Barriers to mental health care: Potential risks of self-medication

Physicians facing mental health struggles may medicate themselves in hopes of treating their conditions. This can be risky behavior. Daniel Saddawi-Konefka, MD, MBA, and Christine Yu Moutier, MD, are co-authors with Jesse M. Ehrenfeld, MD, MPH, of the special communication, “Reducing Barriers to Mental Health Care for Physicians: An Overview and Strategic Recommendations,” published in JAMA. Here they explain why this behavior is extremely concerning to advocates for physician health and wellness.

Medical Economics: You wrote that many physicians overestimate their ability to manage their health independently, self-medicating behavior is common. How frequently does that occur, and what risks does that create for the physician, for their occupational status and for patient care?

Daniel Saddawi-Konefka, MD, MBA:In terms of how common it is, the published reports show that between 9 and 15% of physicians report having self-prescribed antidepressants at some point. And that's not a sample of physicians with depression, that's a general sample of physicians. An additional 7% report getting antidepressant prescriptions informally from colleagues who are not in treatment roles. You know, I'll talk about maybe some of the risks there, I think Dr. Moutier will probably have more to add. I see some significant ones for personal health, in terms of bypassing proper diagnostic evaluation, treating the wrong conditions, approach to medication management, those sorts of things. There's also, because of state medical board regulations, some potential legal vulnerabilities from self-prescribing these medications as well.

Christine Yu Moutier, MD: The suicide literature for physician suicide decedents versus the general population decedents shows that physicians are who die by suicide are as likely to have been suffering from a mental health condition, but are less likely to have been in any kind of formal treatment. And in fact, the self-prescribing may sort of thwart and divert from getting actual treatment, because what we might do in the short term is try to treat the short term symptoms of insomnia or anxiety, and that may really actually prohibit the ability to have that full assessment to understand what is actually going on. And, you know, there's still stigma amongst physicians, to see a psychiatrist and to get a full assessment, just like you would if you weren't sure — if it was a physical health matter, a serious one, you would go to a specialist, and you would find the one that you trust and work with them. And so the other thing in the suicide literature that's very concerning is that the method of death is much, much higher in terms of toxic substances being there in the toxicity reports for physician suicide decedents. So I actually view it as something that, it's an issue of of of a high importance, that can present dangers for individuals, because when you're not well and you're trying to self manage that can really lead to not only ineffective treatment, but actually increasing the dangers and the risks.