Blockheaded research, blockheaded conclusions

When you do simple-minded research, expect to draw simple-minded, blockheaded, and just plain wrong conclusions. What’s worse is the potential damage reports of such research can do to those with mental health conditions in need of treatment.

Case in point… the following description of a McMaster research study from TriCity Psychology Blog:

Anti-Depressants Raise Relapse Risk?
TriCity Psychology Blog
July 20, 2011

Patients who use anti-depressants are much more likely to suffer relapses of major depression than those who use no medication at all, concludes a McMaster researcher.

In a paper that is likely to ignite new controversy in the hotly debated field of depression and medication, evolutionary psychologist Paul Andrews concludes that patients who have used anti-depressant medications can be nearly twice as susceptible to future episodes of major depression. Andrews, an assistant professor in the Department of Psychology, Neuroscience & Behaviour, is the lead author of a new paper in the journal Frontiers of Psychology.

The meta-analysis suggests that people who have not been taking any medication are at a 25 per cent risk of relapse, compared to 42 per cent or higher for those who have taken and gone off an anti-depressant. Andrews and his colleagues studied dozens of previously published studies to compare outcomes for patients who used anti-depressants compared to those who used placebos.

Andrews believes depression may actually be a natural and beneficial — though painful – state in which the brain is working to cope with stress. “There’s a lot of debate about whether or not depression is truly a disorder, as most clinicians and the majority of the psychiatric establishment believe, or whether it’s an evolved adaptation that does something useful,” he says.

This is seriously blockheaded research.

1. Patients who take antidepressants also tend to be more seriously depressed and probably more prone to depression via personality factors and coping skills than those who don’t.

2. Patients who take antidepressants and discontinue them prematurely, typically at about 6 months when they start to feel better, are unquestionably at risk for relapse. They mayu be feeling better but that doesn’t mean theyc are ready to discontinue the medication. Prior research has already demonstrated quite convincingly that those who remain on the antipdepressant medication for 1-2 years are significantly LESS likely to relapse.

“There’s a lot of debate about whether or not depression is truly a disorder, as most clinicians and the majority of the psychiatric establishment believe, or whether it’s an evolved adaptation that does something useful,” he says.

Oh, really? Maybe in the seriously ill-informed world of Andrews and his immediate colleagures. Out in the real world, I’ve never heard of this so-called debate.

Discussion continued at http://forum.psychlinks.ca/prescription-medications-and-otc-drugs/27079-blockheaded-research-blockheaded-conclusions.html

 

Ask-a-Vet: Online Veterinary Help for Your Pets

Ask A Vet Question

Ask Ottawa veterinarian Dr. Marie a question about the health of your pet online. Then continue to converse back and forth with her until you feel your question is answered satisfactorily.

Online veterinary advice

Dr. Marie has been practicing small animal medicine for over 10 years now. She is compassionate and cares for the animals and the wonderful people who own them. She is experienced in treating dogs, cats, guinea pigs, hamsters, rats and mice. She is skilled in surgery, dermatology, ophthalmology, dentistry, behavior and medicine. Dr. Marie has taken courses in Orthopedic Surgery as well. She really enjoys solving complicated medical cases such as animals with difficult diseases like Cushing’s Disease, Addison’s, and those frustrating itchy dog cases that are hard to figure out.

She also has an interest in oncology and gives compassionate and knowledgeable advice whether you are interested in chemotherapy, radiation or simply palliative care.

Her latest venture, this online vet advice site has helped many people who have veterinary questions and need to ask a vet a question and get a response quickly! Need to ask an online vet? Veterinarian, Dr. Marie is here to help.

You can also browse her growing selection of free articles on pet health, including cats, dogs, and hamsters (“pocket pets”).

Please note: I am a psychologist, not a veterinarian. If you have questions about your pet, please do not post them here. Contact Dr. Marie directly at http://www.askavetquestion.com.

What Your Doctor May Not Tell You About Depression

What Your Doctor May Not Tell You About Depression: The Breakthrough Integrative Approach for Effective Treatment
by Michael B. Schacter, M.D., with Deborah Mitchell
Published by Warner Wellness; November 2006.

Beware of books that advertise themselves as “the breakthrough treatment” for anything.

This is a book I really would like to recommend. There is a lot of good information in the book that would probably be useful for anyone suffering from or vulnerable to depression. But ultimately the book suffers from a thinly disguised anti-psychiatry bias and frequently weak or misleading evidence for alternative therapies. On the one hand, the author warns against the “debilitating side-effects” of conventional antidepressant medications; on the other, he recommends dubious procedures such as chelation to cure depression by ridding the body of “dangerous toxins” – but fails to mention that procedures such as chelation have their own risks and side-effects and are based on weak or no evidence to support their efficacy.

As just one example of what I found annoying about this book, in Chapter 3, Discover Your Biochemical Profile, Schacter presents a case study (which, by the way, he seems to prefer to systematic controlled efficacy studies as “evidence” for his recommendations) for one patient, Patricia. Dr. Schacter has this to say about his case study:

The table above [see book] shows the neurotransmitter test results of one patient, Patricia, who was treated with amino acid therapy for depression and fatigue. As you can see, all of her neurotransmitter levels were out of optimal range when she first came to be tested. After four months of amino acid therapy, all of her neurotransmitter levels had changed significantly and moved toward optimal levels. More important, she was feeling 100 percent better and, for the first time in five years, had the energy and motivation to initiate a career change.

Now let’s look at this for a moment. First, we are not told whether Patricia had been treated previously using conventional medications and/or psychotherapies. Could it be that the reason she felt better “for the first time in five years” was that this was the first time she had followed through on treatment recommendations at all? Note that there is no “Patricia control group” for comparison. Second, while he concludes that “all of her neurotransmitter levels had moved toward optimal levels”, he fails to point out that three of the five are still outside the optimal range, or that the two that made it into the optimal range after four months were not very far out of range to begin with. And, third, we have no way of knowing how this patient would have responded to four months of treatment with an SSRI, especially if combined with psychotherapy, (e.g., cognitive behavior therapy).

To be fair, there is a lot of excellent information on nutrition and lifestyle issues in this book. I wish they had been presented as adjuncts to conventional treatment rather than implying that it is one or the other.

Excerpt from the book:

Basics of a Healthful, Antidepression Diet
By Michael B. Schachter, MD, & Deborah Mitchell
What Your Doctor May Not Tell You About Depression

For some people, the phrase healthful diet is enough to send their mood tumbling. “Guess I’ll have to give up everything I enjoy, like chocolate and hamburgers and french fries,” sighed one patient. “That’s enough to make me even more depressed!” But healthful need not be equated with unappetizing or boring. Different, perhaps, and for some people a change to a more healthful diet requires big adjustments — in the foods they buy, where they eat out, and how they prepare their choices. The rewards, however, are many, including improved mood, more energy, enhanced immune system, better concentration, and invigorated sex drive, to name but a few. I’ve found that laying down a few basic but critical guidelines for a healthful diet, and then tweaking them for individual patients, works much better than expecting people to follow a complicated program that involves counting grams of carbohydrates or protein, weighing foods, referring to charts, or combining certain items in complicated ratios. That being said, here are my lists of Positive Foods and Foods to Avoid.

Positive Foods

  • Sweets. In moderation, natural sugars such as rice syrup, date sugar, pure Vermont syrup, unsulfured blackstrap molasses, and unfiltered honey are all acceptable. An herbal sweetener — that has nearly no calories — is stevia, which can be found in health food stores and increasingly in mainstream grocery stores.

  • Fats. Some fats are healthy and instrumental in maintaining mental health, especially omega-3 fatty acids. When you choose oil for cooking, your best choice is probably cold-pressed olive oil. Butter and other saturated fats (like coconut oil, but not margarine that contains transfatty acids) may be used in moderate amounts. I suggest you avoid fried foods (especially deep-fried).

  • Whole fruits and vegetables. Whenever possible, choose fresh, organic fruits and vegetables and eat at least five to seven servings daily. To derive the most benefit from these rich sources of vitamins, minerals, fiber, and carbohydrates, eat them in as pure a state as possible, preferably raw or lightly steamed. (Sorry, deep-fried potatoes and onion rings don’t count as servings of whole vegetables.) Fruit and vegetable juices are good as well, and if you have a juicer, please learn how to make your own fresh juices, remembering to drink the pulp as well!

  • Whole grains and cereals. Whole grains and cereals (organic if possible) are excellent sources of complex carbohydrates. These foods include whole grains, brown rice, and unprocessed cereals. Complex carbohydrates break down gradually and provide a more steady supply of glucose – brain fuel – thus helping maintain an even or calmer mood. Simple carbohydrates, however, such as those found in sugary foods or those made with white flour, metabolize rapidly, contributing to and causing mood swings and energy highs and lows. Also, be aware that some grains and even other whole-food starches may be problematic for some people.

  • Beans, legumes, nuts, and seeds. Choose organic foods in this important category as well. Foods in this group are excellent sources of protein, especially for people who want to reduce or eliminate animal protein. Beans, legumes, nuts, and seeds are also high in fiber and many nutrients. Also in this category are tofu and other forms of fermented soybeans (miso, tempeh) and flaxseed.

  • Eggs and dairy. Eggs and dairy foods — milk, cheese, butter, cream, and yogurt — are good sources of protein, calcium, and other important nutrients. They are also rich sources of saturated fat, which may be fine for many people. The major concern I have about eggs and dairy relates to whether hormones were used in raising the animals; whether or not they were given foods containing pesticides, antibiotics, toxic minerals, or other chemicals; and whether the animals were confined to inhumane cages. Soft-boiled eggs are best because heat is applied without exposure to oxygen, thus reducing free radical damage. I recommend organic eggs and dairy products and prefer nonhomogenized milk. Although pasteurization of milk products is the norm today in order to eliminate harmful bacteria, certified raw milk is preferred in areas where it is available, provided the cows are clean and hygienic principles are used in caring for them. If you are lactose-intolerant because of a deficiency of the enzyme lactase, or you choose not to consume dairy items, nondairy foods may be used. These include products made from soy, rice, or nuts, such as soy milk, rice milk, and almond milk; cheese made from these “milks”; and nondairy desserts. These “dairy” foods are also good sources of protein.

  • Organic meats and poultry. Despite a push for people to eat more fish, meat and poultry continue to be major sources of animal protein for many people. For patients who eat meat, I recommend organically raised products, which are virtually free of hormones, pesticides, antibiotics, and other unnatural additives, all of which can have a detrimental effect on mood and general health. Such meat and poultry choices are slowly becoming more accessible and typically are available in natural and whole-food stores. Meats and poultry are sources of methionine, which is critical for methylation; this amino acid is difficult to get from plant-based sources.

  • Fish and shellfish. Fish and shellfish can be excellent sources of protein and omega-3 fatty acids, if you make judicious choices. I’m calling for “judicious choices” because of the persistent and very real problem of mercury, pesticides, PCBs, and other contamination of the fish supply. Fish that I tend to recommend that are high in omega-3 fatty acids, but relatively low in mercury, are wild Alaskan salmon and sardines. I am wary about farm-raised fish because some studies indicate that they are high in PCBs and other contaminants. The smaller the fish (say, sardines), the less likely they are to accumulate mercury. But if you eat fish fairly frequently, I recommend that you have your blood mercury levels checked, because there is no way to guarantee the fish you eat regularly is not contaminated. Everyone whom I have checked for mercury who eats sushi more than once a week is quite high in it. Swordfish, king mackerel, shark, and most tuna tend to be quite high in mercury.

I would like you to consider two factors when choosing foods from this list. One, do you have any reactions to these foods that may be contributing to or causing your depression? Two, do you have any specific food preferences based on religious, ethical, and/or moral beliefs? If you are a vegetarian, for example, you will not select meat, poultry, or fish, so you will need to choose other protein-rich foods such as soy products, legumes, beans, seeds, and, depending on the type of vegetarian diet you follow, eggs and/or dairy.

Foods to Avoid

Most of the foods included in this list should come as no surprise to you. In most cases, foods on the Avoid list have been highly refined and processed. Fortunately, for every food you should avoid, there is a healthy alternative on the Positive Foods list. You may find that the Avoid list reads like your current grocery list; or you may discover that only one or two categories apply to you. Next time you’re in the grocery store, here are the items you want to skip:

  • Sugar. Avoid all foods that contain added sugar, such as soda, candy, cakes, ketchup, some breakfast cereals, and so on. Become a label reader. If sugar (or one of its companions, such as corn syrup) is one of the first few ingredients, put the item back on the shelf! Sugar can give you a burst of energy, but in the long run it can leave you depressed and tired.

  • White-flour products. Just say no to white bread, white pasta, and other products that use white flour, including many crackers, rolls and bagels, refrigerator biscuits, pizza dough, and baked goods. Also avoid white rice. These overly processed food products have been stripped of their nutritional value, and then they are “enriched” with some nutrients, along with synthetic additives.

  • Alcohol. This includes beer, wine, and liquor. People often forget that alcohol is a depressant, even though it provides an initial kick. Drinking alcohol can also disturb your sleep, which is a problem with many people who are depressed.

  • Caffeine. Avoid coffee, tea, colas, and chocolate. (Okay, you can have a limited amount of organic dark chocolate on occasion.) If you must have coffee, choose an organic coffee, since most coffees are high in pesticides. Decaffeinated coffee is fine for most people, provided that it is organic and does not use toxic chemicals in processing.

  • Hydrogenated fats. Hydrogenated fats are oils to which hydrogen atoms have been added in the factory in order to harden them and improve shelf life. These hydrogenated oils or fats contain high concentrations of trans-fatty acids, which have recently been clearly shown to disrupt fatty acid metabolism in the body and cause serious disease. Hydrogenated fats are found primarily in margarines, snack foods (potato chips, corn chips), crackers and cookies, baked products, and fast foods. When you read ingredient labels, look for the words hydrogenated, partially hydrogenated, margarine, or shortening, which indicate the presence of trans-fatty acids, or look at the nutritional panel for the percentage of trans-fat in the product. Beginning January 2006, food manufacturers were required to list trans-fat content on labels.

  • Chemical food additives. To avoid artificial preservatives, flavorings, colors, and sweeteners, you need to read labels. Not all labels list all the chemicals in the food item, but the general rule is: If the product has been processed, it probably contains chemicals. For example, artificial preservatives such as BHA, BHT, nitrites, monosodium glutamate, and nitrates are often seen in cereals, breads, frozen dinners, boxed meals, and crackers. All foods containing artificial colors (such as red dye 40) or artificial flavorings should be avoided. Artificial additives can cause various adverse reactions, including mood swings, depression, fatigue, headache, rash, aggression, irritability, and attention difficulties, among others. I believe all artificial sweeteners, including saccharine, aspartame, and sucralose, should be avoided. In particular, avoid diet sodas containing aspartame.

  • Fluoride. Do not drink fluoridated water or tap water (unless filtered) or use fluoridated toothpaste. Despite the popularity of fluoride dental treatments for both adults and children, I strongly recommend you not get them. Also, avoid fluoridated vitamins for children. There are a number of excellent books and websites that clearly document the lack of efficacy and dangers of fluoride ingestion and fluoride use. If you live in an area where the tap water is fluoridated and you want to drink the tap water but not the fluoride, you need to use a water filter with a reverse osmosis component; carbon filters will not remove fluoride.

  • Chloride. Do not drink chlorinated water (unless the chlorine has been filtered out), as chlorine is toxic. A simple carbon filter will remove chlorine from tap water. 

In the end, I would like to recommend this book for the useful information it contains. I cannot recommend it globally because of the overly-prejudicial way that information is presented. Had the author aimed more at a balanced view of conventional and alternative treatments, this could have been a much better resource. It is, I think, a worthwhile read for the practitioner with a critical eye, but not recommended for most patients.

Bad logic, bad science, and sensationalism

This is the kind of news release that angers me.

Brian Quinn, LCSW, PhD., Author Of A New Book On Bipolar Disorder, Discusses The Risks Of Antidepressants In Angry, Agitated Teens

It’s ill-conceived, illogical, and dangerous. It starts with the statement that “Dr. Quinn’s new book reviews the most up-to-date research on the use of antidepressants in bipolar disorder” and then proceeds to demonstrate that the author has little grasp of the most basic principles of logic, let alone the principles of research.  His statements are based neither in research nor in logic. They are self-serving and misleading. I get that he wants to sell his new book. I also get that using sensationalism and duplicity as a means to increase sales is perfectly acceptable to him. And that, in my view, is reprehensible.

“Eric Harris, one of the shooters at Columbine, was on an antidepressant when he and Dylan Klebold killed 12 students and then themselves. Jeff Weise, who killed nine people and then himself in Red Lake, Minnesota, was also on an antidepressant, and Kip Kinkel was on an antidepressant when he fatally shot his parents, two students and wounded dozens at a high school in Springfield, Oregon.”

Okay. And so? This tells us what? This is selective bigotry and stigmatization of mental illness at its very worst. “One of the shooters” at Columbine was on an antidepressant? And the implication is that caused him to kill people? What about the other shooter? What caused him to kill people? What about all the other historical and emotional characteristics of Eric Harris? Were those factors unrelated to the shootings? What about all of the other people who commit crimes, including mass or serial murder, every year who are not on any medication at all? What about the millions of people world-wide who are on antidepressants and other medications who will live their whole lives without ever killing anyone?

“Antidepressants have been linked to worsening hostility, suicidal behavior and psychosis in depressed children and teens and some people with bipolar disorder. While no one can say that antidepressants caused Harris, Weise, and Kinkel to commit mass murder, all these cases raise the question of who should be given antidepressants and who should not.”

No. This is false. Antidepressants have not been linked to hostility, suicidal behavior, or psychosis in children, teens, or anyone else, except by anecdotal evidence which is increasingly being exposed as hysteria. However, it is the case that hostility, suicidal behavior, and sometimes psychosis are among the symptoms of the illnesses and conditions that various classes of psychotropic medications, including antidepressants, are used to treat.

“‘These drugs tend to be handed out routinely to anyone with symptoms of depression and without a great deal of thought given to accurate diagnosis or the risks involved in using them, especially in young people with agitated depression,’ said Brian Quinn, LCSW, PhD., author of a new book, Wiley Concise Guides to Mental Health: Bipolar Disorder (John Wiley & Sons, 2007). ‘We don’t know what the diagnoses of these kids were, but we do know that they all had angry, agitated depressions — an indication they may have had bipolar disorder or could respond to antidepressants with a worsening of their symptoms. Caution should have dictated that they not be given antidepressants initially.'”

What absolute balderdash. These drugs are certainly NOT “handed out routinely to anyone with symptoms of depression and without a great deal of thought given to accurate diagnosis or the risks involved in using them”. The author is a social worker. He does not and cannot prescribe medications. What evidence is presented to back up the claim that physicians are ignoring diagnostic considerations in prescribing these medications?

“‘Psychiatrists, psychologists and social workers frequently misdiagnose those in the depressed phase of bipolar illness as having simple depression. This often results in them mistakenly being given antidepressants alone,” Quinn said.”

Okay. So people with bipolar disorder are often initially misdiagnosed with depression. Why is that, Mr. Quinn? I can tell you that it’s not a result of incompetence and it’s not a result of antidepressant medication. It’s a result of the nature of bipolar disorder – a fact you should understand as a self-styled expert on the subject. The majority of bipolar patients first present with depression, not hypomania, and the only way currently to accurately diagnose bipolar disorder is on the basis of longitudinal evidence showing recurrent cycles of depression coupled with evidence of at least one hypomanic or manic episode, evidence which is frequently not available when a patient is first being seen by a mental health professional. Given that, physicians do what they should be doing, viz., treating the symptoms of depression. That doesn’t mean that the possibility of bipolar disorder is ruled out. It simply means that physicians, like other men of science, follow the principle of Occam’s Razor: The simplest explanation is often the correct one and one does not proceed to a more complex explanation (diagnosis) of medical-psychiatric symptoms without first eliminating the simpler explanations (diagnoses).

This is the Dr. Phil phenomenon – the confusion of entertainment and marketing with science and professional practice. It is blatantly anti-science and anti-logic. And it worries me because of the potential damage it does to vulnerable people who need help and may be denied it if sensationalist propaganda such as this is believed.

We’re already seeing evidence of rising suicide rates among adolescents and children as a result of the fundamentally unfounded restrictions on the use of antidepressant medications among these age groups. We don’t need more biased sensationalism to make the situation worse.

antidepressants, bad logic, bad research, bad science, bipolar disorder, depression, sensationalism

World’s Largest Online Medications Database

DrugBank: “World’s Largest Online Drug Database”

Searching for credible information on various drugs can be a daunting task both for professionals and consumers. Web searches often bring up a confusing assortment of information generally inundated with sites that want to sell you something. Just released this month is DrugBank – the worlds largest online database from the University of Alberta, Departments of Computing Science, Biological Science and the Faculty of Pharmaceutical Sciences. It is described as an “interactive one-stop-shop” that offers detailed drug information for patients, researchers and health-care professionals.

The database began as teaching tool developed by Dr. David Wishart for pharmacy students at the University of Alberta. Wanting to develop one source that offers a broad scope of information, Wishart and his team created DrugBank. DrugBank contains detailed chemical, pharmaceutical, medical and molecular biological information on more than 3000 drug targets and 4100 approved or experimental drugs products.

The database allows pharmacists, physicians, drug researchers and the general public to find out just about everything they need to know about a drug or a drug target. It is the only database of its kind. DrugBank provides more than 80 data fields for each drug including brand names, chemical structures, protein and DNA sequences, links to relevant Internet sites, prescription information and detailed patient information.

As patients take more active roles in their own care, they can access detailed information without searching through scientific literature to find it. For example, a search for “acetaminophen,” on the site, will reveal 197 brand names for products and 26 brand name mixtures that contain it. DrugBank will also tell you how acetaminophen works, its side effects, how it’s absorbed, how it’s metabolized and how to take it.

Source: PsychNotes

medications, side-effects, dosage, drug interactions, prescription drugs, over the counter drugs

Should Psychologists Be Prescribing Drugs?

Louisiana Psychologists Begin Prescribing Drugs

Associated Press – April 18, 2005 – BATON ROUGE, La. – The first of the so-called “medical psychologists” began signing prescription pads more than a month ago with little fanfare, among the first psychologists in the nation to prescribe drugs. Louisiana and New Mexico are the only states that allow psychologists who complete specialized training and pass a national exam to write prescriptions for medication. Both states began issuing the prescribing certifications and licenses to a handful of psychologists within days of each other in February. Backers of Louisiana’s new law said it would provide better coordination of patient care, reduce patient
costs and offer greater access to mental health services for people who would otherwise have long waits to see a psychiatrist. “It’s not hard to refer them. I can make a referral, but it would take three months,” said John Bolter, a Baton Rouge psychologist who wrote his first prescription in February after years of front-line work to get that expanded authority. Louisiana, like New Mexico, requires psychologists who write prescriptions to consult with physicians, but critics – including psychiatrists, who must have medical degrees – said both training and supervision are inadequate under the new program and jeopardize the lives of patients. Jason Young, with the American Psychiatric Association, said if the psychologists pushing for Louisiana’s law worried about getting care to underserved areas, the law would have contained incentives for practicing in rural areas with less access to mental health care. “There were no Louisiana citizens clamoring for this law in the first place,” Young said. “This was designed by psychologists.” The issue isn’t limited to two states. Thirty-two others have psychological associations looking into prescriptive authority, according to the American Psychological Association, and legislation was introduced in seven states this year.
 

 

The issue of adequacy of training, especially with respect to drug interactions (not only with other prescribed medications but also with non-prescription drugs such as over-the-counter remedies, herbal remedies, and even dietary supplements) and with known personal and family medical history, is one that as a psychologist concerns me greatly. There are times when I have doubts about the adequacy of training in some of my colleagues even to correctly interpret standardized psychological tests and frankly that doesn’t increase my confidence in the ability of psychology departments to provide what I would consider to be a safe standard for training in pharmacology and medicine. And I do not believe that training in psychopharmacology is sufficient: many medications used to treat anxiety disorders, depression, and other mental illnesses also have implications for patients taking other medications as diverse as antihypertensives and birth control pills. Additionally, I suspect that the American Psychiatric Association is correct when they say it is a certain group of psychologists that is lobbying for this: I really don’t see any great clamoring from patients to grant this authority to psychologists.


Louisiana’s prescribing psychologists are limited in the types of drugs they can prescribe. They have to talk with the patient’s primary doctor to be able to do so, and they cannot prescribe narcotics – areas Blanco cited as protections for patients. Only psychologists who have a postdoctoral degree in psychopharmacology for studying drugs and areas like neuroscience and anatomy can write prescriptions under the new law, after passing a national proficiency test. A small group of Louisiana psychologists had completed the training before the law was passed, hoping they’d one day be able to prescribe medication. Psychiatrists and critics of the new law said the main university to offer a “medical psychology” postdoctorate program ranked in the bottom 10 of 183 schools nationwide offering psychopharmacology programs. They said the training isn’t sufficient to teach psychologists about harmful drug interactions when patients are taking medications for other conditions. Elaine LeVine, a prescribing psychologist in New Mexico, said her new authority helps her better manage care by allowing her to combine medication with therapy, instead of suggesting types of drugs to patients’ primary doctors and hoping the advice is followed. She is under scrutiny by a physician as part of New Mexico’s conditional licensing requirements.

The argument about long waiting lists for psychiatrists is bogus, in my opinion. The types of drugs that these prescribing psychologists are permitted to prescribe would be medications that in most jurisdictions are most often prescribed by family physicians and general practitioners. In my experience, many of these doctors are quite willing to collaborate with or take suggestions from knowledgeable psychologists, but I think that their medical knowledge provides an “extra layer of protection” for patients that is going to be removed if prescribing rights for psychologists becomes widespread. Make no mistake about it: These medications are invaluable in the treatment of common emotional-psychological disorders and in most cases are easy to prescribe and monitor, but they are also medications which under certain conditions can be dangerous. I see this issue as similar to the issue of childbirth with a midwife versus childbirth with an obstetrician: If all goes well and it’s an uncomplicated delivery, the midwife is going to do fine, but if something starts to go wrong tyhat patient is going to need access to someone with more knowledge and expertise in a hurry.

psychologists, prescriptions, medication, prescription medication, prescribing