Thursday, July 21, 2005
Patients with mental illness need medications in spite of side effects

By Dr. Anthony Policastro Nanticoke Memorial Hospital

Recently a famous actor proclaimed himself an expert on psychiatry. He has belittled other individuals in the process. He has indicated that his beliefs guide his knowledge of the use of psychiatric medications. He does not like them. Because he is famous he thinks we should agree with that. As is often the case, there are two sides to this particular story. There are many medications available to help treat mental illness. Some of these medications work better than others. Some of them have more side effects than others. Whenever you use a medication, you should balance the benefits of taking the medication against the risk of side effects. You cannot look at one without the other. The self-proclaimed psychiatry expert has leaned very far toward the side effects side of things. There are indeed problems with the medications he talks about. There are indeed people who will do well without taking the medication. There are indeed some physicians that over use them. Those are all true statements. However, there is another side to the issue. That has to do with the benefits from these medications. We only have to go back 40-50 years ago. In those days there were relatively few medications to help patients with psychiatric problems. The main form of treatment was to identify these individuals. They were then put in psychiatric hospitals. Many of them remained there for years. The nickname "insane asylum" was common. Those days are for the most part gone. Much of this has to do with the medications that have been developed over the years. We have many more medications. We also have medications that treat specific diseases. The result has been that people no longer have to be put in hospitals for long periods. They can take medications and be able to continue on with their lives. It is true that they need to be aware of side effects. That is true with any medications. Those used to treat mental illness are no exception. There are individuals who will do just as well without medication as with medication. The problem is that this is not always predictable. The physician who sees a patient often has to decide whether the medication is really necessary. Sometimes there is no way to know that in advance. If the patient does not need it, you will be risking side effects for nothing. If the patient does need it, waiting might make his/her condition harder to treat when he/she gets worse. The physician has to balance these two things.
The third problem is over prescribing. We know that medications are sometimes prescribed without good reasons. This is true of antibiotics. It is true of psychiatric medications. However, that does not mean, one should condemn all prescribing of these medications because of it. We have become very sophisticated with prescribing medications for psychiatric problems over the years. We have many more medications now. We have medications specific for the particular problem. They are not without problems. However, we also know that there are far fewer patients in psychiatric hospitals for long periods of time. This is a good thing. It would not be possible without the changes that have occurred over the years. Those changes are just as true for the other treatment methods that we use as they are for medications. The two go hand in hand. Removing the medication piece and telling people to tough it out will not work. The actor in question has it partially correct. What he says is true for some patients. But it is not true for everyone.

Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.

Institute on Substance Abuse and Mental Health July 25-29
Limited space is available for registrants at the 34th Summer Institute on Substance Abuse and Mental Health. Sponsored by Delaware Health and Social Services' Substance Abuse and Mental Health Division, the institute, which will run July 25-29 at the University of Delaware's Clayton Hall, is open to mental health and substance abuse professionals, consumers, family members, students, volunteers and others interested in mental health and substance abuse issues. The theme of this year's institute is "Networking and Collaboration: The Strength of Systems." Workshops will focus on the spirit of partnerships throughout all aspects of care across the age spans related to recovery and reintegration of individuals who have experienced problems with drugs, alcohol, gambling and/or mental health. The event annually attracts more than 700 participants from around the state and region. The workshops, staffed by experts from around the country, will challenge participants' understanding of what it means to be in treatment and how treatment and prevention services are delivered. Several workshops will focus on the journey toward wellness, personal power and person-centered care. Other workshops focus on partnerships among staff and clients. To register or for more information, call Gail Lanius, (302) 831-2214 or email