When I finished medical school 20 years ago,
I rarely saw patients taking 10 different medications…even five was a lot.
Now I frequently see patients taking five or ten different medications. A
recent study showed doctors writing 33% more prescriptions from 1985 to
1999.
There are good and bad reasons for the
upsurge in medication use. One good reason for taking more medications is
that a single medication may not fully control a condition. When a disease
is understood thoroughly, it may be possible to control it from several
different directions. For example, high blood pressure can be lowered by
relaxing arteries, by diminishing the rate and strength of heart
contractions and by eliminating fluid from the blood vessels. So someone
with hypertension might take three or more medications to address one
problem.
Another good reason is that when doctors
prescribe a medication they must balance risk with benefit. If there is risk
of a dangerous side effect, it must be outweighed by some great benefit,
such as the possibility of controlling a devastating illness. Recently,
pharmaceutical companies have made newer, safer medications. Doctors may now
treat a condition that has not yet become severe, since the risk of side
effects is smaller. For example, before modern antidepressants became
available, psychiatrists worried about serious side effects of earlier
antidepressants. A patient had to be very depressed before medication was
considered. Now that we have safer antidepressants, we are more likely to
treat milder depression.
Another legitimate reason for increased
medication use is an aging population with its gradual accumulation of
medical ailments.
A less benign reason for increased
medication usage is the strong incentive for pharmaceutical companies to
persuade physicians to prescribe. The companies have also begun to directly
encourage patients to request their products. Since 1997, pharmaceutical
companies have been allowed to advertise to the public; this has increased
prescriptions in proportion to the advertising. Doctors are also targeted.
Every week I receive solicitations to participate in efforts to encourage me
to order more medications. Some involve offers to pay me to tell them how I
decide which medication to prescribe; some are paid surveys to find out how
I influence other doctors’ choice of psychiatric medications; some are
invitations to attend a ‘free’ dinner-lecture by an “expert” chosen to be
sympathetic to their product. I turn these solicitations down. I believe
patient care decisions should be made based on unbiased research and
scientifically demonstrated effectiveness and safety: not clever marketing
strategies.
With so many medications used, you should
make sure all your physicians know all of your current medications (bring an
accurate list, or a paper bag of all pill bottles including over-the-counter
pills and nutritional supplements). Doctors should be able to justify why
each medication needs to be continued, rather than eliminated.
County Psychiatric Associates
Our practice has experience in the treatment of Depression, Attention
Deficit Disorder (ADD or ADHD), Separation Anxiety Disorder, and other
psychiatric conditions. We are located in Northern Baltimore County and
serve the Baltimore County, Carroll County and Harford County areas in
Maryland. Since we are near the Pennsylvania border, we also serve the York
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children, adults, and the elderly. Visit our web site https://www.baltimorepsych.com
We also
maintain an informative web sites on mental health topics, such as Attention
Deficit Disorder, parenting, anxiety and depression.
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