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You may also have doctors who've had bad experiences or learned defensive attitudes, or disagree with direct-to-layman marketing, so for good or ill a doctor may decide to refuse to prescribe something you ask for directly. As for antidepressants, the issue isn't keeping patients from abusing them, but keeping them on the medications at all. Psychiatric treatment usually begins with choices made by protocol or practitioner experience, and then may end up in the weeds months down the line because 1) the drug action is decently well understood but everyone can respond differently and 2) due to the side effects and very nature of mental illness symptoms, psych patients are notorious for stopping their medication whenever. The desired result of psych meds isn't euphoria, or a positive outlook, or basic happiness; it's whatever gets you to a a functional baseline where your lows aren't so low or highs so unmanageably high. So, you often have people get to a workable, functional daily mental state and just stop taking their meds only for the original condition to creep back up. Then they have to go back through the startup side effects again, and deal with whatever daily effects it might have like preventing arousal or weight gain and the cycle begins again. I'm not a psych specialist but IIRC one of the primary metrics of psych medication efficacy is how long patients can tolerate being on them. Of course, that's all before insurance gets to step in and make clinical decisions for your doctor by denying coverage.
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Aug 7, 2019 18:46
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Hired_Sellout might have cooler answers, but in the retail pharmacy world it's usually the people managing your district or market or whatever your big box calls it. One of my classmates the next city over was made to work a 9a-9p shift as the sole pharmacist for her store and then scheduled to teach a 6 hour training class 4.5 hours across the state the next morning at 8am. I helped another floater retire because she had a TIA at work and was regularly showing a systolic blood pressure of 185+ while on the job ( that's immediately go to the ER level) and they tried to bully her into finding her own coverage for her next two months of scheduled shifts or they "wouldn't accept her two weeks notice". EDIT: Almost forgot, my best tech who made it into pharmacy school was scheduled for a drug test by our employer during her mandatory pharmacy school boot camp week. She tried to explain that it was mandatory, she absolutely could not skip it, could they just wait a week for her to have a free afternoon, but of course they refused. So she went to her mandatory event to not get booted from the hyper competitive school that doesn't care about your grandfathered prereqs, and she was "failed" for her drug test. Had this happened later after her intern license showed up she could have been barred from school and pharmacy entirely. And a friend of mine who became pregnant during school so they tried to pressure her to quit halfway through. Or the classmate who's mother died the morning of a test and they told her she'd have to sit for the test or be failed. I'm going to stop because the more I think about this the angrier it makes me. Dr. Red Ranger fucked around with this message at 20:22 on Aug 9, 2019 |
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Aug 9, 2019 20:15
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I'm not much aware of the hip hop scene but I had coworkers in food service showing off their bars and what they were planning to do with them ten years ago, and well to do northside women with oh so stressfull lives demanding their xanax have been an obnoxious phenomenon for longer than that. Maybe it just has a new surge in popularity?
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Aug 12, 2019 20:11
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Bioshuffle posted:I read somewhere that no one knows the exact mechanism of action for SSRIs, that psychiatrists pretty much keep guessing and changing up the prescription and dosage until they get it dialed in. Eh, close? We know what the literal function of Selective Serotonin Reuptake Inhibitors are, and we've got a significant body of evidence over the years built up of their side effects and so on look like. But mental conditions, by their very nature, can be very subjective to diagnose and treat because of the doctor's experience and knowledge, how the patient presents or even understands their symptoms, the patient's personal pharmacokinetic response to the drug, and so on. Imagine, as a doctor, that you have a patient with a broken arm. You would likely agree that such a situation would be a fairly objective diagnosis. The treatment would be relatively straightforward and your medication concerns would be limited to: antibiotics yes/no(and what kind), patient pain tolerance, and allergies. For mental illness, your patient may not be able to accurately describe what they are feeling, or if they are ill at all. What's a bad attitude vs abiding major depression? Are they experiencing a manic episode or are they in a period of personal upheaval that would provoke a similar response? Are they trying to get a particular drug or are they denying they have symptoms at all? Do they even know what a good, functional baseline mood feels like and could they even tell you if they experienced it through learned coping mechanisms? What about ADME, the pharmacokinetics of the drug? Does their absorption/distribution/metabolism/excretion of the drug have any hiccups anywhere due to a genetic enzyme condition that would lead them to experience less or too much of the effect? Beyond obvious issues like weight gain, sexual repression and such that we know these drugs carry, how will the patient know what should be happening and what shouldn't? Should you switch from SSRI's to Wellbutrin, an norepinephrine/dopamine reuptake inhibitor or just change the dose, or go to another in-class drug? You can start someone on something easy like Lexapro, and after 3 uneventful weeks they tell you they felt a strange "pop" sensation go off in their head and they experienced a three day vertigo spell. Heck, I know I'm a slow metabolizer because I once took a single, low dose of an antihistamine and proceeded to feel like I had been dunked in a barrel of lidocaine the whole day. These things get dialed in because treatment for mental illness is like a collaborative effort between you and your doctor to find what "normal" is. Dr. Red Ranger fucked around with this message at 19:44 on Aug 15, 2019 |
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Aug 15, 2019 19:40
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