“Our country is over-medicated.”
I get that a lot, usually right after I tell someone that I write a mental health blog. Not as a hobby. As my job.
Part of me agrees, the part that doesn’t want to get into a long and frustrating conversation, where I explain that it’s really not that simple… That the issue is fairly nuanced and complex.
Are some people overmedicated in this country? Yes. Absolutely. I devote a few chapters of my book, Beyond Blue, to describing the dangerous phase in my recovery led by a doctor whom I call “Pharma King.” I was taking something like 16 pills a day, enough to drop my head into my cereal bowl every morning for about three months. And I wasn’t at all uncomfortable with how the nurses at the outpatient psych program I attended jumped to an increase in medication every time a patient voiced a complaint or raised an issue.
I wanted to scream out, “For crying out loud, let the woman try to sort through this a tad before we up her prescription.”
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I think a big part of the problem isn’t so much diagnosis or treatment of individuals – whether with pills or psychotherapy – it’s that no-one seems to be putting people in their context of society. If you’re a single mum struggling to bring up a family on welfare, someone working 60 hours a week on the minimum wage or an executive working every hour God sends to keep your job then you can take as many pills and have as much psychotherapy as you want but your basic problem will still be there. Until we take a good hard look at our society and stop thrusting the ‘blame’ for people’s mental-health problems onto their thought processes or brain chemistry we aren’t going to get very far with this. But then it’s a lot harder to change capitalism than to keep ratcheting up people’s health insurance!
I agree with the previous comment, in that much depression is justified. One problem is that people think it’s wrong or unnatural to feel sad and discouraged. In actuality, it is often the most sane response to life in today’s world as it is experienced by many people. That doesn’t mean we should just live in misery, but it does suggest we shouldn’t label people ill just because they are sensitive and honest about their situation and their history. If more people suffering from depression were led to accept their pain as healthy and normal, rather than feeling bad about themselves, there might be less demand for medication. Yes, it’s lamentable that many people in pain don’t get help, but it’s also tragic that the help available often perpetuates the belief that one is sick rather than appropriately sad.
Personally, I disagree. I see too many people with a bit of the blues being too quick to run to medications rather than actually dealing with their problems. I see too many people whine “I can’t” as an excuse to avoid their real issues. I hear many people list off litanies of diagnoses as an excuse for why they are smoking crack and can’t keep a job.
I’m not saying their aren’t people out there that need it and I’m not saying that those that really need are getting it. But what I am saying is that there are a lot of “mental health impostors”. These are people that seek attention from purported mental health issues or they are the people that use it as an excuse to hide from life.
Therapists are people too and they can be tricked by some cleverly nefarious people. When I was a child I used to lead my doctor’s around from one string to another convincing them to prescribe drugs and change drugs at my will. And they were all too happy oblige.
Thanks for another good article, Therese. I think you’re right that the “over-medicated” train has got a little too much steam in recent years and the “under-treated” train is off the tracks somewhere. Bravo for bringing access to mental health care back to the forefront!
At the same time, saying over-medication is “not the real problem” I think is a bit comparing apples and oranges. For some, over-medication (or over-reliance on medication that doesn’t work very well) really IS the problem. For others, under-treatment really IS the problem.
I think the article was well-balanced, even though I know the writers here have thrown water on the “anti-depressants don’t work well” fire. But in my opinion the headline pitting “over-medication” against “under-treatment” was unnecessarily divisive.
I think where the mis-understanding comes in is that medication is used to treat SYMPTOMS of depression not the cause. The symptoms aren’t the cause. The causes are different for everyone. Therapy and/or self-help solve the causes. If you’re in a job you hate, do something about it. If you’re in a bad relationship, do something about it. If you’re overweight, do something about it. If you have aches and pains, get some exercise and change your diet. If you are tired, adjust your sleeping schedule/sleep hygiene. Depression is much like addiction–people are in denial about what they need to do and that they truly know what to do to help themselves feel better. Here is a fantastic website I found recently: http://www.clinical-depression.co.uk/dlp/depression-information/signs-of-depression/
Lastly, I think medication can be very helpful but it isn’t a solution for depression. It’s merely part of the solution and although it can make a world of difference, you still have to make changes and work on relieving the depression on your own through other means; coping skills, changes, etc.
If depression were as overly simplistic as you claim, voluntary treatments such as electroconvulsive therapy would not be used. But it is. Patients willingly undergo this procedure not to get high, to feel good, or to avoid exercise.
I take a high dose of (generic) Venlafaxine every day. My diet is excellent, and so is my weekly (out-of-pocket) therapy. I have no relationship issues. And yet, my antidepressant is the only thing preventing me from committing suicide; if my meds did not exist, I would sign as many consent forms as needed to start ECT.
Serious depression is obviously something you know nothing about,
and I am doubtful you’re a LCSW.
I think it is Dr Grohol that always says that Medications AND Therapy are the best ways to abate depression and he is right. The problem being that too many people are all too quick to run to their primary care physicians when it comes to mental health issues and not a psychiatrist. So the Dr writes the script for Zoloft, Paxil, Ativan or Xanax(I could go on forever with the names of medications) and that’s it. Some psychiatrists require their patients to see a therapist in conjunction with their treatment. But let’s face it…therapy is expensive and some people don’t even have the extra hour a week to see a therapist(children, jobs, school and home life just seem to get in a way).
Don’t get me wrong…some people do benefit from medication and medication alone…my own mother was diagnosed with OCD about 14 years ago, was given a prescription for prozac and has never looked back(she’s on of the lucky ones, not everyone responds to a medication on the first try) and she hasn’t had an obsession/compulsion/ritual since…and believe me her case of OCD was pretty bad. Sure she gets the occasional bout of anxiety once in a while and when that happens she goes for a walk.
All in all I think we as a nation are over medicated because its CHEAP and it’s a quick fix. Therapy can take years to bring about change where with medication you can see symptoms improve in weeks.
Your blog is consistently interesting but this one needs a serious fact check.
Severe depression is NOT the most common kind of depression diagnosed, as you quote Kramer in saying. In fact, Dr. Grohol wrote here…
http://psychcentral.com/blog/archives/2010/01/06/placebo-as-good-as-paxil-tofranil-for-most-depression/
“From the “What the…?!” file, new research we reported on today found that two antidepressants — Paxil (still commonly prescribed) and Tofranil (not commonly prescribed) — seem to only really work for the most severe kind of depression. When prescribed for mild to moderate — the vast majority of depression diagnosed today — these two antidepressants did not any better than a sugar pill placebo.”
Mild to moderate are the vast majority of depressions diagnosed. It makes a huge difference in how to evaluate this blog entry.
I didn’t read it the way you did. Her article said “average” not “vast majority” which also makes some difference as well. Just and observation and something to consider….?
There are many obstacles for the depressed to overcome and many barriers to appropriate treatment. Many are obvious, others not so obvious to those who haven’t been there-but all worth mentioning.
- some cannot get out of bed to get treatment; depression can totally zap motivation and will (as opposed to being in denial or addicted to depression as stated above)
- some fight the depression but lose their jobs anyway, then lose their health insurance, leading to a downward spiral
- many cannot take off work for weekly therapy-even if its only an hour long session, you cannot always get that 4 pm slot, and there is travel time
- many cannot take off work for weekly therapy because they cannot disclose the need to their employer
- there is a shortage of psychiatrists in some areas
- psychiatrists do not explain therapy options to their patients, sometimes referring them to cbt when psychodynamic therapy is more appropriate and vice versa (the patient realizes therapy isn’t helping, but does not know there are other orientations and drops out)
- some insurers only cover a few therapy sessions
- psychiatrists sometimes only spend 10 minutes with the patient
- its nearly impossible to qualify for medicaid in some states; if you are able to jump through hoops sometimes you can get it
- many practitioners refuse to accept medicare or medicaid patients
- some are in denial or integrate the depression with their identity as a victim
- the medications can cause side effects almost as bad as the symptoms and the pros do not outweight the cons
- it can take over a year of medication trials while suffering miserable side effects to find one that works – people can feel hopeless and give up
Given that, its not suprising so many do not get adequate treatment. Sometimes the only help people can get is a script from a psychiatrist every three months.
One of the worst culprits is that both general practitioners and psychiatrists do not screen for medical problems that can cause depression, anxiety, bipolar: hormones, neurological problems, infectous diseases, etc.
The inability to afford medical care and mental illness can be a catch 22, and one is left swimming for survival rather than getting out of the water. I don’t think its accurate to blame poor outcomes on the depressed patient.
Therapy doesn’t have to take years…if it’s taking such a long time you are either in the wrong type of therapy for you or you and your therapist aren’t a good fit.
It is difficult to get going to get help. A depressive episode doesn’t last forever, so when you feel better, get yourself some help. If you can’t afford it, go to the library and start learning everything you can.
I didn’t say people are addicted to depression. What I meant was that people who are depressive have a tendency towards denial and making excuses for not getting better.
If medication isn’t working for you, then medication isn’t what you need OR isn’t the only thing.
You choose everything you experience, perhaps not directly. Meaning, we have a choice about what to think about and what we do which indirectly impacts how we feel emotionally and physically. Just because you feel depressed doesn’t mean you have to act depressed; that’s where the thinking comes into play. Just because we think something doesn’t mean that it’s true or fact.
Don’t mean to be “argumentative” but I believe your views are rather simplistic and narrowly focused. And I highly doubt that you have personally experienced severe depression by your remarks. It is a very complicated matter and far from a “one-size-fits-all” situation! It is so easy to judge and have all the solutions when you come from a limited experience or limited knowledge regarding this complicated subject. I suggest you research some neuroscience on the topic. It is a rapidly evolving science and our technology has given us much more insights which will lead to more fact based theories and solutions.
Motivation isn’t something a person “just has”. Motivation is created by action. You don’t need motivation to act. You need action to have motivation.
And to borrow a quote from you… “Just because we think something doesn’t mean that it’s true or fact.” This I agree with you on. There is so much that is still unknown and the science on it isn’t exact and still full of evolving theories. To be dogmatic about it is probably a mistake we all shouldn’t make.
I think it’s very easy for someone who has never suffered from severe depression to comment on what should or should not work. The problem is when you are in the middle of suffering from depression there is nothing that anyone can do or say to you to change how you feel. And it’s very, very difficult to find yourself “feeling better” enough to get help. There is no way to find that motivation.
That being said, I have seen many friends of mine running to the doctor crying PDD after having babies just because things weren’t the same as they were before. There is a big difference between adjusting to a major event in your life and having depression that warrants medication. I think Drs should encourage exercise and eating right but if the person who is sitting in your office is on the verge of losing their spouse, job or otherwise because they can’t manage to move, some medication might provide enough immediate relief for them to allow them to make the other changes.
Schwandy–if you were making the comment towards me about “I think it’s very easy for someone who has never suffered from severe depression to comment on what should or should not work.”, please know that not only have I suffered from depression for years (am not in quite a successful remission) but have been on meds (at my lowest dose and only one med now), but have done lots of self-help, therapy, AND I’m a therapist. So, my advice and comments come from a place of complete understanding.
Just read this after making my “reply” to your previous post. Interesting. But, I would have to say that you would not be a good “fit” for me personally as a therapist. After my own years of research, I would still find your views limited and narrow to what I have been exposed to. I have also been through courses at NAMI. I have experienced depression at different levels and there are different needs depending upon the types and severities. Your approach wouldn’t satisfy me I don’t believe. Glad to hear things have worked out for you in your own way. Respectfully…
**edit to my last post: I am IN a quite successful remission.
After reading your post, the main question I had was “Does everyone who meets the criteria for depression really need to be diagnosed and treated” Obviously severe depression, bipolar depression, and psychotic depression needs to be treated by professionals, but a lot of the time, just having someone to talk to, learning some coping strategies and possibly fixing something in your life will help. If depression is getting worse and/or the patient has other problems, then medication and therapy should be tried. But not everyone needs to run off to their doctor for some medication and go to a therapist for every instance of mild depression. For one thing, that can cost a lot of money and time which may make the person feel worse. And I honestly don’t think the US has enough competent therapists for everyone with depression to go to one. It appears that this is happening, people with more severe depression are getting treatment whereas people with more mild depression aren’t getting professional treatment.
I think community programs and prevention should be explored and implemented more, instead of pathologizing a HUGE segment of the population. However that professional mental health services should be made more available to severely depressed people and more people should be aware of “warning signs” that they need professional help.
oh and I have suffered from all levels of depression for years… I am also a psychology student who hopes to one day be a therapist.
I think its important to realize that people with different circumstances can likely have different prognoses.
Someone with no supportive family, no health insurance, perhaps living in a rural area with limited mental health professionals, a single parent, a unique genetic makeup, and any number of variables may have a different experience with recovering from depression than those with a different set of variables. People with depression also experience different symptoms. For example, some can’t sleep while others sleep too much. Some overeat and crave carbs while others don’t feel up to eating. Some can force themselves to work while another might be in tears throughout the entire day, too ashamed to go to work or unable to present themselves to clients with that demeanor.
Some people just can’t open up to therapy.
For me, therapy has been the most helpful, but it took years to find the right match. I didn’t know I was in the wrong type of therapy until I found the right one. I try to avoid medications, and am able to do so periodically, but accept that others do not. But even though meds are not for me, I can understand why so many turn to medications.
I guess what I’m trying to say is that painting a broad brush to represent those with depression doesn’t seem helpful. What worked for one may not work for others. I strongly believe in the combination of psychotherapy with medications if they are beneficial, but everyone is different. It would be ideal if mental health professionals had insight to tailor treatment plans accordingly, a more individualized approach versus biases or personal preferences. Even evidence based approaches have flaws since not everyone conforms to the mean. The insight, education, empathy, and experience of the professional are ideal qualities of mental health professionals, but not all will have these characteristics.
Patient education is important. With so much information available online, I would guess people are much more informed these days of all the treatment options.
Hopefully in addressing the variety of resons why only 9 percent of patients get the gold standard of care as noted by that study, the numbers will increase.
I see your points Lynn…my thoughts are if someone actually meets criteria for depression, chances are they do need help outside of their own circle or their own means. If by “mild depression” you mean sadness or grief, people feeling that way are likely to be able to “see the other side” of the sadness versus someone who is depressed and lacks the cognitive and emotional ability to see the other side of things. I agree, people don’t need to run off and get meds for all that ails them!
YES, I THINK WE ARE AN OVER MEDICATED COUNTRY. ME I TAKE MEDS BUT I CAN’T DEAL WITH THE WEIGHT GAIN. THAT’S THE ONLY THING THAT BOTHERS ME. BUT OTHERWISE SOME MEDS WORK.. MOST OF IT’S THE TALK THERAPY. THAT I RELY ON ALOT