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August: Can't Get It Out of My Head

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There Has Got to Be a Better Way

It’s generally no more than 10 minutes. Sometimes, just 5. That’s not a lot of time, but in these days of bustling offices and busy physicians, most patients do not get more than 10 minutes face time with the doctor they came to see. Hence, it’s no surprise that when patients complain about feeling depressed, anxious, stressed or panicky, the doctor whips out the prescription pad.

Though psychotropic drugs may indeed be the treatment of choice, I only wish that physicians would “prescribe” a minimum of 6 visits with a psychologist before prescribing medication.

Yes, I am a psychologist, but my wish is not self-serving. It is designed to benefit the patient.

Here’s why:

It’s a rare doctor who has the time (or inclination) to delve into more than surface questions about emotional or behavioral symptoms that patients report. The deeper questions are generally glossed over, if addressed at all.

Examples of such questions are:

When do you feel most stressed?
What do you do when you feel anxious?
How does your depression manifest itself?
What do you do to help yourself get beyond the feeling?
What is the quality of your relationships at home? At work?
What’s your diet and sleep pattern like?

Such questions shed light on a person’s overall emotional make-up, their typical day, their lifestyle and more. Not only do psychologists have the time to ask in-depth questions, they have the training and desire to listen to the answers. And they have the expertise to help people move beyond their negative emotional states – often without reliance on medication and with an emphasis on long-term as well as short-term results.

Let me be clear. I am not against the use of psychotropic medication. But I am strongly against the use of drugs as the first or only treatment approach.

Two recent stories in the media reinforce my take on the matter.

First, The Wall St. Journal reported a study that scrutinized the research of drug companies on the efficacy of antidepressant medications. They discovered that the companies reported only studies which indicated that anti-depressants were effective. Those studies that showed antidepressants to be no more effective than a placebo were withheld or misrepresented. The latter was accomplished by turning the study results upside down, ignoring the negative finding for alleviating depression and reporting the positive secondary outcome.

This is not science! This is propaganda. This does not help physicians make informed treatment decisions. Indeed, if the studies that had been withheld were accounted for, the best estimate of the effectiveness of these drugs was 40-50%. A far cry from what the advertisements suggest. A far cry from what the drug companies tell the physicians in their promotional material.

Second, a recent documentary shown on PBS reported that 6 million kids in this country were prescribed drugs to control their behavior or emotions. 6 million kids – something is definitely eerie about that number.

One child psychiatrist told FRONTLINE that “It’s really to some extent an experiment, trying medications in young children. It’s a gamble. And I tell parents there’s no way to know what’s going to work.” Another psychiatrist said, “We’re dealing with developing minds and brains, and medications have a whole different impact in the young developing child than they do in an adult. We don’t understand that impact very well. That’s where we’re still in the Dark Ages.”

And yet, the skyrocketing use of drugs continues. And often, when the drugs don’t work, the dosage is increased or yet another drug is prescribed, until kids, some as young as 4 years old, are on a cocktail of drugs to get them to improve their mood, curb their outbursts, pay attention or learn better.

Should drugs be prescribed as the first or only treatment offered to difficult or disruptive kids? A resounding no! Yet that’s what often happens. In the documentary, a parent whose child was put on a cocktail of drugs for many years said, “It all started to feel out of control. Nobody ever said we can work with this through therapy and things like that. Everywhere we looked it was, ‘Take meds, take meds, take meds.”

While we shouldn’t negate the possibility that psychotropic drugs can be effective for some kids, it should never, ever be the first or only treatment offered to parents. Before we gamble with the long-term effects of untested drugs on kids’ brains, the skills of a psychologist, family therapist, learning specialist, nutritionist, and sleep consultant should be utilized.

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