ALTERNATIVES TO PSYCHOTROPIC DRUGS FOR KIDS - Accept there is a problem but use alternative approaches to solving it “You can believe the diagnosis but never believe the prognosis”- Deepak Chopra - “if people knew more, I think they would be a little less likely to go down the medication path than the psychosocial treatment path.” Courtesy of the MH4M Website

To Medicate or Not to Medicate? The Question for Treating Mental Illness

July 10, 2012

By Dr. Nafisa Sekandari and Sr. Hosai Mojaddidi

“The part cannot be well unless the whole is well” -Plato

For many Muslims who are dealing with mental illness, the question of medication haunts them due to religious concerns.  Many have questioned the permissability of  psychotropic medications in Islam. From an Islamic perspective,  taking medication for a mental problem should be no different than taking medication for a physical ailment.  However, Western society has also began questioning the over-prescription of medications for mental illness.  Although medication serves a very important role in treating severe cases of mental illness, research has shown many Americans are taking medications that may not work for them or may be completely inappropriate for their mental health needs. Inappropriately prescribing medication can lead to serious harm. Many individuals are currently being prescribed psychotropic medications without a thorough evaluation from a mental health professional. This is due to many individuals seeking mental health treatment from their primary care physician rather than a mental health professional. As a result, many are often unaware of other alternative and evidence based treatments that might be more appropriate and more effective (I.e. cognitive behavioral therapy).  Dr. Steven Hollon, a psychology professor at Vanderbilt University has conducted extensive research on the  effectiveness of  antidepressants and states “if people knew more, I think they would be a little less likely to go down the  medication path than the psychosocial treatment path.”
Sobering Stats
According to industry data, the use of prescription medication has increased by 22 percent from 2001 to 2010, making one out of 5 adults in the U.S. taking at least one psychotropic medication.  Antipsychotics, antidepressants, and medication to treat Attention Deficit Hyperactivity Disorder (ADHD) are the most prescribed.  In 1987, Prozac (fluoxetine) was introduced to society and was quickly embraced by the medical community due to its fewer side effects compared to other available antidepressants at the time.  Since the launch of Prozac, the use of antidepressants quadrupled in the United States.  According to the Center for Disease Control (CDC) data, today more than 1 in 10 Americans are taking antidepressants, making antidepressants the second  most commonly prescribed drug in the United States, right below cholesterol lowering drugs.  Recent research has indicated antidepressants are not as effective as many people believe, especially for those suffering from mild depression.  It is estimated that at least 50 percent of those being treated with antidepressants are not directly getting active pharmacological effects, but results are due to the placebo effect. Research by Irving Kirsch, PhD, also indicates limited efficacy for those suffering from severe depression.  (PLoS Medicine, 2008).  Steven Paul, MD, a neuroscientist states “Medication treatment is but one way to treat depression.  It’s not necessarily the best way or the only way”.  Psychotherapy can be just as effective as antidepressants for many individuals.  Psychotherapy doesn’t have the risk of side effects as medications and has a lower instance of relapse.  Studies show patients with moderate to severe depression who received cognitive behavior therapy were less likely to relapse back into major depression than patients who were treated with medication alone and stopped treatment.
Most antidepressants are prescribed by primary care physicians who often have limited training and experience in treating mental health disorders.  As a result many individuals are not aware of alternative treatment options and the psychotropic medication is often the only treatment option offered.  It must also be noted, due to insurance reimbursement, it is much easier for medical doctors to obtain reimbursement for drug treatment than therapy.  “There is also 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 practice primarily to prescribing, they lose their therapy skills by attrition and do even less therapy” states Daniel Carlat, MD, associate clinical professor of psychiatry at Tufts University and author of the 2010 book “Unhinged:  The Trouble with Psychiatry”.  The pharmaceutical industry has also been very successful in marketing and advertising the psychotropic drugs to physicians and the public. We see the ads on TV and in our magazines, failing to notice the lack of adequate information about the side effects.  As a result of this mass marketing, many individuals request the drug by name when they visit their primary care physicians.  The end result of all this mass marketing to the people has increased the level of comfort we all have with medications.  Currently we are seeing more people being prescribed antipsychotic medications to treat various mental health disorders such as anxiety, depression, dementia, and insomnia under off-label prescription, meaning using the drugs for what they were not initially intended for.  Many of these drugs are being prescribed with uncertain scientific evidence and supporting research.  Of significant concern is the use of these powerful drugs with our children, elderly, and foster kids.  In some cases, even infants have been prescribed psychotropic drugs without any scientific evidence supporting their use.  In a recent health care fraud settlement, the largest in the history of the U.S., the makers of the popular antidepressant Paxil were found guilty of promoting the use of Paxil and Wellbutrin for children under the age of 18 without the approval of the U.S. Food and Drug Administration (FDA).  They were ordered to pay $3 Billion in the fraud settlement.
What Are The Choices??

Due to the stigma of therapy and mental illness in the Muslim community, many Muslims inappropriately treat physical symptoms related to mental illness with medication.  Many simply want a pill in order to “make it all go away”.  Members of the Muslim community, especially the elders, often trust what a physician tells them without becoming fully informed of the choices available to them.  Others, due to recent immigration or unfamiliarity with the language and culture, simply don’t understand enough to make informed choices.  Lack of familiarity with therapy and mental health professionals also limit the choice to the primary care physician.   So what are your choices?

• Seek medical treatment to rule out a physical disorder or disease.Rule this out first.
• If you are otherwise physically healthy, individual therapy can help.  Individual Therapy often involves talk therapy with a trained mental health professional such as a psychologist, social worker, counselor, or a marriage and family therapist but could also include Mindfulness Training and Yoga which have evidence based benefits.  Therapists and trainers help individuals identify the source of their troubles and help them learn new coping behaviors and change their negative thinking patterns.  Many physical symptoms such as frequent headaches, stomach aches, joint pains, and lack of energy are often associated with mental illness and oftentimes, treating the source of the problem will resolve the physical symptoms.  Therapy involves commitment but the effects far outweigh the use of medication alone without the unnecessary side effects.  Initially learning how to stop a negative thought pattern or learning new coping strategies might seem overwhelming but with the help of a therapist, these skills become second nature.
• Diet and Exercise:  It’s no surprise that a lifestyle of poor diet and exercise impacts our physical as well as mental well being.  Food can play a major role in our overall health and well being.  If you are constantly feeding your body junk food, don’t be surprised if it begins to feel sluggish and depressed.  We put more thought into the type of gas we put in our vehicles than we do with the quality of  food we put in our bodies.  Fast food is cheap for a reason.  It lacks nutrition and substance, leaving you unsatisfied, therefore making you eat more of it.  Eating whole foods such as vegetables, fruit, whole grains, nuts and seeds, as well as drinking water will energize your body and mind.  Avoid excessive caffeine and limit your sugar intake.  The mental fog you often feel with eating junk food will clear out once you replace your unhealthy eating habits with a cleaner, more whole diet.  Exercise also plays a key role in helping us feel better mentally as well as physically.  Simply walking as if you are in a hurry, 20-30 minutes a day, can have a significant positive impact on reducing symptoms of depression.  Yoga also has been scientifically proven to significantly reduce the symptoms of depression.
• Limit your exposure to violence on TV and limit watching the news. Watch comedies and funny shows to uplift your mood.  Turn off the TV and electronics at least 30 minutes before going to bed in order to ensure a good nights sleep.
• Improve your social skills and remove toxic relationships out of your life.  Oftentimes we are surrounded by so much negativity and hostility with the people in our lives, we end up internalizing the angst which leads to feeling emotionally overwhelmed.  Either remove yourself from such toxic environments or cut ties with toxic individuals. Do you have a friend that is always making you feel bad about yourself?  It’s time you evaluate the value of this friendship on your life?  What is making you stay in the relationship?  What is stopping you from making a friend that is caring and respectful?  Sometimes we cannot cut the ties with certain individuals such as our parents or relatives but we can change our reaction to them.  Learn alternative and more effective ways to handle the difficult people in your life .  Learn how to communicate your needs and express your feelings.  Repressed feelings don’t just go away because you are bottling them up.  They will show up in some other form when you least expect it but oftentimes you may not recognize the direct connection.  Many physical ailments are a result of repressed emotions.  Start with writing in your journal and get all these feelings out.  If you can’t tell the person directly, you can at least get the feelings out of yourself by channeling them in the journal.  No need to carry unnecessary burdens.  You can also talk to a trusted friend or family member, talk to your pet (sounds weird but it can be therapeutic), or talk to a counselor or therapist.
• Remove toxic chemicals from your life.  Reduce your exposure to everyday chemicals such as room sprays, plastic water bottles, non-stick cookware, over-processed foods, pesticides on fruits and vegetables, toxic paint and asbestos in your homes, and toxic chemicals that line cans of food. Replace your plastic water bottle with glass or stainless steel, use natural essential oils instead of toxic room sprays to deodorize your home, avoid canned food by choosing fresh or frozen fruits and vegetables, and avoid cheap toys that may expose your children to lead paint.  All these steps can lead to better mental and physical health. Please see here  for more information
• Avoid nicotine and chewing tobacco as well as other drugs and alcohol.  Many individuals that rely on such substances are in actuality self medicating their emotional pain.  Getting high is an escape from the pain.  Instead of self medicating, get treated for your addictions and start living a more healthy lifestyle.  Get therapy to treat the underlying emotional pain in your life.
• Educate yourself about supplements.  Fish oil has been linked to better emotional as well as physical well being.  Due to the abundance of overprocessed food, we are currently a society lacking in Omega 3 fatty acids and we need to supplement with fish oil.  Our brains and bodies need Omega 3 fatty acids for optimal performance.
• Naturally boost the feel good hormone Serotonin in your brain.  Serotonin improves our mood but our brain is often lacking in serotonin due to poor diet, lack of exercise, and excessive stress in our lives.  You can naturally boost the serotonin levels  in your brain through diet and exercise.  Certain foods such as bananas, beets, brown rice, cottage cheese, salmon, sunflower seeds and turkey help boost the serotonin levels of your brain.  Supplements such as  5HTP and  St. John’s Wort are 2 supplements that have been used to treat mild to moderate depression naturally.
• Get a massage or acupuncture treatment to reduce the stress and anxiety from your life.  Acupuncture has proven beneficial for treating depression as well.  Chamomile, lemon balm, and Valerian also help calm our anxiety and promote rest and relaxation.  Use essential oils to uplift your mood.  Peppermint oil and orange oil have an energizing effect on the mind while lavender has a calming effect.  Meditate and spent 5 minutes after your morning prayer to do zikhr or simply sit in silence.
• Consider medication and seek psychiatric treatment.  If you have tried the options above and continue to suffer from the symptoms of a mental health disorder, seek psychiatric treatment from a trained mental health professional such as a psychiatrist.  A full evaluation should be conducted prior to writing a prescription.  Always be sure to get a second opinion.  Consider all of your options and really understand the pros and cons of the medications.  Ask questions and be fully informed prior to accepting the prescription.  Medication almost always works best with therapy and continued support from a mental health professional. The medication can ease the symptoms in the short term but the skills learned in therapy can have long term benefits.

“You can believe the diagnosis but never believe the prognosis”-Deepak Chopra

The intent of this article is not to steer you away from medication but to empower you to be fully informed about all your options before using any prescription medication.  Although the focus of this article is about using medication to treat mental illness, the pros and cons should be considered with medication regardless of the disorder.  The pharmaceutical companies are bombarding us with advertisements for prescriptions to treat every ailment, whether mild or severe.  There are so many preventive measures you can take prior to going down the road of medication but there are also many steps you can take to reduce your dependency on medication once you have already started.  There are countless accounts of individuals who have taken back control of their lives and reduced their dependence on medication regardless of diagnosis (diabetes, high blood pressure, high cholesterol, etc.).  Be empowered and make choices by being fully empowered.