I have three questions for you. Lets see if I can verbally state them correctly so they make sence.

If a individual was mis-diagnosed by a family doctor to have a panic anxiety disorder and given paxil 40mg, buspar 30mg, and valium 20mg daily and as needed at night for sleeping; how would this affect him not needing the medication? How would it affect his mental state and physical state?

If an individual was a recoverying drug addict with six years clean and was mis-diagnosed with a panic anxiety disorder and given the same medication as perscribed above and he took it for two years. What could it do to his mental state and his physical state?

Finally, would it be wise to perscribe depakote to a 1500mg a day to an individual who has gone through the Hep C treatment and his levels are good. I hear that depakote should not be given to individuals with liver function problems?

Here is what I think: Diagnosis in psychiatry is based on interviewing and observing people. One method I favor in diagnosis is interviewing a close person as well as the patient in the patent's presence. It can help corroborate and at times dispute the patients perception. We all know ourselves insides very well, but our outsides are often, but not always, easier observed by people close to us. I would hope that the doctor was doing his best to help the patient with panic disorder, and it is only later that the diagnosis is in question. Certainly, taking Buspar, Valium and Paxil over time will lend itself to some physical dependence, with some potential for withdrawal symptoms after the drugs are stopped. The ill effects of the medications would most likely be some sedation, perhaps dizziness and stomach upset (diarrhea, abdominal pain). None of these side effects are good, but they are hopefully not life threatening, and when the medication is cleared, no long term ill effect should exist.

The second case is more concerning in that someone with prior drug addiction has to receive prescriptions with more concern around medications that can be abused or addicted to. Valium would be the one medication with the abuse and addiction potential. At the same time, some addicts do have an anxiety disorder, and if the treatment resolved the anxiety, then the patent's quality of life and ability to function, along with a reduced chance of addiction, might be the outcome. The same ill effects as the first case would exist in this patient also.

In the third case, Depakote can be provided to patients with liver damage, but cautiously so. Assessments of the liver function, close monitoring of the Depakote levels and making sure the patent's mental state is being enhanced by the treatment, are even more important in this patient. A collaboration between the care providers ( i.e. family doctor, psychiatrist, liver specialist) is the safest and best way for this patient ot get optimal treatment.

I guess in summary, it is important for Doctor's and patent's alike, to be careful with the medications provided. At the same time, psychiatric conditions have many ill or "side effects", that the medications are treating. This "weighing" of treatment vs. illness is the art and science of medicine.

I hope this information helps. Remember, there can be more to a case than is first described, and the care giver's views have to be heard. Talk to your doctor and tell them your thoughts, perspective and experience. Only with that can they optimally help you. Thanks for the questions again.