Take medicine or not? While some refuse, others overuse

Take medicine or not? While some refuse, others overuse
Take medicine or not? While some refuse, others overuse
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The colorful posters announce in bold letters the word that shakes the foundations and tickles the palms of many people, impatient to quickly get the best payment method and take advantage of the offer. As psychiatrist Bruno Brandão points out, it is not uncommon to be “harassed” – to use the title of Jean-Luc Godard’s most famous film – by the most varied types of drug “promotions” these days, and this is not even the case today. “This is a controversial question, and I imagine you already know the answer”, he begins, before expressing discomfort with the fact that the same strategy for selling chocolates and soaps is used for various medicines.

“It is undeniable that there is pressure from the pharmaceutical industry for people to consume more medicines. We, doctors, need to be careful with this issue, as well as the patient who, indirectly, is led to this through advertising”, he maintains. This month, data from consultancy Redirection International showed that the pharmaceutical industry had a turnover of around R$190 billion in 2023, remaining at the top of those that invest the most globally, followed by the technology industry, by financing research for the development of medicines. “Obviously, she will want a return on all this billion-dollar investment”, observes the psychiatrist, who attributes the “unrestrained consumption” also to “an excess of distorted information”.

Excesses

Perhaps as a reaction to this commodification of health, many people began to categorically reject the use of medicines, which generated a movement towards the other extreme. In this case, Brandão sees a repetition of the political polarization that has spread across the world. “Being extremely cautious when taking medication is cool, but this is different from condemning it, being against it. You need to look for the middle path. There are people who, at the slightest discomfort, with a slight headache, take refuge in medication. But, if you have a recommendation, which was made through a diagnosis, you not only can but should take the medicine”, he says.

Brandão warns that “any excess is harmful to health”. “If you have a disease and are depriving yourself of treatment, you are putting your health at risk in the same way as if you were taking medication unnecessarily.” At this point, the psychiatrist provides a very didactic explanation. “Every medication has side effects and contraindications. It is worth taking medicine when the benefits outweigh the risks. If you are taking medication unnecessarily, you will not get any benefit and will only be left with the risks of side effects”, he points out. Practicing a healthy lifestyle is still the best medicine.

A balanced diet, physical activity to get out of a sedentary lifestyle, giving vent to everything that helps and avoiding everything that harms sleep basically form the tripod that the specialist defines as a “healthy lifestyle”. “For many people, these behaviors will be enough to regulate their health, and they will be able to live without medication, but for another group, they will still be insufficient.” However, simply incorporating this “philosophy” into your daily life tends to reduce the need to resort to pharmacological measures. “In practice, people use medicine to correct a dysfunctional lifestyle, or they believe that only a healthy lifestyle will be enough. It is necessary to seek balance”, advises Brandão.

Balance

Knowing the side effects, likely benefits and contraindications of medications, which may be related to heart and respiratory diseases and even dangerous allergic reactions, is of “fundamental importance”, as is the so-called interaction profile. These assessments concern professionals in the field, which leads to the strong discouragement of the so-called self-medication. “If the person already uses an antihypertensive, for example, it can reduce the effectiveness or enhance the effect of an antidepressant. The doctor looks at all of this before prescribing medication and the person who self-medicates often does not”, he reinforces.

Brandão believes that this scale is still tipping towards people who take medication without due criteria. “There are a lot of resistant people, who needed to be medicated and aren’t, but, in general, people are medicating themselves more, I don’t know if in the right way”, he ponders. A “classic example” is Attention Deficit Hyperactivity Disorder, better known by the acronym ADHD, with a prevalence of 2.5% in the adult population of Brazil. “But in practice, the number of people who self-identify as having ADHD is much higher. In this pie, there are many people being medicated unnecessarily, whether with a prescription or on the clandestine market.”

Prejudice

A patient who goes to the ophthalmologist and receives a prescription to wear glasses is unlikely to claim that he prefers to see poorly. A heart patient or someone with an infection is also less likely to choose death or worsening illness over antibiotics or surgery. These examples are used by the psychiatrist to state that “drug resistance occurs, mainly, in the area of ​​mental health”, which he attributes to a deep-rooted sociocultural prejudice, and related to the “specific nature of this type of diagnosis”.

“In mental health, we use the term dimensional diagnosis, which is different from the categorical diagnosis, the one in which I determine whether the person has cancer or not”, he explains. He clarifies that, for dimensional diagnosis, it is necessary to evaluate the individual over a certain period of life, with a notion of depth and temporality, acting through trends that are revealed through “an average”, and not through indisputable definitions. . The crux of the problem lies in the characteristic of mental disorders, which, according to Brandão, “are kind of invisible”.

“We were able to see in the laboratory the anatomy of the brain, which is an organ, but the mind is a product of the brain. Thought, attention, memory, concentration and affects such as humor, anger, fear and shame are part of this product. If the brain gets sick, I have repercussions on the mind, but I can’t see it; and people often take the side of ‘willpower’, believing that only ‘thinking positive’ will solve the problem, but when we analyze the brain closely, we detect several circuits in altered functioning, which will require medication chemistry to be corrected”, he states.

Mental health stigma influences drug resistance, says psychiatrist

This stigma that falls on mental health, as if it were “a weakness of character and not an illness”, is a taboo to be overcome, which influences resistance to medication. Psychiatrist Bruno Brandão points out that diabetes, for example, is also diagnosed dimensionally, that is, through a type of analytical average. “You assess the patient’s blood glucose and make an estimate. But everyone, at some point in their life, can have a higher or lower blood sugar level, because it fluctuates. Based on an epidemiological analysis, the doctor will define a cutoff value”, he highlights.

The same procedure applies to mental health. “We need to collect and observe a set of symptoms that accompany the person over a period of time, generating functional and social losses that lead to suffering”, he emphasizes. The difficulty would be in the fact that “everyone experiences these symptoms throughout their lives”, which requires rigorous medical study. Brandão considers it essential to differentiate feelings from disorders.

“Antidepressants don’t treat sadness, this is life happening, we are not a tree, we have emotions. What we treat is disorder”, he confirms. He uses the example of ADHD to explain his thesis. “Everyone can have inattention, hyperactivity, difficulty concentrating, what we need to check is the dimension and depth of how this happens, in the same way that sadness, fluctuations in mood and temperament do not necessarily mean depression”, he concludes. .


The article is in Portuguese

Tags: medicine refuse overuse

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