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The Hidden Dangers of Prescription-First Mental Health Care

Writer's picture: Sabrina JoySabrina Joy


In the modern world mental health challenges are increasingly prevalent. While there are many research-backed solutions to common mental health conditions like anxiety, depression, and ADHD, prescription psychotropic medications are heavily favored, even against solutions which have proven to have higher efficacy and to have fewer side effects. Prescription-based approaches to mental healing continue to rise in prevalence. In fact, according to an article published in the Psychiatric Times, antidepressant use alone has increased “by nearly 400% over recent decades” (Pies, 2014). One in five American adults takes some form of psychotropic medication (Smith, 2012). This increase in prescription-based approaches can be attributed to the over-medicalization of normal emotional experiences, pressure from pharmaceutical companies, and a desire for quick fixes, and must be stopped to prevent an epidemic of prescription overuse.


One of the contributors to the overprescription of psychotropic drugs is the over-medicalization of normal emotional experiences. Often, psychotropic medication is prescribed for mild cases of sadness or stress by general care practitioners (GPs) (Pies, 2014). In an article for Psychology Today, Dr. Graham Davey, writes that “mild mental health conditions or normal emotional responses (e.g., grief) are treated with medications instead of therapy” (Davey, 2014). According to an article published in the American Psychological Association's journal, “many people with mild depression are prescribed antidepressants even though they aren't likely to benefit from the drugs” (Smith, 2010). Part of this overmedication of normal emotional experiences is arising from the fact that people go to their GPs for a referral to a therapist and walk out with a script. A study by the Centers for Disease Control and Prevention found that patients are being prescribed psychotropic medications without being evaluated by mental health professionals (Smith, 2010). This means that the patient’s emoting in a session with a GP is likely leading to a conditioned reaction to prescribe rather than refer as GPs are hearing signs of sadness, grief, or other complex emotions and responding in the only way they know how; with a pill. This is particularly troubling as the pathologizing of emotion; such as diagnosing sadness as mild depression and prescribing a medication rarely results in effective support for the patient (Wise, 2013). Another component of this complex issue is that some mental health diseases are truly challenging to diagnose. For example, ADHD in children is often grossly misdiagnosed as parents’ and teachers’ accounts of behavior are highly subjective (Smith, 2010). As a result, normal childhood exuberance or energy is sometimes pathologized. Around 8% of all youth in the United States have been diagnosed with ADHD and over 50% have been prescribed some form of psychotropic drug to regulate their energy levels, despite the known serious side effects of these medications (Smith, 2010). 




The overprescription of psychotropic medication is also due to the pressure and marketing of pharmaceutical companies who recognize that increased prescribing is in their best financial interest. According to the article published by the American Psychological Association (APA) “In 2010, Americans spent more than $16 billion on antipsychotics, $11 billion on antidepressants and $7 billion for drugs to treat attention-deficit hyperactivity disorder” (Smith, 2010). Around $16 billion indicates a thriving industry and any resource-rich industry will be apt to re-invest resources into the market to fuel future growth. The pharmaceutical industry tripled its spending on marketing with a fivefold increase in direct-to-consumer marketing from 1996 to 2005 (Smith, 2010). Marketing, both to consumers and prescribers, has also increased the range of diagnoses that “warrant” prescriptions now including insomnia and dementia despite the lack of evidential support for such prescriptions (Smith, 2010). Marketing is not the only tool pharmaceutical companies have to use, however. They also leverage biased publishing of scientific studies to support their cause. Researchers at the Portland Veterans Affairs Medical Center examined 74 FDA-registered studies and “found that most studies with negative results were not published in scientific literature or were published in a way that conveyed a positive outcome” (Smith, 2010). Influence inside organizations that the public trusts, such as the FDA, shows that pharmaceutical companies are very aware of how to sway public opinion in favor of prescription medications. It’s also been noted by several studies that prescription ads targeted at doctors and consumers don’t adequately address side effects (Smith, 2010). These companies also lobby for and procure better health insurance reimbursements for drug treatment as opposed to therapy (Smith, 2010). Daniel Carlat, MD and associate professor of psychiatry at Tufts University explains that “There is a huge financial incentive for psychiatrists to prescribe instead of doing psychotherapy, … You can make two, three, four times as much money being a prescriber than a therapist” (Smith, 2010). This financial incentive is in alignment with the best interests of the pharmaceutical companies, not clients’ and patients’ healing. 


Another force behind the increased prescription of psychotropic drugs is the desire for a quick fix. There are several contributing factors to the collective desire for a quick fix; lack of access and training, financial incentives, and conditioned expectations. As previously addressed, many GPs without adequate training prescribe medications for mental health conditions. In fact, four out of every five prescriptions for psychotropic drugs are written by non-psychiatric physicians (Smith, 2010). This is driven in part due to a lack of adequate training and also due to a lack of time. It takes a significant amount of time and education to be aware of the various options and therapeutic modalities available for treatment and to explain these options to patients. Doctors are notoriously limited on time and often prioritize the time-saving option of a script. Lack of access also adds pressure to find a quick fix. There is an industry-wide shortage of mental healthcare professionals and they may not be available in all communities. People also have limited time off of work or caregiving responsibilities. A refill from a local pharmacy can be easier to access for a quick fix than making time for therapeutic sessions, even when those sessions may be more effective in treatment in the long term. Another pressure behind quick fixes is the financial incentive mentioned above for therapists to be prescribers and the higher out-of-pocket costs to clients and patients for therapy (Smith, 2010). Quick fixes in the form of pills are being financially incentivized on both sides of the current system. Finally, as Carlat explains “From the standpoint of consumers and patients, it's very attractive on different levels to take a pill to solve your problems, but we haven't gotten to a point where a pill alone can resolve most people's depression or anxiety” (Smith, 2010). The social expectations created by a society of quick and easy gratification and rewards condition people to believe that healing mental illness should be as easy as ordering something online or having a joint replaced. The reality is, just like these two examples, much goes on behind the scenes in mental healing and nothing is truly as easy as it seems. 



Proponents of psychotropic medication argue that there is plenty of research that proves mediation can be a cost-effective alternative to therapy. While there are undoubtedly some extreme cases where medication is warranted (such as when there is severe suicidal ideation, psychosis, and diagnoses that are life-threatening) medication is rarely more cost-effective than therapy. Part of the problem feeding this misconception, as previously stated, are the biases in pharmaceutical-funded studies and the lack of funding for research into non-pharmaceutical modalities (Davey, 2014). There is also significant uncertainty around the effectiveness of drugs like antidepressants for mild cases (Davey, 2014). In an analysis of all FDA trials for SSRIs, the authors found that the drugs didn’t perform significantly better than placebos for treating mild, chronic, or moderate depression (Smith, 2010). It has been found that therapy is a better long-term solution and is more cost-effective in the long term as it leads to fewer instances of relapse into the original state of disease (Smith, 2010). 


There are undeniably cases in which psychotropic medications are necessary, but as a whole, they are overprescribed and over-utilized. This overutilization of prescription medication for mental health disorders can be attributed to the over-medicalization of normal emotional experiences, pressure from pharmaceutical companies, and a desire for quick fixes. Moving forward, to prevent an epidemic of overuse, the healthcare system and society must take preventative action. A first simple step would be to hold pharmaceutical companies to more stringent regulations regarding their ability to market and financially influence the healthcare system. Another excellent solution would be to invest in research and access to therapeutic modalities such as psychotherapy and somatic therapy. It is in the public’s best interest to explore these solutions to help those in need of effective support for mental healing. 




Sources:


Pies, R. (2014, August 5). Are antidepressants really “over-prescribed” in the US? Psychiatric Times. Retrieved from https://www.psychiatrictimes.com/view/are-antidepressants-really-over-prescribed-us


Davey, G. C. L. (2014, January 9). Overprescribing drugs to treat mental health problems. Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/why-we-worry/201401/overprescribing-drugs-treat-mental-health-problems 


Smith, B. L. (2012, June). Inappropriate prescribing. Monitor on Psychology, 43(6). Retrieved from https://www.apa.org/monitor/2012/06/prescribing


Wise, J. (2013). Antidepressants are overprescribed because of inadequate treatment guidelines, says campaign group. BMJ, 346, f191. https://doi.org/10.1136/bmj.f191



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