Are We Overdiagnosing Mental Illness?

The most eye-opening thing about working as a nurse practitioner in the emergency room is the prevalence of mental illness.  I mean, there are some crazy people out there.  Add in a little cocaine or PCP along with some alcohol (or mouthwash if the patient is on a budget) and you have a situation on your hands.  Yes, I do truly believe in mental illness. 

But, along with the obviously psychotic episodes that unarguably warrant a STAT Haldol injection, some serious therapy and daily medications, I am also shocked by the number of seemingly 'normal' patients I see on psychiatric medications.  Nearly everyone it seems is on some sort of antidepressant or anti-anxiety medication.  Do all these people really need pharmacologic treatment for anxiety or depression?  Or, are we as providers overprescribing?  I think it is the latter.

Doing a big of research for this post, I landed on an astonishing statistic- almost half of people living in the United States receive a diagnosis of mental disorder in their lifetime.  Unfortunately, children and adolescents seem to be the most recent victims in this psychiatric 'craze'.  One third of college students use stimulant medications for performance enhancement or recreation.  The psychiatric disorder fad has led to a forty-fold increase in diagnosis of bipolar disorder in children.  Autism diagnoses have increased twenty fold and attention deficit disorder diagnoses have doubled in recent years.

I know, many of you believe this is simply because with modern medicine we are more aware of these disorders, we now have ways to treat them.  I don't think so.  Individuals are becoming complacent, too lazy to deal with everyday life.   When things go wrong in life, they should not be treated with medication. 

Yeah, it stinks when your boyfriend breaks up with you but Prozac won't bring him back either.  I know, I love my dog too, but when your prized pooch passes, Celexa won't help.  Poorly attentive children may just need a little more exercise and an occasional time-out, not a daily methanphetamine dertivative.  Sometimes social situations make me anxious, I am an introvert and don't always like meeting new people but I surely don't need meds and a diagnosis of social anxiety disorder.  Rather, I put on a cute outfit for some added conference, feign a smile at first and everything turns out just fine.  'Symptoms' of daily life can't and shouldn't be fixed with medication.

Not only do I think the general public has become passive in dealing with everyday problems, we as providers have become apathetic. For example, the new DSM-5 manual which plays a key role in how psychiatrists diagnose mental illness, is removing the clause for exception of bereavement in the diagnosis of depression.  This means that even if you have just experienced the death of a loved one, you qualify medically as suffering from depressive disorder.  Of course you are depressed!  This doesn't warrant medication.  What you need following the death of a loved one is to be surrounded by friends, family and maybe a counselor.

Rather than have difficult conversations with our patients about disciplining children or the benefits of counseling over antidepressant medications we whip out our prescription pads.  Our 15 minute appointment slots don't allow for time to discuss a recent death or a tough personal struggle.  No, printing off a prescription is much quicker.

50 percent of individuals in this country are not crazy.  They are misinformed.  It's time we as providers stop enabling them and take more time before labeling and treating everyday issues as mental illnesses.

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