How many prescription or over-the-counter medications do you currently take? Go ahead, look in the medicine cabinet, your nightstand, or wherever else you may keep medications. I’ll wait. And please don’t forget supplements and aspirin.

According to a report from the Health Policy Institute of Georgetown University, “more than 131 million people — 66% of all adults in the United States — use prescription drugs. Utilization is particularly high for older people and those with chronic conditions.” The percentage may be higher now because the report is a few years old.

What is the annual cost of prescription drugs currently? Up until 1998, it was $73 billion yearly. With the rising increase of direct-to-consumer advertising on television, we can imagine that the number has increased substantially because consumers are now being told to “ask your doctor” for these new and usually expensive medications.

A note is necessary here. Expensive or doesn’t necessarily mean more effective, nor does it mean medications without serious and sometimes fatal side effects. And saying “more hospitals use…” than another med may only mean they get a price break.

But if you are an individual with a chronic condition, it would not be unusual for you to receive more than one drug to take at a time. Individuals with medical conditions such as diabetes are naturally seeking products that will relieve them of the need to self-inject daily. But we also know that individuals with diabetes may have several accompanying medical conditions that the disease brings with it. For these additional medical conditions, patients with diabetes may need medications for many illnesses such as in their eyes, their heart, and other organ systems of their bodies.

The Health Policy Institute also indicated that “three-quarters of those age 52–64 use prescription drugs compared to 91% of those 80 and older. The need for prescription drugs increases with age, and older adults may take up to 22 medications.” Herein lies another of the unsolved medical mysteries; what does taking that many medications do to someone’s body, and is it safe? Yes, I’m also referring to prescription medications.

Not only do older adults take many more medications (how many are treated by geriatric specialists?), but they pay much more for their medications, especially if their expenditures are out-of-pocket ones. And we know that since the FDA approved DTC, there has been an appreciative increase in pharmaceutical sales. Does medical patients’ insistence on being prescribed medications they’ve seen on TV result in better care? We don’t know. But we do know it drives up sales.

“In a decade and a half, the use of prescription medication went up 71 percent. This has added about $180 billion to our medical spending.” But this begs the questions I posed earlier; are we healthier, and do we know what we’re taking?

The medical community had given the era of polypharmacy a black eye because no one knew what the mixture of all those meds did in the body, much less the brain. Now, it is coming back into the armamentarium for treating disease. But the risks remain, and one is that some medications can break down into many metabolites that would have unknown interactions with other metabolites. Yes, specialized computer programs at pharmacies may flag some med-med combinations, but do they get all that are problematic?

If a medication has an inordinate number of known side effects, how is that coming happening? What action is resulting from the medication, perhaps one not wanted by the prescriber? How would anyone with basic medical knowledge be able to assess, other than behaviorally, what is happening? I’m not demeaning healthcare professionals, but some questions require answers.

One area where we see polypharmacy again is in psychiatry. I know of a man who has crippling panic attacks every day. His psychiatrist is prescribing Klonopin, Buspar, Gabapentin, and Cymbalta, and he’s still experiencing panic attacks. Now he is seeking relief from TMS.

TMS is a non-invasive treatment that can prompt brain networks to improve their interactions and resolve depression and, possibly, anxiety. Some patients have shown improvement, but not all. So what’s happening with the patients who aren’t responding well to the treatment? And what of the medications patients are taking while they’re receiving TMS? I would suppose that might exclude some patients.

The moral of the story, if this is a story, is we have a long way to go in terms of medications, and I am hopeful that artificial intelligence can prove to be the helper we desperately need. In the meantime, all of us need to keep up on our medications and the potential for problems.

Our healthcare providers may occasionally make slip-ups like the cardiologist who forgot to prescribe potassium required with one drug. Another was an endocrinologist who prescribed a med that required patients have a urinalysis prior to taking the med. He forgot to get one.

The post What Do Any of Us Know About Polypharmacy – Should We Know More? appeared first on Medika Life.

“One day, I made a remark that I might work with people with mental illness, and somebody in the press heard it, and it was in the paper. And the more I thought about it and found out about it, the more I thought it was just a terrible situation with no attention. And I’ve been working on it ever since.”

Mental illness is a hidden scourge that attacks far too many people, especially those who have schizophrenia. It grinds down people’s dignity, throws their lives into disarray, and leaves them vulnerable to misunderstanding and derision even by mental health professionals.

Too often, I have heard patients belittled by staff, including psychiatrists, who threatened them with forceable IM medication or seclusion and restraint because “you aren’t taking your medication.” When the patient pleaded that they were medication compliant, they were viewed as liars. Coercion is not unusual in some settings.

“If you were taking your medication, you wouldn’t be having symptoms now,” was the retort. But they were taking their medication. The problem was that the professionals hadn’t caught up with genetic research in their field. Ok, it wasn’t as advanced then as it is now.

Then began a seemingly endless process of prescribing serial meds or, on the other hand, polypharmacy which returned to favor after years of disrepute. Washout of meds was ignored as a new med was added in place of the existing one.

My quandary was how spectacular someone would have to be at biochemistry to know the interactions of all those metabolites in the brain. Too many patients developed tardive dyskinesia (TD), which never resolved. The symptoms of TD were hidden by prescribing yet more medications.

A Change in Understanding

The dark days of psychiatry, I would hope, are behind us, but I can’t say that definitively. Some serve as psychiatrists who had their medical residencies and experience in pediatrics, cardiology, and other unrelated specialties. I say this because I’ve seen it first-hand. At least one man failed the psychiatry boards three times and then gave up on them.

The dawn of medical understanding regarding the role of genetics has come, and with it, a new appreciation for what works and what doesn’t. Are patients still blamed when a med doesn’t work? Possibly.

“Pharmacogenomics is the branch of pharmacology which deals with the influence of genetic variation on drug response in patients by correlating gene expression or single-nucleotide polymorphisms with a drug’s efficacy or toxicity.”

Psychiatry has gained sophistication in the knowledge of drug-patient interaction, but not everyone in the field has kept up. Such a failure can only mean more patient blaming.

Movement in the direction of consideration of genetic differences leading to medication inefficacy has begun.

Individual Differences Are the Key

“Pharmacotherapy is one of the primary treatments for psychiatric disorders. Given the variation in individual responses, a more personalized approach is needed. This paper will discuss methods for user-friendly referrals, recruitment criteria, data storage and dissemination, biological sample and clinical questionnaire collection, and advertising.”

The suggestion of biological sampling has begun at how many sites, practices or hospitals? Has anyone provided research to determine this and, if not, why is this gap in the literature permitted to exist? Is patient-blaming too easy?

Undoubtedly, the tests take time and funding, and the metabolic difficulties presented by cytochrome P450 which is always a consideration. But there is literature pointing toward the importance of this research.

“It has gradually been demonstrated that genetic differences in ion channels reflect differences in the distribution of polymorphic traits, such as disease susceptibility and drug efficacy…”

This approach to evaluating psychotropic medications’ efficacy has been further underscored in additional portions of the medical literature.

“For most psychiatric diseases, pathogenetic concepts as well as paradigms underlying neuropsychopharmacologic approaches currently revolve around neurotransmitters such as dopamine, serotonin, and norepinephrine…the effectiveness of these medications is limited, and relapse rates in psychiatric diseases are relatively high, indicating potential involvement of other pathogenetic pathways…”

Absolving the Patient From Blame

How can patients with psychiatric or any other illnesses be viewed as non-compliant with their medical regimes when there is a persistent failure to investigate how their race and genetics are affecting treatment? The answer is obvious, and the blaming must stop. How can we treat patients when this type of neglect persists in the face of overwhelming evidence that is being ignored?

One example that might be remediated if psychiatric treatment were fully compliant with recommended protocols would be homelessness. If patients’ illness can be brought under control, would they choose to live and die on the streets and remain resistant?

The post Blaming the Psychiatric Patient When It’s a Drug-Genetic Interaction appeared first on Medika Life.