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  • Avatar Antares 
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    I suspect closer to 33%, and no I don’t think overall psychotropic meds are overprescribed. There are high levels of untreated depression and anxiety in society. That said, 70% of my work is psychotherapy, and I also agree that many people could benefit immensely from good therapy and aren’t getting it.

    #196267 Reply
    Avatar hightower 
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    If you include alcohol and marijuana in this conversation, I would bet the number is closer to 80% of the population.  Humans have been using mind-altering substances since the beginning of time.  Every society has it’s drug of choice.  Ours is still hands down alcohol.  It’s so ubiquitous that most people don’t even categorize it as a “drug.”

    #196339 Reply
    Liked by hatton1
    Avatar Antares 
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    If you include alcohol and marijuana in this conversation, I would bet the number is closer to 80% of the population.  Humans have been using mind-altering substances since the beginning of time.  Every society has it’s drug of choice.  Ours is still hands down alcohol.  It’s so ubiquitous that most people don’t even categorize it as a “drug.”

    Click to expand…

    And if you want to go that route, you have to add caffeine. That may actually be the most pervasive drug used in our society.

    #196350 Reply
    childay childay 
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    Difficult question to answer.  But I did find this study from a privately insured population in US.  Presumably even higher in Medicaid etc.  Probably in other countries with socialized healthcare or databases would be answerable, but may not apply to US.

    http://apps.who.int/medicinedocs/documents/s19032en/s19032en.pdf

    In above, ~20% were rx in one year in 2010.  Lifetime rx would be much higher.

    #196357 Reply
    Rando Rando 
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    Click to expand…

    Haha. Please don’t.

    I’d say 15-20% for current use, not sure about lifetime prevalence. I’m a psychiatrist and tend to think psychotropics are generally overprescribed, though I’d agree that access to care issues result in under prescribing in certain populations. We need more skilled psychotherapists in my opinion, not more drugs.

     

    Click to expand…

    I think part of the trouble is there aren’t enough skilled psychotherapists and there probably never will be.  I hate to say it but many of the therapists out there don’t seem that skilled, and even if they are it seems to me there has to be a good rapport between the patient and therapist otherwise it doesn’t help.  There has not been an actual psychiatrist in my town in over ten years, and I don’t see that changing.

    #196358 Reply
    Liked by hatton1, childay
    childay childay 
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    Another reference from CDC suggests ~16% in past 30 days, only including antidepressants and anxiolytics.

    https://www.cdc.gov/nchs/data/hus/2017/080.pdf

     

     

    #196362 Reply
    Avatar Panscan 
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    If 1/3 of the country requires mood altering drugs is that considered normal or acceptable? That seems strange to me. Either people have unusual expectations of life or we need to teach coping skills better.

    1/3 of the country shouldn’t need a psychotherapist.

    This is not a knock on mental health at all, I’m just saying it’s hard to say something isn’t over prescribed if we’re getting to almost half the country being on it.

    #196363 Reply
    childay childay 
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    Either people have unusual expectations of life or we need to teach coping skills better.

    Click to expand…

    I am sure 99% of psychiatrists would agree with both.  For the most part the patients psych ends up seeing are not the worried well.  Coping skills are almost non-existent on the inpatient unit.

     

    Source less-thanigreater-thanPsychiatric Servicesless-thanslashigreater-than 20099601167 and Healthcare Business of Thomson Reuters

    #196365 Reply
    Avatar Antares 
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    If 1/3 of the country requires mood altering drugs is that considered normal or acceptable? That seems strange to me. Either people have unusual expectations of life or we need to teach coping skills better.

    1/3 of the country shouldn’t need a psychotherapist.

    This is not a knock on mental health at all, I’m just saying it’s hard to say something isn’t over prescribed if we’re getting to almost half the country being on it.

    Click to expand…

    Modify expectations, teach coping skills, understand what makes you tick, treat actual major psychiatric disorders. But another possibility is that in some way the demands of our society may put a kind of pressure on many people that challenges the limits of their self-management. In our words, what dimension of this is societal and not just personal and individual?

    #196378 Reply
    Avatar IntensiveCareBear 
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    I’m not sure but whatever the number is, it’s not high enough. SO MUCH UNTREATED MENTAL ILLNESS. …

    Click to expand…

    Or people could just learn how to cultivate their own happiness and develop true social skills (liking a photo or commenting on a blog doesn’t count).

    Society is a joke nowadays with the FOMO from social media and the lack of manual labor. People don’t sleep well since they take too many stimulants, do very little exercise or labor, and cause their own anxiety by worrying about things which don’t even affect them whatsoever (politics, celebs, sports, internet arguments, news drama, etc). Our minds are meant for groups of roughly 100-300 in numerous studies, and they are overloaded with nonsense from the news and internet. Very few people can self-start true hobbies and recreation or develop pursuits and goals/mission these days. They are too distracted and overwhelmed with nonsense. It’s sad.

    The labor is a big key, though… whether it is real work (lawn care, remodel, soup kitchen, walk dog) or athletics (run, swim, lift, yoga), it all tires and tones the muscles and lets the mind be at ease during the workout and helps you sleep like a rock. Very few people do that stuff anymore. Fewer kids than ever play sports (great for social, fitness, and communication skill). There would be no doubt that any study would show that dedicated exercisers and professional laborers have less anxiety and sleep disturb and depression than average folks… and better self confidence.

    …Everyone is now looking externally for quick-fix dopamine hits via things that will make them feel happy (food, TV, porn, shopping, etc) or accepted (make up, clothes, status symbols, dating, church, activist groups, etc)… instead of working internally on their own skills of life enjoyment and socialization. The brain is like a computer where only the owner can do the software updates. Simply buying new add-on software can’t fix a hard drive that is effed up.

    Boring people get bored because they do not do happiness inventory and make action plans to increase their happiness. Lonely people are feeling way because they have not developed a plan to create self confidence, social hobbies, and group events. Pills and other quick fixes don’t remedy that stuff, and unfortunately, it really isn’t taught in most schools. Those are fundamental life skills that take time and effort to develop.

    “As a cure for worry, work is better than whiskey.”

    …and to the OP question, I’d say it is 50%, easy (on those Rx or have/will be). Between docs being in a hurry, docs wanting the $ for the refill visits on that stuff, and people wanting quick fixes, that is just how it is now. For better or for worse.

    …I think part of the trouble is there aren’t enough skilled psychotherapists and there probably never will be…”

    Correct. Therapists will also avoid offering the sort of ‘tough love’ that most people need for numerous reasons: 1) money and getting return visits (hand-holding for weeks and years pays more than motivating ppl and teaching real skill sets), 2) therapists are generally “nice people” not necessarily successful and functional happy people themselves, 3) therapy pays low and won’t attract the more talented people who thrive at social life (they’ll usually choose sales, biz, entrepreneur, etc).
    The people who can really do most anxious and lonely and unhappy people a real helpful service are their family or friends, who can do the ‘dirty work’ of breaking it to them that they are the only ones who can fix their own problem and then point them to personal development books or sites or YT channels or etc. They could also teach them some of the skills by mentor and modeling them regularly, but I dunno about you, but I don’t really like being around unhappy and mopey and whiny ppl too often or for extended periods 🙂
    “Law 10: INFECTION: AVOID THE UNHAPPY AND UNLUCKY. You can die from someone else’s misery—emotional states are as infectious as diseases. You may feel you are helping the drowning man but you are only precipitating your own disaster. The unfortunate sometimes draw misfortune on themselves; they will also draw it on you. Associate with the happy and fortunate instead. ” -Greene, 48 Laws of Power
    #196386 Reply
    Avatar wideopenspaces 
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    If 1/3 of the country requires mood altering drugs is that considered normal or acceptable? That seems strange to me. Either people have unusual expectations of life or we need to teach coping skills better.

    1/3 of the country shouldn’t need a psychotherapist.

    This is not a knock on mental health at all, I’m just saying it’s hard to say something isn’t over prescribed if we’re getting to almost half the country being on it.

    Click to expand…

    Have you heard of the ACEs study? It measures adverse childhood events and was studies in middle class white populations. Participants were asked if they experiences the following in childhood:

    • Recurrent physical abuse

    • Recurrent emotional abuse

    • Contact sexual abuse

    • An alcohol and/or drug abuser in the household

    • An incarcerated household member

    • A household member who is chronically depressed, mentally ill, institutionalized, or suicidal

    • Mother is treated violently

    • One or no parents

    • Emotional or physical neglect

    Each participant received an ACE score in the range of 0-9 reflecting the number of the above experiences he/she can claim (e.g., a score of 3 indicates that that participant experienced 3 of the above ACEs).

    The study claims two major findings. The first of these is that ACEs are much more common than anticipated or recognized, even in the middle class population that participated in the study, all of whom received health care via a large HMO. It is troublesome to ponder what the prevalence of ACEs might be among young African American and Latino males, many of whom live with chronic stress and do not have a regular source of healthcare.

    The second major finding is that ACEs have a powerful correlation to health outcomes later in life. As the ACE score increases, so does the risk of an array of social and health problems such as: social, emotional and cognitive impairment; adoption of health-risk behaviors; disease, disability and social problems; and early death. ACEs have a strong influence on adolescent health, teen pregnancy, smoking, substance abuse, sexual behavior, the risk of revictimization, performance in the work force, and the stability of relationships, among other health determinants. The higher the ACE score, the greater the risk of heart disease, lung disease, liver disease, suicide, HIV and STDs, and other risks for the leading causes of death.

    With all the trauma that many people experience as kids and young adults it is no surprise to me that people struggle in the ways that they do-both mentally and with their physical health. It sounds like you grew up in a home where these events were not considered a part of life or normal, which is lucky. Most Americans are not so lucky. It’s not that they have inadequate coping skills, it is that they are experiencing trauma in their lives which is more “normal” than you realize. So this is a societal problem that probably requires more than just meds and therapy but since I don’t see that happening in the US, we as physicians have to do the best we can given the tools that we have.

    #196409 Reply
    Avatar wideopenspaces 
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    I’m not sure but whatever the number is, it’s not high enough. SO MUCH UNTREATED MENTAL ILLNESS. …

    Click to expand…

    Or people could just learn how to cultivate their own happiness and develop true social skills (liking a photo or commenting on a blog doesn’t count).

    Society is a joke nowadays with the FOMO from social media and the lack of manual labor. People don’t sleep well since they take too many stimulants, do very little exercise or labor, and cause their own anxiety by worrying about things which don’t even affect them whatsoever (politics, celebs, sports, internet arguments, news drama, etc). Our minds are meant for groups of roughly 100-300 in numerous studies, and they are overloaded with nonsense from the news and internet. Very few people can self-start true hobbies and recreation or develop pursuits and goals/mission these days. They are too distracted and overwhelmed with nonsense. It’s sad.

    The labor is a big key, though… whether it is real work (lawn care, remodel, soup kitchen, walk dog) or athletics (run, swim, lift, yoga), it all tires and tones the muscles and lets the mind be at ease during the workout and helps you sleep like a rock. Very few people do that stuff anymore. Fewer kids than ever play sports (great for social, fitness, and communication skill). There would be no doubt that any study would show that dedicated exercisers and professional laborers have less anxiety and sleep disturb and depression than average folks… and better self confidence.

    …Everyone is now looking externally for quick-fix dopamine hits via things that will make them feel happy (food, TV, porn, shopping, etc) or accepted (make up, clothes, status symbols, dating, church, activist groups, etc)… instead of working internally on their own skills of life enjoyment and socialization. The brain is like a computer where only the owner can do the software updates. Simply buying new add-on software can’t fix a hard drive that is effed up.

    Boring people get bored because they do not do happiness inventory and make action plans to increase their happiness. Lonely people are feeling way because they have not developed a plan to create self confidence, social hobbies, and group events. Pills and other quick fixes don’t remedy that stuff, and unfortunately, it really isn’t taught in most schools. Those are fundamental life skills that take time and effort to develop.

    “As a cure for worry, work is better than whiskey.”

    …and to the OP question, I’d say it is 50%, easy (on those Rx or have/will be). Between docs being in a hurry, docs wanting the $ for the refill visits on that stuff, and people wanting quick fixes, that is just how it is now. For better or for worse.

    …I think part of the trouble is there aren’t enough skilled psychotherapists and there probably never will be…”

    Correct. Therapists will also avoid offering the sort of ‘tough love’ that most people need for numerous reasons: 1) money and getting return visits (hand-holding for weeks and years pays more than motivating ppl and teaching real skill sets), 2) therapists are generally “nice people” not necessarily successful and functional happy people themselves, 3) therapy pays low and won’t attract the more talented people who thrive at social life (they’ll usually choose sales, biz, entrepreneur, etc).
    The people who can really do most anxious and lonely and unhappy people a real helpful service are their family or friends, who can do the ‘dirty work’ of breaking it to them that they are the only ones who can fix their own problem and then point them to personal development books or sites or YT channels or etc. They could also teach them some of the skills by mentor and modeling them regularly, but I dunno about you, but I don’t really like being around unhappy and mopey and whiny ppl too often or for extended periods 🙂
    “Law 10: INFECTION: AVOID THE UNHAPPY AND UNLUCKY. You can die from someone else’s misery—emotional states are as infectious as diseases. You may feel you are helping the drowning man but you are only precipitating your own disaster. The unfortunate sometimes draw misfortune on themselves; they will also draw it on you. Associate with the happy and fortunate instead. ” -Greene, 48 Laws of Power
    Click to expand…

    I disagree with most of what you have written here as it sounds like some self help nonsense. Yes exercise should be part of a treatment plan, as well as addressing sleep issues. And behavioral activation in the form of hobbies and ADLs is helpful as well. But it’s crazy invalidating to say that is what most people with mental illness should be doing to treat their health and basically telling them that if they would just try harder they would be fine. And any doctor prescribing an SSRI is just lazy and doing nothing to treat the actual problem. Given what you have written it sounds like you have never taken the time to get to know anyone-in real life or as your patient-who has mental illness to understand their individual issues and what is driving their problems.

    #196412 Reply
    Liked by Antares
    Avatar Panscan 
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    Not sure how that is directly related. I also have no idea what my post says about my person experience with/without ACEs or how that is relevant to my viewpoint.

     

    my point is that it’s not normal for 30 % of the population to be considered to have mental illness that requires drug therapy. I absolutely agree people deal with horrible things that set them up for failure down the line.

    People of all spectrums could benefit from better coping skills so I don’t get the argument ” It’s not about coping skills,” It’s a no lose proposition.

     

    at the end of the day it comes down to everybody deals with stuff in their life. some people have it worse. I don’t think 30% of people face insurmountable challenges in life. especially relative to other non-developed nations where it is luxury to have running water.

     

    #196413 Reply
    Avatar wideopenspaces 
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    We should just put lexapro in the water.

    Click to expand…

    Haha. Please don’t. 😉

    I’d say 15-20% for current use, not sure about lifetime prevalence. I’m a psychiatrist and tend to think psychotropics are generally overprescribed, though I’d agree that access to care issues result in under prescribing in certain populations. We need more skilled psychotherapists in my opinion, not more drugs.

     

    Click to expand…

    I agree with this, as the USA has higher antidepressant Rx rates than anywhere in the world.  I work in a detox unit.  So many of my alcoholic patients are on Lexapro etc, and of course it doesn’t do a damn thing for their mood problems when they are drinking a fifth of whiskey a day.  However, for PCP’s it is much more feasible to write for a cheap Rx than do 10 minutes of motivational interviewing.

    I know many psychiatrists are extremely liberal with prescribing antidepressants even if they think it is just for the placebo effect, justifying it because SSRI’s are so benign.  I don’t count myself among them.  Of course they should be prescribed if the patient needs them.  But we used to be a lot more cavalier about prescribing opioids and benzos and now we have a better understanding of the risks of that.

    Image result for where in the world are antidepressants most prescribed

    FWIW, US suicide rates are about the same or higher than almost all the countries listed (among these, only Korea’s is substantially higher).

    Click to expand…

    I mean, in a lot of those countries with low antidepressant use, there is crazy stigma against mental health, they basically don’t even agree that it’s real. And in other countries in the UK they have a lot more structural supports in place so the rates of poverty are lower and access to social goods much higher so less stressors/triggers. In Australia and NZ the first line treatment for depression is 30 minutes of exercise daily and yet they still have pretty high rates of antidepressant use. So I’m not sure what to even do with this data. I don’t think it proves anything as far as the US “overprescribing” and I still say MH is undertreated and stigmatized everywhere in the world. Even doctors still look down on patients with mental health and we should be the most educated about it, yet seems to do nothing for some people. It’s hard enough to open up about depression, imagine doing so and having your provider basically tell you to buck up and go develop a hobby, as though that will fix it.

    #196415 Reply
    Avatar Panscan 
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    it will fix it though for a lot of people. will a hobby cure schizophrenia or bipolar? of course not. but there’s no way we’d have the same amount of depression and anxiety diagnoses if people had something to do with their time. it’s like a mental hygiene theory. their lives have no stress so they make their own. why do we see celebrities doing hard drugs? because their lives have no stress, so they have to make a challenge to have something to grapple with. I would suggest they make their challenge something productive instead of ingesting substances that rot their bodies out

    #196416 Reply

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