Rethink “Rethinking Mental Health”

In your Feb. 6 article, Rethinking Mental Health, the overall tone was quite critical of modern psychiatry and the use of psychoactive medications to treat various forms of mental illness.

While it is clear that many psychiatrists, and physicians in general, are too quick to prescribe potent medications without exploring other approaches to treatment, it is also clear that this is an interplay of physicians and consumers that perpetuate this practice, meaning that our culture as a whole is oriented toward quick fixes, magic bullets, and instant gratification, which leads to the magic pill to solve all problems.

Many people come to a physician for a medication, and are not interested in alternative treatments even when offered. This is a systemic problem that needs to be addressed by physicians along with the public. Blaming physicians and the drug companies without seeing the larger picture is irresponsible and naive. While too many times medications are prescribed where other approaches should be offered and pursued, there are many cases where psychoactive medications are life-saving and life-enhancing.

I have been practicing psychiatry for over 30 years, and I have treated hundreds of people who were so incapacitated by their symptoms they were unable to function in their daily lives, where their quality of life was very poor, and where suicide looked like a good option. For those people, medications were essential to their recovery, and most of them would be the first to say that. …

While it is true that many of the medications used have unwanted side effects and potential withdrawal symptoms, by and large they are safe medications if used appropriately as prescribed, and supervised by a competent physician who understands the nuances and potential problems associated with these powerful medications.

Your article was potentially harmful in that many people who need medications to function … might be distressed to the point that they won't seek the help they need, or will stop their medications abruptly without appropriate supervision. I would say to those people that they need to get more information before making a decision of such importance, and to seek out that information from reliable sources.

— Dr. Ed Entmacher
Asheville

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One thought on “Rethink “Rethinking Mental Health”

  1. inkjen

    Dear Dr. Entmacher,

    I appreciate your widening the lens to the broader social issues and cultural context in which we find pharmaceuticals and many other medications being overprescribed while other recovery supports and lifestyle changes continue to go under-used.

    Another issue which you didn’t raise, but bears mention, is that by far, the largest group of prescribers (70 to 80% at last check) are general physicians, not psychiatrists, which is another problem. The specialists are not prescribing, which increases the potential for overlooking side effects, alternate options, etc.

    At Mother Bear CAN, we advocate for precisely that informed, careful consideration around medications that you suggest. There may very well be a time and place (acute crisis) for medications, but we do also encourage families to look at the literature and evidence, or lack thereof, of the safety and efficacy of long-term psychoactive medication usage, particularly with regard to polypharmacy, off-label prescribing, use with children and metabolic disorder health risks.

    An excellent website for checking medication prescription information, including FDA leaflets, adverse events reporting, side effects, and potential medications interactions is Rxisk.org. The site is free and uses Evidence-Based Medicine and FDA reporting.

    SAMSHA’s website also offers shared decision making tools, free of charge, including those that relate to antipsychotic medication usage http://store.samhsa.gov/product/Shared-Decision-Making-in-Mental-Health-Decision-Aid/SMA12-4696.

    Finally, I would like to underscore your concern that sudden withdrawal from psychiatric medications can be dangerous (even deadly). There are precious few resources for safe psychiatric medication withdrawal, another reason to be careful before starting on these medications. We do list several resources on Mother Bear CAN’s website (www.motherbearcan.org), with the above warning, but much more needs to be done in this area to support safe medication tapering for individuals, families, and prescribers.

    I appreciate your thoughtful response to this article. It broadens the discussion. And thank you for your service for these past 30 years helping our families who are experiencing overwhelming distress.

    Warmly,

    Jennifer Maurer
    Managing Director

    Mother Bear CAN
    “Families for Mental Health”
    http://www.motherbearcan.org
    jennifer@motherbearcan.org

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