The perfect storm of insurance restrictions for non-pharmaceutical interventions, combined with the introduction of better-tolerated psychiatric meds, has led to unprecedented use of powerful, prescription drugs among the public. Psychotropics that were formerly reserved for the seriously mentally ill, are now prescribed for milder forms of depression and anxiety.
What constitutes a mental or emotional disorder that warrants medication is constantly being re-defined. The boundaries between bipolar disorder and attention deficient disorder have widened across populations and age groups. The thresholds for the diagnosis of these conditions have become lower and looser.
A significant proportion of these prescriptions are not coming from actual, qualified psychiatrists; the prescribing may be done by pediatricians, primary care doctors, nurse practitioners and physician assistants who lack familiarity with these medications and their potential complications. In many instances, these diagnoses are made by parents and teachers, or suggested by acquaintances who have been exposed to radio and television advertising.
Of great concern is the “off label” use of psychiatric meds, as well as medications used in treating neurological and general maladies. For example, drugs used for treating hypertension such as clonidine or propranalol may be used for treating ADHD and anxiety. Anti-epileptics are getting prescribed for treating bipolar disorders, headaches, fibromyalgia, chronic pain, irritability, restless legs and aggressive behavior. Much of this off-label use is poorly researched and the attendant risks, benefits and alternative treatment options are often not adequately represented to the patient (or their caretakers). Many cases are brought to court examining the fault of these prescriptions; is it professional malpractice, or big Pharma hiding knowledge of potential hazardous side effects?
Problems related to the use of psychiatric medications are compounded by poor communication between the therapists who do psychotherapy and the psychiatrists who prescribe medications. Sometimes there are limitations on the number of visits that a patient can have. There is an insurance-driven trend to give a three month supply of medications for cost cutting that results in poorer follow up. There is also the very visible and front-of-mind direct advertising of psychiatric medications in popular magazines.
Particularly vulnerable are those who receive mental health monitoring and treatment from public/ private partnerships where the goal is cost-cutting, resulting in poor access to knowledgeable professionals and frequent changes in providers. The list includes prisons and jails, juvenile detention centers and minors in the foster care system. Polypharmacy, without skilled supervision, carries considerable risk of morbidity and even mortality from drug interactions.
Not surprisingly, these trends are spurring a great deal of litigation; both the defense and the plaintiff bars have called upon Atrium as experts in these sorts of cases. As professional psychiatrists and psychologists, our opinions are based on the facts of each case, which of course changes from person to person. We focus on understanding both the causal factors that have lead to the alleged difficulties and the scope and nature of these problems.