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In Reply to: What started this Thread is this posted by Daniel on February 20, 2006 at 00:31:50:
Your friend's situation sounds like a classic case of what's wrong with prescribing SSRIs without psycho-education, talk therapy, or symptom monitoring.
I don't know if your friend saw a psychiatrist or a general practitioner, but in either case, the doc typically spends 30 minutes or less evaluating and diagnosing and 15 minutes or less in follow-up visits on syptom monitoring.
Community mental health psychiatrists practice in a team setting, where therapists and/or case managers work with the individual on a weekly basis and monitor symptoms until the medication is properly titrated and the individual's symptoms have stabilized. When someone starts to destablize and decompensate (as your friend apparently did), there might be a brief hospitalization (3-7 days) and/or intensive outpatient treatment (every day for two-six weeks). This can only happen if the individual is being properly monitored.
The individual who takes psychotropic meds has a right to basic education regarding his/her diagnosis and medication side-effects. Pharmaco-therapy is more of an art than a science. Every individual is different and responds to psychiatric medications differently, which is why careful symptom monitoring is critical. There are even racially-based differences in the way individuals respond to psychotropic meds!
What I'm describing is best practice. It doesn't happen nearly as much as it should. A lot of what I'm paid to do is help improve the quality of public mental health services so that best practices are the norm rather than the exception.
Something I've seen way more than I care to admit is practitioners who rush toward prescribing meds rather than carefully diagnosing a condition based on extended observation and interviews with family members who can provide information about problematic behavior the client may forget, overlook, or fail to recognize. Something that may have happened with your friend is that he was actually in a depressed phase of bipolar disease when the SSRI was prescribed. The stimulant effect of the SSRI can trigger a manic episode. I've seen it happen.
