A Psychiatrist Takes On Polypharmacy

I have known people who were taking 7 and more psychiatric drugs at one time. Doing so is never a good thing. This phenomenon is known as polypharmacy and multiple pills usually means too many pills, or over drugging. Polypharmacy is notorious for having bad, or at least, non-improved outcomes. I was encouraged to find the blog entry of a Psychology Today psychiatrist taking the subject on. The psychiatrist is Dr. Eugene Rubin, and the article is titled How Many Psychiatric Medications Did You Say You Take?

We want to state up front that we are strong advocates of the appropriate use of medications to treat people who suffer from psychiatric illnesses such as schizophrenia, bipolar disorder, severe depressions, and severe anxiety disorders. When someone is ill with a disabling psychiatric illness, one or a few medications in combination with appropriate psychosocial interventions are often extremely helpful at decreasing or eliminating the painful symptoms. Appropriate medications can be life-saving.

We could have trouble with this term appropriate. Perhaps some people see psychiatric drugs as life-saving, but I can tell you right now that there are other people who see them as life threatening and soul destroying. I am a strong advocate for personal choice and physical health. Psychiatric drugs can be harmful, and a non-drug option should always be available for those people who want such treatment. Nobody, but nobody, should ever be forced to take psychiatric drugs against their expressed will and wishes!

However, we find that we are spending a lot of time teaching psychiatric residents (physicians who are doing 4 years of training after medical school in order to become psychiatrists) how to simplify drug regimens for patients. These days, we frequently encounter patients on 5 or more psychiatric medications (including pain medications). Occasionally, complex combinations of drugs may be useful and understandable, but we believe that this is the exception, not the rule. Why, then, is this “polypharmacy” (the simultaneous use of large numbers of medications) occurring? Here are a few possible reasons:

He gives as reasons the following.

1. Incorrect diagnosis
2. Impatience
3. Medications are prescribed inappropriately
4. Many doctors treating the same patient
5. A simplistic belief that psychiatric illness represent “chemical imbalances”

Uh, how’s that? Mental illness isn’t a matter of ‘chemical imbalance’? Did I hear right?

Yes, it’s a doctor saying what you should know to be true anyway. This ‘simplistic belief’, as the good doctor puts it, has been getting a lot of airplay. That it is a ‘simplistic belief’…well, let’s read what the doctor has to say.

5. A simplistic belief that psychiatric illnesses represent “chemical imbalances” – Many patients and doctors believe that psychiatric illnesses result from imbalances in brain chemistry. Psychiatric disorders likely reflect complex dysfunction in brain networks that underlie cognition, emotions, and motivation. These networks use neurotransmitters (chemicals) to send and receive information. While manipulating some of these chemicals (for example, serotonin or dopamine) can produce clinical benefits, we don’t yet understand what is wrong with brain networks in psychiatric disorders and how the medications affect network function. The point here is that if one buys into the “chemical imbalance” myth, then it might make sense to juggle multiple medications in order to “rebalance” the system. However, human behavior and the breakdown of human behavior involve complex interactions of the brain and the environment. Simple fixes do not occur by the simultaneous use of multiple psychiatric medications. What is certain is that the probability of significant side effects increases with the use of more medications.

Psychiatric drugs are no magic bullets, and a great deal of other health complications may accompany their usage. The doctor speaks of side effects, but he can only do so by making some of the assumptions he would be refuting. One of those assumptions is that neuroleptic drugs are a schizophrenia fighting medicine, and that whatever doesn’t act as a healing agent must be a side effect. Actually the effects of the drugs are direct effects, even if those effects aren’t, as the ones he calls side effects aren’t, pleasing.

More drugs = more damage.

When people undergoing mental health treatment are dying at an age on average 25 years younger than the rest of the population, and the practice of polypharmacy is a major reason why this is so, it’s time the general public was brought up to speed about the practice, and it’s time that that public made doctors accountable for the damage they cause.