Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Sunday, March 9, 2014

Follow the Fantasy

I just had this weirdo idea. I saw a commercial the other day for Nasacort, which is now over-the-counter. This is awesome. I have seasonal allergies, antihistamines make me groggy, sudafed makes me jumpy, so every year I have to procure some prescription flonase. And now I don't.

Here's my idea. What if SSRIs were sold OTC? What would that be like?

I poked around online to try to find out if SSRI's are sold OTC anywhere, currently. Maybe India, China, Mexico. I could not find any current information-most recent was 2009.

So I'll have to stick to the fantasy. What would that be like?

In medical school, they taught us that the best down-and-dirty way to find out if a patient in a primary care setting was depressed was to ask, "Are you depressed?" Embedded in that is the notion that people know when they're depressed.

So maybe you'd realize you were depressed, and then you'd mosey on down to your local drug store and pick up a pack of zoloft, along with a birthday card for your niece and a couple of pieces of bazooka gum.

Maybe people would take SSRIs PRN, like tylenol. Maybe this would help with PMDD (I still find it hard to believe that women who take SSRI's for PMDD don't end up with withdrawal symptoms each month, even if the PMDD effects do work via a GABA-ergic mechanism).

Maybe people who weren't depressed would take them. Maybe they'd feel sad that they're hamster died, and think, Oh, I'm bereaved and depressed, I should take prozac.

Maybe there would be more suicides. Maybe there would be fewer. Maybe there would be more work days lost due to side effects and withdrawal. Maybe there would be fewer work days lost due to depression. Maybe there would be more substance abuse. Maybe there would be less.

Maybe people would be emotionally disengaged and spend hours on Facebook and Twitter and playing League of Legends online without ever leaving the house to see their friends. Oh, right, that already happens. Maybe because SSRI's are so freely prescribed by primary care providers.

Maybe there would be fewer starving people in the world, because those taking SSRI's would stop having sex and reproducing, and the population of the planet would be contained.

Maybe people would begin to realize that pills won't fix their character pathology or their interpersonal problems. Maybe more people would make use of therapy. Maybe insurance companies would be forced not to find sneaky ways to withhold reimbursement for therapy.

Maybe the reason I have so much conjecture about what would happen if SSRI's were freely available to whoever wants them is because not much is actually known about what they do. Or more accurately, they do so many things, or are SUPPOSED to do so many things, that it's hard to tell what they are and aren't doing.