Something I noticed about medication prescribing

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At the Harris County Psychiatric Center in Houston, Texas, where I was prescribed Haldol, a disproportionate amount of other people were on Haldol too.


At Burnaby Hospital in Burnaby, BC, Canada, EVERY patient in the psych ward was on Loxapine and Risperdal, save 2 or 3 people. (I was on loxapine as an antipsychotic and Risperdal as a sedative, the others were on Risperdal as an antipsychotic and Loxapine as a sedative). One of the two or three people who weren't on Risperdal or loxapine was on Zyprexa, and they were also going to put me on Zyprexa but I told them about the side effects. So Zyprexa is their third-favorite antipsychotic.


At least the Celexa thing is constant... everywhere I went and everywhere I heard of, Celexa was (and is) the first antidepressant they give you.


But with antipsychotics, the first choice varies with the place, and each place has their own preferred medication to give their patients, but they each have one medication that they give almost everyone.

Yes, that happens. Psychiatrists have a range of medications that do the same thing; so they choose from that range and eventually they end up with favorites. With no other indications to give them clues about which antipsychotic someone should be taking, they'll just use the one they're most familiar and comfortable with. A good psychiatrist will know when to switch the patient from their default choice; a bad one will just increase the dose.

Of course, there are some places where they will hand out antipsychotics to everyone just to reduce the amount of trouble the patients will cause. Obviously that sort of thing infuriates me... Some places, all you have to do is cry, and they'll dose you. Helloo... these are not tranquilizers, they are not meant to be used that way, and they are almost never indicated in the absence of psychosis or uncontrollable rage. Switching to chemical straitjackets instead of canvas ones may make you seem more modern, but it sure doesn't make you a better psychiatrist.

That's because doctors and hospitals get kickbacks from the drug companies. It is in their best interest to aquire more money, not to get their patients better.

Yeah, they get like... free mugs and pens. Huge kickback.

They may not get "kickbacks" but they get a lot more perks than mugs and pens. Expensive dinners in fancy hotels, etc.

But otherwise, what you said is right on the dot - different doctors develop "favorite brands." It's not just with psychiatric drugs. Let's say you have a patient with high cholesterol and you want to put them on a statin - how do you know whether you should choose Zocor or Lipitor or...? They all do the same thing, but different doctors have a preference for one or another.