Overprescribing of Psychiatric Drugs
There are many reasons why psychiatric drugs are overprescribed. Two of the reasons are the misdiagnosis of mental disorders, and that psychiatric drugs are often prescribed for normal mental health challenges.
Over the last several decades, particularly since the advent of SSRI (selective serotonin reuptake inhibitor) antidepressants such as Prozac, Zoloft and Paxil, many normal mental health challenges have become diagnosable mental disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM), contributing to psychiatric drugs being overprescribed.
One of the reasons why normal mental health challenges are misdiagnosed is that the pharmaceutical industry has a dominant influence on determining mental disorders. For example, the fifth edition of the DSM, published in 2013, had 72% of its 28-member task force associated with the pharmaceutical industry. DSM-5 lists 298 mental disorders in 992 pages, and is used by psychiatrists, doctors and other healthcare professionals to diagnose mental disorders. With so many mental disorders listed, many normal people could be be misdiagnosed, particularly since there are no valid medical tests for psychiatric disorders like there is biological testing such as blood tests for many diseases and health conditions.
With no valid medical tests for psychiatric disorders, a diagnosis is often based solely on the opinion of psychiatrists and doctors, and psychiatric drugs might be the only treatment option discussed with patients because of, for example, the decades old false claim from pharmaceutical companies that depression is caused by a chemical imblance in the brain that only SSRIs can correct. There are rarely discussions about alternatives to SSRIs that is required to obtain informed consent, which is a legal right of patients. Some of the reasons why are explained on the Champions for Change page at Know Your Drugs.
One example of a mental disorder that could often be misdiagnosed is ADHD (attention deficit hyperactivity disorder). There was no consensus on how to diagnosis ADHD at a 1998 ADHD Consensus Conference hosted by the National Institutes of Health in the United States. This video was exposed publicly in the 2008 documentary Generation Rx.
Misdiagnosing ADHD can have tragic consequences. For example, many of the ADHD medications are amphetamine stimulants, which is similar in chemical composition to the illegal and highly addicting “crystal meth” street drug but in supposedly therapeutic doses that improve attention and concentration without becoming addicting.
The side effects of ADHD medications can lead to a second diagnosis and more psychiatric drugs being prescribed, including psychosis and mania. A common side effect of ADHD stimulant drugs is anxiety, which could lead to the prescribing of SSRI antidepressants. The common side effects of SSRIs include sexual dysfunction (difficulty getting aroused and/or having an orgasm) and emotional blunting (numbing of both positive and negative emotions e.g., not worrying about consequences), which is one of the contributing side effects for SSRIs to cause suicide, homicide and mass shootings.
The 2023 product monograph for the SSRI Viibryd, for example, includes the warning that there is an “increased risk of self-harm, harm to others, suicidal thinking and behavior with antidepressants use. Closely monitor all antidepressant-treated patients for clinical worsening and for emergence of agitation-type and/or suicidal thoughts and behavior.”
This type of high-risk polypharmacy with psychiatric drugs is a growing concern. Between 2015 and 2020, there was a 9.5% increase in the number of young people (17 years of age and under) in the state of Maryland in the United States enrolled in Medicaid using three or more psychiatric drugs. Researchers warned that the rates of polypharmacy are increasing as the rates rise in the number of children being diagnosed with conditions like ADHD, anxiety and depression without knowing how the simultaneous use of psychiatric drugs can affect health and brain development.