[8]  Drug companies use a particular sales technique known as “off-label” marketing to expand the sales potential market of their psychoactive medications.  

The technique of “off-label” marketing is selling the medication for a purpose that has not been approved by, in the US, the Food and Drug Administration. With this kind of marketing approach, we are being led to participate in a cold, money orientated mental health system that is not really effecting for those who need help dealing with trauma or other mental health issues.

For example, a drug may be approved for treating psychosis, but not dementia. However, that drug may be marketed for “off-label” use for individuals with dementia. This is not at all uncommon. This kind of marketing is often done at seminars that are sponsored by the pharmaceutical companies seeking to boost sales. It is based on anecdotal information they promote rather than peer reviewed studies. You can look at past drug litigation, such as around the use of Risperdal, to see the dangers in this technique. This kind of marketing made Risperdal a multi-billion dollar drug despite harming many children.

This same danger was recently highlighted in a study of Haldol, a drug that has been marketed for decades as an anti-anxiety drug but established an enormous off-label use. That use was for “treating” dementia related anxiety issues. According to the study, there were zero peer reviewed research papers indicating a positive impact of the drug for dementia patients. Here is a warning from 2007 that is instructive, given that the medication had been in used for dementia patients for decades at that point:

“Haloperidol (Haldol, Johnson & Johnson) is approved for intramuscular use, off-label intravenous use of the drug is relatively common for treating severe agitation in intensive care units. However, due to a number of case reports of QT prolongation, torsades de pointes, and sudden death thought to be associated with this practice, the FDA has issued an alert to healthcare professionals. The prescribing information for Haldol, Haldol Decanoate, and Haldol Lactate has been revised to reflect the concern and potential risk when the drug is administered intravenously or at higher doses than recommended.”

Note that this warning doesn’t say you should not continue to use it for dealing with agitation in dementia patients. It is merely an “alert” that was likely issued as a prospective litigation defense.

In short, beware of off-label use of psycho-active medications. Perhaps the anecdotal information promoted by the pharmaceutical industry is accurate, but perhaps it is not.

9) Emotional difficulties have to be approached through first understanding the emotions involved.

All aspects of the individual have to be considered in therapy; the biological, psychological, social and spiritual aspects. There is no substitution for this by prescription. Prescriptions are not time-saving if that is all you offer the patient. Why? It is because missing the underlying factors that generate the symptoms will only cause delay and suffering – often for years – as a result of the wrong treatment. Should the wrong treatment include psychoactive medication, there will likely be an even more difficult path of undoing the impact of that medication before being able to address the actual issues.

Years of pharmaceutical experiments will ensue for the patient. The hunt for another therapist will eventually follow, often many years after the original misdiagnosis and corresponding error in treatment. It breaks my heart that this is so common. It is why I continued to practice psychiatry into my 70s and why, in retirement, I wrote the Engaging Multiple Personalities Series.

The case histories in Engaging Multiple Personalities Volume 1 were all of people that came to see me after being treated to no avail by other therapists and psychiatrists for years. For those I was able to help, it was not that I was a particularly brilliant therapist. It was because I actually listened to them. Without exception, their prior therapists either did not believe in dissociation or were too callous to pay attention to the early childhood trauma these individuals experienced.

An effective therapist speaks to the heart, not to the brain. We must never forget the humanity of our patients, or our own.

This is the final section of this extended post.