Beyond Blue

Beyond Blue

Are We Overmedicating? Or Is Our Health Care System Inadequate?

People who’ve read only the first part of my book, Beyond Blue, often categorize me as being “anti-med” or a “psychiatrist-hater,” because in the early chapters I describe the arduous journey through hell and back trying to find a doctor who could properly treat me.

The first six failed miserably.

Especially the one whom I dubbed “Pharma King” because his toxic cocktail of 16 or so pills a day nearly killed me. That was in addition to the Ativan he told me to pop every hour if I was feeling anxious, even though I had disclosed to him a history of substance abuse.


When people talk about overmedication in this country with respect to depression and anxiety – and this topic comes up a few times a week – I understand where they’re coming from. I’ve lived it. However, now that I’m working with an exceptional doctor who is none of the stereotypes that are pinned on psychiatrists today, I see the mental health care mess from a different, more nuanced perspective.

I think the problem is far more complicated than overmedication. In fact, I’d be more comfortable labeling it “really bad health care.” And if I had to pick a culprit, I’d point my finger at our health care insurance policies, not the doctors themselves.

Here’s the thing. Most good doctors don’t take insurance. They can’t. Because they can’t properly diagnose a person in 10 to 15 minutes. No one can.


That’s when you get into medicating someone who maybe shouldn’t be medicated, or misdiagnosing the ADHD as manic depression. But you have to call it something by the time the ten-minute buzzer goes off. It’s a little like Jeopardy. You rush to collect the facts: Find out if a person is sleeping okay, eating okay, having sex, functioning at work, isolating from friends, thinking about dying, making plans to die, etc. And then you press the red button and give your best guess.

A few of the bad guesses I got back when I was shopping for a psychiatrist like a nanny were: ADHD, Borderline Personality, Major Depression, and NDBSD (Not Depressed But Sleep Deprived). Funny I never found that one in the DSM-IV.

On the contrary, my current doctor won’t accept a patient until he/she agrees to an initial assessment of two hours. Two hours. Can you imagine? Two hours to give a doctor your psychological history, family history, current symptoms – and an exhaustive reading of your non-verbal language as well – so that she can begin to paint the context or story around your illness that’s absolutely crucial in order to diagnose correctly. She keeps her patients accountable to things like diet, exercise, counseling, and meditation, and incorporates alternative therapies like omega-3 capsules into their recovery.


But no doctor who accepts health care insurance can pull that off. And that, I believe, is our biggest problem.

In January 2010, the University of Michigan published a study in the Archives of General Psychiatry that found only one in five Americans with depression has received even one adequate course of treatment in the past year – the criteria for adequate treatment being 60 days of an antidepressant with four doctor or nurse visits over the year or (for talk therapy), four mental health visits lasting 30 minutes or more.

Contrary to popular thought, most people on Prozac or Zoloft don’t see psychiatrists (or “head doctors” as my husband likes to call them). Their primary care physicians pass out prescriptions, which I assert is yet another big problem in the mess of today’s mental health world.


Because, get real, does a primary care doctor really have the time or resources to follow up with a patient on his symptoms of no sleeping, lack of energy, and inability to make a decision? No. He/she are juggling a bunch of strep-throats, killer influenzas, and emergencies involving precancerous-cells. Do you think most GPs will pick up the phone two weeks after writing a prescription for Prozac, and ask the patient, “Have you committed to a exercise program yet? Eating organic vegetables over there? Doing what you can do to untwist your distorted thoughts? Try David Burns’s books, you’ll love them.


I think Judith Warner’s op-ed piece in The New York Times about a year ago, entitled “The Wrong Story about Depression” accurately articulates the bigger problem:


Contrary to popular belief, there’s no evidence that most psychiatrists regularly prescribe pills straight off to people who can get better by reading about depression, exercising or doing nothing….That people have come to believe otherwise may be in part because most patients with depression are treated by general practitioners, not psychiatrists. Studies have shown that these primary care doctors don’t strenuously enough screen their patients for depression before prescribing drugs, or closely monitor their care afterward.

Inadequate treatment by nonspecialists is only a piece of the problem. In fact, most Americans with depression, rather than being overmedicated, are undertreated or not treated at all. This is the big picture of mental health care in America: not perfectly healthy people popping pills for no reason, but people with real illnesses lacking access to care; facing barriers like ignorance, stigma, and high prices; or finding care that is ineffective.


Yes. Overmedication exists. But it’s just one causality of a much bigger problem: A poor health care system in the U.S. based on the earnings and profits of health insurance companies, giving the average doctor ten minutes to throw a solution at his patient. That’s our biggest problem to solve.

This post was originally published on

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  • http://AddaURLtothiscomment Trish

    I have to tell you what happened to my mother back in the late 50’s/early 60’s. She suffered from depression; so she started going to a Dr. to be treated for the depression. This then snow-balled some-how into 3 different dr.s by the time it was all said & done & she had died at the age of 36 from an accidential drug/alcohol overdose. All three of the Dr.s were unaware of her going to them at the same time.
    What is more so a shock is the one Dr. who prescribed her one set of meds also died from an overdose of the same meds he prescribed for my mother, that took her life; some time after her death!!!!
    Unfortunately~ I never did know my mother~ as I was only 14 months old at the time of her death. I am very much afraid of Dr.s who reach for the “tablet” to make you out a script soon after you talk to them!
    Think twice and don’t accept it if your gut tells you otherwise. You are the patient. It affects you & all areas of your life what you put into your body. Research what the Dr. is talking about- find out as much information as possible about the prescription- ask questions..etc. Personally~ I try to stay away from meds as much as possible~ but unfortunately~ that is not entirely possible in my life. I wish it were so~ but genetics plays a big part in everyones’ life & that in itself makes it impossible {in certain situations} to stay off of meds.
    I agree with you 100%. We have to be advocates for ourselves & take care of what matters most to us & our families. Nobody else will do it for us. That is why we have to be pro-active in all areas of our life. You only get one chance to live your life~ you may as well make it the best life it possibly can be; physically, mentally, emotionally & spiritually.

  • http://AddaURLtothiscomment Charlotte

    I have found drugs are thrown at you when the insurance won’t pay for proper care>> I do not do well on medications, never did!

    I am sooooo interested in learning more, thank you…

  • http://AddaURLtothiscomment Nia

    It is oftentimes true what you are saying about Medical Providers writing prescriptions, especially in Primary Healthcare and especially because of the time constraints.
    Currently, a high percentage of people in this country receive their mental health treatment in primary care facilities; this may be because of the ease of access or the stigma of going to a ‘mental health’facility.
    The new Health Care Reform laws mandate that by 2014, publicly funded primary care facilities must include Behavioral Health Providers.
    In order to address the very issues that you are describing, it would be my suggestion to find a primary care facility which already includes an integrated system of Behavioral Health and Primary Healthcare. They exist and they offer a means of not only assessing problems correctly but also offering a variety of treatment modalities, diet, exercise, stress reduction, self care,appropriate referral when needed, medication or not,along with a coordinated team of care providers. Be well.

  • http://AddaURLtothiscomment Razz2

    I live in Canada but things here are very much the same there except for getting an appointment with a psychiatrist. There is little point of “doctor” shopping for a specialist as the only way you can get an appointment with a psychiatrist is by referral from your family doctor. The wait is usually a couple of months for that appointment. So that in itself is a big hurdle in getting proper treatment but now necessarily the first you may face. There are fewer and fewer family doctors going into practise these days and so the number of them accepting new patients are very few. So you are then left with the “medi-center”. I’m sure there are good doctors at these centers but the odds of getting the same one twice are against you. And as Therese has said, they often can only spare the 10 min. to get you diagnosed and on to the next patient.

    Emergency rooms are full of desperate people who have been trying to find someone, anyone who will listen to their cries of help and actually listen. That’s the only option you have left if you or someone you love is in a serious depressive episode. And even then if they are not showing that they are a danger to themselves or someone else chances are they’ll be given something to calm them down and sent on their way home with a prescription.

    Never mind about the stigma attached, lets just try and get those that are reaching out for help someone who will see them! Two years ago my youngest daughter was suicidal. She went to an emergency mental health clinic where she was told to fill out forms and they’d call her with an appointment time. The appointment ended up being two weeks away! Her mistake was not speaking up and telling them that she was going to “off” herself if they didn’t step up. Instead as someone severely depressed… she went home and cried and then called me. The amount of energy and determination it took her to just walk into the clinic was all she had left. If she didn’t have people who loved and cared about her close by (we live 4 hrs. from her) I shudder at the thought of how this story would have ended.

    I have no answers that’s for sure but I wish the politicians would quit telling us what a wonderful health care system we have. It’s a nightmare! And the future doesn’t look much better.

  • http://AddaURLtothiscomment JiLLB

    It’s true how few pdocs there are who are worth anything (as far as providing tx). Mine accepts only MedicareB and nothing else – nothing! He is $95 for 30 mins or $175 for 40-50 mins. Really? I had a pdoc under private pay (an hour away) who took NO insurance and I paid a ton for him. After I was discharged from a hospital stay, the social worker hooked me up with an insurance provider who was closer to home. It was in a clinic and he did take only 10 mins. I saw him twice before deciding that my mental health was worth the money spent. Fortunately my husband is employeed and I had the means to do that. After the clinic doc, I went to the doc I see now – who accepts only MedB. He is also an hour away. I don’t even like him, but he actually communicates with my psychologist and that is worth it’s weight in gold to me.

    Ok, so Medicare is covering 55% (this year and last) from the 50% in prior years. It is supposed to go up to 60% next year. But that’s still absurd, not to mention how many people no longer have straight Medicare but a supplemental because it offers better coverage.

    I saw my GP when I first started meds for this episode. Once I was on more than one med, she sent me to a pdoc. She knows her limits, for which I am very thankful!

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  • http://AddaURLtothiscomment Alan

    I’ve had depression for years. Started with a family doctor when had a HMO insurance. I think I wore him out-knowing that something was wrong but didn’t know what. He finally gave me some meds that helped. He left and I was directed to a mental health clinic. Saw a NP there for years being able to get by and work. She hospitalize me once. Then this place stopped taking private insurance and would only take medicare or medicaid. Then I was directed to a clinic that had both therapy and psychologist. Was functioning enough to get by in life. Then I lost my job and at 61 could not find work anyplace. My life fell apart. Was hospitalized for a month had ECT treatments. When released I was seeing the therapist and doctor ever other week so I saw someone every week. They helped me get disability. Still not a functional person but at least the therapist and the doctor review each others notes. Am now on medicare and problem is Part D and paying for my meds. I reached the “doughnut hole” in less then two months. Wife lost her job but was able to find a part time work after being off a year. Having her home probably saved my life. She still keeps all meds locked up and just gives them to me in mornings and evenings. She got rid of all my guns. and makes me take a walk almost every day. I do very little-I work at a food pantry 4 hours a week and try to keep yard mowed is about it. her part time job has o benefits so paying COBRA for her and medicare, a supplement and a part D that pays for generics durning the :doughnut hole”. (two of my generics are $400.00/month.). So my outflow is greater than my inflow. But I get up ever day and put one foot in front of the other and make it through the day. One day at a time for me. It is rough but I’m still alive.

  • http://AddaURLtothiscomment Serena

    During the first two years of treatment with several hospitalizations and psychiatrists giving me too many pills, an intern doctor got me down to one medication. For the past 15 years I have been stabilized with one med and it took an intern to get me from being a zombie on all these meds to just give me one. I definitely don’t believe in poly pharmacy.

  • http://AddaURLtothiscomment Mary Anne Thompson


    When I saw this topic I just had to give my 2 cents worth. In my opinion it is the pain medications that are being over prescribed. As I told you in a past email after getting a referral to a pain mgt Dr from my Primary Care Dr for my disability…degenerative disc disease. I walked into this Dr and not even looking at the 6 pages of papers I was required to fill out for his ofc that went straight to my file he got out his pen and started writing me Rx’s. He said he wanted to treat me for ANY pain I had anywhere, not just my back. He over medicated me, not to mention the meds interacting with the meds I take from my psychiatrist for depression and anxiety.
    I had to be pro active and detox/withdraw myself off of the ones he gave me. They were making me NUTS! certifable crazy. I only requested one medication from him initially. One I had taken 4 yrs prior from a Pain Dr that I was seeing then under my now X husbands insurance. It is horrible that Medicaid will pay for the actual medications but not for the Pain Mgt Dr’s or they won’t accept it. I understand the Dr’s wanting to get paid and so much of the govt asst. does not pay that they are hesitant to accept it.
    Anyway, in my experience the mental med’s are not as over prescribed as ones that are resold on the streets….like Hydrocodone, Zanex…

    I use my son as an example, he was never interested in any of my Klonopin for anxiety but when I was given small doses of Zanex he took those. When I was given any time of feel good pain meds he was sticking his hand out asking for some but never asked for the Cymbalta.

    This WORLD is being dumbed down by the govt. with poisions in our drinking water, being over medicated by the drug companies pushing meds onto Dr’s then onto us. The air we breathe, it is proven that airplanes are releasing barium and metals into the air every day. If any of us think we are safe or going to stay sane we are in denial.

  • http://AddaURLtothiscomment kenneth

    As a soon to be pharmacy student and researcher who has studied alongside many future doctors, I can tell you: most of them are not as bright as we’d like to believe. Most of what they know about drugs comes from pharmaceutical salesmen and “evidence based medicine” which holds that all treatment decisions can be reduced to handy flow charts and algorithms.

    Through lots of research and attention to my own symptoms, I ultimately came up with my own treatment for seasonal depression: a little bit of selegeline, phenylalanine and SAM-e, along with vitamin D, lots of fish oil and proper hormone adjustment. Works beautifully. That’s not to say it will work for everyone, but you have to be willing to study in depth about your condition and to realize that there are many more tools out there than the ones doctors always first reach for.

  • http://AddaURLtothiscomment e

    I really appreciate this article you have writen. Very informative and seems to me, spot on. Oh and I would have to agree with Kenneth. Sadly doctors are just human like the rest of us, not necessarily more intelligent. I have been dissappointed often by lack of common sense and sometimes intelligence of the doctors I have dealt with.

  • http://AddaURLtothiscomment Elizabeth


    This is not a comment on the post, it is about your blog ever since Beliefnet updated/upgraded…whatever they did.

    I don’t know if you have any control over this but your tag cloud is missing so many tags I used to click on. And when I try to search for topics in your archives like “family” or “toxic friendships”, the searches don’t work. And I used to be able to click on all the labels you had at the end of your posts and get to more posts on a topic I wanted to read about but all your lables are gone too. It is just a bit sad because I feel like I’m not getting to the posts that I really need.


  • http://AddaURLtothiscomment Elizabeth


    Scratch what I said about searches not working… it must have been a hiccup on my computer. I can now do topic searches and they pull up posts from your archives.

    But the labels are still missing and your tag cloud is still pretty bleak :-(


  • http://AddaURLtothiscomment Meg

    Great article Therese! After dealing with mild, but chronic depression (dysthymia) (and now some anxiety) for most of my adult life (I’m now 43), I’ve finally found a psychiatrist who does take insurance and he does insist on a 30 minute appointment. It’s not the glorious 2 hours you get from your psych, but compared to 10-15 minutes from most, it’s great. He actually had my ferritin (stored iron) tested. A level below 50 can cause some of the symptoms of ADD/anxiety/cognitive impairment I was experiencing. I was at 31 and after 3 iron infusions (oral iron was not absorbed by my system) my anxiety has almost disappeared. At first I didn’t trust he knew what he was doing b/c 2 pcps had no idea what I was talking about, but after I went to a hematologist, and my level went to 305 (!) and I felt better, I am so thankful I stuck with his unconventional approach, ie., not whipping out his RX pad and putting me on something else. (Hematologist recommends at least a level of 100) He did prescribe Klonopin to help with my anxiety symptoms, but insisted we check all other possibilities for my symptoms as well. If anyone is suffering with ADD/anxiety I highly suggest you ask your doc to test your ferritin level (different than your hemoglobin in your blood which indicates anemia if too low). My doc was familiar with (apparently little known) studies supporting this ferritin thing. Hope this helps someone!

  • http://AddaURLtothiscomment Marc

    Great column, Therese. I highly recommend Judith Warner’s book because she debunks a lot of the anti-med “facts” she previously believed without oversimplifying the benefits. It’s an issue that I don’t talk about with many people much because they can be so opinionated–especially those who are anti med and are so “sure” that are kids are being overmedicated. I work with many college professors who are convinced it’s just an excuse or the fault of parents. More ideology than facts. Though to be fair, my own experience with depression and my son’s with ADHD have made me less opinionated than I might have been.

    One thing I believe strongly–meds can help kids, but the science of medicating kids still has a long way to go. It’s more art than science. We did feel like our son became a chemistry experiment for awhile and it made him very negative about even considering meds after. It’s also been very hard to find good psychiatrists in my region–the one who prescribed my son and I stopped taking our insurance (and he was not great anyway) and when asking doctors and therapists for referral to a good pschyiatrist, I have ended up 45 miles from home seeking help adjusting my prescription.

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  • http://AddaURLtothiscomment Jean

    Over the past 20-plus years, I’ve taken various anti-depressants prescribed by family doctors and an ob-gyn — never have found the right meds that would WORK for me. The one local psychiatrist that a relative saw, does not accept insurance.

  • http://AddaURLtothiscomment spareparts

    Good post, Therese.

    I used to work for MHMR and do emergency detentions on-call. The police departments and ERs hated me because I used to take, on average, 4-5 hours to assess someone’s spherical orientation before “sending them off” (or NOT). My primary focus was that, once you commit someone, it affects them, in many ways, for the rest of their lives. And then I had to consider all the pecuniary (e.g. RAJ money – that is, money the center would get per year for every “empty bed” they could keep, well, empty) and political (e.g., WHERE the person was being sent – that is, which judge to call at 2 in the morning, or which local psychiatrist would get the patient) ramifications of the commitment.

    As with every story, there are 16 sides or so. We all only know our own, and perhaps 1 or 2 other sides.

    So, while there are several large targets in our endeavors to achieve some semblance of collective, adequate mental health, there are several lesser culprits (and the good people who try to combat them in their own small corners of the field) who could use some attention and support as well.

    The overall “system” limps along. It is a “sick” system, not only filled with insurance companies who deem themselves qualified to assign milieu limits, but also with people who take advantage of it whenever and however they can (doctors AND patients – this is, I think, the vicious circle that started the insurance companies’ over-reaching in the first place). Those of us who are capable (or can be) will have to wear our individual parts of this and forgive ourselves, if we want it to be better.

    I only lasted 5 years in the mental health field. (I had just graduated college; I was young, stupid, and thought I could be helpful.)

    You can’t fix overnight what took years upon years to mess up. I think NAMI has the right idea. They take their battle in “chunks”, and they choose them carefully (lest you upset more than you can fix at that moment).

    Well. My 5 cents’ worth (and this is as much sense as I’ll make today – must be something I care about). Otherwise, ringing in my head and muddling through my day.

    As always, Therese, many thanks. Sometimes, you bring me back to life. At least for a little while.

  • http://AddaURLtothiscomment Margaret

    Therese, This is all so TRUE. I was Blessed to have an awesome Psychiatrist for 35 years. When he retired…I chose not to find another one. I had been at this for so many years, I figured that with all I had learned, and the help of the Lord, I would somehow manage, and I have. If I sought a PDoc in our Insurance plan, I would get the short shrift that you describe, and be passed off to a therapy person who doesn’t have the medical training that is necessary to properly treat us. My Doc too could tell what kind of mood I was in, by my posture, what kind and color clothes I had on, etc. All those tell tale signs they are trained to look for. He also saw me for a year, before he got out his Script. pad.

    Since mood disorders and alcoholism run in our families, I’m not sure if our granddaughters will ever get the care they need, if they have an episode(s) sometime in their lives. Both our daughters are taking an antidepressant, one is also an alcoholic…do you think either one of them has seen a psychiatrist???? NO – even though they grew up with me and my bi-polar, panic disorder and SAD. I couldn’t convince them, but am most upset that their Primary Care docs didn’t send them.

    It may be 2012, but now and the future don’t hold any promise of good, caring psychiatric care for those who have this dis-ease.

    Perhaps we all should collectively PRAY for the Health Care rules and regs. change for the better.

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  • http://AddaURLtothiscomment Denise

    Great article Therese! I’m a long-time follower, first-time poster. I ditched my Texas BlueCross BS years ago; aside from over priced premiums, the company WOULD NOT cover ‘mental health’ because….as we’ve all heard before…a brain disease some how isn’t the same as another part of the body disease. I agree that people with mental health problems are not over medicated; aside from having to have courage to seek help, they may lack the big bucks to pay for treatment.

    Down but not out,

  • Medical Service

    I like this thoughtful article. This is really the great way you discuss this kind of topic. Good job.

  • http://AddaURLtothiscomment sarah


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