A few years ago when I was directing a Medicaid mental health managed care organization, the irascible senator from Iowa, Chuck Grassley, got a burr under his saddle, as they say in the Midwest, about what the federal government was paying out for psychiatric medications in Medicaid expenditures. And he was able to connect the cost information to individual prescribers.
The two highest prescribing billers were in my area in Oregon. I was shocked for several reasons.
The first was that I had no idea what these figures were because they weren’t in my Medicaid budget. The second was that the highest prescriber was in my area. In one year alone, he had billed $457,000 of psychiatric medications, mostly Abilify. The third—and this was an extremely dismaying shocker—was that he was a child psychiatrist, and so he had been prescribing Abilify and these other drugs to children and adolescents.Read More
I am in love. I’m in love with this way of working. And I won’t stop. Open Dialogue Washington began in 2018 upon my graduation/commencement from Jaakko Seikkula’s dialogic approaches to couple and family therapy trainer/supervisor training, in collaboration with Dialogic Partners and the University of Jyväskylä.
In 2016, I embarked to partake in the best training course I had ever experienced as a family therapist. The embodiment I experienced working with my Open Dialogue colleagues felt like the missing key in psychiatry and psychotherapy. Something intangible, yet what I knew all along. Something ineffable, yet also a shared language. Something deeply and autonomically human, yet unrepeatable and fleeting. It led me onto a moment-by-moment path where everything I learned in my 27-year long career about systemic family therapy and emergency psychiatric protocols ebbed, and the present moment of love flowed, neither the ebbing knowledge nor the cresting wisdom having any lesser value than the other. The complete work we do in mental health care is this ocean of love.
We are in constant change when we are in crisis. Timelessness sets in. Growth is happening. We don’t exactly know what we need. That is what mental health work is, sitting with this human happening. In the in-between space something happens, and we don’t know what will. This is the paradox. We are navigating the ebb and flow of incoming knowledge we have from research and the ebb and flow in each patient and family’s difficulties (the meanings they make of them.)
“It cannot be taught, but it needs a teacher.”
(RxISK.org) – It is commonly recognized that certain medications should not be administered with some others. What is not well known is that several over the counter (OTC) medications and herbal supplements can be lethal if taken with SSRIs.
I have a patient who was taking fluoxetine and, experiencing some difficulty with sleep, decided to take one tab of melatonin. He woke up with a red and burning face, headache and blood pressure of 230/180. He was in a full serotonin syndrome.
Serotonin syndrome symptoms often begin within hours of taking a new medication that affects serotonin levels or excessively increasing the dose of one you are already taking. Symptoms may include: Confusion, agitation or restlessness, dilated pupils, headache, changes in blood pressure and/or temperature, nausea and/or vomiting, diarrhea, rapid heart rate, tremor, loss of muscle coordination or twitching muscles, shivering and goose bumps, heavy sweating.
This syndrome may develop within hours to days of increasing a serotonergic dose or adding a serotonergic agent to a drug regimen already containing a serotonergic medication. Symptoms range from mild and chronic, to others that progress quickly to death. My patient is lucky to be alive.Read More
This post helps make sense of the mountain of bipolar drug research. It distills into an infographic the pros and cons of five classes of bipolar drugs and gives observations on what it means for people who face choices on bipolar care.
(The infographic is kept fresh as research evolves. The latest version with footnotes is always here.)
A few key perspectives behind this infographic deserve attention:Read More
I’m excited to announce a new series of Mad in America Continuing Education webinars for 2019. They focus on what I believe is a central issue—what does a true informed consent process look like for the prescription of psychiatric drugs? This is a leverage point for changing the paradigm of care by starting with how people are informed about what psychiatric drugs do.
I believe that righting this ship is largely going to be up to non-medical mental health professionals and persons with experience in having been through a system that fails miserably to provide real informed consent. Since we are a continuing education program, our courses are designed primarily for the first group: psychologists, social workers, nurses, licensed professional counselors, and marriage/family therapists. We will continue to apply for continuing education credits (CEs) and at some point recruit more interest from physicians so it would be worthwhile to apply for the more expensive continuing medical education credits (CMEs).Read More
There is evidence that many individuals are on higher doses of antipsychotic drug than is required for optimal functioning yet there are limited guidelines on how to reduce them. This paper reports on 5 year outcomes for sixty-seven individuals who received treatment at a community mental health center and were offered the opportunity to gradually reduce their doses of antipsychotic drug in collaboration with the treating psychiatrist. Over a period of 6 months, the author invited patients who were clinically stable and able to participate in discussions of potential risks and benefits to begin gradual dose reductions. Initially, 40 expressed interest in tapering and 27 declined. The groups did not differ in age, sex, race, or diagnosis. The group who chose to taper began on significantly lower doses. Most patients succeeded at making modest dose reductions. At 5 years, there were no significant differences in the two outcomes measures, rate of hospitalization and employment status. Many patients were able to engage in these discussions which did not result in widespread discontinuation of drug. This is a naturalistic, small study of a topic that warrants further research.Read More
Some people are asking me, “Why another series of webinars on withdrawing from psychiatric drugs?” That’s a reasonable question given that our first series, Withdrawal from Psychiatric Drugs, covered a lot of territory. We presented general information as well as more specific subjects like wellness, personal experiences, research findings, and the evidence base for drug withdrawal.
But this subject is a complex one, and our first course was just our start in exploring this topic. With this second course we are focusing on the challenges that drug withdrawal presents to prescribers.
As many have noted, prescribers may have extensive experience getting patients on psychiatric medications and then managing their drug use, but little or no experience helping patients taper off the drugs. As some have quipped, prescribers have learned to fly the plane but not land it.Read More
At the beginning of September, I wrote about the next stage of the Mad in America Continuing Education project—the development of webinar formats and I announced the planning for a “course” on withdrawal from psychiatric medications. At that time, I was able to provide only introductory information but now I can provide a full picture of the 7 webinars that comprise the course and update a few other developments.Read More
And the answer is I got hooked. After decades working in television, I was looking for stories that aren’t being told. I came across an article about a group of people diagnosed with mental disorders that were going to weekly meetings, 12 step style. I researched the mental rights movement and I started wondering why we weren’t talking more about the issues they were raising. I called David Oaks and when I got off the phone, my hands were shaking. I met a guy, diagnosed bi polar who told me, “all I have to do to get committed is make 2 doctors nervous…do you know how easy that is?” And then he described how devastating it was to be told that you cannot trust yourself anymore. Your mind, your mission control will have to be run by someone else.
Hmmm. Who decides that? And how?Read More
This series of seven 90-minute webinars will feature presentations by people with “expertise by lived experience,” psychiatrists, and other professionals on a topic of critical importance: What do we know about withdrawal from psychiatric medications? The educational purpose of the series is to present information and insights that arise: