The unknowns of prescription medications
We don’t thoroughly understand why drugs works for certain patients, but not for others. We know the mechanism of the drug, meaning we know if something is a dopamine agonist or a SSRI. However, we don’t yet understand how it relieves certain symptoms. We don’t understand the complexity of overlapping pathways. There is so much more research to be done in the space.
A lot of drugs used in psychiatry are all the same. Something you use for anxiety, you can also use for depression, and even schizophrenia. A lot of what we learned in psychiatry was “know this drug, and know that it works for these diseases.” There were a lot of drugs. There aren’t a lot of curative options in psychology. A lot of treatments are long term, and you make improvements over time, but it takes patience.
Psych is interesting. You meet a lot of people and hear their stories.
I met a man with schizophrenia and he was aware that he had schizophrenia. He would talk about how he could hear the voices telling him to hurt people, and he knew he had to ignore them. You really feel for him because he has a family and not many people know about his condition. He also doesn’t take his medications regularly. There is a socioeconomic relationship for schizophrenics, so many of them don’t have a good support system. Many of them are seen at safety net hospitals, and it’s difficult to see them at follow up appointments. As a psychiatrist, you give them a prescription, but the odds are that they will never get it filled and they’ll never come back for a follow up. There’s no system to deal with that.
There’s OCD and OCPD (Obsessive Compulsive Personality Disorder). OCD is a really debilitating form of OCPD – patients can have a really rigorous morning routine, and they have to do things in a certain order for a certain amount of times. There’s a main source of anxiety that can occur when you don’t follow through with these behaviors. People can think “if I don’t brush my teeth in this certain way, my parents will die.” It’s heartbreaking, and it makes you really want to help them.
Yet, sometimes we feel helpless.
There was a girl presented to the ER with a laceration to the back of her head. She had an abusive boyfriend and was relying on him for everything. That’s why she was staying with him. She turned out to have depression and dependent personality disorder. A lot of these patients get into abusive relationships. The whole time she was defending him, even though these incidents have happened multiple times. She was probably just going to get released and go back to her abusive relationship. As a doctor, you hear these stories, but it’s frustrating because there is only so much you can do. Where is that line?
On mental health stigma
When we get to the point when people think depression is not only a mental illness, but also a medical illness, the stigma will be alleviated.
I have a friend with depression, and even with my knowledge of the diagnostic criteria, there is very little that I felt like I could do to help. I imagine it’s even harder for people who haven’t had my medical education. Having a strong support network is important for recovery.
People don’t take their medication because of the stigma as well. They don’t want to admit that they have the illness. It can make them feel weak or abnormal. People never feel this way about cold and flu medicine, so why should they feel this way about mental illness medications? We are making progress, but still have a ways to go in changing the world’s opinion about mental health.