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 aÂ medical student, aÂ 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:Â 20 or 40 mg/day.
Psych Resident:Â 60 or 80 mg/day.
Expert:Â 100 mg/day or higher.
2. How often have you prescribed a monoamine oxidase inhibitor along with a tricyclic antidepressant?
Med Student:Â Never! You kill people that way.
Psych Resident:Â Never, I hear that one can do that, but I have never done it.
Expert:Â 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:Â Never. Aren’t those anticonvulsants?
Psych Resident:Â 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:Â 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:Â No . . . why would I want to do that?
Psych Resident:Â No . . . but I hear they can be useful to counteract some of the side effects.
Expert:Â Yes . . . they can be quite helpful to control some of the side effects, or potentiate the antidepressant activity.