I regularly get phone calls from people seeking a new psychiatrist, even though I rarely have the time to accept new patients these days.
One of the distinguishing characteristics of these calls is that the person on the other end of the line has often already been, or is wondering if they need to be, labeled with a particular mental disorder.
Now, in some cases, as with the seriously and chronically mentally ill population, (e.g. disorders like schizophrenia and bipolar disorder), the person WILL eventually need to be diagnosed with a serious mental illness and treated with medications, sometimes heavy-duty ones with heavy duty long-term side effects.
However, I must say that the practice of psychiatry has come to a point of near ridiculousness when it comes to over-diagnosing and over-medicating people way too soon in the process, and way too much in general.
The great majority of people who contact me looking for a new doctor are NOT chronically and seriously mentally ill.
However, too many of them have already been “diagnosed” and even “treated” for conditions like bipolar disorder or ADD. In fact, I couldn’t begin to keep track of how many people have either diagnosed themselves or their loved ones with bipolar disorder just by watching a T.V. commercial about a drug used to treat this condition.
“Hi Doc, I think my husband is bipolar.”
“No, your husband is probably a bit of a pain in the @ss, but he’s NOT bipolar.”
And if, per chance, the “patient” happens to be a young person between the ages of, say, 13 and 30, then, for sure, they’re going to somehow “fit” criteria for bipolar disorder:
What other age group has soooo many “mood swings”?
What other age group is soooo impulsive or unpredictable?
What other age group is soooo risky in their behaviors?
What other age group is soooo likely to jump around from thought to though in their conversations?
“Hi Doc, I think my child has attention deficit.”
“Yes, there IS an attention deficit, but we may need to look further at where exactly it lies.”
Other favorites among new callers are ADHD and Adult ADD:
Can’t concentrate at your stressful job?
Thoughts seem to hop around in your head?
Are you easily distracted, especially when stressed?
Do you feel “wired” and fidgety on the inside?
“Of course!”, you say, “I have all of the above!”
The Problem With All This
The problem with all of this over-diagnosing and over-medicating too soon and too much is threefold:
1) It can be dangerous:
The newest marketing techniques involve direct-to-consumer T.V. commercials. Patients then take that information and bring it in to their primary care doc or psychiatrist and the rest is history. They don’t know that some of these medications were originally designed for schizophrenia or bipolar disorder and are now “FDA approved” (don’t get me started on THAT topic) for conditions like major depression as well. But the problem is that other drugs are also available for major depression which do not carry as high a side effect profile as what they might have just seen advertised on T.V.; side effects like high cholesterol, high blood sugar, and heavy weight gain tendencies. Just keep this in mind: heavier meds originally designed for more serious conditions often=heavier side effect burdens even if “only” being used for moderate depression. Of course, in cases of very severe depression, we can and should augment with some of these medications, but not as an everyday first line option.
2) It can distract us from the underlying problems, wasting years of someone’s lifetime:
If you’re 18 and someone tells you that you “have bipolar” and starts you on a mood stabilizer or antipsychotic medication, you may be in for years worth of chasing different pills and pill-manager type M.D.s in order to get the “right” combination of psych meds. At the same time, you may be allowed to be left totally ignorant of the fact that there are underlying themes which need to be processed in good therapy work that can absolutely change your symptoms and brain chemistry over time. But the option of customizing any medication use over time depending on what’s happening in the therapy work gets lost in the patient’s “hope” of finally having a “diagnosis” and a “cure”. The focus becomes pills in cases where it should have been therapy work plus or minus pills. On the other hand, this also points to the absolute importance of saving serious psychiatric diagnoses like bipolar disorder for the people that truly qualify for them, so that proper, often life-saving, medications can be started and maintained.
3) It can play on people’s hopes of finally feeling better:
A lot of trust is placed on us doctors. We take a Hippocratic Oath in which we swear to practice medicine ethically and with the interest of the patient first. People come to us in hopes of feeling better; that our training and our experience can help guide them towards relief of their pain. I hate to say it, but medicine has become like any other business in which the old saying, Caveat Emptor, (“buyer beware”), now holds. If you go to a doctor who only prescribes medications, you’ll get a medication. Which is why, especially with psychiatric issues, it’s best to see an M.D. who is also a therapist as well. I like to tell people that you need to find a psychiatrist with the heart of a psychologist or social worker. In fact, if I were seeking psychiatric care, I’d ask prospective providers, “How do you feel about treating personality and circumstance-driven issues?”, instead of, “I think I might have bipolar or ADD.” The former question will likely weed out providers who are primarily med-driven, whereas the latter will produce too many who are willing to medicate you. Again, and as I’ve qualified in each of the other two circumstances above, this does not hold for that minority that actually does, in fact, have a major psychiatric disorder such as severe, debilitating major depression, bipolar disorder, or schizophrenia. Proper diagnosis, sometimes over time, is absolutely essential before putting pen to prescription pad.
Which brings me back to the title of this blog:
Don’t Go to a Hot Rod Shop for an Oil Change
If my car seems to need an oil change, or maybe a bit of maintenance or repair work, and I take it to a Hot Rod Shop, something quite interesting may very well happen.
That is, they may do a fine job on the oil change, if they remember to do it at all, but I may also come out of there with a super-charged engine, extra fat tires, a sports transmission, modified exhaust, and racing stripes to boot. And I may still need to eventually get that oil change and core maintenance work done on my car.
But who could blame them?
For that’s just what they do. And, after all, they aren’t breaking any laws. In fact, they’re probably very well respected in the community and have lots of experience.
So, I’d say that, in the face of all this, let’s just be careful about who’s shop we (and our families) walk into in the first place, especially if you’re planning on the long term and not just on a quick quarter-mile drag race.
Anthony Ferraioli, M.D.
Author, DON’T GET MARRIED! (UNLESS YOU UNDERSTAND A FEW THINGS FIRST)