A More Holistic Approach to Mental Health Care

Amir Ibrahim

    The advent of modern medicine is undoubtedly one of the greatest achievements in human history, and, yet, there remains a small, but vocal, minority rejecting modern psychiatric treatment. Specifically, many have criticized the American healthcare system for being capitalistic and profit-driven in nature as opposed to actually helping people–many have levied this criticism against mental health care in particular. 

    One of the many issues plaguing the medical industry and testing of drugs is investigator bias–the conflict of interest between commercialization and medical inquiry. Robert Whitaker, founder and president of Mad in America, cites some of the pitfalls of randomized controlled clinical trials (RCTs)  in which the efficacy of medication is tested: specifically, clinical drugs often aren’t properly indexed in the Hamilton Rating Scale of Depression, and medications which aren’t deemed as clinically relevant are still pushed through to industry. Oftentimes, symptom reduction for a trial drug is less than two points on the Hamilton scale, whereas three points or above is deemed as clinically relevant (Whitaker 49). This corresponds to an NNT value (number needed to treat) of around 8 for a given medication, meaning that it takes eight different trials to see positive improvement in one individual (Whitaker 57). This is a woefully underwhelming result, and it’s especially problematic when you consider that for every single person who has been helped by antidepressants, another seven or so have suffered nothing but the adverse effects of the medication. All of this isn’t even accounting for the fact that RCTs are industry funded, and thus there is inherent bias in how participants are selected and which results of the study are published.

    American healthcare needs repair and we should by all means remain vigilant against the shortcomings of the system, but to claim that modern psychiatric treatment has utterly failed society is doing a disservice to the benefits of such medication. Provided that they are paired with active, concerted effort, antidepressants can be an invaluable tool for self-growth and have indisputably saved countless lives. Contrary to popular belief, medicine does need to necessarily uproot the underlying causes–sometimes, simply treating the symptoms and alleviating suffering is a miracle in itself. This is especially true of depressive disorders, which tend to be rooted in external factors outside of the human body. Akin to how there does not exist medicine to cure obesity, it is unlikely that we will invent medicine which is capable of supplying perfect peace of mind and clairvoyance, as these are often rooted in purely external forces. However, we can instead do the next best thing: by supplying users with the tools of medicine, we enable people to momentarily escape from the noise within themselves and address these external forces so that they can discover their own sense of peace.

    Of course, this line of reasoning is contingent on the fact that depression is rooted in external factors, but this is not necessarily the case. It is worth noting that depression is not something that one can always escape from, and many are simply predisposed to chronic mental illnesses. The genetic component of depression remains rather obscure, and there is much debate regarding the extent to which people are predisposed to developing depression. One Stanford study claims that genetic correlation for depression may be as high as forty to fifty percent, and that someone with a depressive parent or sibling is three times more likely to develop such mental illnesses (Levinson et al. 20). But it is unclear whether this is even a meaningful question, as the effect of heritability on psychiatric treatment is still unknown. Until more research comes forth, the most straight-forward course of action here would be to adopt a more individualized approach and take into account factors such as family history when prescribing medication.

    A little anecdote that I feel is relevant is my progress with weight loss and managing eating disorders. Like many, I was plagued with an inability to manage my diet, and thus I had climbed to an extremely unhealthy weight and lost all of my fitness. Thankfully, I was able to lose all of the weight over the span of about a year or so, and I owe much of this progress to weight loss medication. Specifically, I took some dietary medication which helped immensely in managing my appetite, and as a result I could carry on with the other aspects of my life without constantly feeling starved and desperate for food. Granted, depression and weight loss are two separate issues, and, fortunately, I don’t have experience with the former. But, regardless, this type of medication was an invaluable tool for me, and, while it didn't outright cure me, it provided just enough escape so that I could initiate lasting change.

    We needn’t take this overly idealistic approach with medicine and pretend that we can develop an ultimate treatment of everything--depression stems from a wide range of causes, both ecological and internal, and so to assert blanket statements regarding the usage of antidepressants isn't appropriate for the current medical landscape. Instead, we should acknowledge that no matter which healthcare system we implement, there will always be drawbacks, and we should simply strive to do as well as we can within the current paradigm and evaluate patients on a holistic, case-by-case basis.


Sources

Levinson, Douglas, and Walter Nichols. “Major Depression and Genetics.” Stanford Medicine,    https://med.stanford.edu/depressiongenetics/mddandgenes.html.

Pompili, Maurizio, et al. “Antidepressants and Suicide Risk: A Comprehensive Overview.” Pharmaceuticals (Basel, Switzerland), MDPI, 30 Aug. 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034101/.

Whitaker, Robert. “Do Antidepressants Work? A People's Review of the Evidence.” Mad In America, 5 Sept. 2022, https://www.madinamerica.com/2018/03/do-antidepressants-work-a-peoples-review-of-the-evidence/#comments.


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