Psychiatric Prescriptions through the Roof
By the looks of the sales figures for psychiatric drugs, we're becoming increasingly crazy here in the US, and at a very rapid pace. That's depressing news. Since 1996, adult prescriptions for mental illness have risen by 73 percent, and prescriptions for children went up by 50 percent. Among seniors over the age of 65, psychiatric drug prescriptions have doubled. In fact, one in every 10 adults has a mental health prescription (including ADHD medications, anti-depressants, Alzheimer's drugs, and antipsychotics), and one out of every 20 kids.
That's a whole lot of off-kilter people running around. And it's particularly worrisome when you consider that among the most mentally challenged, especially seniors who have trouble feeding and dressing themselves, access to treatment actually declined in the years studied. In other words, patients with serious mental illness did not account for any of this increased prescription mental health care.
Which brings up the question of exactly who is taking all these psychotropic drugs, if not the most dire cases? According to Sherry Glied of Columbia University, director of the study, "Mental health has become much more a part of mainstream medical care." Her comment hints that these days the most likely recipient of mental health medication is your average Joe, or Jane as the case might be. Given that the study also found that up to 70 percent of people "diagnosed" with mental illnesses are well enough to want to work, it certainly does seem that mental illness has gone mainstream.
So have we really become a more nutsy society? Dr. Glied doesn't seem to think so, instead attributing the medication spike to expanded coverage for drug reimbursement under public programs such as Medicare and the federal insurance program for the elderly. If she's right (a big "if"), this means that we've always been as imbalanced as we now are, but easy access to health care coverage has paved the way for us to soothe our disturbances with drugs. But if the rise in med consumption is due to public programs picking up the tab, then why have those with severe mental health problems, as we discussed above, been left out of the loop. Also, consider that a separate study found a more than four-fold increase in anti-depressant prescriptions between 1990 and 2003, with most recipients being middle-aged adults, women, and non-Hispanic whites who don't have serious mental illness. This fact makes it look like psychiatric drugs have become more of a feel-good remedy than a medical necessity in the course of the past decade. That's a very different scenario...and much more disturbing.
It's also noteworthy that psychiatric care increasingly has gone the way of medication rather than counseling. And why not? It's so much easier for the attending physician, takes less time, and is much more profitable. By 2006, drug prescriptions accounted for a full 51 percent of all mental health care costs. In fact, the rise in mental health prescriptions far outpaced the growth of other pharmaceuticals. Prescription drugs only account for 26 percent of health-care costs as opposed to the 51 percent figure for mental health costs. The per-capita spending for mental health care rose by over 30% in the 10 years between 1996 and 2006, with almost all of the increase due to drug prescriptions.
According to Dr. Richard Frank, author of a separate study on mental health costs out of Harvard Medical School, the rise in prescriptions signals that drugs work better than therapy. Really? At first glance, this statement would seem to involve a huge leap in logic; but what exactly is Dr. Frank saying? "What [this] says to me is the increase in drugs by itself -- just expanding the number of people who appropriately get drugs -- can get you improvement." To be sure, he does concede that drugs "may not do enough" for severely disturbed people, who might also require therapy. But if one were to take his statement at face value, it would mean that at the point we get every single person in the world on antidepressants and antipsychotics, we would have optimized "improvement."
But here's another interpretation. Maybe the medical establishment and pharmaceutical companies have found an easy and lucrative way to put the lid on patients suffering from normal life-adjustment issues. I previously reported on a study published in The Archives of General Psychiatry that found one in four people taking antidepressants is actually not clinically depressed, but in fact, just dealing with a difficult life situation. In addition, a 2007 study by the British Prescribing Observatory for Mental Health found that 36 percent of those taking anti-psychotics were receiving more than the maximum recommended dose. And finally, a study last year found that three times as many American kids receive prescriptions for psychotropic medications compared to their European peers. The bottom line is that the facts on the ground say we're prescribing mood altering drugs to excess.
And to what effect are we putting so much of the world on these mental modulators? If the drugs actually worked, there might be some excuse for occasional excess. But in fact, a study in 2008, published in the journal Public Library of Science Medicine, found that antidepressants work no better than placebos for most patients with mild or even severe depression. In another blog last year, I wrote about a study that found that inexpensive magnets work at least as well as meds in treating depression.
Certainly there is a place for psychotropic medications, but as I've written before, given the potentially serious side effects (suicidal ideation, convulsions, nausea, insomnia, sexual dysfunction, hypertension, and so on), the cost, the fact that they don't necessarily work, and the fact that there are other methods that might achieve the same results without the health risks -- particularly for mild anxiety and depression -- psychiatric drugs are best used as a last-resort measure and only for truly serious mental health disorders.
As of 2003, annual spending for mental health in the US was topping $100 billion. The most expensive class of prescription drugs as of 2006 was psychiatric medications, averaging $91.54 per prescription. In other words, there are lots of incentives for the medical establishment to keep the public dependent on these drugs, but from the consumer point of view, there are even more reasons to try other avenues to cope with common problems -- to ignore your physician's recommendation that you start on Lexapro because you're mad at your partner or distressed because you lost your wallet.