Mental Health – Part 1: The Problem with the Modern Approach

This post is the first in a series of several entries about the intersection of mental health and metabolic health.

The scope of mental illness

Mental health disorders are now the leading cause of disability in the world.

There have been rapid increases in the rates of mental illness, especially during the past 2 years (2020 – 2022) during which universal social isolation protocols were initiated.  The WHO reported a 25% increase in the prevalence of anxiety and depression worldwide in just the first year of the pandemic.

 

It is worth noting that there is expected to be a concordant increase in obesity and related metabolic disease as a result of the impact of these global policies on issues such as lifestyle, socioeconomic status, psychosocial health, and food availability.

Managing mental illness with medication

The predominant approach to managing mental illness in modern health care is by the use of prescription medication.  Therapy can be an effective tool for management, as well, but the medication-first approach is trending toward more medications and less therapy.  This reliance on pharmaceuticals largely stems from the theory that mental health disorders are caused by imbalances in neurotransmitters.

Once diagnosed with a mental health disorder, individuals are often subject to indefinite use of these medications, likely due to many factors including persistent symptoms, inertia of treatment plan, lack of protocols for reassessment of medical need, or fear of medication withdrawal symptoms.  Discontinuation of a medication usually occurs only for reasons such as side effects, anticipated interaction with a new medication, or economic restriction (including insurance plan formulary changes).

Medications often effective only temporarily

While these medications may demonstrate benefit in the short-term, they often do not provide benefit in the long run and may cause harm.  Such limitations of psychiatric medication have been reported for various mental health disorders.

• Attention Deficit Hyperactivity Disorder (ADHD)

  • When randomized to stimulants for ADHD vs other treatments, patients demonstrated a good response in the short-term, but no difference long-term

• Depression

  • Recovery rates and relapse rates in the modern era are no better than prior to the availability of antidepressants

• Schizophrenia

  • Patients randomized to reduce the dose of their antipsychotic regimen were more than twice as likely (40.4% vs 17.6%) to show long-term recovery than those randomized to maintain their current regimen.
  • There is evidence of long-term harm from indefinite use of antipsychotics, with increased relapse rates, increased likelihood of chronic illness, and MRI confirmation of pathologic changes in the brain associated with worsening symptoms.

Though pharmaceutical products are the mainstay of current treatment for mental health disorders, they are not the only strategies that show some benefit and may not be performing as well as we think they are.

Continued in Part 2