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Please support the Spritzler Mental Health Institute. And don't even think about Bellevue.

I need every Spritlzer reader to lobby insurance companies to accept and pay for treatment at my new Institute. If you or your loved one's are still "nuts" after one year of treatment, you'll receive a free E-Bike! Plus we accept all major credit cards.

Isn't it time to start feeling good about yourself. Heck, I think I'm wonderful. Shouldn't you? I mean, think I'm wonderful.

PS. Also don't even think about sending your business to Bellevue. They're my chief competitor and honestly they're filled with quaks.

For Mental Illness, Make Medication a Last Resort

Psychiatrists and even internists are often far too eager to prescribe pills.

By Erica Komisar, WSJ

April 4, 2022 6:30 pm ET

You’ve probably heard that anxiety and depression are “brain disorders” that must be treated with psychotropic medication. That’s closer to a pharmacological marketing slogan than settled science. These conditions, along with ADHD and addiction, result from trauma, loss, psychosocial stressors and failed relationships. Even when there is a genetic proclivity to severe mental illness, such as bipolar disorder and schizophrenia, the environment plays a central part in triggering the disease.

Roland Kuhn, the Swiss psychiatrist who discovered one of the first antidepressants, imipramine, in 1956, later warned that many doctors would be incapable of using antidepressants properly “because they largely or entirely neglect the patient’s own experiences.” He was right. As a psychoanalyst, I often see patients who come to me after medication prescribed by psychiatrists—and even internists, who have no specialization in psychotropic drugs—has failed.

Doctors prescribe these medications as a quick fix. But the pills merely mask the patient’s emotional pain. Some medications come with serious side effects and are extremely difficult to quit. In 2020 the Food and Drug Administration issued a warning about a class of drug frequently prescribed for anxiety: “The current prescribing information for benzodiazepines does not provide adequate warnings about the serious risks and harms. . . . Physical dependence can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed.”

Medication can be a godsend in the right context. But it is risky and should be offered only after nonmedical options, such as psychoanalysis, have been exhausted. Why is therapy instead often a last resort for patients? In part because it is uncomfortable. Some patients temporarily become more symptomatic when they expose themselves to the origins of their pain. This temporary pain is necessary for long-term relief, but it’s easier to numb with pills.

Therapy is also expensive. Even if a patient does get a referral to a therapist, it will likely be a cognitive behavioral therapist who focuses on symptom relief rather than the underlying causes. The rise in CBT therapy came out of insurance companies’ demand for a short-term solution to the expensive problem of treating mental health. CBT has an important role to play in treating some obsessive disorders and post-traumatic stress disorder, and with patients who are extremely nonverbal and lack the capacity for deep introspection. But it’s being used as a go-to therapy for anxiety and depression, moving patients further from the root causes of the illness.

I was required to undergo therapeutic treatment as part of my training as a psychoanalyst. This is a critical part of training, so that practitioners don’t risk exposing patients to their own psychological conflicts. But medical schools don’t require it of psychiatrists, and many short-term therapy clinicians have never been in any kind of substantial mental-health treatment.

There are no shortcuts to treating mental illness. Insurance companies should be pressured into covering treatments that work. Patients have to be consumers and say no to medication as a first course of treatment unless their symptoms are severe. Doctors must acknowledge that medication can be risky and have severe iatrogenic effects. Medication should only be used for serious clinical conditions, or only after everything else has been tried and failed.

Ms. Komisar is a New York psychoanalyst and author of “Chicken Little the Sky Isn’t Falling: Raising Resilient Adolescents in the New Age of Anxiety.”

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