Category: Rant


May is Mental Health Month. Established by Congress in 1949, this designation was made to help illustrate the importance of mental health issues to the overall health and well-being of American citizens.  While mental health care has changed dramatically since 1949, one thing still remains: the perceived stigma regarding mental health conditions.

Despite the availability of relatively safe and efficacious treatments for these disorders, many individuals fail to seek treatment for their mental health conditions.  Inadequate treatment of mental health conditions remain a significant public health concern: costing millions of dollars in lost productivity, absenteeism, and health care costs.   Existing barriers to receiving adequate mental health treatment include the availability of appropriately trained mental health providers, affordable treatment options, and perceived stigma.  Perceived stigma is the belief that people will devalue and discriminate against individuals who use mental health services and/or have a mental illness.

Perceived stigma can cause a variety of problems for individuals experiencing mental health conditions, including:

  • a delay or failure to seek appropriate treatment
  • premature discontinuation of treatment
  • rejection or ridicule by family and friends
  • discrimination at work, school, or church
  • inadequate health insurance coverage of mental health conditions
  • feelings of anger, frustration, shame, or low self-esteem
  • encountering harassment or violence

Mental illness was commonly thought of as a personal character weakness; we now know that mental health disorders have a biological basis and can be treated like any other medical condition.  Yet as recently as 2008, an APA survey revealed that more than 50% of Americans saw stigma and potential negative perceptions as barriers that would prevent them from seeking treatment.  While an estimated 75 millions Americans experience a mental health disorder in any given year, only one in four will receive treatment. Current lifetime prevalence rates for any mental disorder (including substance abuse) indicate that 57.4 percent of all Americans will personally experience mental illness at some time in their life.

Historically, the traditional medical model has separated mental and physical health; only recently is science “catching up” and revealing the multitude of “mind and body” connections.  We now know that our physical health is directly impacted by our emotional health; and that suffering from a mental condition can be a devastating and debilitating as any physical condition can be.

Despite the progress that has been made in correcting and removing many of the misconceptions surrounding mental health conditions, we still have a long way to go to defeat many of the biases, fears, and misinformation that people continue to have about mental health and the subsequent stigma these attitudes can create. By talking about mental health, we can raise awareness and dispel the stereotypes that exist about individuals with mental health conditions.

What can you do to fight the stigma?

  • Seek treatment– If you suffer from a mental health condition, don’t let fear keep you from getting relief by seeking appropriate diagnosis and treatment.  Safe and effective treatments are available.
  • Don’t define yourself by your disorder–  You are not “Depressed”, you are a person with depression.
  • Utilize available resources– seek out support and assistance groups such as Celebrate Recovery and NAMI. If you can not afford your medications, inquire about patient assistance programs.
  • Speak out and speak up– Your story may encourage someone else to seek the treatment they have needed but didn’t have the courage to ask for.
  • Don’t allow your mental health condition to cause you to feel shame or self-doubt– Mental health conditions are real medical conditions; they are not character-weaknesses or punishments.  By coming to terms with your own illness, you show others that their judgements are based on a lack of understanding rather than reality.  If you are having problems with negative self-esteem or shame, seek appropriate counseling to come to terms with these feelings.

No! Saliva tests to measure the levels of Serotonin, estrogen, progesterone, melatonin, testosterone, or DHEA are almost never legitimate, are expensive, and do not provide any clinically meaningful information to health care practitioners.  These tests are usually marketed with various supplements to control imbalances of these hormones; a serious conflict of interest.  Some well-intentioned patients have purchased and completed such tests thinking that it might provide their healthcare provider with “important information.”

Saliva testing is not a reliable method of assessing levels of any hormone except Cortisol (which must be done under very specific conditions and only for certain conditions). There is no physiologic reason to measure most salivary hormone levels and no generally published ranges of normal levels of hormones measured in saliva. Hormones are typically measured in blood, which makes physiologic sense; some hormones and their metabolites can usefully be measured in urine, but are not currently a part of any protocol for evaluation or diagnosis of any mental health condition.  Moreover, even if the test results are technically accurate, I’m aware of no science that links salivary hormone assays to non-optimal levels of hormones or neurotransmitters. Nor, even if the tests were entirely legitimate, is there any evidence that the proposed treatments will “optimize” neurotransmitter or hormone levels.

If you are concerned that you may have a mood disorder such as depression or anxiety, concerned about reasons for insomnia, or concerned that you may be approaching menopause, please contact your doctor and have that discussion with him or her. Depression, Anxiety, Insomnia, and all other psychiatric conditions are diagnosed through a “Psychiatric Diagnostic Interview” based on standardized guidelines as put forth by the American Psychiatric Association in the DSM-IV TR (Diagnostic Statistical Manual, 4th Edition, Text Revision).  While certain blood tests may be useful in evaluating for medical conditions that may play a part in certain mental health conditions, such as thyroid conditions, saliva test are not.  Your resources would be better spent investing in yourself through health eating and exercise; you already have all the “important information” any clinician might need: your story.

An article in the August 4th, 2008 Washington Post describes how health and life insurance companies are now accessing databases of individuals’ personal prescription records to rate their relative risk.

They note that consumers authorize the data release and that the services can save insurance companies millions of dollars and benefit consumers anxious for a decision. 

Why are we so focused on saving the insurance companies millions of dollars?  I frequently encounter requests from certain pharmaceutical benefit plans requesting that I change a patient from a medication, that they are usually doing well on, to one that is truly not a generic equivalent, for the sole purpose of saving money.  However, when examined more closely, it only serves to save the insurance plan money.  

 

More and more, I find myself concerned about the future of for-profit, insurance-driven medicine.  It seems too problematic to have such divergent interests working together:  serving the health care needs of the individual (providing quality care) and the business goals of the insurance company (minimizing costs).  We have already experienced the deterioration of the doctor-patient relationship due to time constraints that exist (de-facto) due to the insurance paradigm.  Now we are seemingly at the edge of a more efficient means of maximizing profits for the insurers by mitigating risk:  unfortunately, the risk that is avoided is providing healthcare to those who might actually need it.  What types of conditions will be considered too high a risk: diabetes, depression?  What happens to those individuals when they are excluded or have to pay rates that are cost prohibitive?  It is an unfortunate, and perhaps unforeseen by-product of the move to computerize our health records.  I am entirely in favor of information, but not at the expense of privacy violations or corporate profiteering.

Fad Diet De Jour

As I was reading the Sunday paper, I notice an article entitled “Clinic Takes Advantage of New Weight loss Discovery”.  Turns out, this was not an article, rather a paid advertisement, and in no way a “new discovery”.  I am personally and professionally interested in weight management so I decided to do some investigation. 

 

This local, family practice physician is promoting hCG Therapy for weight loss.  The ad includes the statement, “If you can’t lose weight, it may be because your body’s signals that used to come from brain areas like the amygdala, hypothalamus, and pituitary gland have stopped sending hormones to your stored fat, telling it to move.  HCG Therapy replaces this process.”  I have had two different patients try this program, in their words, “out of desperation”.  They were charged $2500 (paid up-front) for 6 weeks worth of injections of hCG.  Neither patient lost weight, but more shocking, neither patient was told that this was NOT FDA approved.  Stephen Barrett, M.D. talks about this “therapy” on his website: www.dietscam.org/reports/hcg.shtml . I found more information about this “discovery” on the Dr. Weil’s website as well:

 

The acronym hCG stands for human chorionic gonadotropin, a hormone produced during pregnancy. It is made by cells in the placenta and is believed to mobilize abdominal fat to help nourish the fetus. The notion that daily injections of hCG combined with a severely limited caloric intake of only 500 calories per day would prove an effective weight loss method goes back to 1954 when a British physician, A.T.W. Simeons, proposed it. The idea is that if the hormone can convert fat to calories during pregnancy for use by the baby and, in the process, speed the mother’s metabolism, it can do the same thing when injected into people who want to lose weight.

 

The trouble is, it doesn’t work. Over the years, a number of clinical trials have tested the diet both in Europe and the United States, and none has found that hCG has any positive effect. Sure, you can lose weight on this diet – but that’s because you consume only 500 calories per day, not because you inject yourself with hCG. A study published in the American Journal of Clinical Nutrition in 1976 found no statistically significant difference in weight loss, percent of weight loss, hip and waist circumference, weight loss per injections, or hunger ratings among patients who were on a 500-calorie-per-day diet combined with hCG injections and those who were on the diet and received placebo injections. Taking hCG doesn’t appear to be particularly unsafe, but there is no scientific proof that it does any good. (www.drweil.com/drw/u/QAA400413/Pregnancy-Hormone-for-Weight-Loss.html )

 

Such programs “takes advantage”…of individuals’ desire for an “easy fix” and belief that “if it is from a doctor, it must be real treatment.”  I am saddened that there are members of the medical profession engaging in such seemingly profiteering practices.  While I understand the desperation and frustration of failed weight loss efforts, why not promote increasing exercise and a healthier diet (nutritious, balanced)?  Even if individuals did lose some weight from the ultra-low calorie diet, what is the likelihood that they would be able to maintain that weight loss?  Extremely low, especially if the thoughts and behaviors that led to the weight gain were not addressed.  Sometimes there are no shortcuts.  As they say, “If it sounds too good to be true…”