The decision to end a treatment is as important as the one to start it

We have become a pill popping society. It makes absolutely no sense that 20 percent of our population regularly uses a psychotropic medicine and that the United States has more deaths each year from overdose with prescription drugs than from street drugs.

The causes of excessive medication use are numerous — the diagnostic system is too loose; some doctors are trigger happy in. their prescribing habits; the drug companies have sold a misleading bill of goods that all life’s problems are mental disorders requiring a pill solution; and the insurance companies make the mistake of encouraging quick diagnosis on the first visit.

My purpose here is to advise individuals on how best to deal with the risks of over-diagnosis and over-treatment. Elsewhere I have suggested the things government needs to do.

A diagnosis, if accurate, can be the turning point to a much better life. A diagnosis, if inaccurate, can haunt you (perhaps for life) with unnecessary treatments and stigma.

Spend at least as much effort ensuring you have the right diagnosis as you would in buying a house. Become a fully informed consumer, ask lots of questions, and expect clear and convincing answers from any clinician who offers a diagnosis and recommends a treatment. If the diagnosis doesn’t seem to fit, get second or third opinions.

Never accept medication after receiving only a brief diagnostic evaluation, especially if it has been done by a primary care physician who may not be expert in psychiatry and may be too influenced by drug salesmen.

Don’t believe drug company advertisements that end with, “Ask your doctor.” Drug companies profit if they can convince you that you have a psychiatric disorder and need medication. They portray the expectable problems of everyday life as mental illnesses due to a chemical imbalance because this sells pills and makes money — not to help you.

There is a strange paradox in our country. Perhaps half the people taking psychiatric medicines don’t need them, while more than half the people who do need them are not taking them. Symptoms that are severe and persistent should be an immediate call to diagnosis and treatment. Symptoms that are mild and in reaction to a life stress will usually go away on their own.

People visit the clinician on what may be one of the worst days of their lives. Time, resilience, support and changing circumstances often result in dramatic improvement, without the need for diagnosis or treatment. But if you immediately start medication and later feel better, you will likely think the pill did the trick and continue taking it even if it was just along for the ride and isn’t really necessary.

So, watchful waiting beats diagnosis and treatment for mild symptoms’ while immediate diagnosis and active treatment is required for severe symptoms.

How do you decide where you fit. If symptoms are new, in reaction to real problems in your life, and don’t interfere with your functioning, give time a chance. But get help fast if the symptoms are markedly distressing, prolonged, incapacitating, or dangerous.

Study up so that you can have an informed opinion, but don’t make these judgments all alone. Get the advice of clinicians and family. And a decision about treatment, made either way, is not once and for all. You can always start treatment later or decide to stop it as more information becomes available or if conditions change.

If you are on medicine already, don’t ever try to stop it on your own, because you may really need it and also because many medicines cause withdrawal symptoms when stopped abruptly. The decision to end a treatment is as important as the one to start it. Get help with both — but also always be an engaged and informed consumer.

Allen Frances is a psychiatrist and professor emeritus, Duke University.  He blogs at the Huffington Post.

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  • drgn

    Unfortunately he’s right. I think that all these drug commercials etc. have infiltrated the medical system to over prescribing. And he is right that the severely mentally ill don’t get access to care and appropriate treatment as they should secondary to a broken mental health system.

  • Invisible Strings

    great points…amazing how much difference just a little patience will make…diagnoses often happen way too fast, go unquestioned…so this is terrific advice here, about getting more opinions, tests, and basically just being cautious.

  • Glutathione Pro

    The first paragraph says it all, I was recently reading about just how often people are misdiagnosed not to mention over diagnosed. The rates are staggering and the amount of pharmaceutical drugs in use these days is frightening. Some of the best options are often the most simple, a healthy diet, moderate exercise daily and these days a competent nutritional supplement routine is critical for optimal health. Avoid the drugs and opt for nutrition, prevent disease before it becomes a diagnosis (hopefully not a misdiagnosis).

  • cannotsay

    What Mr Frances will not say here (although he has admitted it elsewhere). He bears a great deal of responsibility in having been an enabler to this reality. He was the chair of DSM-IV, DSM-IV created false epidemics of ADHD and bipolar disorder in children for which, you guessed well, the “recommended treatment” is drugging. Cocaine/Amphetamine in the case of ADHD, so called “neuroleptics” in the case of bipolar disorders. So Mr Frances has been probably more instrumental than any other psychiatry we can think of in recent memory in having Big Pharma companies making tens of billions of dollars drugging children.

  • katerinahurd

    How much does the nature of a disease allow the termination of a treatment? Can it be claimed that treatment with deep brain stimulation for Parkinson’s patients fall into this category?

  • Rob Burnside

    Given the option for an “instant” cure, we’ll generally take it, but I think this has more to do with the pace of life than anything else. We have become a drive-through society. Time has literally been value-engineered out of the healing equation and health care altogether, and for this we all–providers and consumers alike–pay a great price.

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