Do we have an "overly medicated society"?

I was reading a synopsis of a book at the library. It ends as such:

I haven’t read it yet, but I would guess that the author, if asked, would say that we take too many drugs as a society, and that “anxiety” and “depression” could be overcome without them if we just worked harder at it, or stopped overdiagnosing it.

I have no idea if I’m being fair to the author or not, having not read the book, but it’s a common enough attitude (especially given the contexts in which drugs, especially antidepressants, come up) that I thought I’d explore.

What do you all think about the level of pharmaceuticals we take and (perhaps even more interestingly) that are available?

For the record, yes, I think our society is over-medicated.
I think the modern pharmaceutical companies have become legalized drug dealers.
Our society expects a pill to cure everything, including the “normal” experience of life (sadness, disappointment, lack of erections, etc).

However, I engaged in this topic during another discussion. The medical people stormed in and demanded objective criteria for establishing the “proper” amount of medication. After all, if you can’t determine the proper amount, how can you determine what is “excessive”.

The discussion didn’t get very far after that. If this one gets any traction, I’ll be pleasantly surprised, and may even participate.

I think it’s possible we are both.

I think a lot of people legitimately require the medical interventions they use. And that’s because we’re expected to function in ways that are NOT conducive for good health. Take caffeine, for instance. I take a quarter of a caffeine pill every morning to perk me up, since I’ve got to be at my desk early in the morning, full of energy, and I am not allowed to take any power naps throughout the day. If workplaces allowed employees to set their own hours, so as to optimize both productivity and health, maybe we wouldn’t be so reliant on drugs like caffeine.

ADHD drugs are another one that have a legitimate need. Historically, we had stable niches for people who are hyperactive and impulsive. Warriors, for instance. And being a high-school drop-out was not a barrier for you to fill one of these niches. But that’s not so today. Today, we feel like all children should be prepared for college. But being “college-ready” means being able to pass exams with flying colors. It means having more As and Bs on your report card than Cs and Ds. It means taking advanced classes and learning a foreign language. Even if you only have ADHD “tendencies”, it would be kinda crazy for you to not at least consider taking meds…at the very least, on a “as needed” basis.

The same with mental illness. Yeah, yeah, mindfulness and therapy and sleep hygiene help. But if I’m working double shifts every day at a minimum wage job and taking classes at the same time, I’m not going to have time for any of these things. We can romanticize some idyllic yesteryear when people supposedly didn’t deal with depression and anxiety. But that means ignoring how crazy and dysfunctional a lot of people were in the “yesteryear”. Almost all of us have some crazy older relative who lived a Boo Radley existence in someone’s basement when they weren’t in the mental asylum. Is that better than taking a few pills every day and being a functioning member of society? I had a dysfunctional aunt who self-medicated with alcohol, cigarettes, and lotto tickets. Maybe she would still be alive if she’d taken some Xanax instead.

But yes, some people run to drugs before trying something else. And then they get hooked on the drug and become enslaved. Or they experience harmful health side effects without ever putting two-and-two together. But prescription drugs are just one “clutch” that people cling to cope with their problems. I can think of far worse ones out there.

There is a problem with overdiagnosis and overtreatment. In cancer a lot of cancers are being treated that aren’t going to cause the patient any problems but doctors insist on treating them anyway.

http://well.blogs.nytimes.com/2014/04/07/look-for-cancer-and-find-it/

As far as CVD, a lot of people who get treated for CVD risk factors do not benefit based on the NNT (generally the NNT is 100+ over a 5 year period, meaning 99% of people don’t benefit). You eventually reach a point where if you treat 1,000 low risk people, the side effects of treatment outweigh the risks of not treating any of them. Arguably we are already at that point in many areas. But the trend in medicine seems to be more and more into early diagnosis, treating everyone, intensive treatment, etc. This is a problem because medicine has consequences (psychological, financial, health). Medicine is the leading cause of bankruptcy and the 3rd leading cause of death. Plus being told you have cancer (when it could be a slow growing tumor you’d never notice) causes emotional harm. It isn’t without risks.

However much of that relates to chronic diseases of old age. I don’t think it is malicious (although there is a strong financial incentive among health providers to label as many people as possible as sick and in need of treatment and maintenance care), I think it is just people looking at medicine with rose colored glasses (overestimating the benefit of diagnosis and treatment, ignoring the risks of medicine). The OP asks about depression and anxiety. If anything, IMO, those are under treated quality of life diseases.

I’m “overmedicated.” It has greatly improved my quality of life, everything from social interactions to work performance to health and weight loss.

What’s the argument that people shouldn’t be medicated? Why should I suffer?

Especially when it comes to mental health, where many people are unmedicated and struggling.

Some woo statistics. If medicating more people against mental illness can benefit society by lowering crime rates and saving money on emergency health care and intervention, what’s the problem?

Yet I have plenty of friends who would rather die slowly and painfully than take even an advil, much less serious treatment for their chronic conditions. I do not get it.

Wesley Clark’s post is excellent, and I do agree that less treatment and more “management” of cardiovascular disease and certain cancers will benefit peoples’ quality of life.

The problem with this whole debate is that people see things in black and white. Don’t think toddlers should be on ADHD medication (no, I’m not exaggerating)? “You mean you don’t support schizophrenic people getting meds?!”

Some people take medication that vastly improves their quality of life. Some people take medication that doesn’t. My general belief is that if you don’t really need pills (of any sort), you probably shouldn’t take them. “We have an overmedicated society” doesn’t mean “You’re depressed? Just drink tomato juice and do some yoga!”

The problem with depression is that there is no one right way to diagnose it. Depression is not a disease with a clear definition, like pneumonia or cancer. It’s a constellation of symptoms, and most of those symptoms are more judgment calls than clear divisions. Some try to make the matter more clear by defining “major depression”. I suffered from major depression while in college and graduate school and can testify that it’s a real condition, which the patient cannot simply snap out of at will. However, there’s no definitive way for a doctor to diagnose whether a patient has major depression or merely blues brought on by a crappy job or their favorite football team having a lousy season. Also, many antidepressants are prescribed by general practitioners who may meet with the patient for 10 minutes or less. That’s not enough time to get enough information to make a good judgment.

Our society is programmed to reach for a pill rather than changing behavior to fix the problem.

Have a cold? Take Schnozzclear Pill Packs and you’ll be able to work all day and take your kids out sledding! (When really, you need a day or two of taking it easy on the sofa, with tissues and chicken soup.)

Indigestion from eating crap food? Take Burple and eat all the crap you want! Burple stops the acid in your stomach from forming at all!

Constipation? Take Poopzmor! Don’t bother with eating a salad or two…take a pill! Now available in gummys!

Those kinds of things? Yeah, change the behavior instead of taking a pill. That bugs me.

But if someone is really sick and changing behavior won’t fix it, I’m all for drugs.

It doesn’t bother me how a person addresses their problems, as long as they address them.

I mean, yeah, taking a pill simply for convenience is not as virtuous as changing your behavior. But changing one’s lifestyle and behavior can be very disruptive to relationships and employment. I have a sibling who is dealing with mental illness issues on top of the fact that she’s unhappy in her marriage. Her depression might go away if she were to divorce her husband to be with whatever lover she’s jonesing for. But then her teenage daughter would be in a broken home. My sister will lose the financial security she’s had for the past decade. She’d lose the support of her loving in-laws. And there’s no guarantee that her new lover won’t turn out to be “dud” too, and then she’ll be spiraling downward again.

It’s hard for me to say she’s better off going through all those motions rather than coping for awhile with medication…until at least her daughter is away at college (hopefully on scholarship) and she’s more financially independent.

Also, therapy isn’t for everyone–not even for those who could benefit from it. Every therapist is different, and folks don’t have unlimited time and money to find the best one. Given this reality, I don’t blame people for resorting to drugs. In this hectic and very competitive age we live in, we are kind of forced to put band-aides over our dents and bruises.

I’ve worked with mentally ill people, and I know something of the history of psychiatric medications. At one time, all the medications were very “dirty,” which meant they came with a lot of side effects, that you either needed to manage with other meds, or with very strict behavior protocols, and so people only took the meds if it made a huge difference: it had to mean being able to live at home vs. needing to be institutionalized, or being unfettered vs. needing to be physically restrained for the safety of yourself and the staff where you lived.

If you could function at all outside an institution, even if you drank too much, had trouble holding down a job, couldn’t keep a marriage together, had social services investigate your parenting, whatever, but you got from day to day, then you didn’t take drugs, because for you, the side effects would be worse than whatever your underlying pathology was that made you miserable, but still functional.

Now, psychiatric drugs are a lot cleaner. They do come with side effects, but they are manageable, and tolerable; not every person experiences every effect, so some people can find a drug that for them is side effect-free, and so minor problems are now problems that can be taken care of with drugs.

IANAD, but I was a social worker with the disabled population, including the mentally ill, so I know about this narrow aspect of medication. I imagine that there are other chronic conditions that are similar, but I’m not informed. I defer entirely to GrumpyBunny on the best way to manage acute conditions as opposed to chronic ones. I hate people who come to work sick and give everyone else whatever they have, and do it because they took a bunch of stuff to mask their symptoms. That’s completely different, though. No one is going to catch your schizophrenia because you take Abilify and go out in public.

If you have a dog, it can be a perfectly well-behaved dog. But then you lock it up in a room all day and, out of boredom, it will still end up destroying a bunch of stuff. Clearly we know that it knows better, since the rest of the time it behaves well. Thus we must assume that something else overrode the higher cognitive reasoning of the dog.

Similarly, if you leave a human alone in a room, with no human contact we know that he’ll go insane. Rationally, he may well know that there’s no value in fidgeting, in flinging poo, etc. But he’ll still end up doing it, no matter who he is, because our underlying systems can take precedence over cold logic under certain circumstances.

If you’re of the belief that prison is better suited as a rehabilitative measure, rather than a punitive, then likely you would agree that punishing a dog that misbehaved - after being locked in a room all day - is going to have no effect. You would say that you need to let the dog out and walk him. And I think you would say that because you would think that it’s reasonable that the reason a criminal misbehaved was because he didn’t have other options in life, he had been pushed in a wrong direction by peers, etc. Punishing him doesn’t correct any of that. It makes more sense to track down the causes and figure out solutions than to leave those in place and punish him for something that may well be very little of his own doing.

But so, if someone is depressive, schizophrenic, hyperactive, or whatever, then basically we’re just saying that for this person, their ability to operate based on their higher rationality is diminished. Slapping 'em and telling them to change their behavior is unlikely to be effective. We have decent reason to believe that mother nature is not fair. People are born with all manner of deformities and afflictions. And we know that those afflictions aren’t nicely binary. You aren’t “20/20 vision” OR “blind”. You’re likely somewhere on a continuum. Likewise, you aren’t “schizophrenic” or “sane”. We’re all somewhere on a continuum, and the medical delineation between the two is arbitrary.

In an ideal world, we could apply genetic manipulation to remove afflictions. But we do not yet live in that world (and many people seem to think it would be a scary, awful place). Nor do we have the medical ability to resolve these afflictions by modifying the body chemistry of those who are afflicted without side effects. We don’t have good ways to test for mental afflictions, to prove that they are due to physical causes, to test the exact percentile that the person is afflicted by, nor target it with the perfect medication.

So overall, we are left with imperfect solutions being applied as stabs in the dark. For some people, that will mean that they are being over-medicated. For others, it will mean that they are under-medicated or wrongly medicated. On average, where we stand is anyone guess. We would need the technology that allowed us to medicate better before we could tell how far off we currently are. Today is not that day.

This, times 10.

I don’t think anyone is advocating the elimination of all medicine. The question is, what is the proper balance?

If you include people that self medicate with caffeine, alcohol, and other recreational drugs, then definitely. Hell, the # of people that drink coffee and soda alone would qualify as overmedication of a society.

We are overly medicated and its because a lot of issues are packaged as psychological issues when they shouldn’t be.

A hyperactive kid is the classic example. Is that a psychological disorder or is the kid hyperactive because his father drinks too much? Do you think anyone asked about his father before sending him to a doctor? Do you think the doctor asked?

Whenever I am in the USA, I always notice the sheer number of ads and commercials for drugs, medical and “health” products to cope with one ailment or another. I’m used to it now, but my first impression was wow, there must be a lot of sick Americans. Now, I just know Americans like to take drugs.

I don’t know but I’m glad all these medications are available today, even just the OTC. My wife will constantly complain about all kinds of stuff: Allergies, Constipation, headaches, anxiety, depression, muscle soreness, etc. Just pop a freaking pill man, If something is bothering me I have no qualms about taking something.

I am reasonably sure that anyone who talks about “depression” in quotes is a “moron”.*

*not that anyone here has done that.

I don’t think recreational drugs count as “overmedicated”. More like “entertainment”. But of course, some people really do have problems they use recreational drugs to manage (most likely because they are easier to get than a prescription), and for those people, rather than being “overmedicated”, it’s probably more accurate to call them “poorly medicated”.

Does anyone else get annoyed by the term “self-medicated” to describe alcoholics or drug addicts (or even just people who smoke a lot of pot, or take Benadryl to sleep every night)? that’s more like “self-prescribed.” Except for children and very disabled people who must have other people take care of their basic needs, pretty much everyone who takes something, whether it is Rx, OTC, illicit, or not technically a drug, is “self-medicated.”

Yeah, I know, losing battle, I and should probably just take it to the “minor things that bug me” thread.