Re: SSRI's and med insurance

[Guest guest]

, my daughter was on quite a few, but never on that one.

Look it up in MedHealth online. It should help.

[Guest guest]

I have asked a few times with no response - does anyone know anything about

" Lamictol " ?

This is a new medication my daughter has been put on added to the ones she is

already taking: Inderol-Propranolol, Effexor XR and Trazadone.

SSRI's and med insurance

all the SSRI's work in very similar manner-BUT individual response

is the key. while some of the drug companies have gone to the

expense of having their SSRI " proved " to work for, say, PMS, or

social phobia, there, in fact is absolutely NO reason why that

particular SSRI should work any better than any other, on AVERAGE

for any of their indications.(it is so trial and error-each person

responds differently-one patient may have terrible nausea from

prozac, but none from paxil. some s/e are common to almost everyone.

and their is some predictability of ONE person's response to drugs

in the same " class " ) most ant-D(TCA, SSRI are CAITIONED in people

with hx of bipolar ds in their FAMILY, and usually NOT used if the

person themselves has had any bipolar episodes-usually one will

choose instead a mood stabilizer(tegretol, valproate-so as not to

risk causing mania-or worse, begin a rapid-cycling bipolar ds. that

may not be able to be stopped) " label use " is what

studies have indicated is a successful use for the drug; " off-label "

use-so much in the press lately, is using a drug WITHOUT a study,

but usually anecdotal evidence; studies are almost always funded by

the drug co. trying to " prove " and indication for their drug's

increased uses)-everyone uses several drugs " off label " -e.g.

tegretol and valproic acid-ONLY approved for seizures(used widely

for bipolar ds.) as well as the " new " panacea: neurontin-also

only " label " use is sz. here in NYC, ON THE RADIO, daily ads by

lawyers(i admit i HATE almost every malpractice lawyer, and lets not

forget made his fortune on malpractice-not usually

helping " the little guy " -but using " focus groups " so that he would

ONLY take the HIGHEST pay out cases-not the most worthy-he had a

minimum of 5 MILLION dollars or he wouldnt touch the case!) anyway-

they advertise for a class action suit against neurontin(average

lawyer fee for class action exceeds $5, 000 an hour of lawyer and

underling time-often exceeds $100, 000 an hour AND by the time all

the expenses are paid the defendents get less than 10% of the

award!)-so they are advertisinfg for all patients who feel they were

harmed by " off label " use of neurontin. a lottery win for anyone who

got a tummy ache. don't misunderstand , i am harder on " my own " than

anyone-i never looked the other way-felt being a doc a great

privelege and one that ABSOLUTELY required total devotion. if my dtr

had not have gotten so ill, i would have left practice last year

anyway- " the system " would NOT allow me time and resources to

practice to even my MINIMUM standards-and yes i could have practiced

the way i wanyted(actually my practice would have fired me b/c i

would not have made enough $, even with their taking 50% take, to

pay for my (tiny) office space-BUT i could NOT have practiced w/o

becoming bitter-next time anyone wonders, or becomes angry that

their child is not getting enough time-let me tell you from the

inside-most docs-under the BEST conditions " net " 20-50% of what is

billed-that " net " though is after ONLY office expenses NOT pension,

ongoing req. med education, lic. fees, DEA fees, hosp. fees, many,

many misc expenses and certainly NOT before payroll, medicare or the

almost 40% personal taxes. many doctors make too much and do too

little. as many do a LOT and make too little for their talent, their

devotion and their time. private psych. can charge $150--400 for an

initial appt and $50-125 for all f/u-and take only cash. that is

what i PAY. but most of us who take ins payment get $37-72 for an

initial hour eval and $7.00-35 for a 15-20 min follow-up. (in my

case the initail appt-b/c of my heavy emphasis on med/neuro

screening took 1-1.5 hours and included: patient interview,

interview w/family, speaking with pts current tx, speaking to any

med MD's if appropriate, reading thru OLD chart material, reading

pertinent med reports, writing up the report, prescribing if

appropriate and answering all Q. and i felt i was morally and

ethically as well as legally responsible for all. my f/u visits

included(before seeing the pt.: reading any new med reports, any tx

updates) then updating the patient's condition, responding to Q,

family Q, writing Rx, and writing up careful notes, recording

medication THEN reporting back to pts tx after i saw them. many ,esp

private MD-psych see from 4-8 patients an hour-how long do you think

it takes to do the RIGHT thing-as outlined. for an initial appt my

re-imbursement was between $35-75 dollars, 50% to practice, then

with all the other expenses, my average hourly net(before income

taxes-was between $15. for an " hour " of f/u-i sched 4 with an

average of 3 showing up , it dropped to $10/hour BEFORE my income

taxes . i had been in practice nearly 20 years, graduated from a

highly regarded residency program, went to an American medical

school, chose to do an extra year of med and neuro(so i could be

sure i was at my best in screening for med problems " masquerading "

as psych illnesses). one of the biggest problems with medicine is

that the " bad " doctor gets paid(by govt or ins) the same as the good

one-and sometimes it is difficult to tell the difference. i was

financially punished by doing the right thing. and MI is so

discriminated by insurers-here are patients, by the very nature of

their illness , have a harder time even having insurance, AND having

income that they can afford what ins doesnt pay. and look at ins re-

imbursement-caps on # of appts a yr. -caps on what they will pay

yearly, an (often small) %of the billed visit. i am on both sides of

the equation-but understood these problems LONG before. how can we,

the UNited States, deprive our most vulnerable, from the care they

so richly deserve? how can we allow people to needlessly suffer? and

so often i would hospitalize (at a cost to the system in excess of

$1000/day) someone who would NOT have required hosp. IF they could

have gotten their medication-a cost of about 1/100th of the FIRST

day of hospitalization!(and that is not taking into acct their

personal-or their family's suffering b/c they couldnt get

medication). In the 60's, under JFK, he began a program that

promised release(many times against their will) long-term state

hospital patients, and the PROMISE of replacing their care with

the " community mental care center " program. clearly hx reveals that

they got released into the community(huge rise in homelessness and

unprecedented rise in the mentally ill in the prison population) BUT

and extremely SMALL % of the money saved actually got to the comm.

MH centers-most significant for the FEDS-the cost shifted from one

borne mainly from the Fed gvt-to the states. and they dropped the

ball. neither political party has done anything significant to help

the MI population. hx records NO better care/more $ or even a

proposal by the democrats, that was any better than the ones made by

the rpublicans. BUT WE all need to try to get mental health " equity " -

with insurance coverage and payment. mental illness is not a perk,

it is not a " dental plan " . the brain is an organ of the body, just

like the heart of liver, so WHY is its ins coverage limited and so

small a % compared to so called " medical illnesses " ? i believe the

1st step is to recognize BPD as a medical illness(a brain ds) -get

respect, get research $ and get INSURANCE coverage.

this is not helped by class action suits like the " off label "

neurontin class action-every psychiatrist i know here, in resp. to

the advertisements just plain STOPPED using it. and it was a G-d

send to some patients-for some the ONLY way they could fx. so what

was accomplished besides a bunch of lawyers making a zillion

dollars. there are bad doctors, or even good ones who manage to

gauge the system. but after being in medicine 25 years, if i had to

pay well ONE profession-and keep the " top " students entering med

school instead of the financial market-then that is what i would do.

i AM bitter(like most doctirs trained in the " old " days-the guy in

the office next to mine-LITERALLY-asked his patient in f/u, just 2

or 3 questions-how were they on a scale of 1 to 10 and any s/e-then

he wrote a new Rx or re-wrote the old one. NO Q allowed. the

patients got what they paid for actually, but NOT what they

deserved.

i believe WE FIRST must see BPD as an illness and not BAD behavior.

for if we can't then why should our neighbors, vcommunity or

society. and w/o that recognition, not only will the kids be seen

as " bad " etc, but the illness will get no respect, their suffering

will get no respect, and no $ will be given for add'l research or tx.

and what a huge waste of good and deserving young lives. a needless

waste. needless suffering by so many. but it starts with us. it IS

harder to see the illness than blame. wecarry such a sad and heavy

burden having a (medically) ill child-but WE, all of us must teach

the rest of out society that this is NOT a way the kids choose to be

(who would CHOOSE to be BPD?) it ALL starts with us. love, rivka

Send questions & concerns to WTOParentsOfBPs-owner . " Stop

Walking on Eggshells, " a primer for non-BPs can be ordered via 1-888-35-SHELL

(). For the table of contents, see http://www.BPDCentral.com

[Guest guest]

I think Lamictol is an anti-seizure drug? - similar to Epilim which is used by

epileptics to stop seizures - these drugs have been found t act as a mood

stabliser for manic-dpressives. I am not sure though - not much on the net about

it.

Chris.

SSRI's and med insurance

all the SSRI's work in very similar manner-BUT individual response

is the key. while some of the drug companies have gone to the

expense of having their SSRI " proved " to work for, say, PMS, or

social phobia, there, in fact is absolutely NO reason why that

particular SSRI should work any better than any other, on AVERAGE

for any of their indications.(it is so trial and error-each person

responds differently-one patient may have terrible nausea from

prozac, but none from paxil. some s/e are common to almost everyone.

and their is some predictability of ONE person's response to drugs

in the same " class " ) most ant-D(TCA, SSRI are CAITIONED in people

with hx of bipolar ds in their FAMILY, and usually NOT used if the

person themselves has had any bipolar episodes-usually one will

choose instead a mood stabilizer(tegretol, valproate-so as not to

risk causing mania-or worse, begin a rapid-cycling bipolar ds. that

may not be able to be stopped) " label use " is what

studies have indicated is a successful use for the drug; " off-label "

use-so much in the press lately, is using a drug WITHOUT a study,

but usually anecdotal evidence; studies are almost always funded by

the drug co. trying to " prove " and indication for their drug's

increased uses)-everyone uses several drugs " off label " -e.g.

tegretol and valproic acid-ONLY approved for seizures(used widely

for bipolar ds.) as well as the " new " panacea: neurontin-also

only " label " use is sz. here in NYC, ON THE RADIO, daily ads by

lawyers(i admit i HATE almost every malpractice lawyer, and lets not

forget made his fortune on malpractice-not usually

helping " the little guy " -but using " focus groups " so that he would

ONLY take the HIGHEST pay out cases-not the most worthy-he had a

minimum of 5 MILLION dollars or he wouldnt touch the case!) anyway-

they advertise for a class action suit against neurontin(average

lawyer fee for class action exceeds $5, 000 an hour of lawyer and

underling time-often exceeds $100, 000 an hour AND by the time all

the expenses are paid the defendents get less than 10% of the

award!)-so they are advertisinfg for all patients who feel they were

harmed by " off label " use of neurontin. a lottery win for anyone who

got a tummy ache. don't misunderstand , i am harder on " my own " than

anyone-i never looked the other way-felt being a doc a great

privelege and one that ABSOLUTELY required total devotion. if my dtr

had not have gotten so ill, i would have left practice last year

anyway- " the system " would NOT allow me time and resources to

practice to even my MINIMUM standards-and yes i could have practiced

the way i wanyted(actually my practice would have fired me b/c i

would not have made enough $, even with their taking 50% take, to

pay for my (tiny) office space-BUT i could NOT have practiced w/o

becoming bitter-next time anyone wonders, or becomes angry that

their child is not getting enough time-let me tell you from the

inside-most docs-under the BEST conditions " net " 20-50% of what is

billed-that " net " though is after ONLY office expenses NOT pension,

ongoing req. med education, lic. fees, DEA fees, hosp. fees, many,

many misc expenses and certainly NOT before payroll, medicare or the

almost 40% personal taxes. many doctors make too much and do too

little. as many do a LOT and make too little for their talent, their

devotion and their time. private psych. can charge $150--400 for an

initial appt and $50-125 for all f/u-and take only cash. that is

what i PAY. but most of us who take ins payment get $37-72 for an

initial hour eval and $7.00-35 for a 15-20 min follow-up. (in my

case the initail appt-b/c of my heavy emphasis on med/neuro

screening took 1-1.5 hours and included: patient interview,

interview w/family, speaking with pts current tx, speaking to any

med MD's if appropriate, reading thru OLD chart material, reading

pertinent med reports, writing up the report, prescribing if

appropriate and answering all Q. and i felt i was morally and

ethically as well as legally responsible for all. my f/u visits

included(before seeing the pt.: reading any new med reports, any tx

updates) then updating the patient's condition, responding to Q,

family Q, writing Rx, and writing up careful notes, recording

medication THEN reporting back to pts tx after i saw them. many ,esp

private MD-psych see from 4-8 patients an hour-how long do you think

it takes to do the RIGHT thing-as outlined. for an initial appt my

re-imbursement was between $35-75 dollars, 50% to practice, then

with all the other expenses, my average hourly net(before income

taxes-was between $15. for an " hour " of f/u-i sched 4 with an

average of 3 showing up , it dropped to $10/hour BEFORE my income

taxes . i had been in practice nearly 20 years, graduated from a

highly regarded residency program, went to an American medical

school, chose to do an extra year of med and neuro(so i could be

sure i was at my best in screening for med problems " masquerading "

as psych illnesses). one of the biggest problems with medicine is

that the " bad " doctor gets paid(by govt or ins) the same as the good

one-and sometimes it is difficult to tell the difference. i was

financially punished by doing the right thing. and MI is so

discriminated by insurers-here are patients, by the very nature of

their illness , have a harder time even having insurance, AND having

income that they can afford what ins doesnt pay. and look at ins re-

imbursement-caps on # of appts a yr. -caps on what they will pay

yearly, an (often small) %of the billed visit. i am on both sides of

the equation-but understood these problems LONG before. how can we,

the UNited States, deprive our most vulnerable, from the care they

so richly deserve? how can we allow people to needlessly suffer? and

so often i would hospitalize (at a cost to the system in excess of

$1000/day) someone who would NOT have required hosp. IF they could

have gotten their medication-a cost of about 1/100th of the FIRST

day of hospitalization!(and that is not taking into acct their

personal-or their family's suffering b/c they couldnt get

medication). In the 60's, under JFK, he began a program that

promised release(many times against their will) long-term state

hospital patients, and the PROMISE of replacing their care with

the " community mental care center " program. clearly hx reveals that

they got released into the community(huge rise in homelessness and

unprecedented rise in the mentally ill in the prison population) BUT

and extremely SMALL % of the money saved actually got to the comm.

MH centers-most significant for the FEDS-the cost shifted from one

borne mainly from the Fed gvt-to the states. and they dropped the

ball. neither political party has done anything significant to help

the MI population. hx records NO better care/more $ or even a

proposal by the democrats, that was any better than the ones made by

the rpublicans. BUT WE all need to try to get mental health " equity " -

with insurance coverage and payment. mental illness is not a perk,

it is not a " dental plan " . the brain is an organ of the body, just

like the heart of liver, so WHY is its ins coverage limited and so

small a % compared to so called " medical illnesses " ? i believe the

1st step is to recognize BPD as a medical illness(a brain ds) -get

respect, get research $ and get INSURANCE coverage.

this is not helped by class action suits like the " off label "

neurontin class action-every psychiatrist i know here, in resp. to

the advertisements just plain STOPPED using it. and it was a G-d

send to some patients-for some the ONLY way they could fx. so what

was accomplished besides a bunch of lawyers making a zillion

dollars. there are bad doctors, or even good ones who manage to

gauge the system. but after being in medicine 25 years, if i had to

pay well ONE profession-and keep the " top " students entering med

school instead of the financial market-then that is what i would do.

i AM bitter(like most doctirs trained in the " old " days-the guy in

the office next to mine-LITERALLY-asked his patient in f/u, just 2

or 3 questions-how were they on a scale of 1 to 10 and any s/e-then

he wrote a new Rx or re-wrote the old one. NO Q allowed. the

patients got what they paid for actually, but NOT what they

deserved.

i believe WE FIRST must see BPD as an illness and not BAD behavior.

for if we can't then why should our neighbors, vcommunity or

society. and w/o that recognition, not only will the kids be seen

as " bad " etc, but the illness will get no respect, their suffering

will get no respect, and no $ will be given for add'l research or tx.

and what a huge waste of good and deserving young lives. a needless

waste. needless suffering by so many. but it starts with us. it IS

harder to see the illness than blame. wecarry such a sad and heavy

burden having a (medically) ill child-but WE, all of us must teach

the rest of out society that this is NOT a way the kids choose to be

(who would CHOOSE to be BPD?) it ALL starts with us. love, rivka

Send questions & concerns to WTOParentsOfBPs-owner . " Stop

Walking on Eggshells, " a primer for non-BPs can be ordered via 1-888-35-SHELL

(). For the table of contents, see http://www.BPDCentral.com

[Guest guest]

Thanks for the tip. I appreciate it!!

Have a good day.

Re: SSRI's and med insurance

, my daughter was on quite a few, but never on that one.

Look it up in MedHealth online. It should help.