"Ask your doctor if this medication is right for you."

Is that statement in TV ads driving you crazy too? I especially love it when they mention a bizarre sounding medicine’s name but they don’t tell you what it’s for. They just say, "ask your doctor if it is right for you." If they tell you what it is for the FDA requires that they tell you its main side effects. I love it when they use an old technique taught to lawyers: if you have to concede a point that is not in your favor do it in a tone of voice as though it was in your favor, or is no big deal. So, they will add nonchalantly that it may cause cancer, heart attacks, strokes, seizures, sexual dysfunction, etc. They will then reiterate how much better your life will be while showing a happy couple skipping off to fun and frolic.

Another thing I love is that they tell you not to mix it with other drugs like MAO inhibitors or Thioridazine, (meds that almost NO ONE takes), or tell you not to mix it with generics of the same thing, or not to take if you are allergic to it. All of this is reverse psychology - it seems to be providing fair balance but it’s mostly irrelevant.

I won’t make the obvious criticisms of the FDA - they have already taken enough heat lately, and their credibility is finally being challenged in various arenas.

What about pharmaceutical companies? They are also taking a lot of heat. They are being criticized for spending more money on marketing than on research. But this is America. Every private enterprise has profit as its goal and without profit they go out of business. Also, in their defense, pharmaceutical companies not only bring us new and better medications, they also play a huge role in educating doctors and the public about the nature of illnesses, dysfunction, and the role of various treatments in health and quality of life.

There’s a lot of criticism about the increasing use of prescription and over-the-counter medications. "Prescription nation" and "Parenting with Pills", are just two examples. The underlying message is that if you would eat right, exercise enough, and have a positive attitude you wouldn’t need medications. To a certain extent this is true. There is no doubt that stress related disorders such as anxiety, depression, hypertension, etc., are becoming more common, starting at an earlier age, and more severe. Everyone of us could do better stress management and have a healthier life style, but STRESS appears to be here to stay for a while. We can be thankful that we have a lot of tools available to help us deal with stress. Some of these tools are medications.

I am adding five permanent sections to my web site on medication. They will be regularly updated as we get new information. I consider these sections some of the most valuable information on my website.

Medication: Why Meds?

Medication: Best Meds

Medication: How to Take

Medication: Side Effects

Medication: How They Work

I have been prescribing medication since 1966. It is as much an art as it is science. When starting someone on a medication, I tell them, “I am not looking for you to say”, “doctor I think it is helping some.” What I’m looking for is “this medication is great! It has made my life better and it’s not causing any significant side effects.” Surprisingly, this is a fairly common response after a week or month or two. The harder challenge and the main goal I have is for a patient to be still saying that in 6 months, 1 year, 2 years or as long as needed. This is a much tougher test and only a few medications consistently live up to that standard. For most medications it is at best a trade off-some definite benefits but also annoying side effects.

The main factor that I use in ranking medications is my clinical experience. Everyone of my patients becomes a teacher-how does this medication help, what side effects does it have, how much difference does it make in their life, do their loved ones agree that they are doing as well as they think they are? I’m not just interested in how they feel overall, but even more importantly, how do they FUNCTION?
Many doctors get skewed feedback because the patients that don’t like the treatment just don’t come back. The ones that come back feel like the treatment is helping and so the perception is this is a good treatment. Managed care especially likes the patient that doesn’t come back. This is counted as a “one treatment cure”.

So what medications have the best batting average? This translates to what are the odds that I’m going to think this medication is great-both short term and long term?

The best medications consistently work great, have minimal side effects, and work as long as they are needed-which may mean indefinitely. I am especially biased because I don’t participate in any managed care programs. I have to get good results to keep my practice going.