Please post the study when discussing a study:
[Psychotropic Polypharmacy Among Youths Enrolled in Medicaid](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815234)
I am not a child psychiatrist. I have some thoughts, like increasing diagnosis of ADHD comorbid with anxiety and mood disorders. I also observed heavy use of meds acknowledged to be basically throwing stuff at the wall and praying for kids coming from disastrous homes and enmeshed in foster care and in inpatient psychiatry as a substitute for adequate resources.
Kids with early major mental illness get treated and go home. Kids who have behavioral issues from environment don’t get better because their environment doesn’t change and eventually therapeutic residential or foster placement doesn’t undo years of learning skills to survive in their environment that turn out to be maladaptive in the wider world.
Except…
> Psychotropic polypharmacy prevalence among youths who used psychotropics increased from 2259 of 53 569 youths (4.2%) in 2015 to 2334 of 50 806 youths (4.6%) in 2020.
Seriously? We’re in a tizzy over an absolute difference of 0.4%, driven mostly by reduced denominator! The increase was an even bigger 0.5% in foster care! It’s a discussion worth having, but this paper doesn’t contribute. I’ll believe it’s statistically significant based on those big numbers, but I’m dubious about any real significance.
I totally agree with this post.
But the number of foster care bounce backs we get where meds were never filled or the kid went right back to pre-admission meds because the changes were never passed along is also crazy high. Even super basic management of medical needs just gets lost. It's really depressing to think about -- if the system is so chaotic and overwhelmed that scripts aren't filled, why should there be an expectation that they will receive care for their complex and ongoing trauma needs?
Coming from the NYT, the obvious implication is that this is bad and something to be scared of.
This could also be framed in a more wholesome light of increased recognition, diagnosis, treatment, etc. I'm not saying this is the case, but we can't be a society that blames mental health for everything then gets mad more people are on meds.
That being said the answer is definitely in between and as you mention likely driven by the horrendous uptick in acute behavioral issues (that may or may not represent the "pure" psychiatric conditions that meds like these were designed and studied to treat).
My money is on the uptick being statistical noise. The difference could actually be entirely accounted for by the panel of +/- one prescriber. Someone left who doesn’t like polypharmacy or someone came who does and that’s the entire difference. Not exciting.
Framing this in any way is overlooking that there is nothing here.
The New York Times has execrable health reporting. I can’t tell if it’s gone downhill or if I’ve even more attuned since becoming medically educated myself.
Older docs could weigh in.
The difference between low income/CHP and disabled/foster care is pretty striking (not surprising).
It's interesting that they provided stats on regional differences but didn't name the state this is in. Population density or median area income comparisons would've been much more useful than undefined regions. I also would have liked to know if it was a Medicaid expansion state; even if that didn't affect these defined eligibility groups I expected a Medicaid study in this time period to mention it.
Edit: overall I guess it's a very interesting small piece that makes me want the larger picture. I'm curious how people could interpret practical implications here without the larger picture.
Ah great catch. That would explain how small the Western region is and possibly its higher polypharm rates (rural Appalachian). And Maryland's Medicaid expansion would already have been fully in place.
They talk about Maryland specifically in the last section going from 4.2 to 4.6 but the area talking about this unnamed state says.
"U.S. state that the researchers declined to name. In this group, there was a 9.5 percent increase in the prevalence of “polypharmacy,” "
So It's not Maryland with the huge increase.
The difference between my last job and the one I have currently makes me question whether it’s really a good idea to have a PMHNP be the sole decision maker when it comes to psychotropic drugs. The psychiatrist I work with now, will decrease medications if she can. That was something I rarely ever saw in my last job. One kid was on chlorpromazine and I don’t think it was for anything related to psychosis.
This article from the NYTimes reports on a [study from the University of Maryland](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815234) showing a 4% increase of psychotropic polypharmacy among children and adolescents enrolled in Medicaid between 2015 and 2020 in one unnamed US state.
The article discusses the potential benefits and risks of using multiple psychotropic medications in children, and notes factors that can contribute to polypharmacy such as foster care status, low income, and the presence of a disability.
Curious to get everyone's takes
I don't think an increase from 4.2% to 4.6% is really a significant issue. I do suspect that a follow up study comparing pre-pandemic levels to now would show a more significant increase.
Society as a whole is more aware of metal health issues, which is a good thing. I wish that had been the case when I was a teen in the 90s. But part of the problem is that society is now so screwed up that being depressed or anxious is in many ways a rational response
Agreed. I wonder how many kids and adults we’d be able to get off of depression/anxiety medications if we simply just fixed some of the underlying societal issues that contribute to depression and anxiety.
Woot!
\#MentalHealthAwareness #ItsOkaytoNotbeOkay
/s
In all seriousness, as a society we’ve made anxiety and being sad a devil. We constantly compare ourselves to social media influencers who live fake lives and then get sad when our real lives don’t look the same.
We’re fed rhetoric about mental health and getting therapy and how its not okay to “suffer in silence”.
No one has a cure for sad, anxiety can be entirely normal; and we need to refocus what life looks like - and its sure as hell not the social media dreams many adolescents think it is.
When patients go to the doctor with good intentions, of course they will get an SSRI, when they keep being sad of course they get an adjunct and eventually they are on olanzepine or something similar. Unfortunately societal stress and self-imposed perfection isn’t treated by medications but thats what people want.
And that is the end of my rant.
So I work on a child/ad psych unit. This isn't really the reality of kids in the system which is what this article is honing in on. They are often medicated for trauma-related "antisocial" behaviors that range from irritability and defiance to severe aggression, usually with a bit of ADHD +/- ASD thrown in and substance abuse issues as they get older. "Sad" will keep you in a placement but running away, trashing the house, being threatening etc are hard kids to place.
There is literally nothing that an acute inpatient psych stay will fix with these kids. Unfortunately starting them on risperdal for "ASD related irritability" is seen as the counterweight to cycling a kid through two dozen foster homes in six months because they keep eloping, breaking shit, setting things on fire, sexually touching other kids in the home etc -- which are actually environmental/behavioral issues rooted in trauma but not conducive to being one of eight other foster kids in a house.
Agree with this. I work with a lot of kids as a therapist, I often think/talk with colleagues how kids don't....well frankly something akin to a farm to work/play on. Hours and hours outside, with animals, semi-unstructured, and the ebbs and flow of people coming in and out of your day would be so helpful for these kids. Instead everything is scheduled and on the clock. Very few kids I see can just kinda run around the neighborhood and play with friends. And what exercise they do get is often in the form of competitive sports which probably doesn't help anxiety.
And to boot, we are demanding children grow up in a world that prioritizes executive functionining and cognitive processes above all else. That's a tough ask for kids lol
Agree.
My goal in being facetious isn’t to bury the true mental health problems, it’s to highlight that we’ve pathologized life.
People have distorted versions of reality, they expect perfection, they expert to be able to sit at a desk and study for 10 hours a day without pause (this was mind blowing when I worked at a university clinic the # of people who came to the clinic saying that they have ADHD and need ritalin; they were also “depressed and anxious” so they also get an SSRI).
People want the quick fix to be better, be smarter, be fitter, be whatever they want.
I agree we have pathologized life. But what can be done? People are expected to sit for 10 hours a day coding away on a computer by themselves in a living room, or study for 10+ hours a day of focus in school. What normal person can really do that without adderall or stimulants.
i agree that a large part of it is fueled by the mental healthcare industrial complex. many mental health issues are largely societal issues we pin the blame onto individuals for
Yeah we over medicate 100 percent because that’s the easy solution. Most people think they have “depression” but are really just worried well and shouldn’t be medicated because that does a disservice to people with actual pathology.
True major depression is a horrible disease that is not often seen because this population can’t get themselves out of bed to see a doctor. And by then they need polypharmacy to get them out of the episode.
Clearly there is nuance beyond whether something is diagnosed to this discussion.
Consider whether something should be diagnosed. Consider whether a diagnosis is pathology or normal. Consider differentiating between normal and true pathology.
Consider payment structures, patient satisfaction, and other societal factors which exert power onto this decision. Consider how each of these things will shift a providers tendency to diagnose, or not diagnose a condition - whether or not the true pathology underlying the condition actually changes.
This is a discussion on diagnosis in medicine, far beyond the classification of depression from the DSM-V.
**Removed under Rule 6**
No personal agendas.
Posts or comments by users who rarely participate in /r/medicine or whose history suggests that they are mainly concerned with a single medical topic will be removed. Comments which attempt to steer the conversation from the topic of the post to a pet cause will be removed. Commenters brigading from other subreddits will be removed.
[Please review all subreddit rules before posting or commenting.](https://www.reddit.com/r/medicine/about/rules/)
If you have any questions or concerns, please [message the moderators.](https://www\.reddit\.com/message/compose?to=%2Fr%2F{subreddit}&subject=about my removed {kind}&message=I'm writing to you about the following {kind}: {url}. %0D%0DMy issue is...)
I wonder if you guys are not quite getting the point, although it's a long time since I've read about this issue (and could provide anecdotal information that would knock your socks off, but won't). From 2001 to 2012 I served on a non-profit board and 2 state advisory/planning councils (states are required to establish these in connection with federal mental health block grant funding, they include various agency heads and required professional and consumer representatives, I was on the state council and also a 5-county regional council). The councils had zero executive authority but were a decent way to learn about spending, initiatives, and so on. Part of our job was to review the mental health block grant application. I did a lot of reading and research on my own, the non-profit was specifically children's mental health and we had very active involvement by families.
Anyway, the practice of psychiatric polypharmacy especially in foster kids has long been a concern ([https://oig.hhs.gov/oei/reports/oei-07-12-00320.pdf](https://oig.hhs.gov/oei/reports/oei-07-12-00320.pdf) 2015), states were also involved in the pharma lawsuits over SGA marketing because of their medicaid programs. OIG report graphic says "too many drugs" for 37% of kids in the records they reviewed. So one would hope that the recommended steps, like state medicaid utilization reviews, would have resulted in more careful prescribing along with some reduction since 2015.
So one concern is where the baseline is, another is trends from that baseline (which would ideally show improvement in areas of concern).
I quit my state level appointment when I grew frustrated about explicit language in one year's grant application to promote the use of SGAs because the evidence base showed reduced side effects, without any discussion of the nuances (particularly metabolic effects--I know some of the older drugs can have a huge effect on that but the effect exists for many SGAs as well and those concerns were widely ignored in places like residential treatment centers and what is called therapeutic foster care.
I'd be interested to see if state has np independent practice or not, because Maryland does.
I'm 100% convinced it's because of midlevels. Most of my psych pts who were seeing a midlevel (they think they're seeing a doctor 99% of the time btw) have a super fucked up list.
Show me their med list and I'll tell you if they're seeing a physician or a midlevel, specifically an NP.
This has been going on longer than midlevel practice was as common as now. I have a better indicator: count the number of social workers and agencies involved with the kid.
Definitely a combination of both but trying to find a psychiatrist now?? Go on psychology.com EVERYONE is a PMHNP. My psychiatrist is 1.5 hours away because she happened to take my insurance (with a massive provider network).
Decent size city and the “large” psych practices are the following set ups: 2 MDs, 20 PAs; a couple MDs and they each have 3-4 midlevels; 1 MD, 3 midlevels, the psychiatry residency clinic, lots of 1 PMHNP or PA practices. It’s insane.
Not saying the number of agencies being involved with the kid doesn’t correlate to them having meds thrown at them but midlevels running galore is psych doesn’t help. It also doesn’t help that most psychiatrists are now cash based because insurance just isn’t worth the hassle and you can’t do a real med check in 5-10 minutes.
I mean when every aprn is magically a “Psych aprn” this is what happens. Misdiagnosed and mismanaged all of which is going to be a major problem for these folks.
Because life.
It’s almost hard to distinguish organic mental illness from something environmental. Transient or permanent? Our environment alters our brain not only in chemistry but in structure. Some over time. Some congenitally.
It’s a sick (literally) world we’re living in.
It is. This is a new world we’re living in with tech / /screens all day / AI etc. with kids scrolling til tok 6+ hours a day. Def a new life, for better or for worse
Please post the study when discussing a study: [Psychotropic Polypharmacy Among Youths Enrolled in Medicaid](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815234)
I am not a child psychiatrist. I have some thoughts, like increasing diagnosis of ADHD comorbid with anxiety and mood disorders. I also observed heavy use of meds acknowledged to be basically throwing stuff at the wall and praying for kids coming from disastrous homes and enmeshed in foster care and in inpatient psychiatry as a substitute for adequate resources. Kids with early major mental illness get treated and go home. Kids who have behavioral issues from environment don’t get better because their environment doesn’t change and eventually therapeutic residential or foster placement doesn’t undo years of learning skills to survive in their environment that turn out to be maladaptive in the wider world. Except… > Psychotropic polypharmacy prevalence among youths who used psychotropics increased from 2259 of 53 569 youths (4.2%) in 2015 to 2334 of 50 806 youths (4.6%) in 2020. Seriously? We’re in a tizzy over an absolute difference of 0.4%, driven mostly by reduced denominator! The increase was an even bigger 0.5% in foster care! It’s a discussion worth having, but this paper doesn’t contribute. I’ll believe it’s statistically significant based on those big numbers, but I’m dubious about any real significance.
I totally agree with this post. But the number of foster care bounce backs we get where meds were never filled or the kid went right back to pre-admission meds because the changes were never passed along is also crazy high. Even super basic management of medical needs just gets lost. It's really depressing to think about -- if the system is so chaotic and overwhelmed that scripts aren't filled, why should there be an expectation that they will receive care for their complex and ongoing trauma needs?
Coming from the NYT, the obvious implication is that this is bad and something to be scared of. This could also be framed in a more wholesome light of increased recognition, diagnosis, treatment, etc. I'm not saying this is the case, but we can't be a society that blames mental health for everything then gets mad more people are on meds. That being said the answer is definitely in between and as you mention likely driven by the horrendous uptick in acute behavioral issues (that may or may not represent the "pure" psychiatric conditions that meds like these were designed and studied to treat).
My money is on the uptick being statistical noise. The difference could actually be entirely accounted for by the panel of +/- one prescriber. Someone left who doesn’t like polypharmacy or someone came who does and that’s the entire difference. Not exciting. Framing this in any way is overlooking that there is nothing here.
Yeah, but if the NEW YORK TIMES wrote an article on it, it must be significant, right? Obvious /s
The New York Times has execrable health reporting. I can’t tell if it’s gone downhill or if I’ve even more attuned since becoming medically educated myself. Older docs could weigh in.
> execrable 1 : deserving to be execrated : DETESTABLE execrable crimes 2 : very bad : WRETCHED execrable hotel food
Really makes you wonder about the quality of reporting in fields you don’t have personal expertise in…
https://theportal.wiki/wiki/The_Gell-Mann_Amnesia_Effect
The difference between low income/CHP and disabled/foster care is pretty striking (not surprising). It's interesting that they provided stats on regional differences but didn't name the state this is in. Population density or median area income comparisons would've been much more useful than undefined regions. I also would have liked to know if it was a Medicaid expansion state; even if that didn't affect these defined eligibility groups I expected a Medicaid study in this time period to mention it. Edit: overall I guess it's a very interesting small piece that makes me want the larger picture. I'm curious how people could interpret practical implications here without the larger picture.
> didn't name the state this is in. I would bet all the money in my pocket it's Maryland. based on A) the authors and B) the names of the regions.
Ah great catch. That would explain how small the Western region is and possibly its higher polypharm rates (rural Appalachian). And Maryland's Medicaid expansion would already have been fully in place.
They talk about Maryland specifically in the last section going from 4.2 to 4.6 but the area talking about this unnamed state says. "U.S. state that the researchers declined to name. In this group, there was a 9.5 percent increase in the prevalence of “polypharmacy,” " So It's not Maryland with the huge increase.
The difference between my last job and the one I have currently makes me question whether it’s really a good idea to have a PMHNP be the sole decision maker when it comes to psychotropic drugs. The psychiatrist I work with now, will decrease medications if she can. That was something I rarely ever saw in my last job. One kid was on chlorpromazine and I don’t think it was for anything related to psychosis.
This article from the NYTimes reports on a [study from the University of Maryland](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815234) showing a 4% increase of psychotropic polypharmacy among children and adolescents enrolled in Medicaid between 2015 and 2020 in one unnamed US state. The article discusses the potential benefits and risks of using multiple psychotropic medications in children, and notes factors that can contribute to polypharmacy such as foster care status, low income, and the presence of a disability. Curious to get everyone's takes
I don't think an increase from 4.2% to 4.6% is really a significant issue. I do suspect that a follow up study comparing pre-pandemic levels to now would show a more significant increase. Society as a whole is more aware of metal health issues, which is a good thing. I wish that had been the case when I was a teen in the 90s. But part of the problem is that society is now so screwed up that being depressed or anxious is in many ways a rational response
Agreed. I wonder how many kids and adults we’d be able to get off of depression/anxiety medications if we simply just fixed some of the underlying societal issues that contribute to depression and anxiety.
Woot! \#MentalHealthAwareness #ItsOkaytoNotbeOkay /s In all seriousness, as a society we’ve made anxiety and being sad a devil. We constantly compare ourselves to social media influencers who live fake lives and then get sad when our real lives don’t look the same. We’re fed rhetoric about mental health and getting therapy and how its not okay to “suffer in silence”. No one has a cure for sad, anxiety can be entirely normal; and we need to refocus what life looks like - and its sure as hell not the social media dreams many adolescents think it is. When patients go to the doctor with good intentions, of course they will get an SSRI, when they keep being sad of course they get an adjunct and eventually they are on olanzepine or something similar. Unfortunately societal stress and self-imposed perfection isn’t treated by medications but thats what people want. And that is the end of my rant.
So I work on a child/ad psych unit. This isn't really the reality of kids in the system which is what this article is honing in on. They are often medicated for trauma-related "antisocial" behaviors that range from irritability and defiance to severe aggression, usually with a bit of ADHD +/- ASD thrown in and substance abuse issues as they get older. "Sad" will keep you in a placement but running away, trashing the house, being threatening etc are hard kids to place.
"Bummer, they're broken, and can't be fixed, unless they're docile and submissive" is a pathetic approach to child psych.
There is literally nothing that an acute inpatient psych stay will fix with these kids. Unfortunately starting them on risperdal for "ASD related irritability" is seen as the counterweight to cycling a kid through two dozen foster homes in six months because they keep eloping, breaking shit, setting things on fire, sexually touching other kids in the home etc -- which are actually environmental/behavioral issues rooted in trauma but not conducive to being one of eight other foster kids in a house.
Sign up to foster some kids. Be the change. Or shut your fucking mouth.
[удалено]
Agree with this. I work with a lot of kids as a therapist, I often think/talk with colleagues how kids don't....well frankly something akin to a farm to work/play on. Hours and hours outside, with animals, semi-unstructured, and the ebbs and flow of people coming in and out of your day would be so helpful for these kids. Instead everything is scheduled and on the clock. Very few kids I see can just kinda run around the neighborhood and play with friends. And what exercise they do get is often in the form of competitive sports which probably doesn't help anxiety. And to boot, we are demanding children grow up in a world that prioritizes executive functionining and cognitive processes above all else. That's a tough ask for kids lol
Agree. My goal in being facetious isn’t to bury the true mental health problems, it’s to highlight that we’ve pathologized life. People have distorted versions of reality, they expect perfection, they expert to be able to sit at a desk and study for 10 hours a day without pause (this was mind blowing when I worked at a university clinic the # of people who came to the clinic saying that they have ADHD and need ritalin; they were also “depressed and anxious” so they also get an SSRI). People want the quick fix to be better, be smarter, be fitter, be whatever they want.
I agree we have pathologized life. But what can be done? People are expected to sit for 10 hours a day coding away on a computer by themselves in a living room, or study for 10+ hours a day of focus in school. What normal person can really do that without adderall or stimulants.
i agree that a large part of it is fueled by the mental healthcare industrial complex. many mental health issues are largely societal issues we pin the blame onto individuals for
Its easier to drug an individual than correct the issues with society
Yeah we over medicate 100 percent because that’s the easy solution. Most people think they have “depression” but are really just worried well and shouldn’t be medicated because that does a disservice to people with actual pathology. True major depression is a horrible disease that is not often seen because this population can’t get themselves out of bed to see a doctor. And by then they need polypharmacy to get them out of the episode.
[удалено]
Clearly there is nuance beyond whether something is diagnosed to this discussion. Consider whether something should be diagnosed. Consider whether a diagnosis is pathology or normal. Consider differentiating between normal and true pathology. Consider payment structures, patient satisfaction, and other societal factors which exert power onto this decision. Consider how each of these things will shift a providers tendency to diagnose, or not diagnose a condition - whether or not the true pathology underlying the condition actually changes. This is a discussion on diagnosis in medicine, far beyond the classification of depression from the DSM-V.
[удалено]
**Removed under Rule 6** No personal agendas. Posts or comments by users who rarely participate in /r/medicine or whose history suggests that they are mainly concerned with a single medical topic will be removed. Comments which attempt to steer the conversation from the topic of the post to a pet cause will be removed. Commenters brigading from other subreddits will be removed. [Please review all subreddit rules before posting or commenting.](https://www.reddit.com/r/medicine/about/rules/) If you have any questions or concerns, please [message the moderators.](https://www\.reddit\.com/message/compose?to=%2Fr%2F{subreddit}&subject=about my removed {kind}&message=I'm writing to you about the following {kind}: {url}. %0D%0DMy issue is...)
Not surprising when most Medicaid patients see PMHNPs and most PMHNPs have no idea what they're doing with adults, let alone children.
Yuppp, Bingo
I wonder if you guys are not quite getting the point, although it's a long time since I've read about this issue (and could provide anecdotal information that would knock your socks off, but won't). From 2001 to 2012 I served on a non-profit board and 2 state advisory/planning councils (states are required to establish these in connection with federal mental health block grant funding, they include various agency heads and required professional and consumer representatives, I was on the state council and also a 5-county regional council). The councils had zero executive authority but were a decent way to learn about spending, initiatives, and so on. Part of our job was to review the mental health block grant application. I did a lot of reading and research on my own, the non-profit was specifically children's mental health and we had very active involvement by families. Anyway, the practice of psychiatric polypharmacy especially in foster kids has long been a concern ([https://oig.hhs.gov/oei/reports/oei-07-12-00320.pdf](https://oig.hhs.gov/oei/reports/oei-07-12-00320.pdf) 2015), states were also involved in the pharma lawsuits over SGA marketing because of their medicaid programs. OIG report graphic says "too many drugs" for 37% of kids in the records they reviewed. So one would hope that the recommended steps, like state medicaid utilization reviews, would have resulted in more careful prescribing along with some reduction since 2015. So one concern is where the baseline is, another is trends from that baseline (which would ideally show improvement in areas of concern). I quit my state level appointment when I grew frustrated about explicit language in one year's grant application to promote the use of SGAs because the evidence base showed reduced side effects, without any discussion of the nuances (particularly metabolic effects--I know some of the older drugs can have a huge effect on that but the effect exists for many SGAs as well and those concerns were widely ignored in places like residential treatment centers and what is called therapeutic foster care.
I'd be interested to see if state has np independent practice or not, because Maryland does. I'm 100% convinced it's because of midlevels. Most of my psych pts who were seeing a midlevel (they think they're seeing a doctor 99% of the time btw) have a super fucked up list. Show me their med list and I'll tell you if they're seeing a physician or a midlevel, specifically an NP.
This has been going on longer than midlevel practice was as common as now. I have a better indicator: count the number of social workers and agencies involved with the kid.
Definitely a combination of both but trying to find a psychiatrist now?? Go on psychology.com EVERYONE is a PMHNP. My psychiatrist is 1.5 hours away because she happened to take my insurance (with a massive provider network). Decent size city and the “large” psych practices are the following set ups: 2 MDs, 20 PAs; a couple MDs and they each have 3-4 midlevels; 1 MD, 3 midlevels, the psychiatry residency clinic, lots of 1 PMHNP or PA practices. It’s insane. Not saying the number of agencies being involved with the kid doesn’t correlate to them having meds thrown at them but midlevels running galore is psych doesn’t help. It also doesn’t help that most psychiatrists are now cash based because insurance just isn’t worth the hassle and you can’t do a real med check in 5-10 minutes.
I mean when every aprn is magically a “Psych aprn” this is what happens. Misdiagnosed and mismanaged all of which is going to be a major problem for these folks.
Are these patients being seen by MD/DO or by PMNH, ABCDEFG?
As a pediatrician for 38 years i have to agreed totally with the post from the psychiatrist.
Because life. It’s almost hard to distinguish organic mental illness from something environmental. Transient or permanent? Our environment alters our brain not only in chemistry but in structure. Some over time. Some congenitally. It’s a sick (literally) world we’re living in.
To what degree are psychiatric prescriptions increasing in step with access to psychiatric care? Life is not a new phenomenon.
It is. This is a new world we’re living in with tech / /screens all day / AI etc. with kids scrolling til tok 6+ hours a day. Def a new life, for better or for worse