Overprescribed And Undermedicated

A recent segment from the liberal-leaning news source Vox was titled “Do I have ADHD?”. A female in her twenties believed she indeed had the disorder, but had never been diagnosed. In truth, there is no concrete answer to the question. While the DSM-5 lists criteria to diagnose the disorder, there is question as to whether the list is accurate. Current academia leans to one of two sides, that Americans are either overdiagnosed or underdiagnosed.

Of course, there are arguments to both, otherwise we’d have little debate. In one sense, the amount of drug companies offering ADHD medication increased just before the rise in diagnoses, prompting experts to create a Big Pharma conspiracy around “selling the ill, to sell the pill”. In another sense, however, studies repeatedly show that young children treated for the disorder drastically improve their learning abilities, and that the more cases found, the better our education.

But the fact of the matter remains, we can never know for sure whether someone has a mental disorder.

A blog post on Adderall addiction a few months back got me wondering, “How badly can access to psychiatric medication change someone’s life?”. Within the post a young woman candidly exposed how easy it was for her to fake a psychiatric exam to receive the drug, when she had personally never struggled with the symptoms of ADHD. She had already become addicted thanks to a friend’s stash, and had finally decided to get herself a prescription for the medication.

While there is no doubt that ADHD prescription medications have helped thousands, have they perhaps hurt just as many in the process? Even outside of the abuse that is rampant among American college students, how many children were wrongly diagnosed for simply being a hyperactive child? I remember those days. No kid wants to sit in school, church, or really sit anywhere. Children are by their nature curious beings, and they will always become distracted by the slightest piece of new information.

I am not here to say that diagnoses are all false, but statistics proves to us that misdiagnoses happen. Whether we are giving drugs to kids without a disorder, or giving the wrong drugs to kids if they have a different disorder, we are not providing them with the free life they deserve. One way or another, if the child was misdiagnosed, administration of drugs will change their lives forever.

Switching over to another psychiatric disorder, schizophrenia, there is a large push to notice symptoms, or even precursors of symptoms in children. Because schizophrenia usually does not show signs until late adolescence, it is very hard to treat in its early stage. The disorder is a result of improper brain cell growth and differentiation, and one hypothesis places the blame on low levels of a protein called beta-catenin. If recognized in childhood, could administration of this protein, or inhibition of its breakdown, help brains grow normally? But once again, how does one morally administer medication to a child without knowing for sure if they have the disorder?

While the question remains unanswered, prescription medication for schizophrenia can only be administered after symptoms show up. And if the beta-catenin hypothesis is indeed correct, by then the damage is already done. The only purpose of the medication is to treat the symptoms, not the cause, and of course it would seem improbable to add beta-catenin after the brain has finished developing.

Antipsychotics are the main treatment option for schizophrenics. These drugs are dopamine-receptor blockers (sometimes serotonin-receptor blockers) and work by “slowing down” the parts of the brain that overstimulate themselves to create the hallucinations so commonly received by schizophrenics.

But schizophrenia has other detriments. Most notably, social isolation and depression. The antipsychotics are only focused on the so-called “positive” symptoms of the disorder, and do nothing to treat these other symptoms. Even further, they unselectively block dopamine receptors, even in pathways of the brain that are undamaged from schizophrenia, leading to numerous adverse effects.

Because of all of this, schizophrenics often refuse to take medication for their disorder, and I do not blame them. As stated, the damage to the brain is already done, terrible side-effects occur, and the drug does not even treat half of the symptoms.

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I am led now to my conclusion (and the title of this article): Americans seem to be overprescribed and undermedicated. We may have doctors willing to give us all sorts of drugs that promise to improve our lives, but in the end the drugs cannot solve the issue at hand. In one case, we create a situation where abuse is rampant and misdiagnoses can alter one’s future forever, and in another we simply don’t have the science to fix the problem at hand.

While I am not against prescription drugs, and agree they do much good in the world, it is our duty to exhaust all efforts to mediate problems by non-prescription means first. Many schizophrenics learn how to live with their disorder with behavioral therapy. In other words, they know how to recognize and cope with the symptoms. But of course, cases ensue where prescription is indeed the best option. The same is with ADHD, and even other disorders. Many behavior therapies can be implemented that mediate the symptoms, and when those fail, perhaps then prescription medication should be used.