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    Thursday, November 17, 2005

    Trading Pills: It's impossible to discern whether this is a true trend or just a New York Times trend. That is, an editor or reporter has a friend or aquaintance who does something or believes something and then writes a whole front page story on the "trend" based on interviews of the friend and the friend's friends. I suspect the latter, but it's disturbing nonetheless:

    "I acquire quite a few medications and then dispense them to my friends as needed. I usually know what I'm talking about," said Katherine, who lives in Manhattan and who, like many other people interviewed for this article, did not want her last name used because of concerns that her behavior could get her in trouble with her employer, law enforcement authorities or at least her parents.

    For a sizable group of people in their 20's and 30's, deciding on their own what drugs to take - in particular, stimulants, antidepressants and other psychiatric medications - is becoming the norm. Confident of their abilities and often skeptical of psychiatrists' expertise, they choose to rely on their own research and each other's experience in treating problems like depression, fatigue, anxiety or a lack of concentration. A medical degree, in their view, is useful, but not essential, and certainly not sufficient.

    They possess two of the worst possible traits that when combined are often fatal - arrogance and stupidity. (Or, as one of my uncles used to say, "It's not a crime to be stupid, but it is to abuse the privilege.") And while they consider themselves savvy, they're no different than previous generations who took amphetamines to stay awake and tranquilizers to go to sleep (think Judy Garland and Marilyn Monroe):

    Erin, 26, a slender hair stylist, remembers laughing to herself as she listed her weight as 250 pounds to order Adipex, a diet pill, for $113. One recent night, she took an Adipex to stay up cleaning her house, followed by a Xanax when she needed to sleep.

    ...When Katherine took a Xanax to ease her anxiety before a gynecologist appointment, she found that she could not keep her eyes open. She had traded a friend for the blue oval pill and she had no idea what the dosage was.

    An Adderall given to her by another friend, she said, "did weird things to me." And Mr. Tylutki, who took the Ritalin she offered one weekend last fall, began a downward spiral soon after.

    "I completely regretted and felt really guilty about it," Katherine said.

    Taking Katherine's pills with him when he returned to Minneapolis, Mr. Tylutki took several a day while pursuing a nursing degree and working full time. Like many other students, he found Ritalin a useful study aid. One night, he read a book, lay down to sleep, wrote the paper in his head, got up, wrote it down, and received an A-minus.

    But he also began using cocaine and drinking too much alcohol.

    It's the same old story playing itself out again in the age of the internet. Physicians wised up to the danger of using drugs like this a long time ago. There was a time early in the golden age of American medicine, when the pharmaceutical industry was really taking flight - the 1950's and 1960's - when mood altering drugs were all the rage. Doctors would give babies phenobarbital for colic and laudanum (a form of opium) for teething. And they gave their mothers' Valium for their nerves and amphetamines for weight loss. That sort of practice ceased because it became obvious that it was harmful. Those twenty-somethings will figure that out in another ten or twenty years, too. Some sooner than later:

    He flushed the Ritalin down the toilet and stopped taking all drugs, including the Prozac that he had asked a doctor for when he began feeling down.

    "I kind of made it seem like I needed it," Mr. Tylutki said, referring to what he told the doctor. "Now I think I was just lacking sleep."

    And by the way, the article makes it sound as if general practice physicians can't keep up with the literature, so they just give whatever the patient asks for. The true reason doctors often give patients the drug they request rather than one of the doctor's choosing in this age of direct to consumer advertising is that there's a strong placebo affect with anti-depressants. Give a patient a drug they believe to be inferior and it won't work. Give them one they believe to be superior and they're more likely to get better. If the drugs have similar side effect and efficacy profiles - as the newer anti-depressants do, then it's wiser to bet on the placebo effect.

    UPDATE: Precision Blogging was ahead of the curve on this.

    UPDATE II: Shrinkette finds the whoe thing shrinkette: heinous, deplorable, and contemptible. Don't hold back. Tell us what you really think!

    posted by Sydney on 11/17/2005 09:39:00 AM 0 comments


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