Happy+Pills+-+Are+we+just+pills+away+from+curing+mental+illness?

Name: Fiona Roberts Student Number: n5415438 Tutor: Abbey Hamilton



**__The Artefact and Public Health Issue__** This cultural artefact is an image taken from the online publication ‘Scientific American’. It accompanies an article written by Nikhil Swaminathan August 13, 2007 titled ‘Happy Days: Unravelling the Mystery of how Antidepressants Work’. When looked at literally, this image is a picture of ‘Happy Pills’, a slang or pet name often associated with antidepressants. After extensive research there are two prominent issues associated with the medications available, these issues are the undesirable side effects the medications have on patients, which then leads to other problems associated with non adherence to the prescribed medications (Wilder, Elbogen, Moser, Swanson and Swartz, 2010). Non adherence and undesirable side effects of medication contribute to the inability of some mentally ill patients to function comfortably in society, as well as increasing unemployment and negative stigma associated with mental illness (Roger and Johnson-Greene, 2008). What can be concluded from these studies is that there is a need for future breakthroughs in mental health medications as they are a vital tool in the management of mental health disorders. Currently the issues associated with their use in some individual cases can outweigh the benefits the patient receives (Covell et al, 2007). This essay will address the issues associated with the use of prescription medication for mental health disorders. Also it will discuss current research on the use and misuse of these medications as well as the, benefits and disadvantages taking antidepressants and antipsychotic medications causes for patients. Finally, based on research of media items, the current social trends and attitudes will be discussed in comparison with the academic research.


 * __Literature Review__**

Covell et al (2007, p435) conducted a study regarding the level of distress to patients with severe mental illness, caused by medication side effects. The study had 1827 participants who were interviewed in a non clinical setting about the feelings they had towards their medication side effects. From a list of potential side effects participants were first asked if they had experienced the side effect and then asked to rate if they were “not bothered at all”, “bothered a little”, “bothered moderately”, or “bothered a lot” by each specific side effect. They found that over 90% of the participants admitted to suffering from at least one undesirable side effect, and amongst the 90%, almost two thirds of them reported that the side effect had caused a high level of distress. The side effect which rated the highest by patients as being “bothered a lot” by was ‘embarrassment with weight gain’. Also notable were patients bothered by ‘sedation’ and ‘dry mouth’. Interestingly approximately 25% of participants listed ‘stigma of medication’ as a side effect that at the very least “bothered them a little”. It is also important to note that the same percentage of patients (90%) that admitted to suffering from the undesirable side effects also stated that their medication was helpful in managing their mental illness. The effectiveness of these medications is why it is important to continue research in this area so that alternative drugs with fewer side effects can be made available. According to Covell et al (2007, p.439) not only can the stress brought on by side effects potentially worsen the original mental health disorder, but also cause other health concerns. Specifically the weight gain side effect, “Weight gain is a well-known risk factor for cardiovascular disease and diabetes, as well as a potential source of physical and psychological discomfort”, Covell et al (2007 p.439).

Research conducted by Wilder, Elbogen, Moser, Swanson and Swartz (2010) indicates that undesirable side effects are a cause of non adherence to prescribed medication amongst severely mentally ill patients. The study examined the use of psychiatric advance directives and their effect on medication adherence. Psychiatric advance directives are legal documents used in the United States which allow patients to record their preferred medication in case of a psychotic incident which diminishes their capacity indicate their preference at that time. Medical professionals have the overruling right to prescribe whatever medication they believe will be most effective in the circumstances. 123 participants, all of whom were suffering from either a schizoaffective disorder, schizophrenia, bipolar disorder or a major depressive disorder with psychotic features were interviewed about their medication preferences and their previous levels of adherence to medications. Wilder et al (2010, para.15) noted that the psychiatric advance directives were effective in raising the likelihood that the patients would be prescribed their preferred medications. Furthermore Wilder et al (2010, para.15) found that patients prescribed at least one of their preferred medications were more likely to adhere to their medication schedule. The benefits of patient involvement in medication selection went beyond improving levels of adherence, “In subsequent interactions with clinicians, patients who have completed psychiatric advance directives may feel empowered and may become more assertive” Wilder et al (2010, para.17). Furthermore, not only educating patients, but also their family and friends about the mental health issue and potential treatment options is effective in improving relationships, adherence to treatment and communication with health professionals (Rogers, Day, Randall and Bentall, 2003).

The need for pharmaceutical aids in the treatment of mental health disorders is proved further in a review of mental health treatment recommendations conducted by Watkins, Hunter, Burnam, Pincus and Nicholson (2005). 127 studies were selected for evaluation and abstracted into tables outlining their treatment recommendations for mental health disorders. From this collection of data they drew conclusions for recommended treatment methods and the need for future research. The treatment recommendation specifically related to medication, is ensuring that patients are educated about the medications they are prescribed, with focus on the potential undesirable side effects and necessary length of adherence before medication will take effect, Watkins et al. (2005, para.13). As discussed earlier, Wilder et al (2010, para.17) also found that educating patients about medications was an effective strategy. Watkins et al. (2005 para.18) addressed the need for further studies in regards to the length of medication adherence necessary once original symptoms are no longer present. Such studies would assess the need for ongoing management of mental health disorders years after the initial diagnosis. In the overall conclusion Watkins et al. (2005, para.22) suggest research priorities need to focus on effective treatment for patients suffering from multiple mental health conditions and studies analysing which treatments have an immediate impact on the symptoms.

Mental illnesses, particularly Schizophrenia, are complex disorders with varying levels or severity for each individual sufferer, although treatments aren’t without problems there are a wide variety of therapeutic options available (Lawrence, 2007). Regardless of what progress is made in the field of pharmaceuticals, there are social barriers which stand in the way of patients accessing treatment. In the article ‘How Stigma Interferes with Mental Health Care’, Corrigan (2004), discusses the indicators that produce stigmatizing attitudes. The author also analysed how these attitudes can cause people who would benefit from treatment, to not access the services available. Corrigan (2001, p.615) lists the symptoms and traits of mentally ill patients that cause stigmatizing attitudes as psychoses, bizarre behaviour, poor social skills, poor hygiene and personal appearance. Corrigan (2004, p.161) highlights the troubling stereotype that mentally ill patients are at fault for the development and continuation of their illness due to personal weaknesses in character and strength. These stereotypes are not only the product of people uneducated in health care but also apply to some health professions that have direct contact with mentally ill patients. Sadow and Ryder (2008) attempted to identify which interventions were most effective in reducing stigmatizing attitudes amongst health professionals towards the mentally ill. The authors found that these attitudes affected access to treatment and the quality of treatment available. The findings suggested that exposure to mental illness, whether through a friend, family member or a patient was effective in reducing negative attitudes, Sadow and Ryder (2008, para.13).


 * __Cultural and Social Analysis__**

Current media displays negative attitudes in relation to the use of antidepressant and antipsychotic medication. An article titled ‘Alarm as More Kids on Antidepressants’ printed in the Herald Sun May 30, 2011 raises concern about the young age patients are being prescribed medication for mental health issues. The Sunday Telegraph, March 6, 2011 printed the article ‘GP’s Medicating Patients for Sadness’ which discusses the cost of the medications to the Pharmaceutical Benefits Scheme for what some people believe to be normal human emotions like sadness. The media is overwhelming in its coverage relating to the overall issue of mental health, however coverage specifically related to medications are few and negative in attitude. August 4, 2010, ‘The 7pm Project’ aired a story describing mental health as the third largest health burden in Australia. There is an abundance of media coving the seriousness of the issue but few stories reporting on the success of treatment available. As the research shows the medications are definitely effective regardless of the side effects (Covell et al, 2007). ‘Road Rage Motorist on Drug Bender’, printed in The Herald Sun, February 2, 2010, reports an incident involving a man suffering from schizophrenia and bi-polar who stopped taking his medication and as a result went on a rampage stealing a truck and running down a pedestrian. Due to his mental illness the man was found not guilty of all charges against him. Interestingly this kind of coverage indicates that not taking prescribed medications is harmful, yet still there are few stories regarding mental health pharmaceuticals in a positive light.

The driving force behind attitudes towards antidepressants and antipsychotics is the cost, not only the cost to the individual but also the cost to the government on the Pharmaceutical Benefits Scheme (PBS). //The National Mental Health 2010// report (Australian Government Department of Health and Aging, 2010), documents that 13.6% of the mental health budget was spent on PBS, a reduction on previous years due to several commonly prescribed antidepressants coming off patent and allowing cheaper generic products to be available to the public. Of the top 50 medications most frequently subsidised by the PBS, five of them are antipsychotic or antidepressant medications (Australian Government Department of Health and Aging, 2010). Regardless of the subsidies offered by the PBS, patients are going to be unwilling to pay the price for prescription medication which isn’t 100% percent effective due to potentially severe side effects (Covell et al, 2007). There is a need for future breakthroughs in pharmaceutical treatments for mental health as the best ongoing treatment and recovery methods are through a combination therapy of medication, counselling and lifestyle changes (Frazer, Christensen and & Griffiths, 2005). Further proving the effectiveness and necessity of these medications, a study conducted by Gijsman, Geddes, Rendell, Nolen & Goodwin (2004), using two groups, one prescribed an antidepressant, the other medication with nothing in it, showed that antidepressants were more effective than the placebo effect.

Beyond Blue, Operation Life and Youth Connections are just a few of the initiatives combating mental health; a full list of programs is available on the Mental Health and Well Being, Australian Government Website (Mental Health and Well Being, 2011). Once the issue of encouraging a patient to access treatment for mental health is overcome, it is important that the pharmaceuticals available to them are effective with as few side effects as possible. The more positive results patients gain from treatment, more people will be encouraged to step forward and seek the help available. The lack of positive media coverage on the topic of medication can only be harmful to patients who are considering pharmaceutical intervention for a mental health issue.


 * __Analysis of the Artefact and Reflection__**

The image accompanying this analysis represents several traits easily applied to our society, particularly generation Y. The world is becoming increasingly fast paced and in some fields, most notably technology, there is something faster and more advanced available before many of us have become familiarised with the original product. The idea of ‘Happy Pills’ is ideal as it appeals to our need for a quick fix and simple solutions to complex problems. For people unaffected by mental health it would be comforting for them to think that should they be faced with a mental health disorder just ‘popping a few pills’ would fix everything. Unfortunately this is not the case, it can take many months before the appropriate dose and medication is selected and even then, as the research shows, the medications aren’t without their flaws. Even harder to grasp is that in spite of the technologies available today, society still struggles to cope with the issue of mental health. Ignorance surrounding mental health issues further fuels the negative social stigma and overshadows the complexity of mental health and the ongoing struggle to encourage patients to access treatment. In a perfect world, this image represents what the treatment for a mental health condition would be, a bottle of pills with the miraculous ability to reverse years of psychological torment. Although a ‘quick fix’ treatment option is not available, it is important that patients know that it is possible to overcome some mental health disorders. With the correct combination of medication and counselling, recovery is a very real possibility.

Corrigan, P. (2004). How stigma interferes with mental health care. //American Psychologist, 59//(7), 614 – 625. doi: 10.1037/0003-066X.59.7.614
 * __References__**

Covell, N. H., Weissman, E. M., Schell, B., McCorkle, B. H., Summerfelt, W. T., Weiden, P. J., & Essock, S. M. (2007). Distress with medication side effects among persons with severe mental illness. //Administration and Policy in Mental Health and Mental Health Services Research, 34//(5), 435-435-42. doi:10.1007/s10488-007-0131-1

Commonwealth of Australia, Canberra. Department of Health and Aging. (2010). //National Mental Health Report 2010: Summary of 15 Years of reform in Australia’s Mental Health Services under the National Mental Health Strategy 1993-2008//. Retrieved from Government Department of Health and Aging website []

Doherty, E. Betts, M. (2011, May 30). Alarm as more kids on Antidepressants. //Herald Sun//. Retrieved from []

Frazer, C. J., Christensen, H., & Griffiths, K. M. (2005). Effectiveness of treatments for depression in older people. //Medical Journal of Australia, 182//(12), 627-627-32. Retrieved from @http://search.proquest.com/docview/235735404?accountid=13380

Gijsman, H. J., Geddes, J. R., Rendell, J. M., Nolen, W. A., & Goodwin, G. M. (2004). Antidepressants for bipolar depression: A systematic review of randomized, controlled trials. //The American Journal of Psychiatry, 161//(9), 1537-1537-47. Retrieved from @http://search.proquest.com/docview/220477030?accountid=13380

Hansen, J. (2011, March 6). GP’s Medicating Patients for Sadness. //The Sunday Telegraph//. Retrieved from http://www.dailytelegraph.com.au/gps-medicating-patients-for-sadness/story-fn6bmg6l-1226016369715

Lawrence, A. J. (2007). Optimisation of anti-psychotic therapeutics: A balancing act? //British Journal of Pharmacology, 151//(2), 161-161-2. doi:10.1038/sj.bjp.0707164

Mental Health and Well Being. (2011). Programs and Initiatives. Commonwealth of Australia. Retrieved November 3, 2011 from []

Roger, R. Johnson-Greene, D. (2008). Attitudes towards depression among rehabilitation participants with acute stroke: Evidence of and age cohort effect. //Rehabilitation Psychology, 53//, 210-214. doi: 10.1037/0090-5550.53.2.210

Rogers, A., Day, J., Randall, F., & Bentall, R. P. (2003). Patients' understanding and participation in a trial designed to improve the management of anti-psychotic medication. //Social Psychiatry and Psychiatric Epidemiology, 38//(12), 720-720-7. doi:10.1007/s00127-003-0693-5

Ross, N. (2010, February 2). Road Rage Motorist on Drug Bender. Herald Sun. Retrieved from []

Sadow, D. Ryder, M. (2008) Reducing stigmatizing attitudes held by future health professionals: The person is the message. //Psychological Services, 5//(4), 362-672. doi: 10.1037/1541-1559.5.4.362

Swaninathan, N. (2007). Happy Days: Unraveling the Mystery of How Antidepressants Work [Image]. Retrieved September 30, 2011 from []

Watkins, K. E., Hunter, S. B., Burnam, M. A., Pincus, H. A., & Nicholson, G. (2005). Review of treatment recommendations for persons with a co-occurring affective or anxiety and substance use disorder. //Psychiatric Services, 56//(8), 913-913-26. Retrieved from @http://search.proquest.com/docview/213073613?accountid=13380

Wilder, C. M., M.D., Elbogen, E. B., PhD., Moser, L. L., PhD., Swanson, J. W., PhD., & Swartz, M. S., M.D. (2010). Medication preferences and adherence among individuals with severe mental illness and psychiatric advance directives. //Psychiatric Services, 61//(4), 380-380-5. Retrieved from @http://search.proquest.com/docview/213104740?accountid=13380

__** Comments on Other Wiki's **__

Cultural Sensitivity, can health services 'feel'?

[|n5415438] Nov 3, 2011 8:14 pm

Your artefact highlighted a major issue with health care, it is good to see that there is research being done in this area. Many of us are studying health degrees and it is dissapointing that there was only one subject in my degree (paramedics) which dealth with communicating cross culturally. In Australia 4 in 5 people speak only English, however the other 1 in 5 collectively speak over 400 different languages. As future health care workers it is important, as you have highlighted, to consider how scary it is for the patient when they aren't fully aware of what is going on. Especially when they are about to undergo invasive proceedures. It is also breach of duty of care, not to provide these people with interpreters so that they are fully aware of what is going on. A very interesting read, I enjoyed it very much!

'I wanted to use sport for social change' (Billie Jean King) - Women in Sport

[|n5415438] Nov 3, 2011 8:46 pm Your artefact was such an interesting read an raised alot of good points. It is scary that we are so absessed with how hot the women playing sports are. Anna Kornikova was so famous yet she never won a major tournament. I had no idea that the women and men were awarded differnt prize money until so recently, that is definitely ridiculus. Is it a shame that looks are the main focus in womens sport. I admit that I am guilty of not wanting women to become too masculine for sport. The idea of sacrificing femininity to be able to throw a ball further is a big price to pay. I worry that if women don't play in skirts and sexy outfits that they aren't becoming better female athletes they are just becomming men? The artefact was well chosen, and it is so unfair that the girls can only earn good money by getting their clothes off. On the other hand maybe if young girls see this they will turn to sports to improve their body image (trying to look like the female athletes in magazines) rather than bulima or other self destructive behaviour. An interesting topic to cover, I enjoyed reading your artefact alot.