Over-prescribed and over-used | Political economics


he past decade has seen a significant increase in mental health awareness and acceptance around the world: a welcome change from the denial and stigma that prevailed in the 1990s and early 2000s. frequent debates around the subject, medical jargon has seeped into our vocabulary, blurring the lines between medical diagnosis and informal discourse. One such example uses depression as a synonym for stress, or its most intense form, distress. Although it may seem innocuous, this interchangeable usage can confuse our understanding of the terminology.

Stress is a normal response to our daily challenges, while depression is a clinical entity. In healthy amounts, stress motivates us to overcome obstacles and achieve our goals. Instead, depression results from an overload of the brain’s coping mechanisms. It is a clinical diagnosis based on a set of predefined criteria.

Confusing distress with depression is not limited to people outside health care. Unfortunately, many doctors seem to share the same misunderstanding of the two terms.

A questionnaire designed specifically for this purpose offered some clarity, but its use is uncommon in our clinical setting. Although physicians in our health care system mostly work as general practitioners in the western health model, their training mandate does not involve psychiatric exposure. As a result, they sometimes lack the clinical insight to deal with mental health issues. Either way, as they see patients more frequently and early in their healthcare journey, they often diagnose distress as depression, leading to over-prescription of antidepressants.

Depression is a difficult topic, like any mental health issue. Even with recent advances in psychiatry, we have yet to make significant inroads in restoring mental health and bringing some sense of normalcy to patients’ lives. Socio-economic and cultural factors are mainly responsible for considerable distress, especially in vulnerable groups. In practice, the nature of these causes makes it difficult to treat depression, especially in a time and resource constrained system. For these reasons, doctors see antidepressants as the only solution.

When used for selective patients who may benefit, antidepressants can save lives. However, clinicians should exercise caution against their excessive and unjustifiable use. The trend among doctors and psychiatrists in the region seems anything but wise.

Given the dangers of overprescribing, the use of antidepressants should be reduced, both by clinicians and patients.

One situation that stands out is the use of antidepressants among adolescents. Almost all adults know the trying nature of puberty for the child and his family; even more so for women, for obvious reasons. Therefore, their mood swings, obvious distress, and rebellious attitudes should come as no surprise. These behaviors reflect a child’s average response to changing physiology and anatomy. Adolescence includes not only a physical growth spurt, but also emotional and psychological development. As they say, stress is a catalyst for growth; this is perhaps one of the few examples where we see tangible results.

With the ongoing developmental process of sexual and personal identity formation alongside the evolution of logical, moral, and abstract thinking, it seems counter-intuitive to use drugs that cause emotional blunting. Allowing a child to work through the stress associated with puberty promotes normal maturation and healthier neural connections. Antidepressants can numb the mind’s response to stress and lead to maladaptive responses during their crucial formative years. Inevitably, this will have long-term implications for dealing with future life challenges. This is not to argue against professional help or antidepressants when needed; however, the threshold for their use should not be as low as it is currently in practice.

With the apparent limitations of a resource-strapped country, expecting professional help beyond medication might be overkill for most; Unfortunately, there are no definitive solutions to the problem. The latest research highlights that social support is essential to mental health recovery. It plays a role in protecting children against stress. Although, for social support to make a meaningful difference, it is essential that those in distress feel seen and heard – a feature that our traditional ways of bonding lack. This sense of security in their social circles allows the overactive neural mechanisms responsible for depression to calm down and promote healing. It also helps to work on strengthening coping mechanisms.

Before considering the use of antidepressants in children, therapists can teach these coping strategies in their clinics. Current guidelines also recommend antidepressants as a second-line treatment option for depression in children. Given the dangers of over-prescription, the use of antidepressants should be reduced, both by clinicians and patients. Also, rushing to the doctor for every little stressful episode might not be a good idea. Accepting stress and grief as part of our lives and viewing them as necessary stimuli for our emotional growth can equip us with better coping mechanisms. In most cases, the time and space to process our feelings with the support of loved ones is enough to manage them.

The author is a physician with a particular interest in mental health. She can be contacted at [email protected]

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