Yes, There is Poly Psychopharmacology in Teens, but There is More to the Story

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

The Sunday New York Times headline story with her picture was “This Teen Was Prescribed 10 Psychiatric Drugs. She’s Not Alone.”¹ No, she is not, but it is not a simple story of overprescribing as this and the accompanying story implies. Yes, there is that, but if we look deeper, as we often can and should do, there is something else driving such scenarios.

As business started to take over psychiatry and the rest of medicine in the 1980s, the role of psychiatrists became more and more circumscribed to being prescribers with brief evaluations and brief follow-up medication visits, instead of doing more psychotherapy like dialectical behavioral therapy (DBT) with or without medication.² Managed care did this by controlling reimbursement and authorized time to be spent with patients, leading to major profits, and just recently the strike by mental health care workers at Kaiser Northern California.³

Resources, such as the limited number of good residential facilities, are often not covered by insurance. Moreover, mental disturbances have been increasing in teens over recent years, especially since the pandemic. No wonder, then, that child and adolescent psychiatrists—always in short supply—came to rely more and more on medication, especially when suicide seemed to be a risk, as it was in this teen.

Fortunately, this teen finally found a psychiatrist who spent more time with her and simplified her medication. It is unclear whether this psychiatrist was unusually concerned or any insurance coverage less controlling. Fortunately, too, and perhaps a major cause in the ineffectiveness of the prior medication, was the thyroid problem diagnosed almost a year ago. Her thyroid cancer was apparently cured with surgery this past April. Though psychiatrists are uniquely trained to look for medical causes of psychiatric symptoms like this one, that usually needs a thorough evaluation with enough time.

Later on Sunday, my wife and I saw the famous Shakespeare play “Hamlet.” Hamlet seems to be a late age teen or young adult. In anguish at the murder of his father, he gives the famous soliloquy, “to be or not to be…” One interpretation is that he was suicidal at the time. As it turns out, his girlfriend Ophelia does commit suicide after his rejection, and he kills her father. Then he dies, as others do, at the end in a sort of homicidal/suicidal mayhem.

Though they did this play in modern dress and speech, there were no psychiatrists in Shakespeare’s time. If there were, perhaps psychiatry could have saved Hamlet and helped him find an alternative solution to his traumatic loss, if only we have better systems that provide us the environment to heal as we can and not burn out in the process of trying to do our best anyways.

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.

Reference

1. Richtel M. This teen was prescribed 10 psychiatric drugs. She’s not alone. The New York Times. August 27, 2022. Accessed August 29, 2022. https://www.nytimes.com/2022/08/27/health/teens-psychiatric-drugs.html

2. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.

3. Moffic HS. To strike or not to strike at Kaiser Permanente in California. Psychiatric Times. August 16, 2022. https://www.psychiatrictimes.com/view/to-strike-or-not-to-strike-at-kaiser-permanente-in-california