This country has become too reliant on pills as a means of solving life’s problems says the editor of the Canadian Journal of Psychiatry.
According to Joel Paris, over the past few decades the Canadian medical establishment has increasingly viewed behaviour problems as biologically caused.
“It’s an attitude that says mental problems are due to chemical (imbalance), drugs restore chemical balances, therefore lets prescribe them,” Paris explained.
“I find it troubling.”
He said it’s likely that decades ago doctors overlooked legitimate mental disorder, chalking it up to merely bad behaviour. But he said now this country has the opposite problem.
“Every nerdy kid is being told... ‘maybe this is autistic spectrum disorder or asperger’s,’” Paris said. “Any kid who’s disruptive in school may be diagnosed with ADHD.”
'Any kid who’s disruptive in school may be diagnosed with ADHD.' - Joel Paris, editor of the Canadian Journal of Psychiatry
And he said it’s by no means a problem limited to children. Paris argued that right across the board there has been a “radical over-diagnoses” of mental illness.
“We’re giving psychiatric diagnoses to people who don’t merit them, are just unhappy and may not really require drug treatment.”
Care used to be holistic
Paris said decades ago when he was trained as a psychiatrist there was a more holistic approach to treatment, which involved psychotherapy. However now “we’re only on this one track and a patient can’t get out of our offices without a prescription.”
Paris argued that’s problematic because “the drugs we use we’ve found are not as effective as has been claimed”.
And he said they have side effects, like weight gain, that can cause more harm.
In many ways Paris’ critique of the Canadian system reflects Allen Frances’ analysis of what’s going on in the United States.
Frances is a prominent psychiatrist who chaired the DSM IV task force. That document is known as the ‘bible of psychiatry.” Frances is also the author of Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnoses.
He said that the healthcare industry, from psychiatrists to family doctors, has gone down the wrong path “turning childhood itself into a disease and way over-treating people for problems that would be better left alone.”
He said the proliferation of new drugs combined with aggressive advertising by pharmaceutical companies has led to a nation-wide crisis.
“Twenty per cent of Americans take a psychotropic drug every single day. So I think that there’s a glut of diagnoses and very often people get harmful and unnecessary treatment for it.”
He said because of the focus on what he calls “the worried well” many people who genuinely need help don’t get it.
“We’re ignoring the more severe problems where psychiatry has a very important role to play and could be crucially helpful,” Frances explained
Canada follows American trend
Paris said research shows over-diagnoses is a problem in Canada too, though arguably not as severe.
Paris pointed out “one out of ten or even more Canadians is now taking antidepressants and they don’t always work but people stay on them for many years.”
And he told CBC the diagnoses of antipsychotic drugs and mood stabilizers are also on the rise.
That’s the conclusion of a recent study by a neurologist from the University of Calgary.
In 2011, Tamara Pringsheim and her colleagues completed the only Canada-wide study on the prescription of antipsychotic medication to children.
They’re being used to treat ADHD, conduct disorder and mood disorder.
The researchers examined Canadian records from 2005-2009 and discovered there was a 114 per cent increase in the recommendation of antipsychotic medication.
The drugs were not only prescribed by psychiatrists but also family doctors and pediatricians.
Pringsheim said she’s examined the same data through to the end of 2012 and the rate of growth continues; which highlights an over-dependency on pills.
“I’m always telling parents not to overpathologize their children’s behaviour; that a lot of this is normal development and that most of the kids I see I don’t treat medically,” said Pringsheim.
“Our tolerance for problem behaviour has really dropped dramatically.”
She said pills can be a quick easy solution in a crisis and can be necessary for some patients but in the end they merely mask the underlying problem.
“As soon as you stop taking the pill things will probably go back to the way they were. But if you can change how someone thinks about something if you can change the way someone reacts to a situation that’s the closest we’re going to get to a cure.”
So she prescribes fewer pills and more talk therapy. Paris couldn’t agree more with that approach.
“I see a lot of people who’ve had a number of drugs tried that haven’t worked,” Paris explained. “There’s obvious reasons why they’re unhappy. They need to talk to somebody. But who’s going to do it?”
Saskatoon attempts to introduce more talk therapy
That’s a question the Saskatoon Health Region has been asking itself.
It is facing a significant shortage of psychiatrists and it’s attempting to mitigate that by developing teams of medical professionals like psychologists, social workers, addictions counsellors and nurses to work alongside psychiatrists.
Dr. Marilyn Baetz, who heads psychiatry for the region, said that work is in its early stages.
“We have very limited teams available,” Baetz explained. “We are certainly overwhelmed. We can’t begin to handle the amount that we have with the teams that we have. So, the teams we have are working very hard. There’s just not enough.”