Saturday, January 22, 2011

This Medicine Might Kill You, But....



We all believe in Informed Consent and ClinkShrink likes to write about it. See Is It Malpractice to Lie...or better yet, read our book when it comes out where Clink talks all about the history of Informed Consent and many other such things. And one of the things people get angry at doctors for (? and shrinks in particular?) is when they have side effects or adverse reactions, and the doctor hadn't told them this might happen. People seem to get really mad about this, especially on blogs or on anti-psychiatry sites (sorry, no links here, find your own anti-psychiatry sites).

So I've wondered, does it matter if a patient is forewarned that they may get a side effect? There are many icky responses people have to meds, some are not very common, and sometimes it's hard to tell if it's the medicine causing the problem. And side effects can be uncomfortable, are they less uncomfortable if you were forewarned? You need a procedure and they make you sign a form saying that you know you could get an infection, hemorrhage, or die. Everyone has to sign or no procedure. If something bad happens, you can still sue, but if you're dead, you're dead. It's become so rote that it almost lacks meaning.

I do tell people about the more common side effects of medications. The pharmacist gives them a longer list. Google has it all for the curious, and I certainly don't discourage Googling, I sometimes suggest it. But I've wondered, does informed consent change things? Here's what my non-scientific observations have revealed.

There a medication that is associated with a rash that can be fatal. I tell people this, and the precautions they need to take to avoid croaking---slow titration, stop med/call if there is any rash at all. A shrink friend prescribed the medication to a patient who had a rare ?never heard of reaction and ended up in an ICU with liver toxicity and nearly died. The patient didn't die, made a full recovery, but the shrink was pretty traumatized and said she wouldn't use the medication again. After my friend's patient had this problem, I told every patient I prescribed this medication to this story. No one flinches. No one has said, "I don't want to take that medication that nearly killed someone." On the other hand, if I say, "This medication is associated with weight gain in some people," the resistance becomes huge. Even though weight gain is gradual and can be monitored, and I tell people they must get weighed twice a week and we can stop the medication if their weight increases by 4 pounds (that's my non-scientific cutoff for beyond the realm of fluid fluctuations). And I know skinny people who take lithium and zyprexa and stay skinny; not everyone gains weight. And I know people who feel so much better that they are willing to tolerate some weight gain.

Just my thoughts this chilly Saturday morning. By all means, tell us your stories.

36 comments:

Harriet said...

You sound like a very good doctor. When I was put on zoloft no one told me about any side effects, or told me to weigh myself twice a week and stop at a 4 pound weight gain. When I ultimately gained 35 pounds and developed high blood pressure and high cholesterol I decided it was time to quit that medication. I lost the weight and my levels are normal now. I also had sexual side effects that I never knew were a side effect of the medication because no one warned me. I thought it was due to my mental issues, and I felt extremely guilty for being a "bad wife".

As for the consent forms before procedures, I don't even read them. What is the point? I can't have the procedure unless I sign it, so it is useless to me.

I tend to be a person who gets side effects from most medications, but I don't particularly like to read about the side effects in advance because they might become a self fulfilling prophecy. If I read that a rare side effect of a medication may be hair loss, I suddenly have a tremendous amount of hair loss. Do I really? Probably not.

So there is a fine line between what I want to know and what I don't want to know.

Kate said...

On a practical level - After 20 years on psych meds I trust my doctor enough that I don't really bother to read the material from the pharmacist. So - SJS - if I hadn't known? Wouldn't have known. Or, if I know severe headaches come with some meds, I'm not likely to call up my neurologist and discuss getting back on the prophylactic migraine meds I used to take. Etc.

Of course I'm going to be mad at weight gain, etc. I gained 2/3 of my body weight on a tricyclic and hated it....but I also got my life back, and deemed it a fair trade. I didn't hold the psychiatrist responsible - it was my choice.

More globally - taking psych meds is so fraught with meaning that I think any small measure of control helps it feel a little more tolerable. Knowing what to expect - whether or not it happens - ie, side effects, maybe makes that a little less awful. A patient has very little control over a genuine psychiatric illness, and no one knows exactly what the prognosis or etiology will be - psychiatrist or therapist included. Hearing about x y and side effects give an illusion of a small measure of control, a sense of being included in the decision making process. In the end, of course it's meaningless: likely I will try whatever med you recommend because you're my doctor and I trust you. But knowing that you have thought out the pros and cons and told me about them makes me feel slightly more (albeit perhaps delusionally) involved in treating the illness that has decimated my life.

Mindful said...

It's swings and roundabouts when it comes to psych meds, especially side affects and their randomness as to how they affect some individusls and not others. That is why I never mention my meds by specific name when asked just the generic SSRI tag. As for the side effects I currently experience, it's a tradeoff between being well and carrying some extra pounds or descending into the blackness again. While being forewarned is being forearmed, it seems there is little choice.

moviedoc said...

Funny how you rarely hear cancer patients ranting about oncologists treating them with meds (the other chemotherapy) or radiation that frequently kill. And when was the last time someone sued their pusher because of an adverse reaction to heroin or meth?

Anonymous said...

Moviedoc,

There are many cancer patients who have undegone chemo treatments that failed to shrink the tumors but rather left them neutropenic, which left them close to death who, provided they actually survived,have railed against their oncologist and refused further intervention despite the doctors claim that "we still have other options to try".
Most of those patients would have signed the forms that stated, yes I know this might kill me and I a am willing to take the risk. It is not that often that they are told precisely what could happen. They are just told without chemo you will die. They end up regretting the chemo and spend their remaining time in a far worse state than had they waited for the cancer to kill them. This is a particular problem when the doctor knows chemo is a real long shot but wants to keep the patient hopeful.
Heroin and meth pushers are not in the health care business.
Some people rail against their psychiatrist for prescribing them and others do not blame the doctor but do wish that better treatments were available. For goodness sake, people get pissed off at the side effects of diuretics, excuse the pun.
Anything you put in your mouth, in your vein, up your you know what can cause side effects.
People ought to be as informed as possible. They need to be told there is no magic cure, this might work and it might not. Weight gain is made to seem like a vanity issue. In some instances it is. In others, the weight gain tips the scales in favor of developing other illnesses. Psychiatric patients die ealier than their counterparts in the general population and that is after controlling for suicide and lifestyle related reasons such as risk taking behavior, smoking, etc
Who wants to bet psych meds are a risky business? We talk about how many hours a cigarette will take off your life but not how many hours each dose of anti-psychotic will take off. It is fair to ask this question and it is fair to say, this could lead to a shorter life span in some people but a better quality of life for some people. That is closer to the truth than anything most people hear which is take care of yourself by taking this or that drug. It is also time doctors took a good hard look at why they treat elderly patients with chemo, expected to yield another 6 months of life, when that 6 months is spent DYING.

Anonymous said...

Dinah,

The issue for me is not informed consent but doctors blowing you off when you report side effects making you out to be an idiot.

By the way, I wish when we discuss issues like this, that professionals like yourself would stop making this about being anti-psychiatry with the inference being that only extremists complain about side effects. With all due respect, that argument is really getting old and needs to stop.

Personally, I think the issue of drug side effects transcends psychiatry as there was a study done that when people reported common statin side effects, they were not taken seriously.

I have told this story commonly but it bares repeating. When I informed an allergist that Allegra caused insomnia (it is a common side effect), he said that was not supposed to happen essentially making me out to be a liar.
What, he thought I was making this up?

I realize that doctors can't tell me every last side effect that may happen. But as someone who is a very informed patient, I find it very offensive when my complaints are blown off.

If I recall, Roy had a pretty good solution which was to have the person stop taking the med and then resume it to see if the problem returned. If it did, that was a pretty good indication the drug was the problem.

Of course, that solution isn't foolproof and wouldn't be right in cases for example if it appeared the drug caused suicidal ideation.

Ironically, I unintentionally used his solution when I was on a psych med that caused an unbearable side effect. My psychiatrist blew me off when I complained about it even though I told him it was listed on the drug company's website. He was quite embarrassed.

Anyway, when the drug I switched to ended being more horrific, I switched back to drug A as I didn't feel like trying another drug. Eventually, the unbearable side effect I complained about returned again forcing a permanent stoppage of the drug.

Movie Doc - With the questionable effectiveness rate of various chemotherapies, I am amazed that cancer patients don't do more ranting.

AA

Sarebear said...

I prefer the doc to tell me the top couple of side effects. I can be kind of dense sometimes at connecting the dots between what's happening to me and, "Oh, this started about the time we bumped up the med". So being told helps. Plus, with a unpleasant side effect in November, if I hadn't been told about it, I would have possibly thought it was my IBS acting up, or been confused, because it quickly became FAR more severe than I've ever had with my IBS. I would have been confused and not necessarily connected it to the med, except for I think the little printout at the pharmacy that usually, if any, may list one or two side effects, DID list this one, for this med.

SO, in this case, having had the doc tell me, helped ALOT.

More recently, I had some side effects that are uncommon enough to not have been told about, and I was so dense that it took a couple weeks of overactive bladder before I really wondered WHY. It took an overactive bladder med commercial for me to put it together with medication, and then my brain realized, wait, this started within about a week of upping the med . . .

So I can be, I guess it's unkind to say dense, but I didn't put it together for a few weeks. I know, though, that the doc can't mention every side effect, either. It IS kind of odd that given the additional side effect that I was worrying about EVERYTHING, that I wasn't worrying about the bladder more.

I had that rash reaction to Lamictal once upon a long time ago, and they pulled me right off it. It was a case where being warned about it was, I think, it would have been negligent in that med's case NOT to have mentioned this particular reaction, but maybe I say that because I happened to get the reaction and wouldn't have thought much of a mild rash, without the warning.

Now I am alert for side effects, so at least I won't be dense, which is good since we're trying something new.

Alba said...

i think it's important to inform people and let them decide if they want to take the risk (and the medication). if their resistance is high, well, then apparently they don't feel it's worth the risk. their life, their decision.

i made this decision. tried several meds, but the side-effects were stronger than the benefit, so i quit. i prefer shitty days and shitty weeks to lactating and gaining weight, thank you very much :).
i found other things that helped me better on a daily basis. and for the worst days, i have my "emergency meds" that i can take as needed.

for me, this is the better option.

Doctor Blondie said...

I always warn patients about the most important side effects.

Was great fun when prescribing Ritalin.

tracy said...

i would never continue to take any med, psychiatric or otherwise, if i noticed weight gain and it was nothing i was doing on my part.

Weight gain would increase my depression a million fold.

moviedoc said...

What would you think of a video patients could watch at their leisure and as often as they want so they don't have to wade through the PI (FDA label)? Here's most of what I would like to think I tell patients before I prescribe gabapentin. This one's for public consumption. Maybe I'll do a video of myself for my patient's eyes only: http://www.youtube.com/watch?v=_DtnULV9rlk

Anonymous said...

Moviedoc, you shaved. Xtranormal should be used to talk about the Federal Reserve, not drugs unless you are referring to the drugs the folks at the Fed are on, and i am guessing it is not Gabapentin. Crap drug in my opinion anyway.
Why do you think patients want to watch vids of their doc rather than wade thru FDA papers? I want the papers, not my doc's interpretation of it and especially not the edited for general audiences version.

Anonymous said...

My psychiatrist never once discussed side effects of any of the drugs he prescribed unless I specifically brought it up. And, once I did bring it up I couldn't get him to give me a straight answer. It was very frustrating because I wanted to know the risks and I guess he had already decided what was best and felt that I should just do as he said without questioning. I was there for his opinion and for information. But, I wasn't there for him to make the decisions for me.

WHen I asked about the risk of memory loss with ECT he went into a rant about scientologists and antipsychiatry groups which told me nothing about the risks which is what I had asked about in the first place. So, I was left to try and sort out the risks on my own without his help. I would have preferred his help in that, but I didn't get it because he just wanted to talk on and on about the antipsychiatry crowd.

Weight gain should not be minimized and especially when a patient has made it clear that they aren't willing to accept those risks. My psychiatrist died from heart disease and was morbidly obese. Not sure if the obesity led to the physician's death, but it probably didn't help things. It's not a minor issue.

Sarebear said...

The psychiatrist I am seeing (can't call her "my" anymore as there's trust issues and no I can't leave, or if I did it would be to no care at all; a sharp, on the ball on meds and cruel in other areas doc is better than no care at all) dismissed sort of my concerns about weight gain a few months ago when I asked about these mood stabilizers she was considering for me. She said, "ALL of them cause weight gain." Then she proceeded to figure out which one to put me on, just ignoring my concerns as irrelevant since there's seemingly nothing to be done. It's a matter of weighing the pros and cons, no pun intended, because my mania WILL return if we lower or remove the medication; recently lowering the Risperdal from 1.5mg back down to 1mg definitely proved that to me when certain symptoms of mania came flooding back like wild horses I was trying to control. So she sees it as, either the patient ruins her life, or we put her on meds despite the weight gain issue (if she even thinks about the weight issue, anyway.) So put in those terms, it is more difficult. Especially since the manic behavior that is, well, it feels like I'm being compelled, but I know I'm responsible for my actions, I'm just saying it's strong urges to do some reckless, awful stuff, this manic behavior WOULD wreck my life, as well as, after I did it, I"d likely feel suicidal (not that she knows that last.) So when compared to the potential consequences of not medicating me, the weight gain seems minor, even at my weight, because I could ruin several people's lives and likely become quite suicidal, if I do what the mania leads me to.

Yeah, I know I have a brain and can choose not to do stuff. It's like fighting wild horses though with everything I've got, and sometimes, everything I've got doesn't seem like enough . . .

I give it everything though. Mania sucks.

Dinah said...

It's not a matter of minimizing the issue of weight gain, or any other side effect for that matter---it's just that it's hard to know who will gain weight before a pill is tried.

Sometimes it's frustrating for a doc as well, and what may be seen as being cavalier, uncaring, or dismissive is simply the psychiatrist's helplessness. A patient's been on a zillion meds, maybe been in the hospital, maybe for long periods of time or repeatedly, and life is unlivable with the symptoms of the illness. So they take a medicine and finally something helps. What a huge relief. But the patient gains weight or loses interest in sex or feels tired all the time and stopping the medication isn't really an option (hmmm, last time you were sick it took 2 years to get you better....last time you were sick you got arrested....nothing else has worked this well). And there's nothing to say. I'm sorry this medicine makes you feel lousy and if there was a better medicine that worked for you and didn't do this I would want you on that. But I didn't make the meds, I just prescribe them from a limited and imperfect menu, and these days insurance companies want to limit that menu even more---

moviedoc said...

Dinah, apparently a lot of psychiatrists prescribe Metformin, a diabetes drug, to counteract wt gain from psych drugs. I don't feel comfortable doing this, but would tell a patient to discuss with their PCP.

Anonymous said...

http://www.montrealgazette.com/technology/Antidepressants+found+fish/4148501/story.html
These poor fish were never told about the side effects but you won't hear them complain.

Re: metformin. It is an option.If it was a great option then everyone would get a script for that along with their other meds.

Sarebear said...

Metformin has its own raft of side effects as well. I've taken it before but not for diabetes nor for the reasons mentioned here. I endured the side effects because after some time they eased up; had they not, it would have been awful.

Regardless, I guess if there's no option but a raft of drugs to choose from that all seemingly have one particular side effect of concern to the patient, rather than sort of blow me off, it would have been nice if she'd said, "While I understand your concern about that particular possible side effect, it doesn't happen to everyone, and leaving your mania untreated right now would be of even greater concern to me. We need to get the mania under control, and unfortunately the medications to do that often have unwanted side effects like this."

Something like that, maybe shorter since I'm not very brief right now, but something like it would leave me feeling like my concern had been acknowledged, and that I was a part of the process a little bit and not just dismissed or blown off. I guess I just wanted to feel heard (which tends to be one of my core issues, not feeling heard.)

Can I live with her not having said the above? Sure. All the other problems we're having set aside, it wouldn't have helped the relationship any to feel blown off or unheard, but it wouldn't have hurt it by a ton either, as many doctors would have done the same.

I see your point, Dinah, about being frustrated from the psychiatrist's point of view on this issue. What I suggest to be said above is just one possible way to help make both doc and patient more satisfied with the interaction.

Marcela said...

Since people brought up cancer, several cancer survivors who wanted to be more involved in their treatment teamed up with some health professionals to form the Society of Participatory Medicine which you can read about at e-patients.net. I'm trying to expand the base to include more people in mental health so am helping to organizing a special issue of the Journal of Participatory Medicine--the announcement is at http://sites.google.com/site/mentalhealthcfp

Anonymous said...

What about the potential negative effects of psychotherapy? Its easy to rattle off a few common side-effects of medication, but no-one mentions potentially harmful effects of psychotherapy.
Re side effects of medication: My psychiatrist told me that because of my personality I notice the side-effects more than most, and refused to believe the symptoms were real.

Anonymous said...

Sarebear, even though I don't have bipolar disorder, I joined a yahoo groups list for people with with BP who cope without meds. I did it while I was tapering off of my psych med cocktail in the hopes I could pick up some useful tips. I haven't really visited there much for other reasons but you might find it helpful.

http://health.groups.yahoo.com/group/ALT-therapies4bipolar/

By the way, I am not suggesting you go off meds but perhaps, joining this group could give you some ideas to your problems you hadn't thought of.

Dinah, I hear what you're saying. All I can say is what a heck of a choice, to barely exist on meds vs. decompensating.

Here is a question for you and other psychiatrists who visit this blog. What about patients who simply can't take meds for various reasons? Then what?

Is that the only thing in your tool box? Medicating for side effects often leads to a huge med cocktail to the point where you don't know what med is doing what.

And just so people are clear, this isn't about being anti-meds vs. pro-meds. If meds work, great. But for people that they don't, people need to be given other options.

Unfortunately, in this day of 15 minute visits, I realize that psychiatrists are in a tough position as they don't exactly have time to research what they might be.

But it is obvious that the current method is greatly flawed.

AA

moviedoc said...

Anon: of course their are other treatments if you can't take meds. Psycotherapy of course, but also ECT, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation. And with meds less is usually more: There's too much tendency to keep adding meds which usually leads to more adverse effects and confusion over what's doing what.

Battle Weary said...

The weight loss effect of Metformin only lasts about 2-4 weeks...the same amount of time it takes for the horrible diarrhea to go away. I wonder if there's a correlation (not really wondering)? That said, had I been put on Metformin when I was on Risperdol, perhaps I would not be a type II diabetic now! For me the weight gain was minor, but the high blood sugar went unnoticed (pre-black box warning)
...Metformin certainly would have helped with THAT issue!

Anonymous said...

Okay, so I'm somebody who kind of overreacted when I found out about a aide effect. I mean, I never would have consented to take the drug if I had known that it could cause irregular periods. I took Geodon for 6 months and started to think I had hit menopause 5-10 years early. Only then does the doc tell me that the Geodon could cause that. I was at the very end of my fertility and still considering whether or not to try to get pregnant--so the information mattered to me. Different roles the patients and the psychiatrists play--doctor trying to avoid weight gain by offering up a weight-neutral med, and patient just trying to live life while still having some control over her own bleeping body. I say that patients should Google their meds and go to every website they find.

The Hyperlexian Aspie said...

i completely understand that people will care more about weight gain than the possibility of death when trying a new medicine. if you look at the rates of weight gain as compared to the rates of death, it is quite clear which side effect is more likely.

also, the concerns are regarding the quality of a patient's life. a person's quality of life can be greatly reduced by certain side effects (weight gain, or how about anorgasmia?), and that is much more of a valid concern than some slim chance that a person could die.

anorgasmia is the side effect i happen to be, errrr, intimately familiar with. it is difficult to even convince a psychiatrist that it is happening beause i am female (and therefore sexual side effects must be blamed on my gender and not on my medicines). but after trying many medicines and suffering the same side effect, i eventually had to choose whether mood stability is worth losing something that profoundly affects my quality of life.

i don't expect that psychiatrists will run down a long list of side effects as i believe that patients should be responsible enough to read their own inserts and do some of their own research (please note that i also live in a less-litigious nation than the US), but i DO expect that my concerns will be taken seriously. quality of life is *very* important.

Sarebear said...

Hyperlexian Aspie, now I'm wondering if someone can have a side effect and not know it, because for so many years it's been THEM, then things look up with ONE, and then you start the heavy meds and NOTHING. Is the NOTHING me, or the meds? I'm used to living this way so I'm resigned to it, but wish I knew what a normal life in that regard felt like. I'll never know if it's me or the meds, and with my history, the doc would never believe me anyway, so there's really no hope, if the meds ARE affecting things. Let's hope they aren't. I dunno which would be better, actually. This is how I have to live so it's just how I have to live.

Anonymous said...

Gone off the meds to shed the pounds they helped me put on. Not caring much about the repercussions, if any. To the person who mentioned sexual side effects. Not one doc ever brough this up but I am getting a divorce now because i cannot show my man how pleasure he gives me--none at all since the meds. He wants a responsive woman. Not a medicated zombie. Cool beans.

Sarebear said...
This comment has been removed by the author.
S said...

I'm hopeful that docs are getting better about warning patients of withdrawals from SSRI. Years ago, i remember seeing it in two friends, who had no idea where their sudden dizziness and "electric shock" sensations were coming from (I recognized it from experience and asked as gently as i could, "Are you on any medicine?") My last two docs did warn me of this, which i take as a good sign.

AA: "The issue for me is not informed consent but doctors blowing you off when you report side effects making you out to be an idiot."

That reminds me of when i was inpatient, and the shrink had decided i was both bipolar and a liar for refusing to admit to having ever experienced mania (because i haven't). Anyway, my first day on Lamictal, i had some trouble talking and tried to explain it to the doctor (which was difficult, because i couldn't talk right!), and he gave me a Look and flatly said, "Lamictal doesn't cause that." That was not reassuring, because the reason i was scared was that it wasn't on the list of side effects, and therefore i had no idea what was happening or how long it would last. The impression i got was that he either didn't care or, likely, thought i was faking. Luckily whatever it was, it went away by the next day.

For the record, i have had shrinks who are wonderful at recognizing the whole risk-benefit thing, particularly how meds affected my ability to do my job (rather than being like, "Just be happy you can work!" which, don't get me wrong, i am!).

Sarebear: I agree with you that just a little empathy can help a lot in these situations, and i think it can aid effective communication. For example, if the doc just blows me off, i might wonder if maybe i just didn't explain it right, so maybe there really is some serious issue going on or something the doctor can do, but they just don't understand the situation due to my bad explanation.

Anonymous said...

I would like for there to be informed consent required for some of the off label prescribing. I was on some cocktails that I now understand there was no data on regarding efficacy, risks, etc, and probably the data is still not there. With chemotherapy, my understanding is that if they start mixing even approved drugs together they will often do a clinical trial to study the risks/benefits of using them in conjuction with each other. I wonder why there were no clinical trials to study the cocktails the psychiatrist put me on?

I probably didn't question nearly as much as I should have in the beginning and would ask more questions today. Live and learn. A good rule of thumb, if the pharmacist hands you your bag of meds and says, "Good luck," that's probably a clue you should pay attention to.

moviedoc said...

Anon: There were no clinical trials of the combination because there was no money to pay for them. If you have to choose between paying attention to a pharmacist and paying attention to a psychiatrist, believe me, pay attention to the psychiatrist.

Anonymous said...

Ok, I can appreciate that there is no funding to pay for studying these drug cocktails (although considering some of the goofy studies people get grants for it looks like someone could come up with the money), but does that lessen the need for informed consent? Maybe, if more people realized it was such a gamble they would be a little less upset when it didn't work or they got worse or ended up with some weird side effect.

The pharmacist was right to be concerned. He wasn't the only one. My primary care physician, ER doc, and family also expressed similar concerns. I should have paid attention to that, although I was pretty blitzed on all the stuff I was on, so I didn't at the time.

I'm not opposed to trying out different things to see if it helps, as long as patients realize what a gamble it is.

moviedoc said...

Nothing will lessen the need for informed consent, but lack of good data will lessen its accuracy. When you're really suffering, you're quite willing to gamble. (I'm sitting here with a pinched nerve in my neck wondering if it's time to consider surgery or a steroid injection.) Who wouldn't be upset at a bad outcome, but if you made the choice with adequate information, don't blame the doctor. If only we could predict who will have which adverse effect.

Anonymous said...

That's the whole point, Moviedoc, there was no informed consent. I don't think it's unreasonable to expect that when someone is prescribed a 5 drug combo that there's data out there on the benefits/risks of that combo or that patients are at least informed that there have not been clinical trials to study the risks/benefits. I wish I had known this prior to taking the coctails as my expectations would have been much lower, and I would have known what I was getting into. The concerns others raised about the drugs I was on was after I was already pretty drugged, and that's a little late at that point.

It's true many people are willing to gamble when they're suffering, but that's not a universal truth and shouldn't be assumed. People who have no other options routinely turn down clinical trials because the data isn't there and they determine it's not worth it. Others choose to try it and thank goodness or we would never have any drugs approved. In those cases, however, people understand what they're getting into. I had a relative who was offered a clinical trial and I saw the informed consent document - it was quite long and he and everyone else understood the gamble. The physician also clearly discussed the risks/benefits. That's the way it should be. I wish my physician had done the same.

Anonymous said...

I respect a doctor more if she/he takes the time and shows enough respect for me to warn me about the side effects.

Anonymous said...

I also wish the issue of adverse effects were separated from the question of extreme antipsychiatry.

An issue addressed by neither the original post nor by comments: when patient considers possible adverse effects, perhaps in light of prior experience, and says, no more. No more drugs. I said that and experienced a fair amount of abuse in response. One psychiatrist laughed in response. Another announced that I must have a PTSD. It was this lack of respect, together with permanent damage (tinnitus from Wellbutrin, about which psychiatrists are in general ignorant) that caused me to run from psychiatry in toto.

And no, I never saw an informed consent form. Never.