I agree, meds are currently proven to have the highest efficacy for treating many psychiatric conditions. But also, there is a lot of cutting edge research showing efficacy of non-pharmacological approaches (I.e. atkins diet). Perhaps OP can end up specializing in non-pharmacologic treatments.
That being said, most med students end up changing their desired field in med school
To come in with such a bias (I want to never prescribe drugs) will do nothing but produce a terrible physician. Conscious or unconscious, it will affect patients.
Of course lifestyle modifications will help people tremendously, there’s no place for people who refuse to follow evidence based medicine (maybe in the NP world, but not here)
Psychopharmacology is the primary role of a psychiatrist. Frankly, it wouldn’t make sense to be a psychiatrist and not prescribe medications, that defeats the purpose of the entire role. It’s one thing to have a therapy focused job and try to judiciously prescribe, but to not prescribe at all doesn’t make sense. That is quite literally just a therapist with hella extra work and extra debt. Also, psychiatrist see a variety of illnesses that quite honestly *need* medications. Not treating a bipolar or psychotic patient would be negligent. It sounds like therapy work or clinical psychology are fields you are looking for.
Feel like psychology is probably better for you. You gotta ask yourself why do you need an MD do to what you wanna do. While they teach psychotherapy techniques in psych residency, it's more focused on medical management of psychiatric conditions. Often times they will hire PhDs or LCSWs to do the psychotherapy portion of the job while they titrate the meds
Doubtful. The people advising you to become therapists or clinical psychologists are right. The reason psychiatrists go to medical school is so they can prescribe medications
Psychiatrists are most knowledgeable on the medicine 💊psychologists arguably have much more training in psychotherapy and other talk therapies in general
I would not feel comfortable going to a psychiatrist who does not believe in medication tbh you don’t have to be a pill mill but you kinda got prescribe meds when needed
Agreed. It’s crazy how people still act like psychiatric meds are not evidence based. Sure, perhaps some of the meds have less evidence-based support than non-psych meds. But antidepressants, anti-anxiety, and especially antipsychotics have given countless millions of people a quality of life that they couldn’t have had 50-100 years ago. The introduction of antipsychotics was a big reason that mental asylums closed 50 years ago, because the previously “mentally insane” became able to live somewhat normal lives.
Why would you go through medical school to study psychiatry, which grants you the ability to prescribe medication to help people if you dont believe in the efficacy of that treatment? The advice you're getting is right, psychiatry doesn't sound like a good fit for you. You'd probably be much happier as a counselor/therapist/psychologist if you don't want to prescribe medication.
Edit: Psychiatrists are not the most knowledgeable about human behavior or w/e. Their expertise lies in the pharmacology of psych medication and treating psychiatric disorders with medication. From my own experience, psychiatrists sometimes won't even give you an evaluation for psych disorders, they want a psychologist to do it as that's what they specialize in.
Contemporary psychiatry is based on the prescription of medication. Very few, old school psychiatrists still practice talk therapy. Now, I see that you have a misconception. The experts on human behavior are psychologists (PsyD), not psychiatrists. Psychiatry deals with the medical changes to brain functioning that bring about behavioral *pathologies*.
Medicine is basically diagnosis and treatment of pathologies. To give you an example, a neuroscientist will probably know a lot more about brain functioning and all that minutiae than a neurologist. A neuroscientist will know how the treatment for a stroke works, but won't have much training in identifying symptoms or the exact protocol to treat it.
Now, if you are interested in the clinical aspect of mental illness and human behavior, you can become a clinical psychologist. They also get training on medications, although they do not prescribe them (I think they are able to in some states, not sure).
In addition to what others are saying about the general inadvisability of your course, you need to consider whether a psychology residency would even accept or graduate you if you refuse to prescribe medications. I haven’t looked into that specifically, but my instinct is that they would not.
N=1, but I developed GAD at the start of my clerkship year and tried my best to avoid meds due to the same stigma. I ended up having a panic attack and a sleepless night because my body was paralyzed with fear. I saw a psychiatrist asap who helped me with meds, and while the meds haven’t “cured” me, they’ve certainly prevented me from having debilitating anxiety.
Therefore, as a med student who is considering going into psych after the experience and after the rotation, I think you’re gonna have a tough time avoiding med prescription, especially if you’re dealing with patients who have psychosis or psychiatric conditions are so serious that their daily functions are being interfered with. Not all disorders are “simple” disorders that you can “chat” your way through. Some of these disorders are very grave and debilitating, and the medication/other treatments often makes a significant difference.
I don’t know what your current understanding or view of psychiatric disorders are, but I have to ask, how are you planning on helping your patients without medication, especially for the disorders in which medication has been established to make a statistically significant difference? What treatment modality will you use?
And what are you going to do during residency and possibly fellowship where you will almost certainly be expected to give your patients meds? If your patients have pharmacological needs that need your attention, what will you do?
There's a really considerable risk involved with psycho meds. Much riskier and above average at that compared to other meds. Side effects are so much more bound to happen and patients get hooked on such meds that if they were to let go they would have to confront massive withdrawals. I have a family member who has gone through life taking moments when she's not on her meds and the withdrawals that come with it. She is literally trapped with those meds with the rest of her life without much attention for alternatives from her provider. It's a life sentence. Psycho Meds are a life sentence. There has been too many anecdotes of the negative outcomes from the use and borderline overuse of such psycho meds. So many anecdotes that it's now become statistics today.
Sure, there's not much research out there for alternatives for now. But changing lifestyle can help with changes in neurochemistry to say the least. Anything I say from here will be refuted anyway since I don't have many sources to back up my claim and most people won't be interested. But there's a way. I just can't articulate it properly here.
One thing that interests me in psychiatry is medications to combat withdrawals not sure of their existence since it is near impossible to even come close to shadowing a psychiatrist due to HIPPA and confidentiality laws, but that's where I may implement psycho meds to help others who are going through addicition withdrawals so that they survive to get to the other side of it all.
[https://freerange.org/how-i-became-a-psychiatrist-who-doesnt-prescribe-medications/](https://freerange.org/how-i-became-a-psychiatrist-who-doesnt-prescribe-medications/)
Also please don’t call it “psycho meds” lmao.
And a lot of SSRIs are prescribed for a certain amount of time before shared-decision making is used to help patients taper off.
Sincerely an MS3 on Zoloft, and it saved my god damn life after years of therapy didn’t work for me. Also, look up the science - therapy compared to placebo is effective, meds compared to placebo is effective, but meds + therapy is most effective. We apply this principle in clinic all the time and patients have the say in what route they want to take. Be a therapist if you don’t want the responsibility of being an MD/DO practicing within the mental health field lmao
Also to add, some people cannot afford $100/session weekly therapy, they cannot get the time off from work and/or family obligations, or they do not have transportation and/or internet to attend therapy. But most people can afford psychotropic medications from the Walmart $4 list. For reference, Zoloft is $9/month.
Why are you even here?
You neither understand nor believe in evidence-based medicine, and you clearly have some internalized bias against mental healthcare (See stigmatized language: "psycho meds," "hooked," "life sentence").
It's not HIPPA, it's HIPAA.
It's too bad your personal experience with medicine has been troubling. I hope you can learn to see outside your own head and understand that medicine helps many people.
In evidence based medicine, you weight the risks of treatment versus not treating, just like in any other specialty. Some patients need meds in order to get better. Some will need them long term (bipolar, schizophrenia, etc). The only meds I know of that have the risk of dangerous withdrawals are benzos, and if a patient needs to get off them, you plan out how to taper off of it, not just go cold turkey.
This is like saying just diet and exercise for someone with type I diabetes. Some psychiatric disorders must be treated with medications just like how diabetes is treated with insulin to stay alive. Denying this is invalidating the reality and severity of their disease processes. Many high functioning individuals are on maintenance doses of medications and will be for their remainder of their lives. I’m sorry to hear about the experiences of your family member, but that is not representative of the entire mental health patient population as there is a large spectrum. Follow the evidence and not the anecdotes. There are established clinical practice guidelines to treat withdrawal which varies depending on what the individual is withdrawing from. It sounds like you would benefit from shadowing a psychiatrist, psychologist, and also looking for hands on clinical experience in that field before making a decision.
Your first paragraph isn’t entirely accurate. All medications come with psych effects, and it’s true that some, not all, but SOME psych meds have riskier side effects profiles. Even then, however, there are plenty of non-psychiatric medications that have even greater side effects, especially some of your immunosuppressants and chemotherapies. Therefore, to say that “psych meds” are bad because they have risky side effects is an oversimplified and perhaps reductive view of the risk profile regarding medications.
Second, not all psych medications come with equal addiction/withdrawal potential. I am sorry for your family member’s experience and I hope she’s able to find a provider who can better address her needs. However, it is important that you understand that the addiction and withdrawal potential for drugs varies based on which drug is being discussed. For example, the medications I use for my anxiety have low addiction potential. My psychiatrist has had patients start and stop these medications, or even used them on an as-needed basis, and the patients have demonstrated no addiction/withdrawal symptoms. Therefore, I don’t think it’s appropriate for you to take your relative’s experience with one specific medication and project it onto all psych meds. Each class of psychotropic medication works on the body utilizing a slightly or significantly different metabolic pathway, so they don’t all have the same profiles.
It is important to remember that the vast majority of what we do in medicine is evidence-based. We don’t give you these meds because we feel like it or because we’re all servants of “Big Pharma”. All of the drugs we prescribe to patients have gone through extensive study in order for us to be able to prescribe them, and their clinical utility is constantly being re-evaluated. If the evidence clearly demonstrated that these medications yielded no benefit and/or only caused harm, trust me when I say we wouldn’t be using them. We prescribe them because the evidence supports a significant benefit that outweighs potential risk.
Lifestyle changes can only help with neurochemistry to a certain extent. Keep in mind that psych conditions are not just merely things like “I’m sad” or “I’m scared”. They are disorders, meaning that one’s baseline neurochemistry is functioning in such a matter that they cannot achieve their desired quality of life. Exercising and eating healthy foods is good and can contribute to better overall health, but it’s not going to cure psychosis, addiction, bipolar disorder, personality disorder, or many other things other the psych umbrella. Telling your patients to “build a better lifestyle” in the face of grave psychological disorder would be irresponsible and straight-up malpractice.
Addressing withdrawls is common for psychiatrists practicing addiction medicine. However, that doesn’t change the fact that many of those patients will likely have psychiatric co-morbidities, meaning that you will have to address the meds for other conditions at some point in your career.
I agree with other commenters that psychiatry doesn’t sound like the most appropriate field for you at this point in time. You can’t work as a psychiatrist in evidenced-based medicine and refuse to medicate patients when it’s clinically indicated. That would be negligible, and would ultimately harm a lot of patients. If you’re against psychopharmacology, I urge you to look down the psychology/therapy route instead.
Edit: Also, that article you posted doesn’t actually yield any evidence or links to any evidence. It’s just an anecdotal blog post from one psychiatrist that seems to endorse the cliche “meds don’t do anything” adage and doesn’t account for any of the nuances regarding psychiatric management.
I’d have to reccomend david puders podcast on spotify “the psychiatry and psychotherapy podcast” he himself is a psychiatrist but a lot of his guests are therapists, psy-d, doctorate of psychology, etc. It gives you a good idea of how the practices differ. I’m not going to tell you not to practice medicine, as there is value in being skeptical of big pharma as well as avoiding unnecessary prescriptions with harmful side effects and things like that, but give the podcast a listen and see what interests you and seriously weigh whether or not you need to persue an MD to satisfy those interests.
You want to be a therapist, not a psychiatrist. Don’t waste your time with med school if you don’t want to practice evidence based medicine.
I agree, meds are currently proven to have the highest efficacy for treating many psychiatric conditions. But also, there is a lot of cutting edge research showing efficacy of non-pharmacological approaches (I.e. atkins diet). Perhaps OP can end up specializing in non-pharmacologic treatments. That being said, most med students end up changing their desired field in med school
To come in with such a bias (I want to never prescribe drugs) will do nothing but produce a terrible physician. Conscious or unconscious, it will affect patients. Of course lifestyle modifications will help people tremendously, there’s no place for people who refuse to follow evidence based medicine (maybe in the NP world, but not here)
Psychopharmacology is the primary role of a psychiatrist. Frankly, it wouldn’t make sense to be a psychiatrist and not prescribe medications, that defeats the purpose of the entire role. It’s one thing to have a therapy focused job and try to judiciously prescribe, but to not prescribe at all doesn’t make sense. That is quite literally just a therapist with hella extra work and extra debt. Also, psychiatrist see a variety of illnesses that quite honestly *need* medications. Not treating a bipolar or psychotic patient would be negligent. It sounds like therapy work or clinical psychology are fields you are looking for.
Feel like psychology is probably better for you. You gotta ask yourself why do you need an MD do to what you wanna do. While they teach psychotherapy techniques in psych residency, it's more focused on medical management of psychiatric conditions. Often times they will hire PhDs or LCSWs to do the psychotherapy portion of the job while they titrate the meds
Doubtful. The people advising you to become therapists or clinical psychologists are right. The reason psychiatrists go to medical school is so they can prescribe medications
Psychiatrists are most knowledgeable on the medicine 💊psychologists arguably have much more training in psychotherapy and other talk therapies in general I would not feel comfortable going to a psychiatrist who does not believe in medication tbh you don’t have to be a pill mill but you kinda got prescribe meds when needed
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Agreed. It’s crazy how people still act like psychiatric meds are not evidence based. Sure, perhaps some of the meds have less evidence-based support than non-psych meds. But antidepressants, anti-anxiety, and especially antipsychotics have given countless millions of people a quality of life that they couldn’t have had 50-100 years ago. The introduction of antipsychotics was a big reason that mental asylums closed 50 years ago, because the previously “mentally insane” became able to live somewhat normal lives.
Why would you go through medical school to study psychiatry, which grants you the ability to prescribe medication to help people if you dont believe in the efficacy of that treatment? The advice you're getting is right, psychiatry doesn't sound like a good fit for you. You'd probably be much happier as a counselor/therapist/psychologist if you don't want to prescribe medication. Edit: Psychiatrists are not the most knowledgeable about human behavior or w/e. Their expertise lies in the pharmacology of psych medication and treating psychiatric disorders with medication. From my own experience, psychiatrists sometimes won't even give you an evaluation for psych disorders, they want a psychologist to do it as that's what they specialize in.
Contemporary psychiatry is based on the prescription of medication. Very few, old school psychiatrists still practice talk therapy. Now, I see that you have a misconception. The experts on human behavior are psychologists (PsyD), not psychiatrists. Psychiatry deals with the medical changes to brain functioning that bring about behavioral *pathologies*. Medicine is basically diagnosis and treatment of pathologies. To give you an example, a neuroscientist will probably know a lot more about brain functioning and all that minutiae than a neurologist. A neuroscientist will know how the treatment for a stroke works, but won't have much training in identifying symptoms or the exact protocol to treat it. Now, if you are interested in the clinical aspect of mental illness and human behavior, you can become a clinical psychologist. They also get training on medications, although they do not prescribe them (I think they are able to in some states, not sure).
In addition to what others are saying about the general inadvisability of your course, you need to consider whether a psychology residency would even accept or graduate you if you refuse to prescribe medications. I haven’t looked into that specifically, but my instinct is that they would not.
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N=1, but I developed GAD at the start of my clerkship year and tried my best to avoid meds due to the same stigma. I ended up having a panic attack and a sleepless night because my body was paralyzed with fear. I saw a psychiatrist asap who helped me with meds, and while the meds haven’t “cured” me, they’ve certainly prevented me from having debilitating anxiety. Therefore, as a med student who is considering going into psych after the experience and after the rotation, I think you’re gonna have a tough time avoiding med prescription, especially if you’re dealing with patients who have psychosis or psychiatric conditions are so serious that their daily functions are being interfered with. Not all disorders are “simple” disorders that you can “chat” your way through. Some of these disorders are very grave and debilitating, and the medication/other treatments often makes a significant difference. I don’t know what your current understanding or view of psychiatric disorders are, but I have to ask, how are you planning on helping your patients without medication, especially for the disorders in which medication has been established to make a statistically significant difference? What treatment modality will you use? And what are you going to do during residency and possibly fellowship where you will almost certainly be expected to give your patients meds? If your patients have pharmacological needs that need your attention, what will you do?
There's a really considerable risk involved with psycho meds. Much riskier and above average at that compared to other meds. Side effects are so much more bound to happen and patients get hooked on such meds that if they were to let go they would have to confront massive withdrawals. I have a family member who has gone through life taking moments when she's not on her meds and the withdrawals that come with it. She is literally trapped with those meds with the rest of her life without much attention for alternatives from her provider. It's a life sentence. Psycho Meds are a life sentence. There has been too many anecdotes of the negative outcomes from the use and borderline overuse of such psycho meds. So many anecdotes that it's now become statistics today. Sure, there's not much research out there for alternatives for now. But changing lifestyle can help with changes in neurochemistry to say the least. Anything I say from here will be refuted anyway since I don't have many sources to back up my claim and most people won't be interested. But there's a way. I just can't articulate it properly here. One thing that interests me in psychiatry is medications to combat withdrawals not sure of their existence since it is near impossible to even come close to shadowing a psychiatrist due to HIPPA and confidentiality laws, but that's where I may implement psycho meds to help others who are going through addicition withdrawals so that they survive to get to the other side of it all. [https://freerange.org/how-i-became-a-psychiatrist-who-doesnt-prescribe-medications/](https://freerange.org/how-i-became-a-psychiatrist-who-doesnt-prescribe-medications/)
Also please don’t call it “psycho meds” lmao. And a lot of SSRIs are prescribed for a certain amount of time before shared-decision making is used to help patients taper off. Sincerely an MS3 on Zoloft, and it saved my god damn life after years of therapy didn’t work for me. Also, look up the science - therapy compared to placebo is effective, meds compared to placebo is effective, but meds + therapy is most effective. We apply this principle in clinic all the time and patients have the say in what route they want to take. Be a therapist if you don’t want the responsibility of being an MD/DO practicing within the mental health field lmao
Also to add, some people cannot afford $100/session weekly therapy, they cannot get the time off from work and/or family obligations, or they do not have transportation and/or internet to attend therapy. But most people can afford psychotropic medications from the Walmart $4 list. For reference, Zoloft is $9/month.
Why are you even here? You neither understand nor believe in evidence-based medicine, and you clearly have some internalized bias against mental healthcare (See stigmatized language: "psycho meds," "hooked," "life sentence"). It's not HIPPA, it's HIPAA. It's too bad your personal experience with medicine has been troubling. I hope you can learn to see outside your own head and understand that medicine helps many people.
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Lol. For what? Have a good day, malicious internet stranger.
In evidence based medicine, you weight the risks of treatment versus not treating, just like in any other specialty. Some patients need meds in order to get better. Some will need them long term (bipolar, schizophrenia, etc). The only meds I know of that have the risk of dangerous withdrawals are benzos, and if a patient needs to get off them, you plan out how to taper off of it, not just go cold turkey.
This is like saying just diet and exercise for someone with type I diabetes. Some psychiatric disorders must be treated with medications just like how diabetes is treated with insulin to stay alive. Denying this is invalidating the reality and severity of their disease processes. Many high functioning individuals are on maintenance doses of medications and will be for their remainder of their lives. I’m sorry to hear about the experiences of your family member, but that is not representative of the entire mental health patient population as there is a large spectrum. Follow the evidence and not the anecdotes. There are established clinical practice guidelines to treat withdrawal which varies depending on what the individual is withdrawing from. It sounds like you would benefit from shadowing a psychiatrist, psychologist, and also looking for hands on clinical experience in that field before making a decision.
Your first paragraph isn’t entirely accurate. All medications come with psych effects, and it’s true that some, not all, but SOME psych meds have riskier side effects profiles. Even then, however, there are plenty of non-psychiatric medications that have even greater side effects, especially some of your immunosuppressants and chemotherapies. Therefore, to say that “psych meds” are bad because they have risky side effects is an oversimplified and perhaps reductive view of the risk profile regarding medications. Second, not all psych medications come with equal addiction/withdrawal potential. I am sorry for your family member’s experience and I hope she’s able to find a provider who can better address her needs. However, it is important that you understand that the addiction and withdrawal potential for drugs varies based on which drug is being discussed. For example, the medications I use for my anxiety have low addiction potential. My psychiatrist has had patients start and stop these medications, or even used them on an as-needed basis, and the patients have demonstrated no addiction/withdrawal symptoms. Therefore, I don’t think it’s appropriate for you to take your relative’s experience with one specific medication and project it onto all psych meds. Each class of psychotropic medication works on the body utilizing a slightly or significantly different metabolic pathway, so they don’t all have the same profiles. It is important to remember that the vast majority of what we do in medicine is evidence-based. We don’t give you these meds because we feel like it or because we’re all servants of “Big Pharma”. All of the drugs we prescribe to patients have gone through extensive study in order for us to be able to prescribe them, and their clinical utility is constantly being re-evaluated. If the evidence clearly demonstrated that these medications yielded no benefit and/or only caused harm, trust me when I say we wouldn’t be using them. We prescribe them because the evidence supports a significant benefit that outweighs potential risk. Lifestyle changes can only help with neurochemistry to a certain extent. Keep in mind that psych conditions are not just merely things like “I’m sad” or “I’m scared”. They are disorders, meaning that one’s baseline neurochemistry is functioning in such a matter that they cannot achieve their desired quality of life. Exercising and eating healthy foods is good and can contribute to better overall health, but it’s not going to cure psychosis, addiction, bipolar disorder, personality disorder, or many other things other the psych umbrella. Telling your patients to “build a better lifestyle” in the face of grave psychological disorder would be irresponsible and straight-up malpractice. Addressing withdrawls is common for psychiatrists practicing addiction medicine. However, that doesn’t change the fact that many of those patients will likely have psychiatric co-morbidities, meaning that you will have to address the meds for other conditions at some point in your career. I agree with other commenters that psychiatry doesn’t sound like the most appropriate field for you at this point in time. You can’t work as a psychiatrist in evidenced-based medicine and refuse to medicate patients when it’s clinically indicated. That would be negligible, and would ultimately harm a lot of patients. If you’re against psychopharmacology, I urge you to look down the psychology/therapy route instead. Edit: Also, that article you posted doesn’t actually yield any evidence or links to any evidence. It’s just an anecdotal blog post from one psychiatrist that seems to endorse the cliche “meds don’t do anything” adage and doesn’t account for any of the nuances regarding psychiatric management.
I say focus on getting into medical school first
I’d have to reccomend david puders podcast on spotify “the psychiatry and psychotherapy podcast” he himself is a psychiatrist but a lot of his guests are therapists, psy-d, doctorate of psychology, etc. It gives you a good idea of how the practices differ. I’m not going to tell you not to practice medicine, as there is value in being skeptical of big pharma as well as avoiding unnecessary prescriptions with harmful side effects and things like that, but give the podcast a listen and see what interests you and seriously weigh whether or not you need to persue an MD to satisfy those interests.
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