In case you don’t know, I scour the net for pictures that echo my theme of the post, so I take the moment now to thank any of you who see a picture you have put on the net that I am now using for my blog. You’ll never know how it may be used for a less than intended reason, though.
Anyway, the other day at http://www.1boringoldman.com, the author wrote a post about how Dr. Tom Insel of NIMH had a moment of epiphany to note that maybe some patients can work their way off antipsychotics. Wow, such a revelation, to those who have had the biochemical model of eternity tattooed onto their skulls. The link:
Well, I will just offer this to readers, it ain’t just about antipsychotics, but all meds for almost any illness psychiatric or somatic, should a patient be showing progress and making changes in a global manner to manage an illness or disease with an effective impact, you owe it to them to at least lower the dose if not taper to discontinue. God, I love taking on patients who have been seeing prior providers who have kept the patients on near ceiling level dosages of meds FOR YEARS, simply under this false premise that “if they are stable, why mess with things”.
OK, let’s review the adage “if it ain’t broke, don’t fix it”. Um, if a patient is stable and on a large dose of a medication, and could risk side effects with time OR should the patient become symptomatic again in the future and the dose not be raised further, don’t you owe it to try to lower the dose and see if things remain stable? And wasn’t that taught to those of you in residencies at least prior to 1995 or so? Or was brainwashing by the pharma and academic elitists so pervasive and effective that all the appropriateness of care flushed through your systems?
Well, I have been doing this for years, and have had very few consequences for those who followed the tapering recommendations, and fortunately for me, I can’t think of anyone who was hospitalized or worse by my efforts to lower dosages, irregardless of class. Again, who followed the plan, not improvised on their own further. I will acknowledge that the provider has to be careful who and how you pursue tapering and/or plan to discontinue a medication. It can quickly be misinterpreted or sabotaged by the patient or others close by. Why it is best to include others close to the patient to keep a close eye and be a responsible and reliable collateral to how things play out.
Oh, and the benzo users, absolutely NO REASON to keep them at least on larger dosages, if at all on them for more than 6-12 months. Yeah, tell us all in your testimonials, if interested to comment, why I am wrong in this approach. And be sure to explain why patients have had to be on dosages at or above 4mg/day of Xanax, or 3mg or more of Klonopin, or one of my favorites recently, the 6mg/day for a 60 year old woman on Ativan. You think her cognitive and motor dysfunction was due to dementia and neuromuscular disease?!
The family was very grateful I tapered her slowly but insistently until she was on just 0.5 HS and, lo and behold, was cognitively and neuromuscularly intact! What a break through, iatrogenic illness once again defined and resolved!!!
So, wallow in the moment by the NIMH Director. Don’t be surprised or dismayed though, be humble and observant. Remember what the adage says, that should be above every single health care provider door throughout the world:
Feel more than welcome to copy it and post it where it fits best.