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Post by Admin on Nov 29, 2017 16:23:19 GMT -4
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Post by neva lemoine on Nov 29, 2017 18:44:37 GMT -4
In regards to the article on 75% of med students are on antidepressants or stimulants, I wanted to add my voice to this inquiry. I feel this definitely resonates with my medical school, where it was a common fact that the majority of students left on psych medication. Many of my good friends developed panic attacks during exams and some even became dangerously depressed from the stress and work load. I feel immensely happy that I had a strong support system back home and eventually built one on the island. Even then we still regarded it as come practice to have at least one emotional break down each exam period. I managed to never reach for the prescription bottle myself, but my caffeine consumption got so high I started developing arrhythmias and I will also admit to reaching for Benadryl to sleep and wine on the weekends to try to unwind. And no matter how many discussions we had on open mindedness toward mental health, many students still kept their diagnosis and meds close to the vest. I defiantly agree mental health struggles are held against students & doctors.
In response to the article on Neurologic Enhancement, I find it interesting that the AAN committee concluded that prescribing neuroenhancers is analogous to anesthetic surgery and is thus ethically permissible activity. However, there is still a huge crack down on prescribing stimulants and a lot of obstacles in even obtaining the medication for those that do need it for mental health. Now this may not be the case everywhere, but my best friend and fellow med student, who has a diagnosis of ADHD, couldn’t even get her Adderall in time for her Step 1 exam! She had to resort to drinking 3-4 monster energy drinks a day and specific fidget techniques to stay focused during her studies and exam. It seems like even if doctors are inclined to prescribe these medications for NE, the bad stigma against them and abuse have elicited protocols to make it extremely difficult to obtain them. And in the end these pts still will not get the neuroenhancement help they desire. I feel like NE medication may be going down the same slippery slope as pain medications/ management.
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Post by Kyle Mitchell on Nov 29, 2017 20:06:11 GMT -4
If anyone is surprised by this please say so in these comments and please be sure to include your name so that when I meet you I will know that you are likely to fib. Everyone knows that professional schools in general are plagued by stress, mental illness, and brutal competitiveness- is it really surprising that 75 percent of the student body is on some kind psychiatric medication? As someone whom attended both law school and medical school I can tell you without a doubt that the use of Adderall is rampant in both settings. People are under unbelievable amounts of stress and pressure in medical school especially when Step 1 comes around, is it any surprise that that people will do whatever they feel they must to cope?
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Post by Rita Rehana on Nov 29, 2017 22:32:14 GMT -4
I'm actually not surprised that the percentages are so high in medical students. I was told in orientation that medical school was going to be one of the hardest things I will ever have to endure in my life. It will be mentally, physically, and emotionally draining, there will be days that will be tougher than others. No one got up and walked out the room, so that was meaningful in itself. Medical school and these articles remind me of the movie "The Wolf of Wall Street", where this stockbroker becomes super successful and begins to require more time staying awake and help getting to sleep from being jet lagged. So he would take stimulants when needed and then something to bring his high down so he could wind down. This is all a bit similar to some of the stories told in the article. Then there's the downward spiral of addiction and dependence which can occur as well. Some people do need the stimulants for ADHD and the antidepressants and relaxers for depression and anxiety, respectively. There is the unfortunate stigma as mentioned that comes along with being diagnosed with a mental illness because frankly that is what they are. However, if the prescriptions are taken as directed and without any abuse potential, you are essentially treating a symptom of a disorder.
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Post by Harsh Patel on Nov 29, 2017 22:47:46 GMT -4
While the second article is by no means presenting a scientifically sound number when the author says 75%, it certainly isn't surprising. I personally know plenty of people who have taken one form or other of a stimulant and plenty of people who are on antidepressants as well. I do feel as though it is common knowledge around most medical campuses that a majority of students are taking Adderall or Ritalin. There is certainly an ethical issue in regards to measuring performance of students who are taking a stimulant vs students who aren't. Is it fair to those who aren't taking it? But keeping aside that thought, the major issue here is the emotional impact medical school is having on students and residents and how having a mental health condition is still a taboo among health professionals at any level.
In regards to the article about requesting neurologic enhancement and whether it is ethical or not, personally I feel as though it depends on the physician and patient/person seeking the help. If a physician considers it within his/her morals/ethics and has properly evaluated the patient, I don't see that as an issue. The issue arises in whether usage of these drugs have any impact on long term clinical performance of these students who end up becoming doctors. There isn't enough research to support or discourage the usage of such drugs. I do think it is interesting that AAN compared neuroenhancers to aesthetic surgery though. It does make sense as both are medical interventions that aren't necessarily required for health reasons but can possibly help an otherwise healthy patient. Personally, I would be against usage of such medications as it would go against my personal ethics. But more research is definitely needed simply due to already widespread usage of these drugs.
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Post by Jennifer Joshua on Nov 30, 2017 0:13:15 GMT -4
The case of Mr. Conway and Dr.Warren is one that comes up very often amongst medical students and students going to graduate school like Mr. Conway where we have to stay focused for long periods of time. I respect Dr. Warren’s approach because if he did prescribe the Neuroenhancement (NE) drug – I highly doubt that Mr. Conway will stop at the point of just using it to achieve a higher score on his Graduate school Entrance Exam. I think he will continue to use it for those days he has other long tests and assignments. Also, it means that people can just go to the doctor to request for it without any Attention Deficit problem.
Sadly, this is true for majority of medical students. A lot of them depend on NE drugs to help them study for long hours and to keep them focused. I think Doctors should be more careful like Dr. Warren when it comes to the issue of prescribing such medication to students and professionals.
The second article is a very touchy subject because it is very true that as medical students, we go through lots of stress between studying for long periods of time during basic sciences and then spending long hours in the hospital during clinical rotations and then residency comes with its own kind of stress. It is important that having a positive outlet or a “good” way to unwind is necessary. If not we can resort to other alternatives that might not be too good.
I think it is important to remember that as we care for others, we should not forget to care for ourselves. We can’t give from an empty cup. So as future doctors, its important we learn to take care of ourselves mentally and physically so we can be better equip to take care of patients.
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Post by Jade Alfasi on Nov 30, 2017 1:29:38 GMT -4
I have never been able to find a good line with need versus want when dealing with different aspects of enhancements of the human body and mind. Many athletes will use different methods to enhance their bodies. Using synthetic EPO to increase the amount of red blood cells and oxygen in a person's body is illegal, but athletes can train at high altitudes and have blood removed to be added before an event. The end result is the same but one is illegal and the other is perfectly acceptable. To what end do we draw the line for the use of NE? How often have we watched other students wondering how they are able to do better on a test, study for more hours, and it all comes down to they were able to receive a special pill. There will always be one thing or another that gives some people an advantage over others. I see no reason why to limit the ability of one person to receive the drug over the other. I see fair access for all to such a boost as a true equalizer.
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Post by Ify Nzenwa on Nov 30, 2017 11:41:11 GMT -4
The problem goes way beyond the student/ patient. This problem is multi-factorial, with problems stemming from the external and internal obstacles that medical students face, lack of support, feelings of loneliness, and the ways that we cope with some of these stressors. Medical schools don’t offer that much help, and it may seem that they are forcing us to find some way to deal with it and move on. I can somewhat sympathize with those that seek pharmacological help to push themselves forward in this profession. However, it does somewhat pervert the playing field, being that some students (maybe even most) are playing with an advantage that others wouldn’t know how or can’t access.
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Post by Nicholas Abourizk on Nov 30, 2017 12:49:56 GMT -4
The problem, in my opinion, is with the mentality of western culture. Having the mindset that any problem can be solved with a pill truly shows a lack of dedication and perseverance. Through proper self-discipline and determination, I believe anything really is achievable. The use of stimulants to increase academic performance, in my opinion, is immoral. Despite all the hardships of this journey in medical school (or any level of education, for that matter), individuals without true disease should not have access to these types of medications. The dependence that will almost inevitably follow will likely hinder the individuals’ quality of life in years to come.
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Post by Michelle Rizk on Nov 30, 2017 20:06:32 GMT -4
It's no surprise that in our fast paced world, the usage rate of prescription stimulants is on the rise. For individuals with ADHD, these drugs such as Adderall or Ritalin are life savers and aid with cognitive enhancement. Due to its stimulant and cognitive effect, these drugs are often used and abused by college students. These drugs have high potential for abuse. I strongly believe this is a problem with society, since these drugs are so easily accessible, especially on the streets, in an uncontrolled manner. This issue is problematic and needs strict, tighter control. Without a doubt, it is safe to say that proper documentation to avoid physician shopping and also proper diagnosing is key to limiting distribution to only those patients who truly need these medications.
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Post by Ukpono Inyangudoh on Dec 1, 2017 12:10:53 GMT -4
Neuroenhancing drugs basically are used to improve concentration and to improve cognitive and affective abilities. Who doesn't want to be smarter? No one. But legalisation of this ME drugs like modafinil and adderall come at a great price. They were previously associated with sickness and crime and making it socially acceptable will cause a lot of controversies.
Despite the short term benefits the long term disadvantages outweighs it. This medications are addictive and has withdrawal symptoms and no one wants to have to take a medication every single day. Also they will be a high abuse of medications even parents coercing children to tank medications to do better in school.It is also unfair to people who don't have access to this medications or can't afford it.
But how much is too much, and can a person be too smart?
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Post by Onyeka Olisemeka on Dec 3, 2017 16:30:19 GMT -4
That statistic of 75% of med students and residents being on neuroenhancing medications is sad, but very true. For instance, at a little get together of about 15 friends from medical school, we played a game called "Never have I ever". The participants were to take a sip of their beverage if they HAD done said thing. It was all fun and games until someone said, "Never have I ever taken or tried Adderall". I sat there amused as my smile quickly turned to a look of confusion. One by one, they sipped. 12 in all. While most admitted that it was a one-time thing and they did not like the way they felt, or were worried about the side effects, I was shocked that 12/15 of us had tried it. I knew the rate would be high, but not as high as it was... which was 80% at that party. I personally stand firmly in the camp of not using neuroenhancing drugs in any context other than its intended use in ADHD and such conditions. The reality, however, is that today, even doctors-to-be who know better and are completely aware of the side effect profile and risks of use. I have to agree with the author of the article and Nicholas who rightly pointed out that Western culture trends towards finding a pill or a quick fix for situations. The rigours of medical school ensure that the student is emotionally, socially, mentally and physically prepared for a career in an even more demanding field. Using NEs as a crutch might get them to the top, but almost seems to assure the unsuspecting student a further way to fall.
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Post by Trushna Patel on Dec 3, 2017 18:20:31 GMT -4
The use of NE drugs in the treatment of ADHD has shown significant improvement in the cognition and mood of children and adults, but the abuse of this psychotropic stimulants for cognitive enhancement among students is unethical and it gives unfair advantage to other students. When it comes to medical students, there are multiple factors that are needed to be addressed before they are prescribed psychiatric drugs. As Dr. Pamela Wibble wrote, approximately 75 % of medical students are taking psychiatric drugs and “occupationally-induced depression is rampant in medical training,” it’s vital that we address this issue in the classrooms and destigmatize the use of anti-depressants on campus. The problem is keeping the diagnosis hush-hush, as if it is a criminal offense to be depressed. I personally know handful of medical students, based on the diagnostic criteria of MDD, have diagnosed themselves with severe depression, yet chooses to keep their health problems to themselves and suffer silently. The negative consequences and stigma that comes with addressing a mental health is unbearable especially in a medical field. It heartbreaking to see how biased medical field is to its own students for seeking a mental help. The responsibility also falls on a students to get an appropriate diagnosis and treatment rather than using psychotropic stimulants to “ get through medical school,” or asking a friend or family to get them anti-depressants.
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Arsalan Sabooree(RC)
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Post by Arsalan Sabooree(RC) on Dec 3, 2017 21:39:17 GMT -4
Sadly, the consumption, or better to say the abuse, of Methamphetamines by student has increased drastically. In my opinion, followings are some of the most important reasons behind the gradual increase in neurostimulant drugs use/abuse, especially among students:
• Clearly, the amount of material that needs to be covered by the student for each course, has been increasing gradually. Furthermore, schools have been rising their minimum admission requirements. Consequently, increased focus, decreased tiredness and increased study endurance have become some of the most important requirements for being successful at school. Hence, more and more students are turning to neurostimulant medications.
• Currently, the complete ADHD testing is not covered by most insurances. This sequentially has led to two more issues:
o Hence, most patient’s, especially the students, will not be able to afford $1000 for just one test
o Doctors cannot say no to patients just because they can’t afford the test. Hence, they will have to prescribe the medication based on their personal judgment and that provided information by the patient
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Erica Marie Román Hernández
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Post by Erica Marie Román Hernández on Dec 4, 2017 9:32:00 GMT -4
Clinical Case “Doc, I need a smart pill”:
I agree with the fact that prescribing these medications pose multiple ethical dilemmas and that its long-term consequences have not yet been accounted for. The fact that 80% of the sample studied in the survey preformed the journal Nature found it thought it was ok to take these drugs while being a healthy individual is alarming. The belief that neuroenhancement drugs make you smarter or more efficient can certainly misguide patient to wanting these medications. It poses a social issue far greater than the prescription of the medication itself and more effort should be placed on proper education to the community of the use and potentially harmful side effects of using Neurocognitive enhancement medications in order to becomes more concentrated and efficient without having any cognitive impairment. If a patient has intact concentration but thinks he/she doesn’t and asks for these medications would he/she see much difference or would they work as a placebo effect? Even worse, would it have counterproductive effects if it were trying to fix something that does not require fixing? Should the side effect profile of these psychotropic drugs be worth the risk of a patient finding this out the hard way?
The physician working with the patient that wants NE medications will encounter tough decisions in which his own values and moral standards will be challenged. For example, the physician might opt to determine whether follow the ethical principle of “Do no harm” versus “ Patient Autonomy” on a case to case basis. The doctor would also have to decide whether the practice would follow a more traditional practice consistent with the first domain described by the AAN or a more patient goal directed approach observed in the second domain. They would also have to outweigh pleasing the patient’s desire of getting these medications versus enabling the patient to continue using these medications as part of the daily routine. It is of outmost important to maintain a sense of transparency and accept higher moral responsibility as a physician for the sake of your entire patients. On the other hand, you cannot abandon a patient that comes in for these medications and further workup must be done in order to obtain a baseline of this patient’s function and determine if there is cognitive impairment in order to determine the underlying cause and give the proper treatment.
As physicians we must hold a patriarchal status and care for our parents always looking out for their best interest. Therefore, we must explain to the patient how these medications work and the negative outcomes that can come from taking them, whether prescribed or illegally, in an excessive manner. We should also take the opportunity to address underlying behavioral and self-esteem issues that might have triggered the patient to believe that he/she needs this drug. It would be a good time to refer the patient to counseling and goal directed therapy in order for the patient to have the type of support they need, to set goals in life as well as creating a structured path in order to achieve these goals.
This way we are not only looking out for the best interest of the patient, but also creating a safe environment in order for the patient to not seek these medications from an outside source.
75% of med students are on antidepressants or stimulants (or both):
I believe that we must break the stigma that medical students or doctors are these unbreakable superheroes that should not be allowed to express their concerns about their mental health. Although, we would not wish to believe that this field as gratifying and satisfying as it is also carries with itself it's own burden and emotional workload. Many have been the times where I've found to take the issues I see everyday at the clinic with me. Its part of what makes medicine humane, the fact that we can feel and empathize with our patients. Although a sad reality, it is seen as all the more common that a medical student or a doctor might resort to anti-depressants as their coping mechanism. However, I believe that with good support groups and better attention to securing the mental health of their students from their respective medical schools offering counseling or coping skills seminars, most students wouldn't have to resort to anti-depressants.
The mental health of people in the field of medicine in general has been a conversation of taboo because some type of iron presence is expected of us. However, we are constantly facing traumatic events on our day-to-day basis, be it seeing a person being diagnosed with a terminal illness, discovering the death of patient, feelings of impotence when a disease does not have a cure and there's so much you can do about it. It's practically astounding that the percentage isn't higher. When it comes to stimulants, I believe unless you have an underlying medical diagnosis, your desire to become a physician shouldn't push you to the point of placing yourselves on stimulants. Yes, this career asks for a lot from us, way much more than we can handle at times, to which yet again I believe that the re-structuring should fall more in the medical school's curriculum and what is expected of a student who wishes to excel in this career rather than the student having to self-medicate in order to stay in a competitive ground field.
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