Mental health: moving beyond just medication


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6 comments

  1. Elizabeth Bonner

    After years of misdiagnosis, beginning at 8 years of age and prescribed medications (SSRIs, now know to be contraindicated for youth as there had been no long term studies and particularly those children with suicidal ideation as my daughter had) my adult daughter (now 30) has weaned herself off meds for anxiety, depression, dual diagnosis, schizoaffective disorder, et.al because she was tired of the travesty of her treatment. All she ever wanted was CBT and yet this was never an affordable option for her. I recall years ago reading, Dr. David D. Burns book titled Feeling Good, where in he advocated for CBT. While my heart aches for the life lost for my daughter as a result of the inequality of care for mental health, I am encouraged by the recent campaigns and policy changes happening as a direct consequence of hard working advocates and agencies such as the MHCC and CMHA.

  2. Rachel Fera

    I see medication and psychotherapy as having very limited usefulness. If you really want to help them, recognize that mental health issues are often caused by sub optimal nutrition. Mad in America had a good lecture series on this topic recently and it is available at no cost online. Help them get on ODSP or Ontario Works so that they have a stable income and can buy healthy food. Stable income and stable housing are essential for good mental health so help them obtain both.

    • Amanda

      While good nutrition is certainly an integral part of good health and can benefit mental health, to say that it alone is sufficient and necessary is naive. The causes and approaches to treating mental illness are wide and complex. It is not a single nor universal cause.

      • Rachel

        I agree. But so often psychotherapy and medications are given out and the basics are ignored (optimal nutrition). Or clinicians just want to call it some kind of mental health issue because looking for the actual cause of the problem would be too much work. What incentive is there to look for the correct diagnosis anyways?

  3. Cynthia Leung

    I agree that the focus should be on psychotherapy – ensuring more people have access to it. As a pharmacist, I have seen how some medications may work to manage specific symptoms but also come with many side effects that affect the patient’s ability to function well. We may need both interventions in some cases but everyone should have access to psychotherapy at a minimum.

  4. Aurelia

    Just to clarify, there is no evidence that psychotherapy is effective for ADHD, and even the out of date article you linked to, was for behavior therapy (social communication skills, interpersonal skills, organizational skills). That kind of behavior therapy (done as DBT) is effective after a full diagnostic psych-ed assessment, and correct medication. The stimulant medication is the equivalent of putting glasses on someone nearsighted, so the person can learn the skills they missed while spending years effectively blind. The problem the media seems unable to communicate is that stopping stimulant medications is like taking glasses away from someone–or taking away a wheelchair. Eg, ADHD doesn’t end. It’s always there inside, although some people can look as if they gain control over their external symptoms over time. But that’s just an image, not inner reality.

    The kind of behavior therapy appropriate for ADHD, only works with meds, and is totally different than CBT-cognitive behavioral therapy, which involves changing thinking patterns and has no effect on neurological disorders, PTSD, or emotional regulation.

    Different kinds of therapy are effective for radically different diagnosis, and can be useless or damaging if given for the wrong issues. CBT for example, can be very invalidating and cold for someone struggling with PTSD and adding exposure therapy too early in the therapy process can actually make trauma worse, and result in the return of suicidal thoughts. Many of these therapies like DBT have gone through RCT in the US and here in Canada, and are proven effective. I have seen very little evidence that e-therapy is useful beyond peer support and follow up by clinicians.

    As for medications? The CAMH Impact study analyzes a patient’s CYP450 gene and figures out which meds are metabolized well, and which are not. Medications that are metabolized too quickly or too slowly result in awful side effects. (That part is proven science, applying it to psych patients and meds is the new part of the study)

    They’ve done this for 8000+ patients, and are having great success. Personally? I found the exact meds I needed once I followed their advice, and have had no issues or side effects since.
    The previous 5 meds were an absolute fail.

    And yes, of course the Social Determinants of Health matter–good nutrition, food, reliable shelter, educational and employment support to give you a reason to get up in the morning, living in a stigma free community that cares so you can have friends, family, neighbours to stave off the loneliness—all of these are critical.

    The Target Kids study has shown that up to 30% of young children in urban Ontario are anemic and D deficient at the exact time in their lives that their brains and bones are growing the fastest. And yes that has an effect on physical and emotional development and mental health. Is nutrition alone the answer? Of course not. No one thing is the magic bullet.

    We need to stop assuming that any one cheap easy thing will be a magic bullet for the entire population, and start doing multi-modal treatment. Tailoring treatments is not hard, and works a lot better—and costs so much less over time than the disaster we have now.

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