christian counseling today
Vol. 20 no. 2
65
n
Diagnostic Challenges:
In this
category, the patient either had multiple
psychiatric diagnoses (e.g., depression
plus OCD/PTSD/eating disorder, etc.),
with one of the other diagnoses not fully
addressed, or the wrong primary diag-
nosis (e.g., Bipolar II instead of major
depression).
n
Drug Issues:
Changing from
a brand medication to a generic form
or from one generic to another was
relevant. Several patients changed to
different doctors (due to insurance
mandates) who adjusted the dosage of
a medication that was working or failed
to monitor blood levels with drugs like
Lithium. In a few cases, it was indicated
to change to a medication with a
different mechanism of action (e.g.,
impacts a different neurotransmitter)—
which every patient (and referral source)
assumed to be the only intervention
needed.
n
Allergies:
Inflammation is a hot
area of study in psychiatry. Hence, it
is not surprising that severe allergies to
gluten and black mold made the list of
fixable problems, due to elevating sys-
temic inflammation.
n
Diet:
Deficiencies with B and D
vitamins were relevant along with the
excessive usage of grapefruit (which
can affect drug metabolic rates), caf-
feine and sea salt (which can result in
decreased iodine levels from not using
iodized table salt and resultant thyroid
dysfunction).
n
Personal Drama:
Patients lied
about taking their medications, used
expired medications, changed their
own dosages or mixed their medications
with questionable medications that
were obtained abroad via the Internet.
Collateral history from family members
was critical here in finding the truth.
n
Therapy:
Medications are contra-
indicated for many problems. Job losses,
relational conflicts, unresolved traumas
and spiritual concerns were examples
of problems where medications should
have failed as a primary and sole
treatment.
In summary, this list is not exhaustive,
but reflects what was seen during this
three-month monitoring period. These
examples do reflect the broad categories
of concerns that illustrate what “working
the problem” should resemble in order
to avoid preventable failures in psycho-
pharmacology.
✠
Michael R. Lyles,
M.D.,
is an AACC Execu-
tive Board Member and is in
private practice with Lyles &
Crawford Clinical Consult-
ing in Roswell, Georgia.
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