Opinion: Do We Really Have an Overmedication Problem?

I remember the day clearly. It was senior year of high school, and we were pitching what would become our senior essays to our teacher. I sat near his desk, and heard one of my classmates pitch her idea:

“I want to write about overmedication. I think people are way too fast to prescribe medication like antidepressants to people who don’t actually need them.”

As I listened to my teacher’s positive response, I couldn’t help but feel a pit deep in my stomach – I was facing a years-long, quickly worsening depression. The stigma against medication and treatment at all was keeping me from help I so desperately needed. Her pitch felt like the exact response I was afraid of if I did seek help – and yes, elect to go on medication:

“You don’t need it. There’s nothing wrong with you.”

Obviously that was not what she meant, and I’m sure she had good intentions and that her essay was an interesting and well-researched exploration of the overmedication problem in America. I want to be clear: I do believe there is a problem with overmedication. But I guess I feel as if the hysteria surrounding overmedication masks the much larger issue: and that’s undermedication of people who need it.

Speaking from personal experience, medication saved my life. I was going into my fifth year being depressed, and things were getting desperate. I found it incredibly hard to find help, both because of my lack of motivation and the lack of resources. I didn’t want my parents to know the details of what I was going through, as they were apart of the aforementioned group that believes Americans are overmedicated and overdiagnosed. Without their help, financial or otherwise, I found myself in a huge predicament. Even as I swallowed the money and my pride and forced myself to seek help, the indifference of professionals I called shocked me. They didn’t have appointments available; they could only see you once a month; they could see you maybe in 4 or 5 months.

When I finally got to see a therapist, it was after being on a waiting list at my campus’ mental health services, for which I did not have insurance. After one session, the woman told me that if I wanted consistent help, I would have to find someone else, as I did not have the insurance to cover more regular visits (even if I did, they would only be every few weeks). I reached out to the psychology department on campus and eventually was connected with a therapist-in-training there, who I am deeply thankful for. The campus psychologist continued to see me once a month or less, and yes, prescribed me medication after I had seen my therapist a few times.

The first medication did not work. I spent about six weeks on it with no effect.

She switched my medication to the one I remained on for over a year afterwards. That one weekend of the switch – Memorial day weekend – I barely left my bed. It was the worst few days of my life. I remember wondering if I would make it to the end of the weekend.

And then, miraculously, things started to get better.

Therapy had not helped me much before that point, because I lacked the will to even try to get better. I lacked the hope to see that I could. I was addicted to my depression; it was the only constant, comforting thing in my life.

The medication lifted all that, so that the therapy actually began working. I was willing to work on myself. I was able to work on myself, more importantly. And when a new psychiatrist took me off the medication, and a year later I started to spiral again, I made the decision to go back on. This time, I was not suicidal, or anything near it. I was not as desperate. But I could not motivate myself to get a job, or make friendships, or get past the tough transition I was going through post-grad. The medication made those things possible.

Obviously therapy was a huge part of that as well. I have been to therapy before without being on medication, and in less serious cases, it has helped immensely. But if I had been so worried about overmedication that I hadn’t allowed myself to take medication, I might not be alive right now.

Obviously, this is my own personal experience. It’s something my father, a lawyer, would call “anecdotal evidence”. But it’s pushed me to look more into this alleged problem we have, and the damage public outcry over it might be causing. Had others experience what I had?

And here’s what I found: less than half depressed people receive treatment worldwide. In some countries, it’s under 10%. Suicide is the second leading cause of death for people 15-29.

According to Dr. Pies, a professor of Psychiatry at SUNY, there’s more of a problem with mis-match between symptoms and medication prescribed, as there are problems with undermedication, overmedication, and the wrong medication. Geriatric patients in particular are often under-treated, and many people in general are not prescribed the correct dose.

One of the biggest concerns about overmedication of antidepressants is its use on people who do not actually have depression, but rather a related disorder such as bipolar disorder, for which antidepressants are not always the best treatment. However, this doesn’t necessarily feel like a problem with overmedication to me, but a problem in education of doctors and patients alike in the difference between bipolar disorder and depression. If people were more accurately screened, and there was less of a stigma, people might receive the medication they need.

I also want to talk about the so-called negative effects of overprescription of anti-depressants. Antidepressants are not addictive – besides, overdosing (which is often not fatal, and would obviously lead to more serious treatment) there is very little reason to fear misuse. Most of the side effects are not very serious, and are comparable to a lot of medications. The exception here is that they can increase suicidal ideation, especially in teenagers. However, the reason why suicide attempts can occur after medication is prescribed is because the medication lifts the person’s motivation – a necessary step in recovery, and something that can happen even if the person is improving without medication. Also, many of these attempts are not fatal. In addition, many of these suicide attempts occur as a result of misprescription of antidepressants in people with anxiety or OCD. Again, it seems the problem is more mis-diagnosis and prescription. It’s not that these patients do not need medication, but that they need a different one.

Unfortunately, I did not find a lot of research on whether or not people who attempt suicide are usually on medication/diagnoses prior to the attempt or not. Thus, it’s hard for to assess the number of people who are suicidal who are not receiving treatment they need. It’s also impossible to know the true amount of people struggling with depression, and due to the stigma, many keep it a secret. It’s completely possible not to know that a close friend or family member is suffering from depression, due both to lack of education in the warning signs, and the person not showing any signs (called “smiling depression” – these people can be at increased risk for suicide).

All in all, it’s very hard to assess the undermedication problem. We do know that depression is very treatable; around 80% of people get better with treatment (it’s also hard to know how many people who committed suicide might have gotten better with continued treatment). Professionals agree that both talk therapy and medication can be helpful.

The stigma around mental health disorders and especially medication is well-documented, and can lead people not to seek treatment. While again, it’s hard to know exact statistics as many people keep this to themselves, it’s a serious problem. People may think they need to “try harder” or they’re just going through a tough time – leading to their depression actually getting worse. This means that the stigma around medication is actually causing people to get more depressed, leading them to a place where they probably will need medication.

There are a lot of obvious problems with the prescription of antidepressants. It’s hard to know which of the 22 FDA approved antidepressants will be the right one, leading to doctors and patients trying out a number of different antidepressants, some of which can cause adverse side effects. I’ve already mentioned the side effects. But I think in the media we need to stop demonizing antidepressants, as this is a major cause in people not seeking treatment when they need it. If we can frame it instead as a lack of research, testing, and education in different disorders and medication, then we can actually bring down the overmedication of antidepressants without making people who need them feel as if they shouldn’t seek them.

The moral of the story is this: before starting your rant about how everyone’s popping “happy pills” they don’t need nowadays, remember who might be listening. Because you might be part of the reason someone is not seeking the help they need. And it is not up to you to assess whether or not they need medication – even if they’re your best friend or family member.

The only people it’s up to are them and their doctor. And if we can erase this stigma, while focusing instead on education, then that’s the way it will be.

And that way, we might even be able to fix the “overmedication problem” you’re so worried about.

Hannah’s Guide to Therapy

While there are lots of ways to improve your mental health, such as practicing gratitude, exercising, eating and sleeping well, helping others, and talking about your feelings with a friend, I’ve found the most effective way to maintain your mental health is through therapy. This is because therapists are trained for this very purpose – just like seeing a chiropractor for back problems, or a dermatologist for skin problems! You also do not need to have a diagnosable mental illness to go to therapy; therapy can help with lots of things besides treating mental illness! Some of these include learning self-love and confidence, improving relationships, setting goals, and aiding in transitions and big events.

But I’ve already talked about the why: what about the how?

Unfortunately, finding a therapist and/or psychiatrist can be very difficult, especially if you are dealing with something like depression or anxiety which makes it difficult to reach out and find places. While most health insurance does cover psychiatric help, it can be hard to find someone in your network; and even if you do, they might have an expensive co-pay or not be accepting new patients. 

IF YOU HAVE INSURANCE:

Go to your insurer’s website and search for therapy/pschiatry/pschologists and you will see a list. It’s best to call places, but many also have emails. You can also go to your GP and describe the feelings you’re having, and they can usually refer you to someone. For short-term cases, they can also prescribe things like antidepressants. So if you’re unable to find a new doctor on your own, going to a doctor you already know is a great option!

IF YOU DON’T HAVE INSURANCE OR CAN’T USE IT (i.e., you are insured under your parents and they can’t know):

One great option is churches: it depends on the church, but a lot of churches have counseling available, even if you’re not a regular attendee of the church or even Christian. It’s free, so if you’re really in a bind, this is a great option. Just make sure you’re comfortable with the people you’re talking to.

Another option is university psychology departments. Therapists have to train somewhere, and many colleges will have students take on clients with the assistance of department heads or a licensed psychologist. Your sessions will probably be recorded or with multiple people, but the same privacy rules apply. Many of these are cheap and/or often sliding scale for income.

If you’re at a university, then there should be a specific center for mental health. While there are not always a lot of appointments, they can usually refer you to someone else. There are also often student groups aimed at helping those with mental illnesses, or putting out resources online to help students. UCLA’s Depression Grand Challenge is a great example.

If you are not yet comfortable talking to someone in person: websites like 7cupsoftea and Talkspace are great online chat options. There are also free hotlines that can be found here.

Group therapy is also a great cheaper, easier option. Many universities and therapists have groups available that are much cheaper and more consistent. There’s a great list of support groups in the US here.

Opening up to family and friends is also a great first step if you feel comfortable. But I do want to mention that they should not be your only crutch if you are dealing with something serious. They are not properly qualified to help you; plus they can feel a lot of pressure if they feel they’re the only thing keeping you healthy. That is not a healthy or sustainable relationship to have, and both of you will be better off if you are seeking professional treatment in addition to speaking with them!

Remember: there is NOTHING WRONG with seeking help! In fact, it’s incredibly brave.