Time to Get a Second Opinion?

 

If a mental health provider has you on a whole lot of different psych meds on the basis of a cursory diagnostic interview without much follow up and almost no attention to what is going on in your life currently, it is time to see somebody else.

In the July issue of Clinical Psychiatry News, Nicolas Badre and David Lehman discuss what is known as “malignant polypharmacy” –  the tendency of some psychiatrists and psychiatric nurse practitioners to confuse symptoms that appear in different forms with a variety of different psychiatric diagnosis. 

They then make multiple diagnoses – many of which are not really separate conditions co-occurring with a primary diagnoses – and prescribe a variety of medications. Many of these are not only not indicated but may interfere with each other or produce unnecessary side effects. This diagnostic and treatment stew also creates a great deal of confusion for the patient about exactly what they are being treated for.

An example they give is a patient who comes to a new doc having been diagnosed with bipolar II (a b.s. diagnosis to begin with), high anxiety, split personality, post-traumatic stress, insomnia, attention deficit and depression.” The medication list of such a patient may include a stimulant and a tranquilizer (uppers and downers and bears, oh my!), a mood stabilizer, two antidepressants, and a low dose antipsychotic!

Overprescribing of dangerous meds is another problem. The Wall Street Journal exposed abuse of Adderall prescriptions by telehealth organizations. One story (8/19/22) was about a man with substance abuse who was given an Adderall prescription after a “30 minute consult” with a Nurse Practitioner who’s specialty was family medicine with no psych training. 

Reports show the company sometimes prescribed after just a 10 min consults, giving 90 day scripts with limited or no follow up. The NP was making 20k per month. Patients were charged $79 to subscribe. Some of these “providers” were given $10 per script per month with some having over 2,000 of them filled per month.

 

In adolescents, overprescribing has become pandemic. The New York Times (8/27/22) reported on the common medical practice of “the simultaneous use of multiple heavy-duty psychiatric” medications among adolescents. “Such medications are too readily doled out, often as an easy alternative to therapy that families cannot afford or find, or aren’t interested in.” 

The medicines, “generally intended for short-term use, are sometimes prescribed for years, even though they can have severe side effects,” and a number of psychiatric medications “commonly prescribed to adolescents are not approved for people under 18.”

 

While of course, as the authors of the Clinical Psych article point out, there is in psychiatry a high rate of co-occurring conditions, a lack of treatment specificity, and poor understanding of causes. However, a complete work up includes the doctor looking at all of the patients’ symptoms, biological factors, psychological factors, and social factors, as well as the course of the patient’s illness. 

Are the symptoms present all the time, or do they come and go depending on environmental factors? If the latter, what factors are we speaking of? Does one diagnosis preclude another, like bipolar and unipolar depression? Is there a family history of certain disorders?

 

Did your clinician even ask about any of this? Like I said, if not, time to find a new one.