"You Don't Need Medication!"

[HYHYBT]

Is "medication as a first-line treatment" always a bad thing? If I had, say, tuberculosis, I'd sure hate to run in to a doctor who wanted to try months of talk therapy before resorting to antibiotics. Are there no mental conditions where the same holds?

[crashhelmet]

Is "medication as a first-line treatment" always a bad thing? If I had, say, tuberculosis, I'd sure hate to run in to a doctor who wanted to try months of talk therapy before resorting to antibiotics. Are there no mental conditions where the same holds?

Talk therapy for tuberculosis? Seriously?

But hey... Let's talk TB diagnosis procedures. As someone that had to be tested in order to get a local Health Card i can tell you all about that annoying ass procedure.

Step by Step:

1. Go down and get a "Skin Pop." The doctor sticks a needle just underneath the skin of your forearm infected with an extract of tuberculosis.
2. Wait 2-3 days.
3. Go back to the doctor to get the results read. If you're healthy, you get your card and you go home. If it appears to be positive for TB, you move on to Step 4.
4. This varies from doctor to doctor. Almost all will send you down for a chest x-ray. Some will order a blood test as well. This is done to confirm that you have TB due to false positives that come up from time to time. Depending on your insurance, if you have it, these could be done same day or at a later date.
5. Get results from test(s). If Chest X-Ray shows possible TB, they will test your Sputum (sp?) aka the phlegm you cough up.
6. If the Sputum is positive for TB infection, they test the infection itself to find out which meds it's immune to.
7. Start meds

They do NOT just hand you a prescription for meds when they first meet you and you say "Doc, I think I have TB"

[Andara Bledin]

They do NOT just hand you a prescription for meds when they first meet you and you say "Doc, I think I have TB"

But they do just hand out meds when you go in and say, "doc, I think I have a sinus infection." They'll give you the antibiotics independently of the results of the tests, and you either stop if it's not an infection, or you take them to the end if it is.

Being utterly pedantic on the matter is of no value to the discussion.

[crashhelmet]

But they do just hand out meds when you go in and say, "doc, I think I have a sinus infection." They'll give you the antibiotics independently of the results of the tests, and you either stop if it's not an infection, or you take them to the end if it is.

Being utterly pedantic on the matter is of no value to the discussion.

No.

If you have a sinus infection, they check for signs of an infection. They check up your nostrils, in your ears, and the back of your throat. Not to mention they check your breathing and for a fever.

[Andara Bledin]

If you have a sinus infection, they check for signs of an infection. They check up your nostrils, in your ears, and the back of your throat. Not to mention they check your breathing and for a fever.

And yet, despite all of that coming back normal, they'll still take a swab and write a script or two for medication.

Because, as I said and you've done nothing to refute, giving medication prior to knowing the cause of symptoms sometimes is the correct response.

[SongsOfDragons]

I know one where medication is absolutely the first thing given.

In the UK at least, if you are showing severe meningitis symptoms - photophobia, headache, fever and stiff neck - they will start you on empirical antibiotics immediately. As in, I think, en route to hospital. Waiting for any blood test results, or the results of a lumbar puncture, to identify the bug could be a fatal delay.

As for other conditions, I will agree there's a barrage of testing to some level done before any treatment for anything. I always thought epilepsy's a weird one, mostly in physical but with half a hand in mental, as stress and such can exacerbate it and partial seizures especially alter one's mental state rather unpleasantly. I had to have an EEG and even after that diagnosis have a second seizure before they started treatment, which is usually drugs of some type. As well as a plethora of those (which are all nasty buggers in themselves; I've been reading up because I need to switch my meds >.<) there are epilepsy surgeries for some types too, and other treatments like the Ketogenic Diet, which is one of the weirdest and most fascinating treatments I've ever read about. But these only come in when the meds fail, I think.

[HYHYBT]

I was speaking of "medication as first line of treatment." Why is my comment instead being treated as if I were talking about "medication before confirming the diagnosis?"

[Andara Bledin]

I was speaking of "medication as first line of treatment." Why is my comment instead being treated as if I were talking about "medication before confirming the diagnosis?"

Because if you stick with the question of whether medication is sometimes the optimal choice as the first line of treatment, then there's no argument.

To debate against that position (and not be thought ignorant or insane) you either have to move the goalposts or set up a straw man.

[Mongo Skruddgemire]

They do NOT just hand you a prescription for meds when they first meet you and you say "Doc, I think I have TB"

No, but they have a set procedure for proper diagnosis and as soon as it's positive <bam> they hit it with the proper med straight away.

And what you described is what they do for a TB screening. They do that just as a routine. I have to get one every year working at a hospital. It's the least invasive way of getting tested. This method is the "Since you haven't been in contact with anyone who has had it that you know of, we assume that it's unlikely that you have it but just in case this will detect it." way of looking at it.

If they suspect that you have come in contact with someone with active TB, then they cut out a lot of that and go for sputum screenings and other rapid results tests. This is the "You were in contact with someone who had it and as such we must act quickly to stop it doing serious damage in case you do have it." approach.

In any case, the point here is that while I do agree that at times doctors are pill happy, but just because Doctor "A" can't be arsed to do a proper diagnosis and just hands out pills...doesn't mean that Doctor "B" who hands out pills as a first line treatment for a condition properly diagnosed and responds well to said pills, is in the same category as Doctor "A".

Doctor A hands out antibiotics when a patient comes in and asks for them because they're sick.

Doctor B hands them out when the disease is known and responds to said antibiotics.

[HYHYBT]

Because if you stick with the question of whether medication is sometimes the optimal choice as the first line of treatment, then there's no argument.

To debate against that position (and not be thought ignorant or insane) you either have to move the goalposts or set up a straw man.

Thanks.

So, if it's the right course for at least some obviously physical ailments, why would it not also be the right response for some mental conditions, particularly those which essentially are physical? Diagnosis is not going to be so precise, of course.

[crashhelmet]

The 7 Sins of Psychopharmacology
Blogged by a Bi-Polar writer that writes a lot about bi-polar issues.

Taken from the Journal of Clinical Psychopharmacology