Posted by dbc on March 30, 2008, at 14:11:47
In reply to Re: Inductive versus Deductive Reasoning » dbc, posted by seldomseen on March 30, 2008, at 12:19:44
> It has been my experience that most of medicine, including psychiatry is not like that at all.
>
> Most doctors follow the guidelines for practice set forth by working groups of physicians in that field. The groups decide on the quality of evidence for a specific treatment and issue standards for physicians to follow.
>
> With most meds it is about risk/benefit analysis which is figured into the guidelines.Of course theres a system in place where the most obvious treatment is used for a problem (first line drugs). You get a patient presenting with clinical depression and the first drug you throw at them is an SSRI. If that doesnt work you move on to a second line drug but after that it gets a little fuzzy and you have to start thinking about past patient feedback and how it relates to the current situation, you're in no mans land as far as treatment. Sometimes this works great and sometimes its a disaster.
The previous poster brought up lamictal. Now my DX is complicated and im treatment resistant to all the common things so this doctor concludes finally that im bi-polar despite the fact that i lack any symptomes of mania cough.
I Grudgingly start taking lamictal and everythings going good and then i hit about 100-125mg and i start having minor delusions (oh god im being watched etc) and audio hallucinations. My doctor will not belive its the lamictal (she's never heard about this side effect yadda yadda) and assumes im flipping into some mania and forgot to mention for 2 years that i have them. So she starts giving me Atypicals...they do nothing to dent the crazyness.
I start trying to find cases online of similar situations with lamictal and come across people talking about dose dependent psychosis experiences with lamictal and also a study with a vague description of something similar.
I call her and explain that im still crazy but i have a solution and if it works you'll look silly. We bump the dose to 200mg and the hallucinations go away.
Whats my point? Eh well i guess that sometimes just sometimes anecdotes are useful and the tiered system of prescribing can be flawed because of anomalies like me. I kind of lost my point half way through that but you'll get the gist of it.
poster:dbc
thread:820639
URL: http://www.dr-bob.org/babble/20080330/msgs/820695.html