Earlier on Sanity Break I interviewed Dr. Ronald Pies on the topic of overmedication in America. Given the complex nature of this question and the controversy that surrounds it, I wanted to follow up with another interview on how to respond to people who say that we are overmedicating. I’ve been in this position countless times, and my mouth opens but no words come out. Dr. Pies provides an excellent argument that provides a nuanced and holistic perspective to the problem. Dr. Pies is Professor of Psychiatry and Lecturer on Bioethics and Humanities at SUNY Upstate Medical University in Syracuse, New York and Clinical Professor of Psychiatry at Tufts University School of Medicine in Boston. His most recent book is “The Three-Petalled Rose: How the Synthesis of Judaism, Buddhism, and Stoicism Can Create a Healthy, Fulfilled and Flourishing Life.”
Question: How do you respond to people that say we are overmedicating?
Dr. Pies: The first thing I say is that this issue is something of a distraction from the much larger problem in American health care—the fact that most people with serious psychiatric illness have great difficulty getting the proper care and treatment, whether medication or “talk therapy.” In part, this is due to problems in the way our so-called “health care system” is set up—if you don’t have insurance, or enough money, you often are denied appropriate care. Often, there is also a mismatch between the patient and the level of expertise of the clinician; for example, few patients with clinically-significant depression ever get to see a psychiatrist or psychologist, in the U.S. I don’t mean to slam primary care doctors—they are doing their best under difficult conditions—but they are often overwhelmed, and can’t do an adequate work-up in a fifteen minute encounter. By the way, neither can a psychiatrist, when first assessing the patient! So, one thing I would tell anyone who is considering medication for an emotional or behavioral disorder: make sure that your initial diagnostic evaluation is thorough, complete, and—ideally—performed by an expert in the mental health area. Do not accept a diagnosis and treatment plan, based on a single, 12-15 minute “evaluation”! This is especially important when distinguishing medical and neurological causes of the problem from psychological and social causes—of course, all of these factors may be relevant—and in planning treatment for bipolar disorder, as contrasted with “ordinary” (unipolar) depression. Getting a second exert opinion is always worth considering if you have any doubts about the diagnosis or treatment you have been given.
Remember that medication is a bit like fire: it can heat your home comfortably in the winter, or it can burn it down. It all depends on when and how it is used, and with what degree of care and caution! Finally, as I always tell patients: medication is just a bridge between feeling bad and feeling better. You must still “move your legs” to get across that bridge, and that means working on new ways of thinking, feeling, and living!
Originally published on Sanity Break at Everyday Health.