Design by Samantha Sweig

This past week, I went to the University of Michigan’s student health services to get routine blood work and lab tests done. After checking in for my appointment, the receptionist handed me a small clipboard with a questionnaire attached. “It’s just protocol,” she assured me. “We ask all college students to fill it out.” The survey asked me to consider my feelings and behaviors over the past two weeks, prompting me to rate the extent to which I had little interest or pleasure in doing things or felt tired and had little energy — and, unsurprisingly for a college student in the middle of exams, I ranked each of these categories pretty high. 

When I was finally admitted into the doctor’s office, I handed over my questionnaire, and waited as she scanned over my responses. After a couple minutes, she began slowly nodding her head back and forth while I braced myself for the follow-up question that I already knew was coming: “Have you ever considered taking anti-anxiety medication?”

It is precisely this line of questioning that has contributed to the doubling of anti-anxiety and antidepressant prescription use among college students, with one in four college students reporting having taken some form of psychiatric medication within the past year. Although pharmacological treatments for mental illness have provided life-changing results for many people, they do not come without repercussions. Specifically, the appallingly low thresholds for prescribing psychiatric drugs have engendered harmful trends of overprescription and misdiagnosis. 

The form that I was asked to complete by the receptionist in the doctor’s office, formally known as a PHQ-9 questionnaire, is a major culprit in the progression of this epidemic of overmedication. Not only does the form’s reliance on self-reporting of symptoms open up a strong potential for error and response bias, but in a recent study researchers at McGill and Stanford found that the questionnaire “substantially overestimates depression prevalence.” 

When compared with structured clinical screenings for depression, the PHQ-9 was shown to falsely overestimate depression rates by more than 50%. This is particularly concerning, considering that almost all population estimates of depression prevalence are based exclusively on cursory screening tools such as the PHQ-9. Thus, a vicious cycle ensues: depression and anxiety rates are inflated by inaccurate and unreliable clinical practices, and production of psychiatric drugs is bolstered to meet false quotas of perceived necessity. 

Consequently, such trends of overdiagnosis, paired with worsening shortages of psychiatric professionals, have promoted the false perception of psychiatric medication as a complete and total solution. The National Institute of Mental Health identified the growing threat of this mindset, affirming that “prescription drugs are not a cure for anxiety, but rather only one part of treatment.”

In fact, multiple studies have found that the continued use of antidepressants may be harmful in a way that many would not expect. Identified as “tardive dysphoria,” experts have established that extended use of these drugs substantially increases the risk that an individual will experience chronic depression in the long term. This is normally accompanied by an overall loss of antidepressant efficacy, rendering the patient’s corrective options limited and fraught.

A study conducted at Yale found that usage of SSRI (selective serotonin reuptake inhibitor) antidepressants more than doubled the risk that a depressed individual would develop bipolar disorder. This emerging patient demographic has been revealed as chronically overmedicated and undertreated, highlighting a growing need for critical reevaluations of societal views of mental illnesses and their plausible remedies. 

The solution to this problem lies in the prioritization of both holistic and cognitive therapies for mental illness, rather than strictly chemical ones. These approaches have tentatively been shown to be equally or more effective than psychiatric drugs in treating depression and anxiety disorders, with reduced risks of relapse after ending treatment. Another recent study coming out of Georgetown University Medical Center suggests that consistently practicing mindfulness and meditation had the same success rate in reducing symptoms of stress and anxiety  as psychiatric medication did. Such findings are imperative for efforts to reduce medication reliance, as the results could increase the likelihood of insurers to cover costs for holistic treatments and therapies, which currently can cost up to $500 for an 8-week session.

These circumstances serve as a sobering reminder that matters of health are highly personal and unique to each individual. Mental health issues in particular are extremely complex, and often unable to be fully ameliorated through blanket solutions such as medication. Health care systems have come to rely too heavily on prescriptions rather than preventative action, and this trend threatens to pose serious harm to the American public if not corrected. Ultimately, although effective for some individuals, no medication comes without a set of side effects and repercussions. Accordingly, it is important to always do your research, with considerations of whether these potential risks will be offset by the benefits. 

Tate Moyer is an Opinion Columnist & can be reached at moyert@umich.edu.