THE BLOG

Do We Need a New Pill Drill?

This is thethat needs to be revisited and dismantled. Thisinvolves a lack of access to preventative, alternative and/or complementary approaches, and resorts to swift prescribing without exploring additional means to understand and treat mental health and stress-related issues.
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Commercials that get into our kids heads drive us crazy. When we see them salivating over enticing ads designed to make them pine for every last morsel of candy, new gimmick or any unhealthy vice, we are outraged. And we should be. It's pretty despicable companies do this.

As adults, we are also of great interest to marketers, but the version of "candy" being shoved down our throats -- almost literally -- are prescription meds.

The United States, along with New Zealand are the only two countries across the world that allows Direct-to-Consumer (DTC) pharmaceutical advertisements. We turn on our television and are bombarded with the latest breakthroughs that will allegedly help us out of our emotional, physical and even sexual ruts.

One that makes me choke is the cartoon advertisement for Abilify. This drug has been historically used for symptoms of psychosis, has heavy duty side effects, and is now being propped up like a magic bullet for women my age, who find themselves feeling "stuck" with "hard to treat, atypical depression".

A recent America's State of Mind report reveals that more than a quarter of adult women in their 40s and 50s take antidepressants and anti-anxiety meds. We are on the radar of drug companies, for sure. By the way, guys, you are not off the hook-the report also reveals that younger men, ages 20-44, have experienced a 43% rise between 2001-2010. And, of course, our children are being medicated at a higher rate than ever before.

For the record, I am not against medication. Doctors, pills, western medicine and even the pharmaceutical industry are not the enemy (but we do have to be aware of the multi-billion dollar industry that "Big Pharma" represents. They rake in hefty annual profits).

The advances in mental health awareness and treatment are extraordinary. Over the twenty years I've worked in the field, I've seen lives saved through effective assessment, diagnosis and treatment. As Allen Frances, MD, writes in his prolific book, Saving Normal: "An accurate diagnosis can save a life; an inaccurate diagnosis can wreck one."

Medicine undoubtedly can bring someone back from the brink, and be a total game changer. I've seen scores of people realize dramatic improvements through proper treatment. I've also seen Doctors and their patients rely too heavily on pharmaceutical intervention instead of comprehensive, combined approaches to both prevention and treatment.

This is the pill drill that needs to be revisited and dismantled. This drill involves a lack of access to preventative, alternative and/or complementary approaches, and resorts to swift prescribing without exploring additional means to understand and treat mental health and stress-related issues.

When interventions are purely reactive, or pharmaceutical in nature, we are missing a valuable opportunity for better treatment outcomes. A recent APA study reveals that only 1/3 of patients receiving antidepressants also engage in evidence-based interventions such as cognitive behavioral therapy.

Beyond balanced treatment, we need to bring prevention and education to the forefront of this conversation. Luckily, a host of health, government and advocacy groups are doing just that. Take for example, Mental Health America, whose "B4Stage4" campaign emphasizes early action when signs and symptoms of distress first appear. Prevention is always less costly than repair.

I recently attended a Harvard conference where there was a great deal of focus on Lifestyle Medicine, which fortunately, is gaining a lot of traction in the face of unprecedented lifestyle related illness. Lifestyle Medicine, as its name implies, takes a proactive, practical approach to decreasing risk and illness burden through non-pharmaceutical interventions like nutrition, stress reduction, exercise, avoiding alcohol and drug abuse, adequate sleep, and healthy relationships.

Have you ever wondered whether the so-called "hard to treat, atypical depression" could at all be connected with the constant cortisol overload in our bodies and brains that come with our rickety economy, non-stop demands, intense responsibilities and little time to actually take care of ourselves properly, or what Journalist Brigid Schulte refers to as a "constant state of overwhelm?"

This became especially real to me while I was providing therapy to "Brie", a bright, forty-two year old woman who was in a rut of epic proportions. The pill drill was very familiar to her. She had been put on a litany of meds, with barely any relief, and was drowning in a sea of self-defeated thoughts, stemming from here the constant gnawing of underperformance in the face of her never-ending checklist of demands.

Brie's depression was indeed "hard to treat", insofar that her symptoms stayed around for way too long, and had permeated her daily experience. She felt demotivated, isolated and stuck.

When she arrived in my office, she was fed up and filled with shame. After a couple of meetings, I learned she was an exceptionally bright woman who had yielded to her husband's career and found herself staring at piles of laundry, beating her brow she wasn't doing her "duty". She held a Masters degree and was highly skilled. And she was a prisoner in her own home and of a society that reinforces gender role pressure to be some sort of domesticated goddess, instead of pursuing her true passions.

Before therapy, she saw the ad for Abilify, her Doctor readily obliged to prescribe it, and Brie felt a tad of relief. But, it wasn't enough to tip the balance, or to make up for the side effects it brought on. To put it bluntly, and in non-clinical terms, her face was twitching and her jaw was messed up (the formal name for this condition is tardive dyskinesia).

A few sessions in, I suggested she consider engaging in her career with more intention. Just weeks later, she landed a new job she loved that renewed her sense of purpose, started hitting the gym more regularly, and hired someone to help with the laundry mounds. Her "hard to treat, atypical depression" was put in its place. This example teaches us:

1) We need to push back. Unhelpful, prescriptive roles that limit our growth and potential can disrupt our mental health. If you find yourself "stuck", a change in your routine or environment can often make a huge difference. It might just be that your emotions are not "atypical", but very natural given the pressure to live up to a certain standard or expectation assigned to you that just doesn't contribute to your wellbeing. Going against the grain isn't always easy, but is often necessary for our health.

2) Prevention is a must. Individually and collectively we have to avoid waiting until we are in an advanced state of distress. Sometimes we may be so busy we may not even notice what our bodies are telling us. A 2011 American Psychological Stress in America survey says that we are caught in a "vicious cycle of insurmountable barriers that prevent us from making lifestyle and behavioral changes for good health". This same study says that we often don't notice we're on shaky mental health ground until we get physically sick. It seems we could benefit from less advertising from drug companies, and more public health campaigns like that of First Lady Michelle Obama's Let's Move that help us find ways to get and stay on track.

3) There is no health without mental health. Prevention is not merely an individual act or concern. Our context of today can also bring about a lot of unrest and contribute towards our anxiety and depression bottom lines. We must demand changes in messages, policies and practices that get in the way of reaching our potential and employing needed Lifestyle Medicine strategies. We need to band together on this to question what is being sold to us so that we can respond to the charge of the World Health Organization that there is "no health without mental health", and create new multidimensional drills (that may or may not involve pills) that keep us on a preventative, proactive and comprehensive trek to wellbeing.

#B4stage4 #Onlywe

Please note: All of our health needs are unique, contextual, and case specific, and the assertions made in this blog or any, for that matter, should not substitute medical advice from your licensed practitioner. It is meant to be read in its entirety so as to not make the dire mistake of dismissing medication as an often needed, life changing intervention approach. Similarly, lifestyle medicine approaches are vital to our wellbeing and their tremendous value should not be discounted or understated. Identifying names and information have been changed to protect confidentiality.