Shirah Vollmer MD

The Musings of Dr. Vollmer

‘Nonessential Medications:” Another Rant

Posted by Dr. Vollmer on May 7, 2012

Teaching Primary Care Residents, I learn so much. I also get frustrated, angry, and fantasize about going on the rooftops to let others know of my unhappiness. “Sometimes, when a patient comes in the hospital, and we are not sure what is going on, we stop the SSRIs and all the nonessential medications to see what is going on with the patient,” an excellent, smart, hard-working resident says to me. “Who says the SSRI is nonessential?” I ask, thinking that no one is checking in with the patient to see if he feels their SSRI is “nonessential”. “Well, you know, it is not life and death,” he says, understanding my discontent. “No, it is usually not life or death, but it is quality of life, and this can determine if the patient is motivated to help himself get better,” I say, knowing that the resident does not need an education about the importance of SSRIs, but that he is reflecting back to me the feelings of the team-the medicine team, composed of interns, residents and attendings. “I am sorry,” I say, “but I think that behavior suggests a dismissiveness to mental health. I think that the team is believing that SSRIs are relatively trivial medications and so they can be stopped, similar to vitamins.” He agrees, but looks at me with some sense of regret for bringing this to my attention because he can see my upset. I wonder how to push through this arrogance, sometimes seen in primary care, where they believe that physical health trumps mental health, every time, as if they are not closely linked. Medicine, as a field, has a lot of room for growth. Openness, as with all growth, has to be the first step. For now, I am stuck.

7 Responses to “‘Nonessential Medications:” Another Rant”

  1. Jon said

    While I agree with your need to link the physical and mental health of a patient, I have some sympathy for the desire to the resident who wants “to see what is going on with the patient.” Getting a sense of what a system (the patient’s body, in this case) is doing without extraneous forcing functions has its merits. Can one consider selective serotonin reuptake inhibitors (SSRIs) to be considered an extraneous forcing function? The answer is probably individually dependent. However, if a patient has been prescribed such a drug, it is probably important for that patient’s mental health. The balance between physical and mental health to form a healthy person is tricky.

    • Hi Jon,
      We totally agree. The point of my post is only to consider that adjusting SSRIs is not a trivial matter and it needs to be thought about with the same seriousness as adjusting antihypertensives. “Nonessential” is a relative term. My sense is that their use of “nonessential” in the case of SSRIs, implies that they don’t understand how they help mental health issues. Thanks.

  2. Shelly said

    I understand your frustration and it’s precisely because of these attitudes and the stigma associated with taking medications for mental health issues thatost people do nit admit yo taking them, even to primary care doctors. Without admission of such, the residents would think that they were seeing their patients at their baseline (as they would be if they would be hospitalized without their SSRIs, etc…).

  3. jo said

    I wonder what the resident would consider ‘essential’. To me, that would determine whether he’s giving SSRI’s a fair shake or not (I’m guessing not). I’d also be concerned that they might stop SSRI’s cold-turkey and cause additional short-term health problems.

    • Hi Jo,
      Yes, indeed! Essential is a vague word, so I am guessing they are talking about life and death medications. Having said that, I doubt they stop the cholesterol medication, even though that is not a life and death medication. Yes, abrupt discontinuation of these medications can cause problems, as you suggest. Understanding the value of SSRIs is tricky or nuanced business, which takes some time and patience to comprehend. Thanks for your comments.

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