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Why mental health treatment needs to move away from ‘the shotgun approach’

Posted on 04-09-16 in Mental Health

Picture this extremely common scenario:

Thomas has been feeling lethargic lately. He hasn’t had any motivation to complete his college assignments. When his friends ask him to hang out, he tells them no, since spending time with other people no longer seems worth it.

The doctors diagnose Thomas with depression and give him an antidepressant. Unfortunately, when he starts taking the antidepressant, Thomas develops new symptoms, including racing thoughts, tense muscles and the occasional flight of fancy. The doctors change his diagnosis from depression to bipolar disorder and prescribe him with a mood stabilizer. When Thomas starts taking the mood stabilizer, however, he experiences regular bouts of nausea and exhaustion. The doctors change his mood stabilizer again but, this time, his depression returns.

The doctors change his medication again, and again, and again …

This is the shotgun approach to treating mental illness. Doctors look at symptoms, make a diagnosis and then choose one medication out of dozens to treat the issue. Sometimes, the medication causes unpleasant side effects. Other times, the medication simply doesn’t work.

Why does the shotgun approach so frequently fail?

The shotgun approach is different from how doctors treat other conditions. For instance, when individuals report heart palpitations, doctors don’t diagnose the patients with palpitations and give them palpitation medication; physicians investigate the patients’ heart, find the cause of the palpitations and treat that. When people have mental illness, however, doctors make their diagnosis based on the symptoms rather than on what’s actually happening inside the brain.

Why don’t doctors look at the brain when treating mental illness, a brain disease? Since neuroscience is still a new field, researchers and clinicians don’t fully understand how the brain works just yet. No one knows what causes depression, bipolar disorder, schizophrenia or any other number of mental illnesses. This is why doctors try out diagnoses and medications before knowing for certain whether or not the diagnosis is accurate or if the drugs will work.

What are alternatives to the shotgun approach?

Pharmacogenetics is a one alternative. With pharmacogenetics, clinicians can look at each patient’s genetic profile to determine which medications are the most likely to work. For example, a person who was diagnosed with bipolar disorder might receive pharmacogenetic testing to see whether lithium, lamotrigine or aripiprazole would be the most effective drug to use. Unfortunately, pharmacogenetics cannot help doctors diagnose the actual illness, so if the person doesn’t actually have bipolar disorder — for instance, if the person actually has depression instead — the drugs would have no effect.

Even though pharmacogenetics is still far from perfect, its advantages are tremendous, especially when compared with the shotgun approach.

How far away are we from ending the shotgun approach?

Far. This hasn’t stopped researchers from pouring time and money into finding the biological cause of mental illness. Large-scale gene studies, functional magnetic resonance imaging studies and diffusion imaging studies are all attempting to understand the genetic and neurological features of each illness so that, someday, doctors may treat these conditions more precisely.

At Sovereign Health, each patient is fitted with an individualized treatment plan designed to best address his or her unique challenges. Prior to treatment, our patients receive a thorough assessment that can include psychiatric evaluations and neurofeedback to identify — and ultimately treat — any underlying medical conditions. We treat mental health disorders, addiction and co-occurring conditions. For more information, please contact us at our 24/7 helpline.

About the author

Courtney Lopresti, M.S., is a senior staff writer for the Sovereign Health Group where she uses her scientific background to write online blogs and articles for a general audience. At the University of Pittsburgh, where she earned her Master’s in neuroscience, she used functional neuroimaging to study how the human cerebellum contributes to language processing. In her spare time, she writes fiction, reads Oliver Sacks and spends time with her two cats and bird. Courtney is currently located in Minneapolis. For more information and other inquiries about this article, contact the author at news@sovhealth.com.