Getting Meds Is Easy, Support Maybe Not So Much

In June of 2015, Johann Hari gave a talk at the TedGlobal stage in London titled, Everything you know about addiction is wrong. Since then, his talk has been watched over 8.5 million times and provoked a global discussion around the misperceptions of human behavioral science.

“I love you whether you are using or not…I love you in whatever state you are in…and if you need me I will come and sit with you, because I don’t want you to be alone, or to feel alone. The core of that message, you’re not alone and we love you, has to be at every level of how we respond to addicts, socially, politically, and individually.” – Johann Hari

Today, we work more, sleep less, and are connected to global political, social, and cultural domains more than ever. But, are we aware of how it is shaping us at a micro and macro level? Maybe not.

Let’s start with some hard facts:

• 71% of employees in the U.S. are dissatisfied with their current job
• 85% of employees worldwide are not engaged at work
• 66% of U.S. employees work more frequently outside normal hours due to tech
• 79% of employees worldwide feel they’re not managed in a motivating way

One of the greatest advantages and opportunities of being part of an organization should be that you are able to observe and engage at every level within your organization; to become their ‘eyes and ears’. Therefore, if managers and leaders are not spending the time to understand the motivations and strengths of each team member then they are actively NOT: 1. Supporting their colleagues to feel important with their engagement; 2. Visually creating a map of where talents can be best utilized; and, most importantly, 3. Building trust and empathy. These are the components for high performing teams that never fail in fine-tuning performance and building deep bonds.

Now, imagine 85% of the global workforce not being fulfilled in that respect. You are told to put your head down and to toe the line, and maybe, just maybe, there is a future for you at the company. Well, this lack of professional support manifests in other realms of people’s personal lives. To put it bluntly, it is a direct attack on the value of an individual’s mental well-being.

And that’s also affecting the very care we entrust to our dedicated clinicians:

• In 2013, the Medscape Lifestyle Survey reported an overall rate of 40% burnout amongst all physicians. In 2017, that rate increased to 51% overall.
• 42% of all Psychiatry and Mental Health specialists reported burnout last year

The reasons:

1. Too many bureaucratic tasks/administrative work
2. Spending too many hours at work
3. Feeling like a cog in the wheel
4. Increasing computerization of practice (EHRs)

How can we expect to be supported by the people who know the most intimate details about us when we aren’t focused on taking care of them? When both the caregiver and the care receiver are stressed out there isn’t room for engaged listening on either side.

Ok, now we are here. So, what resources do we have available as our saving grace in these moments of duress and disorientation? Well, it’s complicated. First, we have to explore two major crises currently occurring across all borders: 1. Depression is the leading cause of disability worldwide; and 2. 60% of adults with a mental illness didn’t receive mental health services in the previous year.

Today how we interact with the physical world has changed immensely with technology. Even children are spending less time playing outdoors than they are in front of a screen.

Tyler Cowen said in his book, The Complacent Class, “the necessity for ever greater calm creeps along, and the next frontier is that it is becoming common to give drugs for schizophrenic and bipolar individuals to disruptive children under five years of age.” We are shifting our values from innovation, restlessness, and avant-garde idealism to gripping manufactured safety.

I’d imagine that a significant portion of the global youth population knows more about Prozac and Zoloft than the numerous support organizations (i.e. National Suicide Hotline, Trevor Project, RAINN, The Society for the Prevention of Teen Suicide, National Youth Crisis Hotline) available to them just a phone call away. Why? Well, here's one reason: Eli Lilly spent over $46 million dollars on advertising for Cymbalta in Q1 of 2012 alone.

Awareness and advertisement aren’t the only disparities between medication management and cognitive therapy. Generally, there is just a lack of mental health support systems and access to them.

Recent research has demonstrated that psychotherapy has been shown to be just as effective as antidepressants, without the risk of side effects and relapse. Additionally, there are enduring effects from this kind of therapy that can prevent depression from reoccurring.  

"The reality is that there are not enough mental health care providers around to treat all who need it," says Dr. Gary Small, a psychiatrist and director of the UCLA Center on Aging. 

There’s no denying the stigma surrounding depression and mental health is very real and dissipating. But, not fast enough. 1 in 10 Americans take SSRIs (Selective Serotonin Reuptake Inhibitors) to treat major depressive and anxiety disorders, yet less than 30% of those people actually saw a mental health specialist. Likewise, most clinicians advise taking antidepressants for only 6-12 months, but 60% of Americans on antidepressants have taken them for 2 years or longer.

Don’t get me wrong, there are people who depend on these drugs to lead functional lives.

But, it does make you wonder if ~50% of individuals being treated by antidepressants aren’t benefitting from active pharmacological effects and the rate of SSRI use has sky-rocketed by 400% in the U.S. alone (between 2005-2008), how effective is medication management in the mental fitness of individuals faced with depression and anxiety daily.

Daniel Carlat, MD, associate clinical professor of psychiatry at Tufts University and author of the 2010 book, Unhinged: The Trouble with Psychiatry, stated "there is a huge financial incentive for psychiatrists to prescribe instead of doing psychotherapy. You can make two, three, four times as much money being a prescriber than a therapist. The vicious cycle here is that as psychiatrists limit their practices primarily to prescribing, they lose their therapy skills by attrition and do even less therapy."

It should not be difficult, nor shameful, to seek help. We all need help. That’s why it is far more important that we change the narrative of depression from being a fixable problem to an opportunity we face together as a society. Are we capable of looking in the mirror and collectively asking, “are we doing enough to augment our personal authenticity?”  

Anxiety knocked at my front door. At 12 years old I had my first experience with OCD (Obsessive Compulsive Disorder) and anxiety. For years, it was debilitating for me and my family. But, I refused to battle it with medication. I worked on getting better daily. I leveraged the support of my family, friends, and outside research to be better informed and to lay out a plan. The best feeling in the world was knowing I had the strength to create my own journey of success. And, as a result of that journey, I was able to harness that same discipline and courage in every aspect of my life. Meanwhile, I even had the privilege to help other young adults overcome similar adversity. 

Where can support solutions make a critical global impact?

• Information about medication management and psychotherapy resources should become ancillary instructions that accompany all health care visits.
• We need to better inform the greater population about the risks and benefits of medication management through government and private partnerships.  
• Genetic testing should become a covered service under the umbrella of the mental health care pathway (40-60% of the time genetics is the underlying cause of drug dependency).
• Integrating mental health care with primary care services and placing primary care clinicians in mental health clinics will improve health outcomes, reduce cost, and reduce burden on the overall system.

There is fine line to walk between the sustainable and fleeting. Like Johann highlighted, our core goal should be to focus on optimizing the progress of human connection; to nourish our moments with love, acceptance, and sustenance. If we start by opening up about how we talk about depression maybe we can start to be proactive about giving more to our communal well-being.

Citations:

(1)  Gallup News. https://news.gallup.com/topic/employee_engagement.aspx. Retrieved on Jan 2018.

(2)  Medscape Lifestyle Report 2017: Race and Ethnicity, Bias and Burnout. https://www.medscape.com/features/slideshow/lifestyle/2017/overview#page=4. Retrieved on Jan 2018.

(3)  National Alliance on Mental Health. Mental Health by the Numbers.  https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers. Retrieved on Jan 2018.

(4)  LiveScience. Suicide: Statistics, Warning Signs and Prevention. https://www.livescience.com/44615-suicide-help.html. Retrieved on Jan 2018.

(5)  FiercePharma. Cymbalata. https://www.fiercepharma.com/special-report/cymbalta-1. Retrieved on Jan 2018.

(6)  American Psychological Association. Inappropriate Prescribing.  https://www.apa.org/monitor/2012/06/prescribing.aspx. Retrieved on Jan 2018.

(7)  ABC News. One in 10 Americans Use Antidepressants, Most Don't See a Therapist. https://abcnews.go.com/Health/Wellness/10-americans-antidepressants-therapist/story?id=14763251. Retrieved on Jan 2018.

(8)  Addication Center. Antidepressant Addication and Abuse. https://www.addictioncenter.com/stimulants/antidepressants/. Retrieved on Jan 2018.

(9)  American Psychological Association. Data on behavioral health in the United States. https://www.apa.org/helpcenter/data-behavioral-health.aspx. Retrieved on Jan 2018.

(10) Hari, Johann. Everything you Think You Know About Addiction is Wrong. https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong. Retrieved on Jan 2018.