COMMENTARY

Use of Psychiatric Medications in Medical Students and Residents

Disclosures

October 23, 2017

Hello and welcome. I am Dr George Lundberg and this is At Large at Medscape. This column extends our "Be Kind to Addicts" focus.

One of the earliest and most powerful lessons that pre-med students learn is how to study hard to get good grades. The stakes are high. Medical school is the goal. Many believe that success towards achieving this goal is improved by the use of cognition performance-enhancing drugs (cPEDs). For their athlete classmates, recognition of taking PEDs means probation, suspension, or expulsion. For nonathletes, it may mean academic success.

The range of potential cPEDs is huge, all the way from caffeine and nicotine through amphetamines—especially Adderall—and the many ADHD and antidepressant therapeutic agents. Low doses are said to enhance and high doses to impede. A key problem is that tolerance to many of these drugs develops and may become a stimulus, so to speak, to increase dose size.

Since the time when amphetamines were first synthesized in 1887 in Germany, there has been a complex and convoluted history of their use, misuse, abuse, promotion, prescription, proscription, and prohibition with heavy legal penalties. Military forces used them extensively as stimulants in World War II. In the 1960s, amphetamines were among the best-selling of American prescription drugs.

I first encountered amphetamine overdose in San Francisco in 1962, which led a group of us to define and publish [an article about] the toxicology, pathology, and pathophysiology of acute amphetamine poisoning.[1]

Not long thereafter, we began encountering "speed freaks" using intravenous methamphetamine in San Francisco and Los Angeles. The US Congress made amphetamine a controlled substance in 1971.

When does drug use become drug abuse? I define drug abuse as "the use of a psychoactive drug in a manner that may be calculated as likely to produce harm—predictable harm."[2] Fast-forward to September 2017. Indefatigable healthy-physician advocate Dr Pam Wible reports that 75% of American medical students and residents are taking stimulants, antidepressants, or other psychiatric medications.[3,4]

What did I just say?

I just cannot bring myself to believe that this is a good thing. And I also have not the slightest idea what to do about it. Does this reflect a high degree of mental illness requiring drug therapy in a majority of our upcoming physicians? Or has that level of society's culture simply acknowledged "better living through chemistry"?

If the latter, state licensing agencies, hospital staff organizations, and health insurance plans have not caught up with it. They require a check box reporting ever having any kind of mental illness or treatment. So, sneaking antidepressants, stimulants, anxiolytics, and mental health care off the record may have become the norm for docs.

As I said, I do not know what to do about this, unless it is to establish safe and confidential mental health care for students and residents akin to successful impaired physicians programs.[5,6] Sounds good to me. Who will lead?

That's my opinion. I am Dr George Lundberg, at large at Medscape.

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