Who's Really Gorked Out? Part 2

The best part of psychiatry is the meds. They do some cool stuff. According to our patients, they make your life better, fix your mood, take away your pain.

'I've been feeling this way all my life, I just want you to fix me'.

'That's what meds do, they glue you back together'.

'Why won't you give me my pills that take the voices away?'

On the other hand, according to this article in the NYT, psych drugs kill people. By making them fat.

So who to believe? The drug-pushing, soul-less ad folks at the drug companies, or the liberal hippies who want to treat colon cancer with Lemon Grass herbal tea?

Well, neither. I first read the article, which is about olanzapine (Zyprexa), a new anti-psychotic. My reaction was typical for a medical student, new as I am to my profession, in that I dismissed the worries. 'Oh', I thought to myself, 'of course, worry about the weight gain in the context of a crushing psychiatric illness'. But then I talked to my resident. His response was actually measured. Yes, in general, treatment is necessary, as it was in the case of this patient, who had severe bipolar illness with psychotic features, or perhaps a misdiagnosed thought disorder such as schizophrenia. But, he pointed out, olanzapine was probably a bad choice for long-term therapy, as it does lead to the weight gain mentioned. Which is why we don't use it at the UW.

So, in the end, the article has merit. A better choice would have been a different antipsychotic, leaving the Zyprexa for short-term use in people predisposed to side-effects like drug-induced Parkinsonian symptoms (like young, African-American patients who need help for a week or so). The key is to avoid over-reacting and shooting off one's mouth. Patients will come in with all sorts of concerns about medications. We can't listen only to the drug companies OR the 'I cured my liver cancer with aromatherapy' people. The best path is the middle one.

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