Special Editorial: Meds, meds, meds…Do we really need them or is it all in our heads?

Okay, so the medication debate is not as black and white as the title may suggest.  It sure is worth having, however, as an article that came out this June in APA’s Monitor on Psychology about the inappropriate prescribing of psychotropic medication spells out.

Before I go any further, I am completely aware that medication can be a game-changer for some people, allowing them to function in ways that they simply could not before being prescribed an appropriate medication.  For many others, more than we may guess, medication may not be as necessary or helpful as we are led to believe.  And when it comes to medicating children, I vote for being even more careful with prescribing, especially in light of the fact that many medications have not been thoroughly researched for kids.

So here’s the low down on the article:

  1. Many psychotropic medication prescriptions do not come from professionals that are well-versed in mental health issues (4 out of 5 come from non-psychiatrists).  Primary care physicians know a lot, but they may not know as much as we need for them to when it comes to something as serious as treating a mental health disorder with medication.  And they may not be in the know on other effective treatments, such as cognitive-behavioral treatment, that are non-pharmaceutical.
  2. The placebo effect is thought to be a major player in the effectiveness of anti-depressants.  Current research suggests that it’s mostly people with severe cases of depression that seem to truly benefit from the chemical impact of anti-depressants.  Most others reportedly benefit from simply knowing that they are taking something to help their depression.  (As would be expected, there is controversy about these findings.  One thing seems clear, though.  Cognitive-behavioral therapy continues to get positive results in the treatment of all levels of depression and the skills learned can last a lifetime.)
  3. Misdiagnosis can lead to inappropriate prescribing.  One should make certain that an appropriate evaluation has been conducted and confirms a diagnosis of ADHD, for example, before starting a child on a psychostimulant.
  4. Published research tends to include the studies that show positive outcomes for medication rather than being balanced by the publication of studies that do not.  An examination of FDA studies in 2008 reported that the studies were about half and half with positive to negative results; however, over 90% of the studies published were with positive results.
  5. There is a huge financial incentive, both to doctors and patients, to go down the medication route.  Docs get paid a whole lot more and patients pay a whole lot less, in general, when they pursue medication in lieu of therapy.  And advertising for psychotropic medication can lead to greater public awareness about the existence of a drug, which may contribute to patients pursuing this route more readily than therapy.
  6. Vulnerable populations, including the elderly, foster children, and infants, are prescribed psychotropic medications, oftentimes for off label use.  Foster children were found to be over four times more likely than other children to be on psychotropic meds, frequently more than one kind, including antipsychotic drugs.  In my field, we call these drug cocktails chemical restraints because they are oftentimes used to subdue children with difficult-to-manage behaviors.
  7. ADHD continues to prompt a lot of psychostimulant prescriptions.  Sometimes they are very helpful and sometimes not.  (Cognitive-behavioral therapy has been found to be useful in this area as well.)
  8. Psychologists across the country continue to explore the possibility of gaining prescribing privileges in order to add to the pool of mental health professionals that are well-versed in both medication and non-medication-based therapies.  New Mexico, Louisiana, Guam, and the armed forces have approved programs to train psychologists in prescribing.

And now I step up on my soapbox for a moment.  Ahem…I get why psychotropic medications are so popular, including in teens and children.  We want our kids to feel better, quickly.  And if our pediatrician tells us that we can have that happen with a pill, then we are inclined to listen.  I know that therapy takes time.  It is a process.  And I know that it can be expensive.  Keep in mind, however, that a good therapist will arm your child with skills that can carry them forward with a greater ability to handle a multitude of stressors and situations more effectively.

Of course, there will remain individuals that get better results when medication is added to the treatment plan.  For these children and teens, I implore parents and guardians to monitor them closely for medication effectiveness and side effects and to have regular check-ups with their prescribing physician.  If it is feasible, I also highly recommend seeing a child psychiatrist, at least to get things started.  Regardless of the provider you use, please include something like this in your initial discussions, “I am interested in learning about a variety of options, both pharmaceutical and otherwise.”

And while your medical provider may know a lot, he/she is likely a busy individual that does not have time to read every relevant research article as it comes out.  You can keep yourself informed, however, by doing your own periodic searches, setting alerts for when relevant articles are published, and visiting reputable websites that specialize in what your child is being treated for.

Okay, I’ll climb back down now.  Thanks for reading.  -Anita

Source: Smith, B.L. (2012, June). Inappropriate prescribing. Monitor on Psychology, 43 (6), 36-40.