Are Psychotherapeutic Drugs Overprescribed for Treating Mental Illness?

¶ … psychotherapeutic drugs overprescribed for treating mental illness?

Pros

With the development of SSRIs such as Prozac, some psychotherapists proclaimed the end of depression and there were even concerns that such drugs would change the human character by making treatment of the illness too easy. Now, after many years after the birth of Prozac, it is clear that no antidepressant is a silver bullet when it comes to eliminating a particular mental health problem. In fact, the concerns are that SSIRs and other drugs commonly used to treat depression are substantially less effective than their manufacturers claim. "An analysis of all FDA clinical trials for four SSRI antidepressants found that the drugs didn't perform significantly better than placebos in treating mild or moderate depression, and the benefits of the drugs were "relatively small even for severely depressed patients" (PLoS Medicine, 2008, cited by Smith 2012:36). Even studies which indicate a more optimistic view of the potential uses of antidepressants suggest that antidepressants must be combined with cognitive behavioral therapy for the most effective method. However, lower rates of reimbursement for talk therapy vs. medication from insurance companies have clearly had an impact in skewing the debate in favor of greater prescribing of antidepressants to the exclusion of other treatments. Not only is this less effective, but it raises concerns because antidepressants are not without their side effects, including weight gain, sexual dysfunction, and in some patient populations such as teens, increased risk of suicide (Smith 2012: 36; Hershel, Kayne, Jick 2004).

Although antidepressants are one of the most common drug classes that have increased in terms of their prescription rates, they are not the only one, nor the most serious. Antipsychotics, once reserved for a relatively small percentage of the severely mentally ill, have also escalated rapidly in prescription rates, thanks to the development of new drugs by pharmaceutical companies and also to more aggressive marketing campaigns. "The use of second-generation antipsychotics nearly tripled from 1995 to 2008…Of particular concern is the prescribing of antipsychotic drugs to vulnerable populations, including foster care children and elderly nursing home residents. Foster children are up to four-and-a-half times more likely to receive psychotropic drugs than other children covered by Medicaid" (Smith 2012: 36). Antipsychotics have long-term, sometimes irreversible side effects such as tremors, extreme weight gain, and diabetes.

Con

However, there are those who dispute that psychotropic drugs are being over-prescribed at a notably higher rate than before. Bruce M. Cohen, in his article "Mind and medicine: Drug treatments for psychiatric illnesses" suggests that because a number of substances, spanning from foods to illegal drugs to hormonal imbalances can have effects upon mood, the notion that psychotropic drugs can likewise have a major impact in alleviating depression should be evident. Cohen advocates a biological, versus a psychological approach to treating depression. He claims that the efficacy of these drugs have been established in numerous trials (Cohen 231). "No simple connections are likely to exist between a molecule and a thought or a nerve cell and a mood. However, it is reasonable to expect that the state of our networks of nerve cells in the brain may be closely related to conscious states of thinking or feeling" (Cohen 238).

The proponents of the use of psychotropic drugs would also likely contend that the cost of conventional talk therapy and its duration must be of concern when prescribing treatment. The fact is that time and money is limited and drug treatment can bring a more aggressive response given its direct effect on brain chemistry which may be more difficult to engineer with therapy alone or at minimum is less likely to be reimbursed by most insurance companies.

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