Here's a shocker...

[OldPsychDoc]

Document Details Plan to Promote Costly Drug

Does this come as a surprise to anyone?

[Edit: here's Carlat's take on it.]

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Members don't see this ad.

 

[whopper]

That's making me feel even better that I got several dozen patients off of Lexapro to generic Citalopram. Between me, and 2 social workers, and getting to word out to residents who were working under me when I was chief, I think we put a $150K/year dent in Lexapro's sales--and pretty much all the transitions from Lexapro to Citalopram occurred with no problem.

 

[Faebinder]

That's making me feel even better that I got several dozen patients off of Lexapro to generic Citalopram. Between me, and 2 social workers, and getting to word out to residents who were working under me when I was chief, I think we put a $150K/year dent in Lexapro's sales--and pretty much all the transitions from Lexapro to Citalopram occurred with no problem.

We rarely prescribe it now a days. Celexa is key.

 

[Doctor Bagel]

Just read this today and was thinking about the private pcp's I just worked with who used lexapro as their go to drug for depression and anxiety. There are so many good drugs that are available super cheap (Walmart's $4 stuff), so I don't get why doctors don't start there without having a really good reason.

 

[OldPsychDoc]

Just read this today and was thinking about the private pcp's I just worked with who used lexapro as their go to drug for depression and anxiety. There are so many good drugs that are available super cheap (Walmart's $4 stuff), so I don't get why doctors don't start there without having a really good reason.

Lots of good reasons!

1) Lexapro's "free" in my sample cabinet--plus that hot rep gave me some attention and brought me a latte and scone this morning.

2) Prozac sounds scary. Didn't people commit murders on that?

3) Celexa? Sounds sissy.

4) Paxil messed up my wife's orgasms and made her fat.

5) The Zoloft rep stopped coming by when it went generic. (Gosh it's been a long time since I had chinese...I wonder if the Wyeth rep would bring some...)

 

[chameleonknight]

Lots of good reasons!

4) Paxil messed up my wife's orgasms and made her fat.

That one is probably true!

 

[whopper]

Why someone would consider Paxil as a first line over the SSRIs I do not know.
There's enough data out there showing is has a significantly higher amount of side effects vs the other SSRIs.

I remember I had a patient with schizoaffective disorder bipolar type, who was stabilized on Geodon & Lexapro (this was before the $4 generic days). This patient specifically mentioned she did not want to gain weight and to please put her on meds where this was not a problem. I discharged her and her outpatient psychiatrist put her on Zyprexa and Paxil.

I called up that attending and asked her why she put her on 2 meds which are known to cause significant weight gain. Her answer? "That's what I put all my patients on."

 

[kugel]

Why someone would consider Paxil as a first line over the SSRIs I do not know.

Whopper,
We know you meant,
"Why someone would consider Paxil as a first line over the OTHER SSRI's I do not know."

OPD,
Really? A Latte and a scone?
I thought you'd be a higher priced wh.....
I mean, "morally challenged person."

 

[whopper]

first line over the OTHER SSRI's I do not know."

I type too fast, and in a stream of thought manner. I often do not see the errors in my typing until at least several minutes after I type. Sorry, and thanks for the correction.

 

[OldPsychDoc]

Whopper,
We know you meant,
"Why someone would consider Paxil as a first line over the OTHER SSRI's I do not know."

OPD,
Really? A Latte and a scone?
I thought you'd be a higher priced wh.....
I mean, "morally challenged person."

Just to clarify, the posted "reasons" above were listed as a window into the hypothetical thought process of a physician who might actually prescribe Lexapro...so are not indicative of my daily practice style. I operate in a (thankfully) Drug Rep Free environment. However, I would probably sell my soul for a decent dark roast most days, so as they say, "now we're just haggling about the price"...

 

[whopper]

I forgot to mention that the above patient, I discharged her stable, and the reason why I called her outpatient doctor was because she showed up back in inpatient about 6 months later and 100 lbs heavier.

She told me that she asked her outpatient doctor several times to put her back on what she was on before (Lexapro and Geodon), but that attending didn't listen to her. She didn't have the opportunity to get another psychiatrist in a timely manner because of the shortage of psychiatrists.

She eventually became non-compliant and ended up back in inpatient. When I noticed the 100 lb weight gain, remembered she specifically demanded to be put on metabolically neutral meds, and that she was stable on a metabollically neutral regimen, and her family backing her up, that's when I decided to call her outpatient doctor to hear that doctor's end.

Several patients with these types of stories, well often times we psychiatrists think they are minimizing or distorting the story, often times they are. However, after 4 years of residency in the south Jersey area, and hearing the umpteenth story where this same attending did several similar acts, and seeing her work quite often (no she wasn't a teaching attending in my program, but one of the few psychiatrists we could work with in discharging patients because of the shortage of psychiatrists), in hindsight I think that patient was telling the truth.

When that attending told me she put her on Zyprexa and Paxil because that's what she did with all her patients, that pretty much IMHO was an admission she didn't know her psychopharmacology. Any monkey can throw an antidepressant to someone who's depressed, an antipsychotic to anyone who's psychotic or a mood stabilizer at anyone manic. Does someone really have to spend 12 years of higher education to attain that level (or lack thereof) of mastery? Any of the bachelor's level mental health workers IMHO could do that, actually IMHO I think someone with a high school education could.

That's why I sometimes mention that the shortage of psychiatrists is good for our wallets, but causes other problems we and our patients have to deal with. That specific psychiatrist had a very lucrative private practice doing IMHO "monkey" level psychiatry.