Medication Overuse, Underuse, or All of the Above?

There’s been this funny phenomenon lately with the news media and blogosphere running multiple articles about psychiatric medication overuse at the same time new scientific research articles are showing something very different.

These scientific findings tend not to bother the critics of psychiatry because they simply dismiss these data as being corrupted by the pharmaceutical industry, even when the authors of the studies have no financial ties to the industry whatsoever. For example, an important study of over 170,000 adolescents was recently published in the journal Pediatrics by a research group with zero financial ties to drug companies. The team found a troubling recent increase in the rate of depression particularly among adolescent girls, yet less than half of them received any kind of professional help, with only 1 in 5 depressed adolescents taking a medication. Another recent study looking at the horrible tragedy of suicide among children less than 12 years of age found that nearly 90% were not taking an antidepressant. Clearly, the research tells us over and over again that the majority of people who struggle with serious emotional-behavioral problems, whatever we choose to call it (or not), do so without any outside help. Don’t like the label ADHD? Then perhaps being called “just” lazy or stupid is better, but I doubt it. Sure, blaming psychiatry and medications for everything sells books and attracts attention to websites, but it will only take us so far. Indeed, perhaps the most destructive thing about the anti-psychiatry fad is it gives us a false hope that we have discovered the answer to our problems. When you think you have found your culprit, you stop looking anywhere else.

At the same time, it is hard to ignore the fact that if medications were as awesome as they are often portrayed then things should be better than they are, given how many people take them these days. As much as I want to rise in total defense of my field, there is no denying the fact that psychiatry and the medications we prescribe can be part of the problem rather than the solution. In the all too common model of quick “medication management” appointments, it is not surprising that the toolbox for too many of us has shrunk (no pun intended) to this one type of treatment. As a result, medications begin to exist as our sole intervention strategy rather than being one possible component of many, as part of a comprehensive treatment strategy. In my 15 years of practice, working and consulting to thousands of children and families with mental health questions and concerns, what has struck me as a far greater concern than the trendy idea that people with no real problems are seeking treatment with medications, is rather the premature and exclusive use of medications for individuals who are legitimately suffering. For some people with anxiety, for example, medications are an essential aspect of treatment no matter what. For others, however, psychotherapy, mindfulness, physical activity, and other health promotion activities could produce a more robust and long lasting improvement but medications quickly come on the scene instead as an easy “shortcut” for patients and doctors alike.

In trying to wrestle with these two perspectives, I am personally left with the less than flashy but inescapable conclusion that there are BOTH large numbers of people who overly rely on psychiatric medications and large numbers of people who suffer in silence. I am frustrated with BOTH the deceptive marketing and objectives of the pharmaceutical companies and the anti-psychiatry extremists who shame people into thinking that their struggles aren’t “real” just because there isn’t some big spot to see on an MRI scan.

Is it naïve to try and curb the excesses of medication use while at the same time searching for the real engines behind the troubling rise in depression and anxiety? Must the two important messages of undertreatment and overtreatment be shouted at the public by different people or organizations, or can “passionate moderates” find a way to get a balanced message actually heard above the din of more polarized views? Let’s find out.

@copyright by David Rettew, MD

David Rettew is author of Child Temperament: New Thinking About the Boundary Between Traits and Illness and a child psychiatrist in the psychiatry and pediatrics departments at the University of Vermont College of Medicine.

Follow him at @PediPsych and like PediPsych on Facebook.