Earlier I read a startling statistic about antidepressant drugs. Apparently, four out of five times they are prescribed, there is no psychiatric diagnosis:
Antidepressants became the third most commonly prescribed class of medications in the United States thanks in part to non-psychiatrist providers prescribing the drugs to individuals without any psychiatric diagnosis, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health.
“We’ve seen a marked increase in antidepressant use among individuals with no psychiatric diagnosis. Nearly four out of every five antidepressant prescriptions are written by non-psychiatrist providers,” said Ramin Mojtabai, MD, PhD, MPH. He was lead author of the study and an associate professor with the Bloomberg School’s Department of Mental Health.
“Between 1996 and 2007, the number of visits where individuals were prescribed antidepressants with no psychiatric diagnoses increased from 59.5 percent to 72.7 percent and the share of providers who prescribed antidepressants without a concurrent psychiatric diagnosis increased from 30 percent of all non-psychiatrist physicians in 1996 to 55.4 percent in 2007.”
Hmmm…. Sounds like the bread and butter of the medical profession.
To be fair, it should be noted that antidepressants are now so frequently prescribed for pain that the Mayo Clinic calls them a “mainstay” of pain therapy. They are also prescribed for a host of other ailments, including anxiety, weight loss, premature ejaculation, etc.
It should not surprise anyone that a lot of Alzheimer’s patients (and patients in nursing homes) are given antidepressants:
Treating Symptoms Associated with Alzheimer’s
Depression. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac) and sertraline (Zoloft), may be effective in relieving depression, irritability, and restlessness associated with Alzheimer’s in some patients.
Apathy. Depression is often confused with apathy. An apathetic patient lacks emotions, motivation, interest, and enthusiasm while a depressed patient is generally very sad, tearful, and hopeless. Apathy may respond to stimulants, such as methylphenidate (Ritalin), rather than antidepressants.
Psychosis. Antipsychotic drugs are used to treat verbally or physically aggressive behavior and hallucinations. Because older antipsychotic drugs, such as haloperidol (Haldol), have severe side effects, most doctors now prescribe newer atypical antipsychotics, such as risperidone (Risperdal) or olanzapine (Zyprexa).
So there’s considerable overlap between drugs prescribed for diagnosed mental illnesses and Alzheimer’s.
Considering the way Alzheimer’s affects the brain in the most profound manner imaginable, and the way almost everything has now become one form of mental illness or another, you’d think it might be a mental illness, right?
You’d be wrong. Believe it or not, the question of whether Alzheimer’s is a mental illness is a political question:
This is more of a political question in many ways than a scientific one. When we speak of a psychiatric disorder we often use the term “functional” as opposed to “medical”. Functional essentially means without an organic cause.
We know that AD has a specific course, with specific and non-specific signs and symptoms. It has demonstrated changes in the brain at a microscopic cellular level as well as a macroscopic level when it is advanced. The gross brain of a victim with advanced stages of AD looks different than the gross brain of a person without the disease.
In many psychiatric disorders you can not find the physical changes in the brain. That does not mean they do not exist, it is just that science has not caught up in certain psychiatric disorders.
For a long time when AD was first becoming known in our conscious awareness some twenty or so years ago, the issue of a psychiatric disorder or not was a hotly contested and emotional issue by many advocates and groups. It really stemmed from the fact that we have terrible biases and stigmas associated with mental illness. In fact we still do. We did not want to classify our AD victims with ‘those’ kind of disorders.
In fact there are many psychiatric disorders where you can find differences in the brain. It is well-established that people suffering with schizophrenia for example, have larger ventricles in the brain compared to people without schizophrenia.
The debate was further compounded by the fact that the Diagnostic and Statistical Manual (DSM) which is still on its 4th edition and goes back to the early 1950’s in the first edition, lists Alzheimer’s Disease. This manual is sort of the “Bible” of psychiatry developed by committees of experts that have time, and published by the American Psychiatric Association. It lists diagnosis and criteria to make the diagnosis. It has two actual practical purposes besides academic (and political). lawyers and judges love it, in a court of law, because it is in black and white and considered dogmatic, and insurance companies like it because they recognize some diagnosis of which they will actually reimburse for.
Many people do not like that Alzheimer’s disease is listed in the DSM.
Fascinating. I guess the stigma of mental illness is considered so awful that families of the victims of Alzheimer’s just don’t want their loved ones tarred with it.
The irony is that both schizophrenia and Alzheimer’s can be totally disabling, rendering the victims incapable of intelligently caring for themselves. But just try getting care for someone with schizophrenia. Because it’s a mental illness, everyone looks the other way and society passes the buck. Families are on their own having to work their way through a system that doesn’t care, and which treats schizophrenics as rational citizens.
If a family member has Alzheimer’s, though, there is a well-oiled system in place to take care of them. They can be put away in rest homes with very little fanfare. A wife whose husband is diagnosed with Alzheimer’s has far more options than if her husband were diagnosed with schizophrenia, and why? Because the former is a “physical” illness while the latter is not.
Why, there’s even a movement to keep schizophrenics out of rest homes, as if they’re supposed to be reserved for Alzheimer’s patients, and schizophrenics belong on the street.
After all, if we let Alzheimer’s patients roam the streets, it would be inhumane. This is a rational double standard, right?