limitation

07
OCT
2013

Not a Lab Rat

Minnie was forty years old, and came to see me in my office to discuss being depressed. She had felt depressed off and on for many years, but had rarely told anyone about it. It was like dragging a weight around. She could still get things done in her, just not quite as well as she’d like.

At one point she had told her family physician about this, and she was offered an antidepressant, lexapro. She took it for a few days, didn’t like how it made her feel, and stopped it. Her physician told her they could try something else, which might work better. She responded: “I don’t want to be a lab rat.”

Now of course the first thing I would tell her is that the first few days on antidepressants are not a good indication of whether it will work or not. There are potential early side effects that will go away, often within the first week. That isn’t the issue I wanted to address here, though.

I hear from people that they don’t want to be “experimented on,” or “feel like a lab rat.” As if doctors are purposely sitting in labs running experiments on their patients, for some other endgame. The only purpose of trying out different medications is to find what works for YOU. This seems to come from the expectation that the psychiatrist has to “try” different medications in an effort to find one that works.

It’s absolutely true that we do not know that a certain medication works. I tell this to people all the time. The current state of the science in medicine cannot predict if a medicine will work for you. What the research says, for example, is that in a group of a 1000 people somewhat like you, 30% got better on this. Which means 70% didn’t. We don’t have the science, quite yet, to be able to say which group you will fall into. So it comes back to trial and error. Even with a blood pressure medication, where we understand just about all the physiological changes occurring from the medication, only has the desired effect in 20% of individuals. And again, we don’t know which 20%. So meds are often combined to get the desired change in blood pressure.

“Personalized medicine” is an emerging approach, where factors like genetics can be used to predict if someone will respond to a medication. We’re juuuuust beginning to crack this area, such as with tests for the blood thinner warfarin. We can identify who might be sensitive to it, and who might not respond. We’re still some steps away from being able to reliably do this in the field of psychiatry, but it’s well on the way. Ideally, a finger-prick blood test will be able to tell us whether a medication will benefit you or not. That will still be a far distance away from understanding and treating all aspects of depression, but maybe it’ll help people stop believing their doctor is experimenting on them.

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