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Comment by PragmaticPulp | Hacker News Reader

Comments like these are baffling. Where are people finding these psychiatrists who are blindly writing prescriptions and sending people out the door?

Around here (US location) my medical professional friends are all hesitant to prescribe any controlled substances to more than a certain number of their patients for fear of getting flagged.

Whenever I read these stories of people receiving benzos and other scheduled substances for years with no oversight, I can’t tell if this is actually happening regularly somewhere or if we’re just reading a lot of exaggerated second-hand stories.

I know these things happen somewhere, sometimes but the insinuation that it’s just the norm in American medicine is baffling.

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I'm completely with you. In my personal experience doctors are extremely hesitant to prescribe these drugs.

I saw multiple doctors for years about anxiety issues and the most I got prescribed was an antihistamine. I also suffer from chronic back pain due to a genetic issue and it's been pretty much impossible for me to get a prescription that does anything for it.

I don't think people are lying about their experiences, I'm just baffled as to where this is going on because it's been totally opposite to my experiences.

I have a suspicion that many people who are getting these long-term benzo prescriptions aren’t just going to a random doctor and walking out with huge prescriptions. I think the vast majority of doctors wouldn’t dare risk their job or career like this.

I suspect there’s a lot of word of mouth references where patients are telling their friends which doctors prescribe which medications and giving guidance about what to say to get those prescriptions. This was definitely the case in the early opioid crisis years where the bulk of prescriptions were coming from a small number of doctors.

If those doctors were outliers, it would have been very simple and quick to detect the anomalies. And, I went to a random doctor, twice in the last couple of years, both prescribed me SSRIs including two psychotic substances. I have been fine without taking them. Anecdotal, but perhaps it attenuates your suspicions, mine is that it's pretty generalised.

SSRIs are actually a very appropriate treatment for anxiety and depression disorders over the long term.

It’s benzodiazepines that are the problem. These should be reserved for short-term use in extraordinary circumstances, but a small number of doctors seem to hand them out too aggressively.

SSRIs and benzos are in entirely different risk categories. That’s why benzos are controlled substances and SSRIs are not.

The job of psychiatrists in the US is in large part diagnosis and prescriptions, at least when it comes to the more routine mental health conditions.

If therapy is part of the treatment plan, they're often referred down to a psychologist or therapist for that part of things. A psychiatrist can do therapy....but their hourly rate is a whole lot higher.

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As to personal experience, my current psych (ADHD), requires a ~15min "medication management" session about 4x a year. It's not exactly a ton of oversight.

The couple previous psychiatrists I've had when I lived in other places were about the same way once we got past the initial phase.

It is worth noting that my prescription (+ it's effectiveness) has been generally steady for a long time and I don't exactly have a profile in terms of age/dosage/history that suggests abuse risk.

That’s actually fine. If you’re stable and have a long history of that stability with a provider, you don’t need to be forced into in-depth high-frequency analysis.

You could always request a more in-depth conversation if necessary.

Benzos are a completely different scenario because, unlike your ADHD medication, they’re not indicated for long-term use except in extraordinary circumstances. They can’t be compared to your long-term ADHD prescriptions.

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