Why do I take so many medications?

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


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


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


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

County area. Our services include psychotherapy,

psychiatric evaluations, medication management, and family therapy. We treat

children, adults, and the elderly. Visit our web site https://www.baltimorepsych.com

or http://www.ncpamd.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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