Five years ago, my 21-year-old son Bradley died of psychiatric drug interactions, after years of battling anxiety, depression, and an eating disorder. In most respects, Bradley was very much like many kids you know. He was funny, smart, and talented, constantly making people laugh with goofy impersonations, and starring in school plays and musicals. We—me, my husband, and Bradley’s siblings—deeply supported him in his challenges with mental health. He had access to the best healthcare available. But despite his privilege, we couldn’t save him.
At the time of his death, Bradley was taking a cocktail of medications prescribed by respected doctors. Bradley died unexpectedly in his sleep because of a practice called polypharmacy—the layering of multiple medications on top of one another, often without regard to what other doctors have already prescribed or the potential interactions between the drugs.
Psychiatrists are prescribing medications more frequently than ever before. In 2017, the year Bradley died, over 70,000 people died from some kind of drug overdose, including both illegal and prescription drugs. That number increased to over 100,000 in 2021. Medication was necessary in Bradley’s treatment, but too many medicines, in the wrong combination, cost him his life.
It is not uncommon for patients to receive psychiatric medication without being evaluated by a mental-health professional. Often, a primary-care physician will prescribe an antidepressant without considering various other evidence-based treatments that may be more effective and without possible side effects. There are also the financial incentives, whereby insurance companies are more inclined to pay for medications than therapy, and at a higher reimbursement rate. That’s not to say that medications can’t be helpful; often they are critical to treatment and produce miraculous results. But many medications come with serious side effects. When many medications are taken together, they can cause harmful drug interactions. Plus, there is the risk of taking the wrong dosage, either too high or too low, which can lead to potential withdrawal symptoms or accidental overdose.
Additionally, the pharmaceutical industry in America has been very successful in marketing psychotropic drugs to physicians and the public, through television, magazines, and billboards, a practice that is unseen anywhere else in the world other than New Zealand. In fact, many organizations in the U.S., including the American Medical Association, have called direct-to-consumer ads unreliable and misleading, seeking to ban them. A 2023 study featured in JAMA Open Network confirmed that over 70% of prescription drugs advertised on television were rated as having “low therapeutic value,” further bolstering public concern.
Research indicates that prescription drug ads don’t adequately explain side effects and can adversely affect decisions by patients and doctors. These ads play on patients’ desperation, fueling a vicious cycle of patients grasping at straws and doctors willingly trying yet another approach. Patients who requested advertised drugs were nearly 17 times more likely to receive a prescription than patients who did not request any drugs.
It’s easy to write a prescription, but doing so is not always the safest or most effective option for a patient. The psychiatric medications prescribed on a “PRN” basis—that is, to be taken “as needed” are particularly troubling. One of the most overprescribed types of these medications, and among the most dangerous, are benzodiazepines—commonly known as “benzos.” From mid-February to mid-March of 2020, prescriptions for them increased by 34%. While these medicines can be helpful in relieving anxiety, depression, and other symptoms, they can lose their effectiveness when taken on a long-term basis. Eventually, the initial dosage becomes ineffective, and patients come to need larger and larger doses to achieve the same effect. Within a few short weeks, patients can develop a physical dependence on them ending up worse off than before the medications, struggling with addiction and withdrawal. Benzos can also have serious side effects, including respiratory depression, which can cause death.
Stanford psychiatrist Anna Lembke, lead author of a New England Journal of Medicine essay, calls our overprescribing and overuse of benzos a “hidden epidemic,” which remains inadequately publicized in light of the raging opioid crisis. “Even if we get the opioid problem under control, the benzodiazepines will still be there,” she stated in an interview.
And then there is the problem of communication and coordination of care. A psychiatric patient’s care is often so fragmented and piecemeal that the psychiatrist managing the patient’s medication does not coordinate care with the patient’s therapist or determine what medication the patient’s healthcare providers have already prescribed. At one point I asked Bradley’s psychiatrist why he was on two medications that treated the same condition. His response was a non-response, as he directed me to ask his neurologist that question. And, of course, the neurologist was no better prepared to answer my question. Not one of Bradley’s doctors possessed a full picture of the breadth of his treatment.
Too often, patients and their families are left to untangle the treatment process by themselves, jumping from one crisis to the next, addressing emergencies, but not doing the more painstaking work of addressing the deeper root causes. Besides a good match with a mental health professional, there needs to be a medication “quarterback”—someone who helps to coordinate care. Unfortunately, I found that coordinated and integrated care is the exception, not the rule, in the mental health field.
I’m not a mental health professional, a lobbyist, or a drug company executive. I am just a grieving mother advocating for solutions to prevent others from suffering the way we did. Since my son’s death I have dedicated my life to helping others with mental health issues and most specifically to avoid polypharmacy deaths. In 2019, my husband and I started the Bradley Sonnenberg Wellness Initiative partnering with USC Hillel to bring therapy and wellness programming to college students. We created a mental health curriculum that offers education and awareness to college campuses around the country. And I host a podcast called Getting Thru, where I talk to young people struggling with mental health issues who have learned to successfully manage their condition.
As a result of doing this work, here are some things I’ve learned: We must demand the use of evidence-based treatments in lieu of simply prescribing multiple medications. These include Cognitive and Didactical Behavioral Therapy, Eye Movement Desensitization and Reprocessing (a form of trauma therapy commonly referred to as EMDR), and mindfulness training. We must push leaders in healthcare and medical training for integration of more holistic treatments of mental health into the curriculum, including greater focus in grand rounds and among physicians about developing more nuanced strategies to heal the patient. We must demand stronger communication between healthcare providers, especially when medications are involved. And we must reach out to our lawmakers to insist on relevant polypharmacy and coordination of care legislation, before this scourge affects—and ends—even more lives.
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