How Expert is Your Psychiatrist/Psychopharmacologist?

I am often asked how one may tell if one’s doctor is truly an expert when it comes to the practice of psychopharmacology. By asking a few questions it is possible to see to what extent one’s doctor most closely resembles a medical student, a psychiatric resident, or anexpert psychopharmacologist. Here are four test questions and typical answers:

1. What is the highest dose of Prozac that you have ever prescribed?

Med Student: 20 or 40 mg/day.

Psych Resident: 60 or 80 mg/day.

Expert: 100 mg/day or higher.

2. How often have you prescribed a monoamine oxidase inhibitor along with a tricyclic antidepressant?

Med Student: Never! You kill people that way.

Psych Resident: Never, I hear that one can do that, but I have never done it.

Expert: Occasionally. Every once in a while such a combination is very useful.

3. How often have you used levetiracetam (Keppra) or zonisamide (Zonegran) for the treatment of people with hard to treat mood problems?

Med Student: Never. Aren’t those anticonvulsants?

Psych Resident: Never. I hear some people are using those to treat people with hard to treat mood disorders, but I have not used them as yet.

Expert: I have prescribed one or both of those for a few people with hard to treat mood disorders.

4. Do you ever prescribe Dexedrine, Mirapex, Ritalin, Periactin, pergolide or bromocriptine along with SSRIs?

Med Student: No . . . why would I want to do that?

Psych Resident: No . . . but I hear they can be useful to counteract some of the side effects.

Expert: Yes . . . they can be quite helpful to control some of the side effects, or potentiate the antidepressant activity.