a year, they are starting to get on the right track. But, that won't show much...unless they do it after the heart has been under stress. Wanna bet that unless I specifically request it, they won't have the sense to finally use the right diagnostic tool?

Please don't try to tell me that talking to a doctor is the only solution.

After 18 months, 4 different doctors haven't proven to me that I wouldn't be better off ordering my own tests. Talking to doctors may, or may not be harmful, but a lot of the time, it is useless.

An MRI of the shoulders, rather than x-rays would have produced a correct diagnosis 2 months sooner than happened. When they heard a complaint of high pulse rate with irregular rhythm, an EKG under stress and an echo-cardiogram under stress, would have determined the problem...a year ago.

[Galactus]

To take one example, I've had one guy claim he had no major health problems and no prior surgeries... but who had stents and a pacemaker which hadn't been interrogated in over 2 years.

This is just one of those "weird moments" for me, in a "Wow, the US really is different". Because that kind of thing... Would be noted in your medical records. The doctor might ask "Would you allow me to review your medical records?", and there are of course stuff that might not be recorded. (such as sympoms that never made it into the medical system, or surgeries etc. performed abroad) but the entire "review history" thing is largely done automatically.

[Aemon Stark]

Perhaps Kalbear will understand better with this anecdotal information. My provider under Medicare and supplemental insurance is Kaiser-Permanente. I chose them because they are convenient to public transportation and everything is under one roof. I don't normally seek medical assistance, but in January of 2011 after suffering terrible pain in both shoulders, I reluctantly scheduled an appointment. The first doctors I saw prescribed an anti-inflammatory, but were much more concerned with my blood pressure. Fine, now, I take blood pressure medication. They also wanted to do some lab work. Fine, I was already there, so why not. Then they told me I had hypothyroidism and prescribed more medication. Well, I hadn't noticed any ill effects from low thyroid output, but fine, I took those pills as well. After a couple of months, they concluded I'd torn the rotator cuff tendons in both shoulders. Aside from a couple of cortisone injections, my only options were to live with the pain until the tendons slowly healed or have surgery. I decided to tough it out. In June of 2011, I got an appointment with my primary care physician because I was experiencing episodes of rapid, irregular heartbeats. The doctor listened to my heart and said everything sounded normal and suggested that more exercise would help keep the pulse rate down. Over the next month the rapid pulse, irregular heartbeat worsened. I requested and got a new primary care physician. I saw that doctor and his first statement was a guess that the thyroid medication dosage was to high. The lab confirmed that he was right. Fine, he reduced the dosage. That brought the pulse rate down, but didn't address the irregular rhythm.. Recently, I went in on short notice because of swelling at the base of my big toe. This doctor correctly diagnosed it as in inflamed bunion, and not gout or pseudo-gout. But she noted some swelling in my legs, which though I'd pointed out had occurred in the past if my sodium intake got too high and that it would subside if my diet got more reasonable. Since doctors never listen to such things, when said by patients, she scheduled me for for an echo-cardiogram so they could see how my heart was working mechanically. Fine, so I'll go. After almost a year, they are starting to get on the right track. But, that won't show much...unless they do it after the heart has been under stress. Wanna bet that unless I specifically request it, they won't have the sense to finally use the right diagnostic tool? Please don't try to tell me that talking to a doctor is the only solution.

It is NOT normal to experience leg swelling simply due to excess dietary sodium. An echocardiogram is an appropriate investigation to evaluate heart function. A stress test would not be indicated specifically for that and would not provide the key information about your cardiac output.

After 18 months, 4 different doctors haven't proven to me that I wouldn't be better off ordering my own tests. Talking to doctors may, or may not be harmful, but a lot of the time, it is useless. An MRI of the shoulders, rather than x-rays would have produced a correct diagnosis 2 months sooner than happened. When they heard a complaint of high pulse rate with irregular rhythm, an EKG under stress and an echo-cardiogram under stress, would have determined the problem...a year ago.

It's unfortunate that you've a somewhat complicated course, yet I can't help thinking that you haven't displayed much understanding of WHY certain tests were ordered and others weren't.

For example, you can diagnose a rotator cuff injury through simply history and physical exam. MRIs might help guide surgery, but might not change the management much if at all (especially if you didn't want surgery!). Xrays, on the other hand, provide a cheap way to check for bony injury, which you need to rule out.

Similarly, a complaint of palpitations or irregular rhythm is best investigated with a simple 12-lead EKG or - potentially - a Holter monitor (basically just a 24-h EKG). There is little to no role for any kind of stress test (and a stress echo in particular is only done under very specific circumstances) in that situation. Stress tests specifically evaluate oxygen flow to the cardiac muscle under situations of increased oxygen demand (stress/exercise). They ONLY pertain to assessing for signficant blockages or narrowings of the coronary arteries and don't help at all for assessing heart function generally or rhythms.

In any case, I think one should always explain the Whys of a test and why other things are not needed.

[Aemon Stark]

This is just one of those "weird moments" for me, in a "Wow, the US really is different". Because that kind of thing... Would be noted in your medical records. The doctor might ask "Would you allow me to review your medical records?", and there are of course stuff that might not be recorded. (such as sympoms that never made it into the medical system, or surgeries etc. performed abroad) but the entire "review history" thing is largely done automatically.

Canada, actually. ;)

Anyway, this was a guy who'd just moved from North Carolina or thereabouts and who came without any of his own records. So we had nothing on him.

[Sci-2]

Talking to doctors may, or may not be harmful, but a lot of the time, it is useless.

This just one of the varied examples of fallacious reasoning in your post. There's a difference between decrying bad doctors and writing off the entire science and practice of medicine.

[Kalbear]

Please don't try to tell me that talking to a doctor is the only solution.

After 18 months, 4 different doctors haven't proven to me that I wouldn't be better off ordering my own tests. Talking to doctors may, or may not be harmful, but a lot of the time, it is useless.

An MRI of the shoulders, rather than x-rays would have produced a correct diagnosis 2 months sooner than happened. When they heard a complaint of high pulse rate with irregular rhythm, an EKG under stress and an echo-cardiogram under stress, would have determined the problem...a year ago.

I didn't state that you should obey your doctors no matter what.

I didn't state that you shouldn't do research yourself.

I didn't state that doctors are god and all-knowing.

I'm sorry that doctors fucked you over, Deathstalker. (or you think they did) That you had a bad experience does not mean all doctors are bad. Nor does it mean that because Nuke is off his meds he should take the advise of random people on an internet forum based around books with dragons in them as better advice than his own doctor's. I absolutely agree that a doctor's advice and counseling should be one factor in your ultimate treatment, not the sole factor - but at the same time I think it's incredibly foolish to state to a person off their medication with diagnosed mental illness that they should ignore their doctor's advise and seek out their own views, as you did. If you think that's somehow a poor decision, so fine. I'm willing to live with Raidne and you believing that somehow this is bad advice on my part. I'll err on that side every single day.

[Guest Raidne]

Why is it that you think reviewing medical records - those submitted for legal review anyway, hardly representative of ideal practice - gives you such a particular insight into the practice of medicine that you can make these kinds of claims?

I don't get records submitted for legal review. I get entire VA medical treatment files + entire private medical files. Problem lists, appointment notes, consultation reports, labs, x-rays, everything. You're Canada so not familiar with the VA health system, right? If I'm wrong about that, they're the records right off CAPRI. Those are different than the medical opinions I get back from experts we consult from the case. I have hundreds and hundreds and hundreds (seriously, feel bad for me) per case, and I have to read them all, every word.

I've had one guy claim he had no major health problems and no prior surgeries... but who had stents and a pacemaker which hadn't been interrogated in over 2 years. We wouldn't have gotten that info if it hadn't been an exceptional long and thorough first visit for primary care.

Exactly - I see that stuff all the time. We're on the same page. With some leading questions, a doctor can get that kind of thing out of a patient, or if the guy had Googled "what should I report at my first primary care visit with my new doctor" before seeing you, he would have just told you.

I feel like people are taking what Raidne is saying to an illogical extreme, though I don't being a doctor is like being a lawyer and its flawed to draw an analogy between them. (For one thing I suspect we'll have AIs for a good deal of legal work, given time.)

Seen turbotax? Already happened. It's not meant to be a perfect analogy by way of argument, just trying to illustrate a point.

What I am trying to say is that being an informed consumer of health care is a really good idea. Gathering information is part of that. You should read whatever information is on NIH (which is very accessible to a layperson, since that's it's purpose in many cases) and, yes, if you want, talk to people out there who have had similar experiences or know people who have. I don't think anybody's saying you should stop seeking medical care and just listen to people on the internet - that's contrary to the whole idea of being an informed consumer of health care services, because you wouldn't be using any, i.e. not a consumer. I do think people should feel free to gather information from wherever they want, including from people on the internet.

I mean, hell, taking this full circle, I sometimes go to a forum on ADD. It's hosted by one of the leading psychiatrists on ADD. If a leading psychiatrist thinks talking about a mental health condition online can be helpful, I'm not sure why any layperson would disagree.

[Guest Raidne]

This is just one of those "weird moments" for me, in a "Wow, the US really is different". Because that kind of thing... Would be noted in your medical records. The doctor might ask "Would you allow me to review your medical records?", and there are of course stuff that might not be recorded. (such as sympoms that never made it into the medical system, or surgeries etc. performed abroad) but the entire "review history" thing is largely done automatically.

In the U.S., your records aren't in one consolidated system. You really should have your records transferred from one office to another, but this is not common practice. Every provider is a different system. Patients who use the Dept. of Veterans Affairs (VA) health care system have their records in one database that are searchable and accessible across the country, but only within VA. It's one huge advantage of having a single health-care provider. It's just like the stuff you mention that might be performed abroad if you substitute "at any other office" for "abroad."

[Kalbear]

I mean, hell, taking this full circle, I sometimes go to a forum on ADD. It's hosted by one of the leading psychiatrists on ADD. If a leading psychiatrist thinks talking about a mental health condition online can be helpful, I'm not sure why any layperson would disagree.

I don't think talking about mental health conditions is a poor idea. I think it's a very good idea, and it is something that should be done more often and more openly.

I don't think that telling a person with mental health problems who is off their medication that 'they shouldn't listen to doctors because doctors are often useless' is a good idea. I think that's a profoundly dangerous idea. I also think that there is a profound difference in a community associated with talking about mental health issues and a community associated with talking about how awesome shadowbabies are and what a douche Theon is.

Gathering information is great. Asking people for their experiences is great. Listening to them tell you that you shouldn't trust your doctor - when you're off your medication - is a bad idea. That this has had to be stated multiple times seems really, really stupid to me, so fine.

[Merentha]

Since doctors never listen to such things, when said by patients, she scheduled me for for an echo-cardiogram so they could see how my heart was working mechanically. Fine, so I'll go.

An echo after a report of edema following a high sodium count is a good move under any circumstances, since that isn't a normal response to an abnormal sodium.

An MRI of the shoulders, rather than x-rays would have produced a correct diagnosis 2 months sooner than happened.

Sure, except that MRIs are big, expensive, time-consuming, and not something you casually offer unless you feel that it is necessary. X-rays are a good first step unless you suspect something will only be seen on an MRI. A full BMP every day will catch a lot of things early too, but that's not something you just do daily. I mean, you could, but why? Especially if you've already opted not to undergo the treatment that would potentially see a need for the MRI.

As for the irregular rhythm, I am slightly confused as to why a 12-lead wasn't ordered right off the bat, but there's no need for a stress EKG there.

edit: Kal, one person said that the doctor shouldn't be trusted and the other suggested that blindly following one doctor's advice wasn't always a wise course of action. The first is a dangerous idea. The second is something to consider, if your doctor isn't listening and responding to what you say, especially a psychiatrist, you should consider getting a new one or a second opinion. But while you're there, you should continue to follow their advice and plan of care.

[Kalbear]

Agreed, merentha - and holy fuck, you're doing med school? I remember when I couldnt buy you a drink and you were off to college as a freshman.

Sigh.

Anyway, if you feel like your doctor is not cooperating well with you or that things are not going the way you like, finding a second opinion is a great idea. But (as others stated) doing it while in withdrawal is not a great strategy.

[Guest Raidne]

I don't think that telling a person with mental health problems who is off their medication that 'they shouldn't listen to doctors because doctors are often useless' is a good idea.

Gotcha. I thought that's what you were saying after your last few posts, but then nobody's actually made the point you were arguing against, so it was a bit confusing. I am saying that it's totally reasonable to discuss your health issues with people who aren't doctors, even on the internet. That is directly contrary to your first post in this thread. If you've decided to modify or clarify that position, great.

What I read Deathwalker as saying is this:

With the exception of those breathing some humor into this thread, the replies were overwhelmingly don't go cold turkey and contact a doctor. Apparently, this "crowd sourced answer" was both rational and proper, invalidating the assumption it wouldn't be. That said, I have very little faith in doctors, based on my own experience with them I never take a doctor's diagnosis or suggested course of treatment at face value, without doing my own research.

You said something like (to paraphrase) "thank you for proving how fucktarded you are." But as I understand your position now, you both think people should do their own research before talking to their doctors. Excellent.

[Kalbear]

Deathstalker did say that he thinks Talking to doctors is often useless, so I have been talking to that point.

I also think that it is not a good idea to ask people on the Internet advice on things while off prescription medication. You seem to be glossing over that little detail.

[Fez]

The better question is "seersucker before Memorial Day?"

In the south (and I'm including DC here), absolutely. I'd be dead without it, been wearing it for weeks now.