Tag Archives: mental health

Is There a Safe Amount of Drinking Over the Holidays?

By Dr. Marc Manseau

With the holiday season upon us, there are many opportunities to drink alcohol. Some are undoubtedly tempted to over-indulge, and people who struggle with alcohol may find this time of year particularly challenging and stressful. But what are the benefits and risks of alcohol? Many people can enjoy alcohol without any immediate problems, and may find that it helps them to relax and socialize. In some cultures, it is important for observing traditions or celebrating religious feasts. But does an apparent lack of alcohol-related problems make it safe?

The science on the possible benefits and safety of alcohol use resembles a mudslide more than a crystal-clear glass of chardonnay. Certainly, heavy alcohol use is associated with myriad health problems, from mental illness and dementia, to heart disease and stroke, to cancer and liver disease, to earlier death. But what about light-to-moderate alcohol consumption? Some studies have actually linked moderate alcohol use with health benefits, including decreased risk of ischemic heart disease, ischemic stroke, diabetes, dementia, and mortality.

However, since we can’t randomly assign people to take alcohol or placebo, these studies have numerous limitations. For one, there is the “sick abstainer effect,” whereby a subset of people reporting no alcohol may actually have quit drinking due to a history of problems from past heavy alcohol use, which would put them at elevated long-term risk of certain health problems. Another problem is confounding. For instance, people who moderately consume alcohol have been shown to have higher average socioeconomic status, which is associated with better health and a longer life. Researchers have tried to control for potential confounders, but it isn’t possible to account for all of them; only randomization can do that. Finally, almost all studies are based on self-reports of drinking behavior, which is fraught with potential error and bias. We know that people tend to under-report “undesirable” behaviors like heavy drinking, and studies have attempted to correct for this, but no adjustment strategy is perfect.

Recently, an extremely large, international study tried to get a definitive answer to the question about the safety of alcohol use. Using data from 195 locations across the globe, including 694 data sources about alcohol consumption, 592 studies on the health effects of alcohol use, and a combined study population of 28 million people, the researchers sought to determine the total burden of disease and disability caused by alcohol use between 1990 and 2016. Importantly, they did not solely rely on self-reported drinking, but adjusted alcohol consumption estimates using alcohol sales data, which were further corrected for tourism-related and unrecorded consumption.

In 2016, globally, among people aged 15 to 49 years old, alcohol was the leading risk factor for death and disability, with 3.8% of female deaths and 12.2% of male deaths attributable to alcohol use.

The findings were sobering. In 2016, alcohol was the seventh overall cause of death and disability globally, accounting for 2.2% of deaths among females and 6.8% among males. Among people aged 15 to 49 years old, alcohol was the leading risk factor for death and disability, with 3.8% of female deaths and 12.2% of male deaths attributable to alcohol use. And the study was unable to identify any safe level of alcohol consumption (or in other words, the safest amount of drinking was zero).

But don’t pour your eggnog and brandy down the drain just yet. Even though this was a massive study with key methodological innovations, there were still limits. Like all previous studies, it wasn’t randomized, so confounding remains a possible explanation for some of the links between alcohol and health problems. Further, the findings have more obvious implications for public health than for individual risk. That means that while the study revealed important harms of alcohol use within the population at large, the danger to any individual person remains quite small. For instance, the top three causes of alcohol-related death for younger people were tuberculosis, road injuries, and self-harm. If you don’t live in the developing world, the first basically doesn’t apply to you. And if you never mix your moderate drinking with driving and have never had a problem with suicidal thinking, the next two aren’t relevant either (though someone else’s drinking and driving could still hurt you).

For the older group, cancers were the main causes of alcohol-related deaths. This risk technically applies to everyone who drinks any amount, but the actual increase in cancer risk that an individual would experience from moderate drinking is small. For example, if a man in the United States drinks 3-4 drinks per day (moderate-to-heavy drinking), his risk of developing colorectal cancer would increase from about 4.6% to around 5.7%. Assuming this 1.1% absolute risk increase is entirely due to alcohol (and not confounders), this would mean that alcohol is causing a lot of cancer cases in the overall population, but that it arguably does not present a very significant danger for an individual person.

Finally, especially in wealthier countries, light-to-moderate alcohol consumption was associated with a protective effect against ischemic heart disease for men and against ischemic heart disease and diabetes among women. So you might kick yourself for drinking if you develop a possible alcohol-related cancer at 70 years old, but you’d have no way of knowing whether or not this same alcohol use prevented you from dying of a heart attack at 68.

So, by now you’re likely asking whether you should drink. Unfortunately, I can’t make a strong recommendation. Yes, there are real risks associated with alcohol, but many also find benefits in light-to-moderate drinking, and every decision we make requires some amount of weighing the risks and benefits (e.g., driving a car is fairly risky but also confers many social and economic benefits). Each person’s calculation will be personal and different.

But what we do clearly know is that heavy and/or problematic drinking is very unhealthy. Heavy drinking is defined as more than three standard drinks a day or more than eight a week for a woman, and more than four a day or 14 a week for a man; and a standard drink is much less than you might think (that martini is likely two to three standard drinks). If associated with social, occupational, or health problems, any amount of alcohol can be considered problematic. If your drinking habit matches these definitions, you should consider cutting back and speak with your doctor if you need help. But if you enjoy light-to-moderate drinking without any problems, you may decide that enjoying a little Holiday cheer is worth the risks.

This article was first published by JustCareUSA. Reprinted by permission.

Childhood Infections, Antibiotics Use Linked to Mental Disorders

Children who have infections and are treated with antibiotics are at an increased risk for developing psychiatric disorders, according to a new study.

Researchers in Denmark examined the medical records of about one million children born in the country between 1992 and 2012 and followed their mental history for an average of 10 years. Children who developed a severe infection that required hospitalization had an 84% higher risk of developing a mental illness before turning 18, and a 42% increased risk of filling a prescription for a psychotropic medication, according to results published in JAMA Psychiatry.

The use of an antibiotic to treat an infection was associated with around a 40% increased risk for a future mental disorder and a 22% increased risk for getting a psychiatric medication. The mental illnesses with the highest risk following infection were schizophrenia, obsessive-compulsive disorder, personality disorders, mental retardation, autism and ADHD (attention-deficit/hyperactivity disorder).

The researchers suggested several reasons for the association between infections, antibiotics and mental illnesses. The first is that an infection may impact the brain, increasing the risk for a mental disorder. Another theory is that antibiotics can negatively impact the “good” bacteria in the gut, which can subsequently alter the brain and increase the risk for mental disorders. Also, some people have a genetically higher risk of getting more infections and mental illnesses.

Quick Hits: Older Adults Want To Take Fewer Drugs, Talk Therapy Side Effects & More

Two out of three older adults would like to decrease the number of medications they are taking, according to a new survey. Also, nine out of 10 of them would stop taking one or more medicines if their doctor told them it was okay. Researchers based their findings on results from the National Health and Aging Trends Study, which includes adults 65 and older. Almost 50% of seniors take five or more medications. Taking many medications simultaneously, commonly known as polypharmacy, can lead to an increased risk of side effects and drug interactions. The survey also showed that those with chronic medical conditions were more likely to want to cut back on the number of drugs they take. The researchers said the results indicate that doctors should be comfortable bringing up the idea of deprescribing with senior patients. Posted October 15, 2018. Via JAMA Internal Medicine.

Cognitive behavioral therapy (CBT), one of the most popular treatments for various kinds of mental illnesses, is not without unwanted effects, according to a new study. These unwanted effects include distress, strains in relations with family, feelings of guilt and shame and intense emotions. Researchers interviewed 100 therapists and asked them to think about a client they had seen for at least 10 sessions. The therapists were then asked if the client had experienced any of 17 unwanted effects from therapy. Based on the interviews, researchers say about 40% of those undergoing CBT experience at least one unwanted event. They added that the unwanted effects may be an inevitable part of dealing with difficult thoughts and events. Posted October 7, 2018. Via Cognitive Therapy and Research.

Drugmakers would be required to disclose the price of a medication in television drug ads under a new proposal from the Trump administration. The proposed rule would mandate that the ad mention the wholesale or list price for a typical course of treatment, or a 30-day supply if the drug is a long-term medication. This is the price of a drug before insurance coverage picks up at least part of the cost. The administration is pushing the requirement as part of an effort to increase price transparency of drugs. Medications with a list price of less than $35 per month would be exempt from the price disclosure requirement. The top 10 most advertised drugs on television have list prices ranging from $535 to $11,000 per month, according to the Department of Health and Human Services (HHS). Posted October 15, 2018. Via Centers for Medicare and Medicaid Services.

Opioid-Related Complications Sending More Seniors to Hospital

Despite efforts to reduce the use of prescription opioids, a significant number of seniors continue to take them, and an increasing number of seniors are landing in the hospital because of opioid-related complications.

Between 2010 and 2015, the number of emergency room (ER) visits among seniors related to taking opioids more than doubled, while hospitalizations increased by 54%, according to a new report from the Agency for Healthcare Research and Quality (AHRQ). In 2015, there were more than 124,000 hospitalizations and 36,000 ER visits as a result of complications from opioids.

Researchers said that as seniors tend to be prescribed more drugs than younger adults, they are more susceptible not only to adverse events from opioids themselves because of body changes, but from the opioids interacting with other medications. Many seniors also have mental health issues, cognitive decline and dementia that, compounded with taking opioids, puts them at increased risk for adverse events such as falls or delirium that can lead to a hospital visit.

An associated AHRQ report found that between 2015 and 2016, about 20% of seniors – around 10 million – filled at least one opioid prescription and 7% – about 4 million – received four or more.

AHRQ Center for Evidence and Practice Director Arlene Bierman, MD, who worked on the first report, told HealthDay that healthcare providers can address the situation by using non-opioid pain medications or even non-drug treatments before opioids. And if opioids are deemed necessary, the lowest possible dose should be prescribed.

What’s the Best Medicine for Brain Health?

By Marc Manseau

To support brain health, we know many things that people should not do, such as smoke, drink alcohol heavily, use most recreational drugs, and engage in activities associated with frequent head trauma. But other than getting adequate sleep, there isn’t much that we know people should do to promote brain health, sharp cognition, and good mental health. Of course, we recommend eating a healthy, well-balanced diet, but very few individual foods or nutritional supplements have been proven to be good for the brain. The same goes for “brain teaser” activities and “cognitive skills training” programs. Contrary to logic, they haven’t been shown to produce sustained benefits.

However, time and again, one activity has been connected to robust improvements in brain health and prevention of brain diseases and mental health problems: exercise. And the encouraging results keep rolling in.

Regular aerobic exercise has been linked to reduced risk of developing dementia, such as Alzheimer’s disease. This type of exercise has also been repeatedly shown to prevent depression, and has even been proven to be an effective treatment for depressive and anxiety disorders, with effect sizes roughly equivalent to medications. These benefits have been consistently demonstrated in both human studies and in studies examining animal models of mental illness. More recently, non-aerobic weight training has also been definitively associated with positive effects on brain and mental health outcomes.

The ‘dose ‘ of exercise you need is not as high as you think — walking 20-30 minutes a day may be enough.

As if this news wasn’t good enough, the amount or “dose” of exercise that people need to promote brain health is not as high as you may think. Minimal amounts of exercise such as 20-30 minutes of walking or gardening a day – not even enough to lose weight – may be enough to boost cognitive functioning and lower the risk of mental health problems. So, it should be possible to fit into all but the very busiest schedules.

Exactly how exercise helps the brain is unclear, and there are many theories, multiple of which may be simultaneously true. Exercise may increase blood flow and oxygen supply to the brain. It may also increase the production and activity of “neurotrophic” (literally “brain feeding”) factors, such as brain-derived neurotrophic factor (BDNF). BDNF in critical brain areas such as a memory center called the hippocampus promotes brain health and mental resilience through stimulating the growth of new neurons and connections between them.

Exercise causes chemicals to be released from muscles and bones that may be essential to sustaining proper brain functioning. In addition, physical activity causes the release of several “feel good” substances, such as endorphins and endocannabinoids, which have been implicated in the feeling of general well-being and relaxation after a workout often referred to as a “runner’s high.”

Finally, exercise may benefit your brain for the same reasons that it is good for the rest of your body – it lowers blood pressure and inflammation levels and enhances proper blood flow and heart functioning.

Regardless of the exact reasons why it’s so healthy, we know that exercise is a relatively easy-to-do, inexpensive, and fun way to improve brain health and reduce the risk of mental illness and cognitive decline. So, do your brain a favor and grab those running shoes or that bicycle and head outside!

This article was first published by JustCareUSA.org. Reprinted by permission.

Suicide and Mental Illness: The Forgotten Health Crises in America

Last week, mental health was front and center in the news for several reasons. First, the suicides of two high-profile individuals, fashion designer Kate Spade and celebrity chef Anthony Bourdain, captured headlines.

But you may have missed a CDC (Centers for Disease Control and Prevention) report that came out last Thursday that found suicide rates have skyrocketed in the US between 1999 and 2016. Twenty-five states saw suicide rates increase by at least 30%. Montana had the highest rate. Suicide rates rose in every state except 1: Nevada.

Just how serious a problem is suicide? According to the CDC, in 2016, about 45,000 Americans 10 years old and older died by suicide. Taking one’s life is the 10th leading cause of death and is 1 of only 3 leading causes that are on the rise, the CDC says.

These figures are a major wake-up call that we need a multi-faceted approach to not only stem – and hopefully reduce – the rising rates of suicide. It is also an indication that the way mental illness is considered, approached, treated and funded in this country is not right.

Why Now?

The drastic rise in suicide rates is all the more shocking considering that since the early 1990s, access to mental health care has – on the surface — actually increased. The Mental Health Parity and Addiction Equity Act (MHPA), signed into law in September 1996, requires that annual or lifetime dollar limits or benefits on an individual’s health insurance not be lower than limits for medical care.

And in 2014, the major provisions of the Patient Protection and Affordable Care Act (PPACA), also known as Obamacare, that went into effect included mental health care as an essential health benefit that all insurance plans on health insurance exchanges must cover.

Despite MHPA and PPACA, we have a mental health crisis in our midst. Why? It’s hard to say, and it is likely a combination of many things.

Can Antidepressants Make the Problem Worse?

One thing is for sure: An increasing number of Americans are depressed – or at least unhappy. Many of them are turning to their doctors and they are receiving prescriptions for antidepressants. And those drugs could actually be doing more harm than good.

A CDC report that came out in August of last year found that between 1999 and 2014, the number of Americans that had taken an antidepressant rose by 65%. That’s not a typo. In 2014, about 1 in 8 Americans over the age of 12 said that they had recently used an antidepressant.

Why is the relatively high use of antidepressants a concern? While antidepressants may well help a lot of people, there’s a mountain of evidence indicating they are no better than a placebo. They also come with a “black box” warning – the most serious the FDA can require for a drug – stating that they may increase suicidal thoughts or actions.

Another study, published in 2016, found that when given an antidepressant, people with no prior history of mental illness were twice as likely to become suicidal and violent.

Other drugs are also known to have suicidal thoughts as a potential side effect. Bourdain, for example, was said to be taking the smoking cessation drug Chantix (varenicline), according to news reports. The prescribing information for Chantix notes that “serious neuropsychiatric adverse events” have been reported in people taking the drug, including suicidality. Chantix used to have a “black box” warning regarding suicidality, but following an intense lobbying campaign from the med’s manufacturer, Pfizer, the FDA agreed to drop that boxed warning from Chantix’s labeling in December 2016.

We don’t know exactly how much impact antidepressant use has had on the increase in suicide rates (If any mental health researchers are reading this, it would be a good idea to investigate this, if you aren’t doing so already), but the evidence seems to point it could have a significant effect.

We also don’t know exactly what drives people to suicide. It’s likely a combination of factors. But there are roles both governments and society can play in helping to turn the tide of rising suicides.

Federal and State Government Funding Failures

Our federal government — as well as state ones — have a role to play by adequately funding mental health programs, especially for the poor and elderly. Yet, they have largely failed. Under the Trump administration, the situation is getting even more grim. Trump’s proposed fiscal 2019 budget calls for massive cuts to Medicaid and Medicare. It also reduces funding for the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Mental Health and Substance Abuse Treatment Programs of Regional and National Significance by about $600 million, according to the non-profit group Mental Health America.

Inadequate investing of mental health can have severe consequences. “Failure to invest in mental health as a matter of urgency will have health, social and economic costs on a scale that we have rarely seen before,” a World Health Organization (WHO) report on mental health released this year stated.

The WHO report also found that spending on mental health makes economic sense. The organization projects that every $1 invested in mental health treatment leads to a return of $4 in improved health and the ability to work.

Society’s Role in Making Change Happen

Having a mental illness carries a lot of stigma in our society. Many people that could be helped with mental health treatment often don’t get it because they think it will reflect badly on them by their friends, family or co-workers.

This mentality held by far too many among us needs to end and we can help doing so by treating mental illness exactly the same as someone who has a medical condition, such as diabetes or cancer. There is absolutely no shame in having a mental illness.

We need to talk openly about mental illness much more than we do now. We also need to raise awareness that if someone is depressed, is suffering from bipolar disorder, schizophrenia or any other mental illness, there is help available and they shouldn’t feel afraid to seek it.

Together, we can help stop the rise in suicides. Speak up and advocate for greater mental health awareness and funding. It may just save someone’s life.

Why School Shootings Are as Much Public Health Issues as They Are Gun Control Ones

For students at Santa Fe High School in Santa Fe, Texas, life changed forever on Friday morning. Armed with a handgun and a sawed-off shotgun, 17-year-old Dimitrios Pagourtzis methodically walked through the school and killed 9 students and 1 teacher. He planned on shooting himself after the bloodbath, but apparently didn’t have the courage to do it in the end.

And then what always is the case after school shootings of late happened: President Trump and Vice President Pence offered condolences to the Santa Fe community, offered federal support, and didn’t do much else. Talking heads on cable TV news networks began the gun control debate. And then, late Friday afternoon, the networks shifted attention to something apparently more newsworthy – the following day’s wedding of Prince Harry and Meghan Markle.

Is there something wrong with this picture? Of course. While we try to “fix” the issue of school shootings, it seems like too many people think there is only one approach, or that some are better than others, or that we don’t want to infringe on the rights of others in order to do so.

This is wrong and why, if it continues, school shootings will continue. It’s time to face the reality that the epidemic of school shootings is as much a public health issue as it is a gun control issue. It will take a combination of approaches to end. And the sooner those in positions of power to make changes realize this, the sooner these tragedies can finally come to an end and no more innocent lives will be lost.

What public health issues in particular? First and foremost is mental health. In almost every school shooting, mental illness in some form played a role in the tragedy. Mental illness is still widely stigmatized in our society, especially among teens. This may give pause to young people who may realize they need help, but don’t seek treatment out fear of embarrassment from their peers. This mentality must change, and change immediately. In addition, every school should have a trusted mental health professional available for students to consult.

You should also know that statistics show people with mental illness are much more likely to be the victims of gun — and other — violence than to perpetrate it.

The second is bullying. Some of us were likely bullied in our youth. While many of us are resilient and/or didn’t get bullied constantly, there is only so much getting picked on that some adolescents or teens can take before they can’t take it anymore. Anti-bullying education should be required in every school, and reinforced by parents.

The argument for gun control of some sort seems to be obvious to everyone except too many who seem to care more about their weapons than reasonable measures — whatever the cost to society. And there is a public health issue with guns themselves. In many school shootings — including the most recent at Santa Fe — the guns used by the teen perpetrators came from within their own homes, and were legally obtained. More education on how to safeguard weapons within the home is imperative to prevent future shootings.

If all of this sounds sensible, it’s because it is. The main problem? Politicians not wanting to risk contributions from powerful political contributors — such as the National Rifle Association — to do so. If children really are our future, then politicians have to do what is right, no matter the financial costs. Children’s lives are in the balance.

And what can the general public do? Follow what has happened since the school shooting in Parkland, Florida. Speak out. Attend rallies. Write letters to elected officials. Eventually, they will hear you and make the long-needed changes to save lives. I pray they will.

Mariah Carey: An Unexpected Mental Health Advocate

Superstar singer Mariah Carey has had a rough few years. She has been dragged through the media and been the target of many a late-night talk show host’s jokes. And this was even before her near meltdown on Dec. 31, 2016, during a nationally televised New Year’s Eve performance.

However, no one should be making fun of Ms. Carey now. In fact, we should be applauding her. Why?

Last month she gave an exclusive interview to PEOPLE magazine detailing her struggle with bipolar disorder. Anyone going through bipolar — I know several — is battling demons. Ms. Carey is fighting those monsters while in the public limelight and performing.

Yes, Ms. Carey is famous. Some may argue that we should have more sympathy for those struggling with bipolar disorder who aren’t a celebrity. They may have a point.

However, her bravery — particularly as a celebrity admitting she has a serious mental illness while knowing the consequences that can come with such a revelation — can be useful to mental-health awareness and treatment. Like most mental illnesses, there is a severe stigma attached to many in our society to bipolar disorder. Perhaps Ms. Carey’s interview will educate some people on bipolar, or at the very least get a conversation started.

When it comes to health and medicine, you are more likely to see a celebrity talking about an illness if they are shilling for a drug or medical product. Ms. Carey is opening up about an illness she is personally suffering from. This is exactly why she should be lauded and why I personally applaud her for her bravery, considering my own history with mental illness.

Will ridiculing of Ms. Carey continue? Undoubtedly, as that is what gets people to read articles and watch late-night comedians. But I see her as an advocate for mental-health awareness – and as an example other celebrities could learn from. Thank you, Mariah.

Quick Hits: Americans Open to Non-Drug Pain Treatments, Psychiatric Drugs’ Impact on Cognition & More

More than three-quarters of Americans — 78% — say they are willing to try non-drug alternatives for pain before turning to prescription painkillers. Results from the Gallup-Palmer College of Chiropractic Annual Study of Americans show that 40% of Americans consider prescription painkillers such as opioids a “crisis” or “very serious problem.” And 55% of those who know about the nation’s opioid epidemic place some of blame on the drug industry’s encouraging physicians to prescribe opioids. Another 53% place a lot of blame on doctors overprescribing painkillers to patients. About 23% of those polled said prescription pain meds such as opioids are not very safe, and 8% said opioids are not safe at all. In 2015, more than two-thirds of the opioid deaths reported involved prescription opioids such as oxycodone, hydrocodone, morphine and fentanyl. Posted Sept. 13, 2017. Via Gallup.

Taking high doses of antipsychotic drugs over an extended period may be associated with poorer cognition in schizophrenia. However, taking low doses of antipsychotics such as benzodiazepines and antidepressants over a long time doesn’t affect cognition, according to a new study published in the journal European Psychiatry. The research also found that schizophrenia patients who took a long break from using antipsychotic drugs tended to see their cognitive function improve. Posted Sept. 5, 2017. Via EurekAlert/European Psychiatry.

Women who take antiepileptic drugs (AEDs) during pregnancy have a higher risk of having premature babies or babies that have a low birth weight for their age in the womb. Women with epilepsy who took AEDs while pregnant had a 9.3% increased risk of having a premature baby, while women without epilepsy who took an AED had a 10.5% increased risk, according to results published in the Annals of Neurology. Women who did not take a medication and didn’t have epilepsy had only a 6.2% increased risk of a premature baby. Compared to women who didn’t take an AED and didn’t have epilepsy, women with epilepsy who took one of the drugs gave birth to a child with a mean lower birth weight of 3.9 ounces. For women who took an AED and didn’t have epilepsy, the figure was 4.8 ounces. Common AEDs include Lamictal (lamotrigine), Topamax (topiramate), Tegretol (carbamazepine), Keppra (levetiracetam) and Neurontin (gabapentin). Posted Sept. 11, 2017. Via Medical Express/Annals of Neurology.

Are There Any Side Effects From Psychotherapy?

The vast majority of people who receive psychotherapy through the Internet benefit from the treatment, though a small number do experience some kind of side effect.

Alexander Rozental, PhD, a psychologist, decided to explore the side effects of online cognitive behavioral therapy (CBT). Online CBT is similar to the CBT one would get from seeing a mental health professional directly or reading a self-help book, but support is given through email with a psychiatrist. The dissertation is thought to be the first examination of the side effects of Internet-based therapy.

Rozental’s research found that only 6% of 3,000 patients receiving Internet-based therapy got worse during treatment.

When he examined patients who received psychotherapy in an outpatient setting that were asked if they had negative effects of the treatment, one-third said they had a difficult memory resurface, had more anxiety or felt stressed. In addition, some said they had a poor relationship with their therapist or the treatment was subpar.

Rozental explained that what is needed in further research is a better understanding of therapy side effects, both to identify patients who become worse early in treatment and to shield patients from bad therapists.

“’I hope that psychologists and psychotherapists become more aware that there can actually be side effects and that they need to ask patients whether they are experiencing any,” he said.

High Percentage of Americans Taking Psychiatric Drugs

Nearly 17% of Americans — 1 in 6 adults — took a drug to treat a mental illness at least once in 2013, with antidepressants as the most common prescription filled.

About 12% of adults said they used antidepressants; 8.3% filled a prescription for an anxiolytic, sedatives or hyponotic; and 1.6% reported taking an antipsychotic.

White adults were the most likely to have taken a psychiatric medication. Nearly 21% of them did. Next were black adults at 8.7%, followed by Hispanic and Asian adults at, respectively, 8.7% and 4.8%

The analysis, published Dec. 12 in JAMA Internal Medicine, was based on data from the 2013 Medical Expenditure Panel Survey. The authors said that the use of these drugs could even be much higher as the prescription use data was self-reported.

Older age was also associated with higher psychiatric drug use. About 25% of adults 60 to 85 reported use compared with 9% of adults 18 to 39 years of age. Also, women were significantly more likely than men to take medication for a mental health issues.

“Safe use of psychiatric drugs could be improved by increasing emphasis on prescribing these agents at the lowest effective dose and systematically reassessing the need for continued use,” the authors noted.

If you are experiencing side effects with antidepressants, check out MedShadow’s feature on how to cope with them.

Where Clinton and Trump Stand on Health Care Issues

With Election Day less than 2 months away and the first presidential debate scheduled for later this month, Hillary Clinton and Donald Trump are campaigning at a feverish pace. Although it has not been talked about frequently on the campaign trail during stump speeches, Clinton and Trump tend to have widely different views on various health care issues, from what to do with Obamacare to how to handle rising health care costs.

With this in mind, I decided to dedicate my blog to an examination of where the candidates stand on 3 key issues.

Issue #1: Rising Prescription Drug Costs

Clinton: In the wake of the EpiPen pricing controversy, the former secretary of state has come out with an aggressive plan to curb such increases. She has just proposed to form a dedicated group of representatives from federal health agencies (with input from patient advocates and non-governmental experts) to investigate cases of exorbitant price hikes for drugs that have been on the market for a long time. Enforcement actions — including fines — against a drug company would be taken on drugs that are life-saving or critically needed when:

  1. The price goes up with no meaningful change or improvement to the product ;
  2. There is limited or no competition among manufacturers of the treatment; and
  3. The increase is considered unjustified.

She previously unveiled a plan to curb prescription drug costs by calling on health insurance plans to cap out-of-pocket spending at $250 a month for people with chronic or serious health conditions. Clinton would also spur competition of generic versions of biologic medications — among the most expensive treatments available – by lowering the patent exclusivity. And, she would also allow Americans to purchase drugs from certain other countries that have lower costs.

Trump: While Trump has been largely mum on the EpiPen brouhaha, he has talked about ways to reduce prescription drug prices in general. On his campaign website, Trump calls for removing “barriers to entry into free markets” for pharmaceutical companies that want to provide safe and cheaper products. Although he is scant on the details, he does add that consumers should be allowed to purchase drugs from foreign countries where the prices are far cheaper.

In January, Trump told a crowd that he would save hundreds of billions of dollars per year by having the agency behind Medicare negotiate prices directly with pharmaceutical companies as the program stands as the biggest purchaser of prescription drugs. However, it is unclear if he was being serious or it was just an off-the-cuff remark as he has not provided details on how he would accomplish this.

Issue #2: Obamacare

Clinton: Clinton has been a staunch defender of the health reform law signed by President Obama, but concedes it needs some revisions. One of her proposals would be to give all Americans access to a public-option insurance plan. She would also give the secretary of Health and Human Services the power to modify or reject premium increases for plans offered by private health insurers that are deemed excessive. Clinton will also push state governors extend the law’s Medicaid expansion, as 19 governors have chosen not to do so. Regarding Medicaid, she would allow Americans 55 and older the choice to opt into the program.

Trump: On the first day of his presidency, Trump said, he would ask Congress to repeal Obamacare, which he claims has led to runaway costs, rationing of care, higher insurance premiums and less competition. However, the candidate has some ideas on how he would replace the health care reform law. Trump would allow the sale of health insurance plans across state lines –- currently prohibited –- as a way to promote competition and lower premiums. Individuals would be allowed to deduct their health insurance premium on their tax returns. He would also provide states with Medicaid block grants, as he believes each state is in a better position to manage the Medicaid program for its people. Trump would also encourage use of personal HSAs (health savings accounts) to help pay for medical expenses.

Issue #3: Mental Health Reform

Clinton: A cornerstone of Clinton’s mental health plan is to make sure mental health is treated in the same way as other medical ailments. To accomplish this, she will promote early diagnosis and treatment of mental illnesses, as well as set up a national initiative for suicide prevention. Clinton also calls for greater integration of the nation’s medical and behavioral health systems, and enhanced community-based treatment. Another part of her plan is to provide resources to better train police officers on how to deal with situations that involve people with mental illness.

Trump: Trump has not talked extensively about plans to improve mental health. The issue is mentioned in several policy platform areas on his website. For example, under Second Amendment rights, he says that gun-related mass murders over the last few years had the same thing in common: red flags that were ignored about the perpetrators. He does call for an expansion of treatment programs for people with mental illness that are not violent. In a section on reforms for veterans, Trump calls for greater funding to treat post-traumatic stress disorder (PTSD) and traumatic brain injury and to support suicide prevention services.