How often are youth prescribed antidepressants, and how can they weigh the potential risks and benefits?
TVO Today unpacks the use of prescription medication in youth-mental-health care and where the trend is now with experts including Onil Bhattacharyya (Frigon-Blau Chair in Family Medicine Research), Kim Hellemans (Carleton University Neuroscience), and Mina Tadrous (Ontario Drug Policy Research Network).
The episode also features a mother and a daughter who share their story about what a family member being prescribed psychiatric medication amid the pandemic meant for them. The worst-case scenario leaves them with big questions about how best to communicate the risks and needs of pharmaceutical care, why diagnostic criteria and treatment plans for mental health feel so detached and clinical, and how family doctors and families can better support one another.
Read the full transcript below.
Matthew O’Mara (producer): This episode is about psychiatric medication, suicide, trouble with concentration, and grief. Please listen with care. If you’re feeling like you need support, we’ve got resources listed in our show notes.
Jennifer: He was very, very humble, and he would want to do something out of the goodness of his heart.
Mary: Just that type of person. Very open and honest and caring and very strong. Never angry.
Jennifer: My brother, he was kind of like the voice of reason. And he would tend to mellow us out.
Mary: He liked to pull pranks as he got older. I know he used to like to tease his sister.
Tiffany Lam (host): [laughter] Do you remember this?
Jennifer: Was it when he would tease me, I would get upset. [laughter]
Lam: This is In Our Heads, a TVO Today podcast about Generation Distress. I’m Tiffany Lam.
Mary: I think a big problem in our household was that his father left and left in a bad way.
Jennifer: He took it as, “Oh, my dad left. What’s wrong with me that he doesn’t want anything to do with me?”
Mary: Didn’t know how much he was liked. You assumed that, “Well, at some point, I must be spoken about behind my back.” I mean, we all feel that.
Jennifer: In the outside world, he was always the person who would light up the room. I think inside our house, our home, maybe some of those emotions he let out. I think he felt things very deeply and very strongly, and he took things very personally.
Mary: I think he was struggling. He really wanted to find his path quickly because he wanted to get out and be making money. And I think he felt a little bit frustrated in that he couldn’t find his path.
Lam: That was a mother remembering her late son and a sister, her loving brother. In this episode, we’ll call him Max; the sister, Jennifer; and the mother, Mary. We can’t use their real names due to a court order to protect the identity of the family members. But Jennifer and Mary still wanted to share their story about what had happened after Max was diagnosed with depression and prescribed antidepressants.
Jennifer: I remember that day very clearly, and then I don’t remember much afterward. I remember I woke up, and my mom had texted me to come over. It was really nice out. It’s just the beginning of COVID. So my mom and I were sitting outside, and we were talking a lot about my brother and how he started the antidepressants. He hadn’t told me that he was on antidepressants. I knew from my mom. So I actually hadn’t spoken to him about it yet. I didn’t know if he, you know, maybe he’d get upset that my mom shared that information with me. But as my mom and I were speaking, I decided that I wanted to talk to him about it. So I told my mom, “All right, let’s wake up my brother.”
Mary: And I remember hearing there was a song on, too, and I thought, “Oh, he’ll like this song.” And then I went down, and he wasn’t answering me. And his lights were on, and his computer was on, which was not characteristic of him, to have his computer on while he’s sleeping. He never does that. And I was knocking on the door because I didn’t want to walk in on him just waking up or whatever. And then I realized there’s something wrong because he’s not answering me.
Jennifer: And when I heard her scream, I had this gut feeling that my brother had killed himself. And I called 911, and that’s what I told them. And they said, “You have to go to him.” So I went to his room, and I told them what I saw, and they told me what to do. But it was very apparent to me that he was dead.
Lam: I’m so sorry. That must have been so hard to walk in on.
Mary: That’s what happened. And it shouldn’t have happened. There was no reason for it to happen.
Lam: There’s something universal about grief, making sense of loss after the fact. Did I do all I could? Did everyone around me do all they could? Where could it have been different? For Jennifer and Mary, the only thing that changed prior to their loved one’s death was psychiatric medication.
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Lam: What was your impression of antidepressants?
Jennifer: I just had this general feeling that they could be dangerous.
Lam: Research into whether antidepressants cause suicide in youth has been fraught. There have been experiments that have shown that it’s possible, but very unlikely. Others have outwardly said they want to challenge the notion that antidepressants directly cause adverse effects. Only one meta-analysis I found — that’s a study of studies — quantified the possibility. That study scanned 656 studies, closely examining six of them. It showed that, out of 574 young people, nine who had died by suicide had had recent exposure to selective serotonin reuptake inhibitors, or SSRIs. That’s a type of antidepressant. And nine out of 574 young people amounts to 1.6 per cent. An Oxford University collaboration with three other institutions outlined how challenging it is to test the causal relationship between SSRIs and suicide. Not only are there different variables inside our brain that can splinter into potential scenarios, but environmental factors play a role, too.
From Max’s story, I think we can argue that medication alone as a treatment for mental-health concerns is not ideal. The cultural moment that wellness and healing is having in 2023 would probably argue the same. In Max’s case, psychiatric medication was meant to help, and it didn’t. Shortly after he died, his family decided to file a complaint with the review board of the provincial-health professional body. Their complaint included four points. One: the medication was inappropriate for what they went to see the doctor for. Max’s mom, Mary, remembers that when they had made an appointment to talk to the doctor —
Mary: It was about zoning out. And now, after the fact, it’s all about depression.
Lam: Two: this type of medication was inappropriately prescribed over the phone. Mary remembers that the doctor —
Mary: Never even examined him physically — just asked him questions and made a diagnosis over the phone. He didn’t look in his eyes.
Lam: Three: the follow-up and guidance for psychiatric medication was inadequate. Jennifer remembers being concerned about the timeline to go back to the doctor to check in.
Jennifer: The doctor followed up with him four weeks later, which I felt was a really long time to be on a brand-new medication without any interaction.
Lam: And four: there was an overall lack of clear verbal and written communication about the risks that came with taking the psychiatric medication. Here’s Mary again.
Mary: His medication didn’t say anything about suicidality. I was told by someone else that sometimes it is written, but this is another inconsistency.
Lam: Jennifer remembers speaking with the doctor after Max died. The doctor said —
Jennifer: Oh, yeah, I told your mom to kind of keep an eye on him. What does that mean? And what are we looking for? It was very just in passing: “Like, by the way, keep an eye on him.” So I don’t think that’s sufficient.
Lam: It’s true. Max’s side-effects pamphlet didn’t warn about suicidal ideation. It listed mostly physical side effects like nausea, possible vomiting, mouth dryness, and the runs. There’s one bullet point on potential excitability or drowsiness. It said that patients should use the medication with caution until they knew how they reacted. The insert, however, does say to contact your doctor if you’re experiencing any side effects at all. But maybe noticing subtle side effects — like changes in your mood or behaviour —requires a level of self-awareness that youth might not have always developed.
Mary: Your brain is changing. Your body is changing. Your hormones are changing. You’re in lockdown.
Lam: The pandemic would definitely have muddied the reasons for changes in mood even more. Max’s depression diagnosis was also confusing to his family, because he wasn’t showing typical symptoms of depression, like not getting out of bed or neglecting personal hygiene or upkeep.
Mary: He was growing out his hair, and he was fixing his hair every day. There’s no evidence of severe depression. He was simply struggling to find his way, what he wanted to do in life, and a bit frustrated with that and maybe anxious about that.
Lam: And the family hadn’t heard about depression being a concern when Max’s high school was doing psych evaluations for their students. According to the family, he had previously received an ADD diagnosis from school. When Mary brought that up to the review board, they said that depression can come on very quickly. But that also felt contradictory because Max’s doctor said that his moods had been down for several years. Mary had offered to bring his school psych assessments to the doctor’s office, but Mary says the doctor declined.
Mary: I’m the one that said I would drive the paper over to your office. You can read it yourself. I’m the one that was trying.
Lam: We tried to reach out to the family doctor for comment, but they declined to participate in the episode. But from medical records, here’s what we can glean about the diagnosis and treatment plan. The doctor’s notes showed that focus was, in fact, what Max reached out to the doctor for. But the doctor then noticed another red flag during the appointment: his mood had been low for years.
The medical records after that point list how Max was experiencing different symptoms of depression, including trouble with focus (“concentration: terrible at present”). It showed the doctor ordered blood work and a heart scan to see if there may have been physiological reasons for his moods. The start of the doctor’s notes for that appointment reads: “phone call request, start time, verbal consent obtained for telephone visit.” It showed that, at this first appointment, the doctor had Max start medication and that they had discussed side effects. The line reads: “side effects of medication, including depression, nausea, headaches.” It also showed that the next follow-up was to be a month later, which Max did make it to. At the follow-up, Max had told the doctor that things were getting better. He’d also listened to their advice about lifestyle changes, like quitting his job. The note on side effects reads: “side effect of meds only mild headaches. Nothing serious. Depression improving. Still poor focus. Not sure if depression versus ADD.”
Lam: When people have a complaint about a doctor, they can take it to the provincial-health professional body. All practising doctors in the province are members. That body assembles a committee, considers the complaint, and can do one of the following: (1) take no action against their member’s practice, (2) issue a caution or direct remedies to improve an aspect of their member’s practice, or (3) refer specified allegations of professional misconduct or incompetence to a discipline committee. In this case, the committee decided to take no further action.
The committee said that COVID restrictions at this time limited in-person assessments. That meant phone assessments were used to determine whether an in-person appointment would be necessary. The committee also said that the diagnosis wouldn’t have changed even if the appointment had been in-person, because Max had met the diagnostic criteria. A little more on those criteria later. The committee also said Max’s death appeared to be an unfortunate example of the far-reaching impacts of the pandemic on personal health and health-care provision. Ultimately, the board reaffirmed that the doctor had followed the protocols of a depression diagnosis.
Mary: They back it. That’s basically what it was. And so there’s no fault there.
Suicide Prevention for Teens and Young Adults with Dr. Ali Mattu
Lam: Do you feel any sympathy for the doctor for having to make a choice to treat something, then it ends up not working the way you thought it would?
Jennifer: Yeah, I definitely do. And I felt this from the beginning. The doctor didn’t do anything wrong. Technically, you know, legally. It’s the procedures that we have are not up to par.
Lam: Impressively, Jennifer was able to distance herself from the tragic loss that her family experienced and named ways that her brother’s death may actually be a symptom of a systemic problem.
Jennifer: The standard procedure for prescribing antidepressants is following up within four weeks. I think if there were better procedures, she would have followed them. So I do have sympathy, and I can also understand that maybe she was overwhelmed at the beginning of COVID with patients. And it was kind of like a reflex. Oh, someone seems like low mood, like poor concentration, probably depressed — antidepressants. That’s kind of the cycle I think a lot of doctors are in. And we have to kind of shock the system and change that.
Lam: Back in April 2021, the Investigative Journalism Bureau’s Generation Distress series found a troubling trend leading up to the pandemic from 2009 to 2019: family doctors and pediatricians across the country were leaning on medication more than ever before.
Morgan Sevareid-Bocknek: The data that we had showed that there was a 240 per cent increase in prescriptions of antidepressants for people under 18, which are paid for by public drug plans in British Columbia, Alberta, Manitoba, Saskatchewan, and Quebec between 2009 and 2019. My name is Morgan Sevareid-Bocknek. I’m an investigative reporter at the Toronto Star. My pronouns are she/her/hers.
Tiffany Lam: Morgan was the lead reporter of this original story in the Star.
Sevareid-Bocknek: In Ontario, those same publicly funded claims rose by 224 per cent in the first eight years, which is in line with the overall national portrait.
Lam: She wanted to flag a caveat in the Ontario dataset. In 2018, there was a change in Ontario’s drug policy. OHIP+ was introduced to help cover prescriptions for everyone under the age of 25, so she didn’t include the Ontario numbers from 2018 and 2019.
Sevareid-Bocknek: We didn’t include that data in our analysis, because it’s like an unfair math problem. There are no bad guys here. These medications are generally not considered to be a big deal. Lots of people, more people than anyone realizes, are on them for different lengths of time, and they are generally considered to be pretty safe. There’s a silver lining here: People are more open to having conversations about their mental health. They generally feel less ashamed, and antidepressants are so common that sometimes they can be the only thing you have in common with somebody else.
Lam: Mina Tadrous studies the way prescription drugs are used throughout Ontario. He’s also a pharmacist himself.
Mina Tadrous: I am an assistant professor at the University of Toronto, and I am also a scientist at Women’s College Hospital and a scientist at ICES and an investigator with the Ontario Drug Policy Research Network.
Lam: ICES stands for Institute of Clinical and Evaluative Sciences.
Tadrous: When reporters call me and they say, “Oh, this is growing — are we overusing these medications?” I’m not convinced. I think this is a byproduct. It’s a marker of something greater happening in our society and a need for patience that’s happening.
Lam: Professor Tadrous generally trusts that doctors put patients on medications that could help them.
Tadrous: The thing I worry about, the bad-news side of this, is: Are we just using medications as a simple, cheap, and quick Band-Aid for something that requires not just medications? Perhaps people are staying on it longer. And that’s why we’re also seeing increased numbers.
Lam: And that, by extension, suggests people can’t access treatment that’s guided by the specialists they need.
Tadrous: We know that from Ontario — there are countless studies from some of my colleagues that show that the ratio between psychiatrists and patients who need help is really low. So we don’t have enough staff and supports there. I do think that a medication is a very quick way. There’s no rate-limiting step there. You just have to see your family doctor. And although that’s challenging in its own right, it’s much easier than seeing a mental-health specialist.
Lam: Research out of CAMH (the Centre for Addictions and Mental Health) shows a correlation between places with less mental-health support and the likelihood of youth being on medication. For instance, CAMH found that, from 2009 to 2019, youth in northern and western Ontario were more likely to be on medication for anxiety or depression compared with provincial averages. Here’s Morgan from the Star again.
Sevareid-Bocknek: Psychotherapy is not as available as antidepressants by a long shot. And CAMH estimates that three in four Canadian children and youth with mental illness do not have access to specialized treatment, and that imbalance can create a serious equity issue, since patients who should have a choice between antidepressants and therapy often don’t get that choice immediately — especially those who have moderate depression. They can’t choose unless they have insurance or are able to pay. And the data that we have is for those publicly funded medications for youth. And so it is perhaps showing us who is on medication and of a lower socioeconomic status.
Lam: When Professor Tadrous took a closer look at trends around psychiatric medication, there was a more complicated picture. Antidepressant trends varied based on the specific type. Like, are we talking about a stimulant like Ritalin or a sedative like Xanax? Professor Tadrous’s research found that, if you break usage down by specific type of medication, there wasn’t as clear a geographic trend. Professor Tadrous’ other major concern stemmed from witnessing people make tough choices at the counter.
Tadrous: If they get a new antidepressant, that’s a couple of hundred dollars a month, maybe $200 a month — that might be $1,500 a year. And they have choices to make. They may start not taking the therapy. They probably do. And I’ve seen this countless times, where somebody will come in and fill it for a month and then take a month off. And these medications don’t work if you do that. So what ends up happening is, they’re kind of using the medications when they need them or when they feel worse.
Lam: Do you ever say anything when you notice that?
Tadrous: Absolutely. When I notice it, right away, we have conversations about what’s available to them. If you’re having trouble paying for your drugs, talk to your pharmacist. We are the experts on not just the drugs themselves, but how they get paid for.
Lam: To this day, Jennifer wonders whether Max’s trouble focusing was the cause of his depression rather than a symptom of it.
Jennifer: After his death, I read that depression can be caused by ADD because you keep procrastinating or you can’t focus, you can’t finish it, and it frustrates you. And then you get depressed. You get down on yourself that you can’t do this one simple task. I think in my brother’s case, we might have been treating the depression. If we went the other way, treated the ADD first and helped him focus, maybe the depression would have subsided.
Agenda segment, June 13, 2023: Why depression exists
Lam: I think Jennifer names a valid concern. How do doctors know if they’re treating a symptom versus the actual underlying condition? The neuroscientist we’ve been speaking with for the show, Dr. Kim Hellemans, she told me that substances can change how you feel and act, but someone’s existing mental health shapes that impact on emotions and behaviours — the classic chicken-or-egg debate. Does medication change our headspace, or does our headspace shape the effects of medication? Again, Max’s doctor declined to participate in this episode, but the committee reviewing the doctor’s treatment plan agreed with their decision to address depression first because it was a more pressing diagnosis — ruling it out meant reining in the risk for it to slide into self-harm. Mary remembers discussing the new medication with her son. Mary was concerned about antidepressants, given that she thought focus was the issue. But Max comforted her.
Mary: He said he only had to be on them for a short term — I guess to rule out depression — and then they could discuss more about the zoning-out or focus issues.
Lam: How, then, do doctors decide the treatment plan?
Dr. Onil Bhattacharyya: My name is Onil Bhattacharyya. My pronouns are he/him. And I’m the Frigon-Blau Chair in Family Medicine Research at Women’s College Hospital. I’m a clinician scientist, practising family doctor.
Lam: What does that conversation look like when you’re considering medication as an option for them?
Bhattacharyya: Typically, we go through a series of questions to make a diagnosis. We’re going to be asking all these structured questions, and it allows you to get a sense of severity, right? Then we’ll say, well, you know, what do you want to do about this. And people whose function is severely impaired, it’s hard for them to start therapy alone. Often I say, medication will allow you to feel good enough to then start therapy. Some people are very quick; some aren’t ready for it. And other people don’t want to take pills under any circumstances. So it’s an open conversation about what are you ready to do.
Lam: When a patient first walks into his office wanting mental-health care, Dr. Bhattacharyya takes notes on the symptoms the patient has.
Bhattacharyya: Typically, the first conversation, I’ll say, “Okay, let’s talk in a week.” And in that week, lots of things change. Often, people just unload, and then a week later, you talk to them, and they’re like, “You know, I came to you at a bad time, but actually I kind of have a plan.” And the thing that I often put focus on is: your mental health depends on your life, what’s going on in your life and the balance of stress and your ability to cope. And if there’s too much badness in your life, how do we dial it back?
Lam: I asked people who work in the medical field about whether there is a standard practice for prescribing psychiatric medication. There didn’t seem to be. Dr. Bhattacharyya’s ask to return in a week’s time, for example, seems to be at his own discretion.
Bhattacharyya: All medications have similar effectiveness, but they have very different side-effect profiles. There are a bunch of side effects, and then we decide which side effects you’re willing to put up with. And then that guides the choice of therapy.
Lam: Looking at both the doctor’s notes and Max and Mary’s conversation, the answer to Jennifer’s concern seems potentially unsatisfying. Doctors can’t really know with full certainty. They try lines of treatment, and they examine patient reactions to narrow it down. Mary also has questions about how the doctor came to the decision to put her son on antidepressants.
Mary: On that questionnaire, if they say, “Have you ever considered suicide?” and you answer “yes,” the next question is, “Do you have a plan?” But when you’re young, that should be a discussion right there. Why can’t that be a discussion? Why is it just a questionnaire?
Lam: It seemed ironic that the way you receive such an intimate diagnosis about your well-being is through such a cookie-cutter set of questions. Ultimately, Mary wonders whether her son needed to be on psychiatric medication at all. It’s unclear to her what the threshold for prescribing medication is.
Mary: I was offered these for grief. So what, we’re going to say that grief now is deep depression? Grief is supposed to be normal. Sometimes you just need to know someone cares. And maybe someone besides your family is more objective that you can talk to.
Lam: Experts still don’t fully understand why medication can land so differently between users, broadly speaking. Professor Tadrous — the professor/pharmacist/researcher from earlier in the episode — wonders whether part of the reason they land so differently is due to the way people typically don’t only have one diagnosis, and if people do have only one diagnosis, there are subtypes. There’s no one-size-fits-all, but medication is prescribed as if there were. Professor Tadrous also wonders whether the way we label our medication is appropriate.
Tadrous: I’ve actually written a paper on how I think that these namings of antidepressant and antipsychotic and all these mental-health drugs is actually the worst thing.
Lam: For Professor Tadrous, the way medication is called an antidote to a specific illness is misleading. The antidepressant that Max was on, for instance, is a type of medication doctors commonly prescribe to treat depression. But Canada also uses it for treating anxiety, meaning it’s not strictly an antidepressant. The United Kingdom has approved Max’s medication to treat OCD, severe phobias, panic disorders, PTSD, and even bulimia.
Tadrous: The irony is they’re not as selective as we think. It’s like a dull weapon.
Lam: Imagine a hammer trying to hit a specific nail among many protruding nails. That tool could easily hit an unintended spot that could spur a different chain of events. The relationship between youth and antidepressants has an additional rub. We don’t study youth as much in medications for these drugs as we would like.
Tadrous: What we find is that most prescriptions go toward one or two different antidepressants that have been most commonly used and have the longest history and strongest evidence. That doesn’t mean that they’re the best. It just means that we have the best evidence and so have the most certainty around if they’re going to work and their safety. So that risk-benefit ratio is much clearer.
Lam: And that’s considered an acceptable risk-benefit ratio by medical standards. Here’s Morgan again, the investigative reporter from the Star, on that.
Sevareid-Bocknek: It’s called off-label prescribing when they prescribe something that’s not approved for that age group. It happens all the time, and it’s considered completely fine to do. The majority of pediatric prescribing in Canada is off-label. it’s not controversial. It’s considered a clinical standard and completely appropriate.
Agenda segment, June 29, 2022: Is Gen Z over-diagnosing their mental-health problems?
Lam: But at least one organization thinks that the risk warrants a re-evaluation of how we prescribe medication to youth.
Sevareid-Bocknek: The Canadian Paediatric Society did issue a call to action for improvements in pediatric prescription medication in 2019.
Lam: According to the Canadian Paediatric Society’s call to action, off-label prescribing is associated with significant risk, including adverse reactions and efficacy concerns.
Sevareid-Bocknek: And Health Canada is currently developing a response to those regulations. They’ve been busy, understandably.
Lam: We reached out to Health Canada about how they’ve responded to the call to action. Here’s what they emailed back: “Health Canada is currently focusing its efforts on implementing measures under the Pediatric Drug Action Plan that will help to increase access to paediatric safety, efficacy and dosing information for medicines. A pilot program designed to encourage the submission of pediatric studies to Health Canada is expected to launch in 2023.” A senior media-relations adviser said, “This pilot program will help to inform the development of pediatric regulations for Canada.”
Lam: Max’s family remembers hearing about risk-benefit ratios after Max died. After he died, his family reached out to the doctor to meet. Jennifer remembers being surprised by the doctor’s admission that antidepressants can increase the chance of suicide when someone first starts taking them.
Jennifer: That was news to me. And so I said, “Well, why are you prescribing him medication that could increase the chance of suicide if you think he’s depressed?” And she said, “It’s because she felt that the benefits outweighed the risks.”
Lam: Literature from places like the Centre for Addiction and Mental Health says it’s normal to feel worse before you feel better with these medications. The CAMH pamphlet says it can take six months before the medication really starts to help and that most people need to be on it for at least a year to experience any meaningful change. The medication has helped relieve symptoms of depression and anxiety in up to 70 per cent of people who try them.
Jennifer: What I felt initially is that, if he’s had these low moods for two years and has survived for two years — has gone to school, held down a job, been going out with his friends — I don’t see how the benefits would outweigh the risk. I felt like that risk-to-benefit analysis was kind of not taking us seriously. I think it’s very clear that the risks were far greater, especially my brother being in this mood for two years. And then after four weeks on these, he’s gone.
Lam: Mary is particularly frustrated with the notion that side effects are framed as to be expected.
Mary: I didn’t connect the dots when he said things like he wasn’t sleeping, and I told him he didn’t have to stay on this medication. He told me the doctor said that was to be expected. So that’s normalizing a side effect.
Lam: How would families know when one certain side effect is something to worry about?
Today, psychiatric medication is trending toward recognizing that adverse reactions to medication may in fact be due to genetic factors or even epigenetic factors. Epigenetic refers to how DNA is shaped by factors that aren’t hereditary. In other words, things like life events can mould genes as much as what you get biologically from your family. And one test on mice showed that epigenetic changes crossed generations. I reached out to Kim Hellemans again, a neuroscientist at Carleton University, to find out where she thought the forefront of treating the brain and mental health was these days.
Kim Hellemans: The future is individualized medicine — recognizing that we each come into this world, and we each develop and have mental-health challenges that have very unique paths to how we became depressed and how we became anxious. And what helps me might not work for somebody else.
Lam: According to Professor Hellemans, there are emerging programs that already recognize this.
Hellemans: The CAN-BIND program is looking at biomarkers for depression. This is really where I think the future is going: “Okay, say you’re depressed: Let’s do a baseline EEG. Let’s look at the functioning of the cells of your cortex. Let’s maybe even put you in a brain scanner. Let’s take some blood and saliva and look at other proteins associated with depression.” And we can predict with very good reliability now that you’re going to be a responder with this kind of treatment pattern.
Lam: I think this approach makes sense in theory. People are the sum of so many variables. The fact that treatment plans can almost be atomically tailored theoretically makes sense.
Hellemans: That’s where I think this conversation and the future of psychiatric medicine is really going. It’s becoming less about the passive giving of meds and more about looking at the patient as an individual, looking at the importance of many other tools in the toolbox to be able to support wellness.
Lam: But the more I thought about what Dr. Hellemans said — the part about poking and prodding to figure out what genes can help indicate what to fix in people and how – it did sit awkwardly for just a sec.
How do you feel about that? Does it excite you? Does it go into eugenics territory like —
Hellemans: Oh, boy.
Lam: I hope I didn’t come off as a know-nothing questioning something that could be potentially cutting edge.
Hellemans: Well, I appreciate that you said that, because I do think we need to acknowledge neurodiversity in this space, that sometimes certain cognitive states, certain experiences of attention and mood and cognition, are something to be treasured and valued instead of fixed. So I would say it’s always about the wellness of the individual. If you are living well and you have severe ADHD, severe autism, whatever, then let’s just keep that going. And if you need intervention at some point in your life, that’s okay as well. It’s all about how the individual may feel. And I think that’s really important.
Lam: As the public was panic-buying toilet paper during the pandemic, people like Professor Tadrous decided to watch for how quickly medication flew off the shelves. He was surprised byy what he found.
Tadrous: When we looked at antidepressants, we looked at antipsychotics, we looked at anxiolytics — like benzodiazepines and things like that — and we didn’t see any differences.
Lam: The trend that the Investigative Journalism Bureau found a couple of years ago — that psychiatric medication is on the rise among youth in Canada — may be plateauing.
Tadrous: And it really just made us scratch our heads. And I started to think, well, like, what’s happening here? Do we have an access issue? Is it that we are seeing a shift in society, and that shift may have made some people’s lives better — or worse, and they cancelled each other out?
Lam: Professor Tadrous’s team continues to update their research. As for Jennifer and Mary, they continue to sit with the loss they’ve experienced.
I wonder if you would be willing to share how you honour and continue your bond with your brother and with your son today.
Jennifer: I think doing this podcast is one of them. I said that my brother was very humble, but he always wanted to help others, and I think being able to share his story and being able to save even one person, that’s what he would have wanted.
Lam: How about you?
Mary: Doing this podcast? Yes, he would be so devastated to see our suffering and the lack of anyone taking any kind of responsibility. He would want to change it. He would want to never see this happen to anybody again.
Lam: What message do you have for families who might be observing changes in their child’s or sibling’s behaviour?
Jennifer: The power of conversation. I think a lot of times, with my brother, I was worried about talking to him about certain things or worried about upsetting him. And I think just being open and honest with each other and being vulnerable, it helps us to make it more concrete and understand more what we’re feeling. And maybe from those conversations, something does come out, and you need to go to the doctor. But I think a lot of the times it’s just talking it out and just saying it and sitting with it and realizing what you’re feeling and then figuring out an action plan from there.
Mary: I think you need to articulate that you matter and you’re wanted and important — because when a teenager is not sure what they want to do with their future, you don’t know how much they want to please you as a parent. Teenagers will get angry and stomp away and turn away, and they might get angry at their parents just because they’re so frustrated. It was difficult. And there are some young people who take it very much to heart, the way the world is.
Lam: Next time, we’ll look at how technology can make therapy more accessible.
Bhattacharyya: The need for mental-health services outstrips anything we could ever offer.
Unidentified psychologist: So what we really did was take CBT and make it available on the internet.
Lam: Can apps be our therapists and counsellors? Can TikTok?
Unidentified psychotherapist: I see it as strictly psychoeducation.
Lam: Thanks for listening. I know this stuff can be tough to take in. So if you’re feeling like you need help, know that you can always call Wellness Together Canada at 1-866-585-0445. Or you can text “wellness” to 686868 for youth or 741741 for adults.
This transcript has been condensed and edited for length and clarity.
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