Thread by @Altostrata

@DrFulli @lapsyrevoltee I do agree, Dr. Fulli. Response to the drug most certainly is not a diagnosis, & those physicians who conclude an adverse reaction to an #antidepressant is diagnostic of bipolar disorder not only have poor pharmacology knowledge but poor logical skills as well. /1

@DrFulli @lapsyrevoltee Even people with no pre-existing #psychiatric symptoms may have a severe adverse reaction to an #antidepressant or any other psychotropic.

Conversely, any psychotropic might relieve "depression" in someone, eg. amphetamines or opiates. This is another law of psychotropics. /2

@DrFulli @lapsyrevoltee For what it's worth, I have a collection of case studies where people had immediate severe adverse reactions to #antidepressants & even though they quit within a handful of doses, suffered symptoms identical to post-acute withdrawal syndrome #PAWS for months or years. /3

@DrFulli @lapsyrevoltee A severe adverse reaction causes neurobiological upset, not drug-induced unmasking or emergence of a #psychiatric disorder. CBT or other psychotherapies may or may not be helpful -- everybody can use some psychotherapeutic support, that's not diagnostic of disorder, either. /4

@DrFulli @lapsyrevoltee #Psychiatry has long suffered from denial or ignorance of fundamental pharmacological laws of psychotropics, i.e. adaptation->dependence->tolerance->withdrawal, idiosyncratic response & adverse reaction patterns, & post-discontinuation imprint of drug on nervous system. /5

@DrFulli @lapsyrevoltee Categorization of drugs as #antidepressant or #antipsychotic, anxiolytic, etc. is arbitrary, as can be seen by promiscuous prescription of #psychiatric drugs in the US, often with unproven polypharmacy or prescription cascades intended to mask adverse effects of prior drugs. /6

@DrFulli @lapsyrevoltee Not only is response or reaction to drugs not diagnostic of #psychiatric disorder, their application to various "illness" is also arbitrary & actually experimental in every individual case, as most prescribers will admit. Mixing & matching #psychotropics is considered "art". /7

@DrFulli @lapsyrevoltee In #psychiatric treatment, mixing & matching #psychotropics is considered "art", with success defined as when the patient stops complaining. Adverse effects are not considered mistakes but challenges for more "art". Ultimately, patient is blamed for "treatment resistance". /8

@DrFulli @lapsyrevoltee In addiction medicine, repeated adverse reactions are recognized as introducing neurological vulnerability i.e. #kindling, while in #psychiatry, persistent deleterious effects of repeated adverse reactions not considered. This is another aspect of pharmacological ignorance. /9

@DrFulli @lapsyrevoltee Again, CBT or other psychotherapeutic treatment may or may not help a patient traumatized pharmacologically & psychologically after going through the mill of severe adverse reactions, repeated drug trials, & burden of polypharmacy so common in #psychiatric treatment. /10

@DrFulli @lapsyrevoltee #Psychiatry in practice has a lot of room for improvement, & better understanding of the drugs utilized by this specialty supposedly expert in psychopharmacology is definitely one of those areas requiring improvement. Ignorance of the laws of psychotropics is inexcusable. /11

@DrFulli @lapsyrevoltee You asked for my opinion -- there it is. You're welcome!

@threadreaderapp please unroll.