The truth about psychotropic drugs: “Medication ends up being the only alternative when there is no access to therapy”

The data doesn’t lie. What happens is that, when they are put on the table, they surprise. They alarm, rather. And if what they talk about is health, even more so. According to the Ages 2024 Report, prepared by the Ministry of Health, The consumption of hyposedatives (anxiolytics, among others), with or without a medical prescription, has increased in Spain by up to 27.4% in the last year. In 2024, 12% of people aged 15 to 64 said they had consumed them in the last 12 months, with the proportion of consumption being higher among women (14.7%) than among men (9.3%). Furthermore, 4.8% of the population of Spain, between 15 and 64, admit to having consumed them at some time in their life, 1.8% in the last year and less than 1% in the last 30 days.

As if that were not enough, according to the International Narcotics Control Board (INCB), Spain is the country in the world with the highest consumption of benzodiazepines (a drug from the hyposedative family). Well, with this x-ray of psychotropic drugs on the table, the psychiatrist David Lopez Gomez (who does not like data to be presented without contextualization, due to the risk of stigmatizing those who use psychotropic drugs), listen to LA RAZÓN to talk about the use/abuse/addictions/good and bad use of drugs aimed at alleviating mental health problems. mental health.

Medicines, loved and reviled in equal measure, that came into our lives in the fifties and that have undergone spectacular development. «The main therapeutic targets in psychiatry were established with the drugs of the 1950s. These targets are, for the most part, the neurotransmission systems and the neurotransmitter receptors in our body. To our knowledge, there are no new therapeutic targets in psychiatry. Subsequent research has focused more on fine-tuning existing drugs, rather than developing completely different new approaches. “Current drugs continue to have similar efficacy profiles to those of decades ago, although with significant improvements in safety and side effects,” points out López, who has just published «Let’s talk about psychotropic drugs» (Arpa)where he details the typology, consequences and dependency (or not) that they generate.

Clarified that the effectiveness remains similar to that of older medications, but with a “much better tolerability” profile, that is, fewer side effects, the expert asserts that it is necessary to dismantle some myths such as the generalized dependence they cause. benzodiazepines (anxiolytics). «Psychological and physical dependence are closely related. If you take a medication and it helps calm your anxiety, the body can develop a tolerance, which means that You will need a higher dose to get the same effect. But beyond physical dependence, there is a psychological dependence, since the patient begins to believe that only with the medication will he be able to control his symptoms, such as anxiety or insomnia. This mechanism creates a vicious cycle, where the patient believes that they cannot function without the medication. “It is crucial to educate patients so that they understand that the drugs are a short-term treatment and that once the underlying cause disappears, they can safely stop using them.”

Regarding patients “hooked” on psychotropic drugs for years, López, who is also director of thementeAmente clinic, points out that “in many cases, the patient is not aware that they could stop taking them, especially if it has never been explained to them that the Antidepressants should not be taken indefinitely without medical supervision. “This is a common problem I have seen in practice, where patients continue to take medication without a proper review plan.”

But, despite the fact that they are sensitive medications, don’t you think there is an overprescription of them?

“The WHO estimates that there are 300 million people with depression in the world and estimates that half do not receive treatment. Of course, this may be related to the lack of resources in developing countries, but even in Spain, there are cases of depression treated. The message that drugs are overprescribed in Spain can actually harm those who really need them. If a treatment is indicated for a person who is going to benefit from it, it is not really overprescribing. therapy pathway is blocked by the waiting list, and the most accessible route is medication. Medication should be a valid option, as long as it is indicated to alleviate the person’s suffering, but when therapy is not immediately available, it is the option that is available. That does not mean that medication is a substitute for therapy, but that in those moments, medication is what can be offered.

An evil, that of the waiting lists of our health system, which is closely related not only to the number of cases, but also to the lack of professionals (approximately 10 psychiatrists per 100,000 inhabitants). «The shortage of professionals makes mental health cases more difficult to manage, and the volume of patients does not allow the necessary time to be dedicated to each case, especially the most serious ones. It is a complex problem, because the pathologies are very heterogeneous, and while some patients require urgent attention, others may have milder, but equally important, emotional problems,” López Gómez points out.

Thus, as he adds, “the more patients who arrive, the less time there will be for the most serious cases, those that really need urgent medical treatment. Sometimes you cannot dedicate the necessary time to the most complex cases. Therefore, medication, although not the ideal option, ends up being the only alternative when there is no access to therapy. But that does not mean that it should not be prescribed if it is indicated, because, in the end, the important thing is to alleviate the patient’s suffering.

Of course, he clarifies that “it is important that the patient chooses whether to take the medication, understanding the benefits and risks involved. However, we must recognize that mental health care is limited, as is the case with other medical services.

And, on the other side, on the patient’s side. Have we not become people who are too intolerant of frustration, of the evils of everyday life? Do we readily resort to easy solutions (medications)?

“The discomfort of everyday life should not be resolved only individually. It is not about people learning to deal with negative emotions, but we must also support each other. Society has an important role in preventing mental illnesses, and if people receive the necessary support, they may not seek medical help in the first place. The solution is not only in individual consultation, but in strengthening social support. We live in an increasingly individualistic society, where success. business and economic seems to be the most important thing. That people go to the doctor looking for a solution to their problem, without expecting that their environment can offer them help. This individualism can aggravate mental health problems.

As our appointment with the psychiatrist comes to an end, curiosity takes over. What guarantees do the new psychedelic therapies (based on psychotropics) that are gaining more and more followers? Are they safe? The doctor is clear: «In Spain, currently, the administered doses of these substances are very small and controlled. Patients should be in a hospital setting to ensure they are closely monitored. The main concern is that psychedelic substances can cause hallucinations, so they should be taken in a safe, controlled environment, not at home or on the street.

And, as has been proven, many of these treatments they have good results«but there must always be a rigorous medical evaluation. The main message is that, if someone is going through a bad time, they should consult a psychiatrist who can guide them correctly and offer treatments with scientific evidence,” says the psychiatrist.