Anti-psychiatry movement thoughts?

[spaceinthesky]

I'm pursuing prereqs to be a PMHNP, largely because this is the population I want to work with and currently work with teaching yoga and working w/ ED children.

I have personally seen people helped function better by medications but I have also seen people that seem to be strongly damaged by them (ie. the anti-depressant sparking mania, suicidal thoughts and actions that are resolved after they go off of them).

Mainly I feel children who are depressed, etc. usually have home lives that warrant that, and these medications can cause a lot of harm in growing brains from seeing the students in schools.

PMHNPs, how do you reconcile this with the oath to "first do no harm?"

There is a lot of information out there from reputable sources and psychiatrists themselves about how this is all speculation (there has never been proof that depressed people have lower serotonin, psychotics have dopamine issues, etc.) and that the psychiatric medications themselves are proven to perturb the brain.

Can you tell me more about how you operate and remain in integrity?

Thank you so much.

[spaceinthesky]

It sounds like there are a lot more shades of gray than I can even imagine, as zenman pointed out. You sound like you'd be really good at discerning the right thing.

[elkpark]

It sounds like there are a lot more shades of gray than I can even imagine, as zenman pointed out. You sound like you'd be really good at discerning the right thing.

Psych is all "shades of grey." There are v. few black & white, "always do A, never do B" situations or rules. People who can't work with huge amounts of ambiguity tend to not do well in the specialty.

[zenman]

It sounds like there are a lot more shades of gray than I can even imagine, as zenman pointed out. You sound like you'd be really good at discerning the right thing.

There are at least 50 shades of gray that I know about….

[TheOldGuy]

What I love about psych is that we have the opportunity to potentially help someone experience life in a more full and complete way. Having worked in the ED, ICU, etc, etc, I have found that in Psych we can make the experience of life better no matter what other issues or health the individual has. Now, your questions asks about reconciling....I'm sure that all of us can point to cases where we've made a med change, started someone on a med or taken them off meds that has resulted in a profound improvement. The point is that appropriate med management means more than throwing pills at people. It means developing a solid therapeutic alliance, understanding the likely pathophysiology/neurocircuits that are involved in a psychiatric disease - which in turn means doing a thorough job of teasing out symptoms... understanding the various med choices that are available and their likely mechanisms of action, understanding the history of the person that you're trying to help - including other co-morbidities and the meds they are taking (how those work, interactions, etc), getting a feel for likely adherence to be expected with this pt, and based on all those things (and a few others) making a calculated, reasoned decision about what to do - which med and at what dosage. We need to do this with the pt as a partner - educating them about what to expect....THEN, we need to follow-up: any side effects, how are things working, are we hitting any of the major symptoms, what other symptoms are still there, do we need to do something to address side effects....etc, etc....

When it works, it is awesome! When it doesn't we keep trying until it does!