In the spirit of full disclosure, let me stop you right here. This will be an angry post. Anger is not an emotion I feel often, but this week’s topic is one of my soapbox issues.
Be advised that the stance I take in this blog post is purely my opinion based upon over two decades of navigating bipolar disorder in my own life.
If you follow my blog, you already know that I am pro-medicine in the treatment of mental illness. I am sure there are those who could eloquently explain their argument against taking psychotropic medication to treat mental illness, but I am not buying it.
By the way, “psychotropic medication” is just a fancy term for any medication capable of affecting the mind, emotions and behavior.
Even though I am vehemently pro-medicine, I am disturbed by the trend of non-psychiatrists prescribing psychotropic medications.
Wait a minute. Didn’t I just say that I am militantly pro-medicine in the treatment of mental illness? Shouldn’t I be excited by the notion that more people are receiving the medication they need to treat their mental illness?
No. No. No.
Painting a Picture
Let me paint a picture here. I have a degree in Secondary English Education. I am certified to teach English to grades seventh through twelfth.
Should I be teaching your fifth grader math? Of course not. I am not qualified to teach math. (Trust me. NO ONE wants me teaching their children math.)
It’s no different with doctors. You may go to the best internist in the world who you trust with your life. His training and skills are impeccable. Would you want him to deliver your baby? No, you would find a gynecologist at the top of their game who understands the ins and outs of their field.
Why would you settle for less than expert care for your mental health?
Here are four reasons it is dangerous for non-psychiatrists to prescribe psychotropic medication:
1. A doctor who is not a psychiatrist does not have the training to do a complete psychiatric workup of a patient.
Mental illness diagnoses are not made lightly. There are clinical guidelines and training for a reason. A physician that sees a patient 10 minutes once a year lacks the proper information to make an educated diagnosis.
They are only seeing the behavior and symptoms that the patient presents in those ten-minute intervals. They do not have a full picture of the patient’s behavior and symptoms over time.
They do not know the right questions to ask, and they lack the ability to read between the lines of their patient’s answers. They miss details that would lead to a proper diagnosis.
2. A doctor who is not a psychiatrist does not have adequate knowledge of the psychotropic medication he or she is prescribing.
When a non-psychiatrist prescribes psychotropic medication, they do not have the benefit of training and experience in dispensing mood-altering medication regularly throughout the course of their career.
They don’t have the experience of watching how psychotropic medications affect a variety of patients over time. They may not know of rare side effects that can be life-threatening.
Symptoms overlap in several mental illnesses. The wrong medication can flare up a hidden mental illness that the doctor wasn’t aware of. The wrong medication can make the condition worse.
For example, I have bipolar disorder. If I am prescribed the wrong antidepressant, it could lead to mania and psychosis. Careful monitoring is crucial.
They also lack knowledge about the variety of medications that are available. All doctors—even psychiatrists—have favorite medications they prescribe. The problem with a non-psychiatrist prescribing psychotropic medications is that their favorite medication may not be the best medication available to treat the patient’s symptoms.
3. The patient may not require medication at all.
Even though I am pro-medicine in the treatment of mental illness, I am against taking unnecessary psychotropic medication. We live in a society where doctors throw pills at every problem—whether or not medication is warranted.
Without the proper training and a thorough psychiatric history of a patient, a doctor may prescribe a drug for a symptom a non-medication intervention could effectively treat.
For example, a patient who is struggling with depression might not have a chemical reason for their symptoms. Sometimes the same symptoms present because the patient endured a traumatic event. In that case, the depression could be situational, and there is a strong possibility that talk therapy, not medication, would be the best intervention for the patient.
4. Psychotropic medication alone is not a complete treatment plan for mental illness.
Taking the right medication alone is not the answer to all a patient’s mental health concerns. A complete treatment plan must have a multifaceted approach to ensure the success of the patient’s recovery and stability over time.
Psychiatrists conceive treatment plans after thorough examinations, conversations, and trial and error. A treatment plan should be specific to the individual’s needs.
Cognitive behavior therapy may be effective for one patient but not for another. Talk therapy may change one patient’s life while it leaves another patient cold.
Through years of practice, psychiatrists can take some of the guesswork out of developing treatment plans for their patients. They can gauge what works best for certain diagnoses and personality types because of their vast experience dealing with a variety of patients with mental illness.
When a non-psychiatrist prescribes psychotropic medication without other interventions in place, it is like putting a band-aid on cancer.
Playing Devil’s Advocate
When I talked to my mom about this post, she debated the other side of the issue with me. She pointed out that many people do not have access to a psychiatrist and/or therapist but truly need psychotropic medication. They have no insurance or insufficient insurance, and the only avenue to receive care for their mental health issue is through a primary care physician.
I am sympathetic to their plight. I remember when I didn’t have insurance and had to receive treatment from a state-funded hospital. It was inadequate at best.
I still stand firm in my stance. Without a proper psychiatric evaluation and a balanced treatment plan, I believe it is dangerous for non-psychiatrists to prescribe psychotropic medication. In my opinion, the wrong treatment is worse than no treatment at all.
I liken it to someone throwing a cup of water at a house on fire. The person meant well, but his or her efforts were inadequate to the problem at hand.
What do you think? Should non-psychiatrists prescribe psychotropic medication to their patients? What might be a more balanced approach to finding proper care?