Question:
Is this how it's usually done by competent doctors? Or should my friend
go and see someone else before she continues taking Lexapro? Is this the
drug of choice for her problem, or is there something that has fewer
side-effects and is a little more established? (Two years seems
relatively new to me.) It just strikes me as odd that someone is getting
prescribed "strong stuff" after such a short consultation, but I have
little experience with depression and appropriate treatment.
She's nineteen years of age, has not had any threapy before, and never
took any drugs of this or similar kind before.
Answer:
A close friend of mine has been having problems with depression and
stress, partly due to family issues and college matters. After a very
stressful relationship argument that lasted for days, and inability to
stop crying, she went to a clinic a few days ago. After speaking for
only fifteen(!) minutes with the doctor, she was prescribed Lexapro. The
doctor did not tell her to take only half pills, so she took the full
dose (10mg) starting on Monday evening. She's been hit by side-effects
right after the first pill: her body tingled, stomach was queasy. After
the second dose, her hands felt numb, and she was anxious -- couldn't
concentrate, and yawned (i.e. looked tired, but wasn't), yet was wired.
After reading some first-hand experiences at
http://www.prozactruth.com/lexapro.htm, I'm really unsure if Lexapro is
the right choice, or even necessary. Now, I'm not a doctor, so I won't
attempt an diagnosis, but it seems dubious to me that the lady spoke
fifteen minutes with her, did zero physical tests, and put her on an
apparently fairly potent drug. She will see her again in one month(!).
My friend was not sobbing uncontrollably at the doctor's office or
anything of the kind that would have seemed to require immediate medication.
Is this how it's usually done by competent doctors? Or should my friend
go and see someone else before she continues taking Lexapro? Is this the
drug of choice for her problem, or is there something that has fewer
side-effects and is a little more established? (Two years seems
relatively new to me.) It just strikes me as odd that someone is getting
prescribed "strong stuff" after such a short consultation, but I have
little experience with depression and appropriate treatment.
It is not a evil drug.
I mean it is ok for her to take. She needs to ramp up, i.e. start with half
pills. If the side effects are a concern talk to the pharmisist, or call
the doc again.
15 minutes is short, but unfortunatly, it is often the norm for a lot of
busy doctors.
I am A OCD'er, Obsesive Complusive Disorder. Basically, take something you
worry about, say that you turned off the iorn. You might check it once. I
might check it 3, 4, 5 or more times, including driving home more than once
ot check it,, and talk about it to everyone I know for days and days.
Anyway the point of my story, I wanted to rule out all other medical causes
of my depression, anixeity, etc. Well I did. I estimate it has cost the
insurance company well in excess of $75,000 and closer to $100,000. But, I
did have every test done to me that could have caused my problems, and I
even have some more tests next week. I hate the tests. I mean I freaking
hate them. I just want to be well, but for me, there was no other way to
know I was ok than to have all the tests.
I have had 3 MRI scans, 1 cat scan dozens of x-rays, hundreds if not
thousands of lab tests, seen about a dozen specialists, had multiple
surgeries to test for problems, and remove skin problems that "might" be
cancer, because I worry so much about them.
If you have the time, money, insurance and resources to do all of this
testing, and you want to do it, then by all means do it. But for most
normal people, the amount of medical care I receive would be considered
insane. I dont really like to keep going in to the doctors, but it is part
of my disorder, that I feel compelled to check everything, and to worry
about it over and over and over and over and over and over.
My point being is this:
your doc has a couple options when the paient comes to him that is
depressed:
#1. Ask some basic questions, rule out major medical problems with questions
asked to the paient, and pick a anti depressant and prescribe it.
#2. Same thing, ask some questions, but then, do several hundred dollars
worth of basic lab tests, cbc, tsh, ast alt, fbs, etc. Then if all is good,
prescribe the anti depressant on the second visit.
#3. Go much more in depth with the testing. In most cases, I think this is
unnecessary. In my case, I needed this level of care to feel good about my
mental health care. Plus, I do have a liver disease, and other actuall
medical problems with my digestive system. So for me, It was approiate to
have the tests done. For most people that dont have liver disease or
anythng else majorly wrong with them, the level of testing that I went
though is completly unnecessary, and a waste of your time and money or the
insurance companies money. My health problems and testing have nearly
destroyed my life, It ruinied my business because I could not work, I was
at the doctor all the time or obsessing about a medical problem. I still do
this today, but I am activlly getting help and things are getting better.
To answer your question, what your (or your friends) doctor did, is
basically normal by many of todays standards, and is certinally not illegal
or unethicall.
However, In my opinion, you should be treated as I described in #2 above.
It is worth several hundred dollars of tests to rule out common medical
problems.
If I were you, I would go back to this doctor, and ask them to rule out
common medical problems, and express your concerns about how they did not
start the medication slowly enough, and your friend experianced side
effects.
If you are not comfortable with this, find a new doctor that is willing to
do #2. It is a very reasonable request, and you or your friend deserves
this level of care at a minium in my opinion.
I use Lexapro. While it is relatively new, it is a fairly common
formulation that has been around for years. It supposedly has the
fewest side effects of the common SSRIs. I was somewhat nauseous when I started on 10 mg/day. But got over it.
With respect to the competence of the doctor, it is hard to tell. If it
is a college clinic and she is seeing an intern, I would be concerned.
If the doc is a psychiatrist, then 15 minutes is like 2 hours with a
regular MD. We're dealing with an art here where the patient describes
the symptoms and the pdoc prescribes the meds.
If she is suffering from depression, she needs to understand it and
manage it. She should see a therapist and investigate some self help
books. I recommend "Feeling Good-The New Mood Therapy" by Burns. It is
pretty mainstream and I found it very helpful. It was recommended to be
by a friend and my psychologist encouraged me to practice some of the
techniques in the book.
Can your friend talk to a counselor? Try talk therapy? It sounds like
your friend might just be going through a rough time with life right
now. Antidepressants like Lexapro are for people who have clinical
depression, not for people who are having situational depression. I would advise your friend to go talk to a therapist for a few sessions,
and see if the therapist still recommends Lexapro after a few hours of
talk.
ok, first of all, "prozactruth.com" is run by people who think all
antidepressants are evil. they're extremely biased against medication, so
you might want to take their site with a grain of salt. or maybe an entire
salt shaker. second, i would recommend a second opinion, because i would not trust a
doctor who prescribed antidepressants to someone who was not also in
therapy. unless that psychiatrist was also doing therapy, which is
obviously not the case if her appt was only 15 minutes.
Lexapro is not a bad medication for first line treatment of clinical
depression. but it's not a magic pill, and it takes a while for the side
effects to go away and the medicine to start working.
but first, i'd recommend she see a therapist.
