A pill is not always the best medicine
IN Ireland, if you’re anxious or depressed, where do you turn for help? If you’re 65 years or older, chances are, you reach for a little pill.
According to the Department of Health, the use of benzodiazepine medication by the over-65s in Ireland is the highest in the OECD, with women using 40% more than men.
Benzodiazepines, sedatives that affect the nervous system, treat a range of conditions, including anxiety and insomnia. They are safe and effective when used correctly over short periods. But their misuse can have serious side-effects.
Professor Catherine Comiskey, vice chair of the Scientific Committee of the European Monitoring Centre for Drugs and Drug Addiction, says that one explanation for our high rate of benzodiazepine use is that our population is ageing.
Prof Comiskey also points to the over-prescribing of benzodiazepine by GPs. “Anecdotally, people are saying that this is because it’s a quick-fix. Medical practitioners are under pressure, resources are few, and it is a quick-fix.”
Her belief is echoed by Elisabetta Petitbon, clinical psychologist and psychotherapist. “They are easy to use and help us to control the symptoms we have,” she says. “It’s an immediate way to solve something.”
Petitbon, vice-chair of the Irish Council of Psychotherapists, says psychotherapy requires people to open up, “to feel worse before they feel better. It’s not a process that a lot of people are ready to do.”
She is not against drugs, which can be beneficial in addition to psychotherapy. “But only taking a tablet will never solve the issue completely,” she says.
Addiction, physical and psychological, can result from misuse of benzodiazepines. Physical symptoms can include, but are not limited to, sweating, shakes, and aches and pains.
Psychological addiction is much worse than physical. If someone has been using a particular drug for years, says Petitbon, it may not give them the same relief and the dosage may need to be increased. “Some of the side-effects include suicidal thoughts and an increase in anxiety.”
Comiskey, who has just written a book, Addiction Debates: Hot Topics from Policy to Practice, says that there isn’t a typical drug user. “It could be anybody.”
Medication is only one part of treating the whole person, she says. “It’s an important part, quite often. But more than that, we need to discover the underlying reasons why a person is using this drug.”
In the US, she says, health insurance companies have found that “adverse childhood experiences” are leading to later mental and physical health problems among the general population. “These can be separation, loss of a parent, abuse, physical abuse, being in an accident.
“We’ve been through the era of ‘children should be seen and not heard’ — there are many childhood traumas that we just didn’t talk about.
“Many people aged over 65 may have gone through some of those adverse childhood experiences, but they’re not experiences that they could talk to people about.”
Comiskey believes we need to treat the whole person, and the whole person from a young age. “Yes, we need to treat the person and keep them safe and well, but we need to address the underlying factors. They’re not going to go away.”
A study by the Royal College of Surgeons suggests that the use of these medicines had somewhat decreased in the decade between 2005 and 2015.
Comiskey thinks that people are generally well informed about the dangers of addiction to medication, but “they don’t think it’s going to happen to them.”
There is an onus on the medical profession to look at prescribing practices and alternatives, she says. “There needs to be more education on addiction and more focus on it and removal of stigma. Stigma is a big issue.”
Petitbon agrees. “We need to talk about our problems; there’s nothing bad in that,” she says. “We have to get through the stigma that there’s something wrong with you if you have therapy... We all need to talk to somebody.”