Over Prescribed
I.
Twenty years ago, my friend’s mom hovered nervously around the prescriptions pick-up counter in a local pharmacy. In her hand was a crumpled doctor’s requisition for her son with an order for Ritalin, a medication that masks the symptoms of ADHD.1 She stood at the counter staring at the white coats mixing and pressing and bottling pills. Then she tucked the little paper back in her purse, turned sharply on a heel, and dashed out leaving the order unfilled.
Recounting the story to her son, she still can’t articulate why she walked out that day. She attributes it to a deep-rooted hard-to-place-a-finger-on feeling that it was wrong to medicate her six-year-old son. My friend shudders at the thought of the person he may have become had his mom filled that prescription.
I don’t think you can medicate a child with amphetamines and expect them to develop into the same person as if they had learned to regulate their attention, emotions, and impulses naturally. But even if you can, that child will be reliant on medication just to get out of bed in the morning for the rest of their lives. And, as in the case of my friend, they may have never needed it in the first place.
Today, this friend is one of the hardest working and most focused people I know. I’ve lived and travelled with him, and he has no trace of any sort of attention or mood disorder. Whatever traits or tendencies his pediatrician was attempting to medicate away with that prescription, he learned to cope with on his own. And he likely developed better work ethic, tenacity, and self-belief because of it.
Although the greatest gift his mom gave him by leaving the pharmacy that day was his personal agency. Giving a kid a drug they don’t need tells them they can’t do it on their own. It seeds their malleable minds with a victim mentality; a lack of agency, learned helplessness, and negative self-talk. It teaches them to blame external forces for their misfortunes rather than digging down within themselves and building a well of resources to handle the world. A well that they will repeatedly draw upon over their life in dark, harsh, and challenging moments.
Being told you need medication to get by when your life has barely begun rips the rug of agency right out from under your feet. And agency—the capacity to act autonomously, consciously, and intentionally—is the most important ingredient to creating a good life.
II.
We are in an over-prescription crisis.
In attempt to dampen every imperfect human tendency left within us, we’re dousing ourselves and our kids with drugs. Our twenty-first century cultural values of quick-fix, low-effort solutions are driving us to pills to eradicate the responsibility of managing the messier parts of the human experience.
The management of our mood, attention, and bodyweight are the three realms of human responsibility I see most outsourced to drugs like SSRIs, SNRIs, Adderall, and GLP-1s. This increasing societal drug-dependency to help us cope with being human is a serious epidemic. Nearly half of all Canadians with a mood disorder take medication alone to deal with their problem.2 In the U.S., 16% of all adults take prescription medication for their mental health.3 And these stats are 7+ years old.
Our mood, attention, and weight are human responsibilities and, as evidenced by the 300,000 years of human existence before us, most of us have the capacity to build up the internal machinery to manage them on our own. When we refuse to carry the human burden of managing these aspects of our lives, and instead ask medication to do it for us, the tinder catches a flame that begins a slow-burning decay in the quality of our minds, bodies, and lives.
By way of a disclaimer, I’m not against drugs. Many drugs perform miracles and can help prevent, cope with, and cure illness and disease. And some people genuinely need medication to handle their ADHD, anxiety, or depression. The drugs I see as destructive are those that mask problems instead of addressing the root cause and are turned to as the lowest effort, most expedient solution.
III.
Mood medications to treat anxiety and depression should be used as a life raft for those who are in a dark state of mind and are having thoughts to do something irreversible, such as suicide or self-harm.
But most people on mood meds are not suicidal. And while life rafts are great in emergencies, you wouldn’t want to cross the ocean in one.4
For the average person experiencing bouts of anxiety or depression, using these drugs is the equivalent of amputating a foot because of an ingrown nail. SSRIs and SNRIs, common anxiety and depression medications, can induce side effects like suicidal thoughts, weight gain or loss, insomnia, muscle spasms, heart arrythmias, sexual dysfunction, and God knows what else. These meds substitute normal, manageable human feelings with real, hard to fix, potentially life-threatening problems.
This is a tragedy because, as far as I can tell, most mood disorders are downstream of how we choose to live our lives.
Here’s an interesting stat to back this claim: prescriptions for anti-anxiety medications rose by 34% in the initial months of the COVID pandemic.5 The average pandemic lifestyle was one of isolation and sickening amounts of screen time. People sat inside, binged TV, scrolled social media with a newfound ferocity, doomscrolled news feeds, ordered everything from socks to supper online, and smoked and drank too much. In-person connection was eliminated completely, and almost no one got enough sunshine or exercise. The pandemic not only provided proof that your lifestyle can make you anxious and depressed, but it also showed us the type of lifestyle that is certain to do so.
Many people who find themselves unable to cope with anxiety and depression are still living a pandemic lifestyle. Then to fix the problem, they’re reaching for pills as the easiest solution on the shelf, while continuing to scroll TikTok and order DoorDash, rather than making the hard lifestyle changes that will get to the root problem. And like wrapping the leaking pipes below your kitchen sink with duct tape, quick effortless solutions are almost never effective over the long-term.
I learned from a visit to the ER in 2019, in which I thought I was having a heart attack that was really just a panic attack, that I subconsciously struggle with anxiety. I still have moments when it feels like a bag of bricks is sitting on my chest. But I’ve never considered taking medication for it because I’ve internalized that anxiety is a normal emotion that will eventually pass and can be managed with a little bit of effort. I know from experience, which studies have confirmed, that the best cures to anxiety and depressive episodes are movement, sleep, good food, time outdoors, social connection, kind deeds, and offline hobbies.
Put differently, the key to mood management is getting outside of yourself. Get out of your head and into your body. Get out of your home and into the outdoors. Get out of your selfish self-prioritization and do something of service for someone else.
Another big piece of coping with these emotions is recognizing that bouts of anxiety and depression are foundational to the human experience. Feeling them is no different than feeling joy, surprise, sorrow, and excitement. It’s not a popular message, given our modern expectation that everything should be perfect all the time, but we have to accept that we won’t always feel great. If we don’t, any negative feelings we experience will compound from the judgement that stems from non-acceptance. Sometimes we’ll feel down, and we won’t know why, and we’ll just have to ride it out until we turn the corner.
IV.
Another one of my friends was told by a therapist that they may have ADHD and should consider medication. This person has a five-year undergrad degree and is almost through a four-year post-grad. And they don’t even drink coffee to focus.
If someone purportedly displays ADHD tendencies, but has been successful in their life’s pursuits without pharmacological assistance, why would you suggest medicating them? We all have unique traits that exist on a spectrum. And like experiencing anxiety or depression, having above average hyperactivity or below average focus are just variations of the human condition. By definition, a disorder implies functional impairment. Unique variations of the human condition should not be medicated unless they impair one’s ability to live in a way that cannot be overcome through individual effort.
More importantly, attention is earned.
We seem to have forgotten this in a haze of ambitious over-medication, but the ability to focus, especially on something challenging for long periods of time, is hard work. It’s not supposed to be easy. Attention can be developed by consistently focusing on challenging tasks for increasingly long periods of time. But just as our attention muscles can be strengthened, they can also atrophy.
During the pandemic, when social media and screen use skyrocketed, prescriptions for stimulants to treat ADHD more than doubled.6 Furiously scrolling social media feeds while reality TV reruns play in the background destroys our ability to focus.
Many attention disorders are just internet addictions.
The most impactful force that shapes our attention span is how we choose to spend our leisure time. Low-quality leisure cultivates an inability to pay attention. But high-quality leisure, like reading a good book, carving a soapstone bear or a wooden spoon, taking a course, playing pickleball, gardening, cooking for friends, swimming at the local community centre, or quite literally anything that is not on a screen, trains your brain to relish slow, challenging, and ultimately more meaningful tasks.
When your leisure becomes consistently analog, you will be rewarded with a mind that can bask in the joy of slowness and focus for long periods of time. Your attention will improve, your brain will become boredom-proof, and your life will become more interesting and enjoyable.
V.
The world found its miracle weight loss drug in GLP-1s like Ozempic and Wegovy. But alas. If it sounds too good to be true, it probably is. Despite the numerous physiological drawbacks of these drugs, like loss of lean muscle mass, significant weight gain upon discontinuation, gallbladder issues, potential thyroid cancer risks, permanent blindness (!!), etc., the quality-of-life and spiritual drawbacks may be even greater.
The thread I’ve tried to weave throughout this essay is that the management of our mood, attention, and bodyweight are aspects of the human condition that are our responsibility to handle, and to equip our children with the tools to handle. But with the rise of drugs that can manage them for us, too many of us have sidestepped the responsibility of doing so. And sidestepping responsibility has serious consequences.
Before being shot in the street, Uncle Ben said to Peter Parker (aka Spiderman), “With great power comes great responsibility.” The reverse is equally true. With great responsibility comes great power. When you seek out real responsibility and carry it earnestly, you’ll forge an inner power and belief in yourself that can only be built by choosing a big boulder and pushing it up a steep hill.
This is the story of Sisyphus in Greek mythology, who was forced, for eternity, to roll a boulder up a hill only for it to roll back down every time he neared the top. Although it was meant as a punishment, those of us who have achieved something or arrived somewhere know the human condition isn’t too different. As soon as we crest the top of the hill, the boulder rolls back down, and we begin again.
The most important aspect of the pursuit of physical fitness and health is the type of person you become along the way. The outcome of a lean and muscled stature is significantly less meaningful than the traits you develop and the crevasses of your psyche you discover as you pursue a healthy body. And health is a journey that does not end. So, if you fast-forward to skinny with Ozempic, you’ve achieved the result without becoming the person that is capable of achieving those results. You’ve robbed yourself of the journey of becoming. And that’s all that life is: a bunch of journeys layered on top of each other and placed side by side stretching from birth to death. If you strip the significance from those journeys, you lose the meaning in your life.
I’m not saying that these drugs never have a place. But as a society, we’d be physically and spiritually healthier if we chose the slow, grinding path of pointing to where we want to go and owning the daily hardship it takes to get there. I can say with a certainty that comes from lived experience that if you step onto the path and walk it for long enough, you will no longer yearn for the destination that kickstarted your journey because you will have fallen in love with the day-to-day process of becoming.
VI.
The solution to this over-prescription crisis is adopting a high agency lifestyle: choosing to take responsibility for your life and, in doing so, making it uniquely your own.
To live with agency requires a basic level of in-touchness with yourself to first understand what you, as an N-of-1, want your life to look like. But it’s hard to figure out who you are and what you want if you live like a rock submerged under white water rapids, letting the noise of news and TV and social media drown you out while invisibly, but surely, eroding and shaping you.
Screens shepherd us into a passive existence of sitting and observing other people live. The human response to consuming online content is never a slow, sturdy sense of joy and fullness, but rather hollowness, jealousy, and malaise. Layer this not-enoughness with the fact that if we’re on a screen, we’re not doing the analog stuff that makes us feel good (exercise, sunlight, friends, cool hobbies, helping people, etc.), and it’s not surprising that more and more people are turning to drugs for quick solutions to focus, shed pounds, and relieve the anxiety or depression that their choices, or rather lack of conscious choices, created in the first place.
I struggle with all of these things and have friends and family who take medications for anxiety and focus. Our modern environment is not conducive to well-being. Screens target the same reward pathways in the brain as cocaine and heroine. They are designed to make you an addict. So quitting them is some of the hardest, but most rewarding, work you can do. Winning the digital war is a daily battle that will force you to cope with a lot of uncomfortable feelings from boredom to FOMO.
When you delete social media, you’ll miss out on group chats and your “friends’” latest Instagram posts. When you throw out the TV, you’ll fall out of touch with the latest series and face temporary boredom as you figure out how to spend the dozens of hours a week you used to spend zoned out in the undertow of a glowing screen. And when you quit doomscrolling the news, you’ll feel “uninformed” and “out of touch” with the world. But as time passes, you’ll realize that none of these things were improving your life. Social media wasn’t social. TV wasn’t relaxing or restorative. The news wasn’t making you more educated or worldly.
As the weeks go by, you’ll watch your friendships grow stronger because instead of passively observing their carefully cultivated life on Instagram, you’ll schedule time together to call and go for walks and grab coffee. Without a TV, you’ll discover skills, hobbies, friendships, and interests that would have never been revealed to you if your evenings were filled with shows. And you’ll realize the news never provided you with actionable, life-enriching information but rather just hijacked your brain with the worst things that happened in the world today. As you gain distance, you’ll become less involved in this weird online world, and more rooted in your real-life in-person community. These changes will be extremely uncomfortable and will force you and your relationships to evolve, but it’s a worthwhile fight.
Over years of living in this way, the wedge of agency will drive your life so far away from the default way of living that you won’t recognize your former self. You will have acquired skills, hobbies, friends, and tastes, and discovered a new depth to your most important relationships that would have been left unearthed had you spent those years in front of a screen. And your mood, attention, and weight will manage themselves.
No matter how hard it is to ditch your online additions to live in a more analog way, the most compelling reason to change is how much life you’re leaving unlived if you don’t.
It would be a tragedy to realize when it’s too late that you spent too many evenings shoulder to shoulder with your partner on the couch, and not enough on your hands and knees in the garden, chasing your kids through the rain, reading books that break and open and mend your heart or, in whatever way that calls you, building an unmedicated life that is unmistakably your own.
With love and humility,
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I say “masks” not “treats” the symptoms of ADHD because, to me, treatment implies a solution that causes or contributes to a permanent long-term resolution. ADHD medication does not meet this criteria as it must be taken indefinitely for the patient to experience the benefit of the drug.
I attribute this analogy to my brother, Tommy Dixon, who kindly edited this essay.
Yes, yes, yes!
I could talk about this topic for hours and if you were in the States, I'd love to buy you a coffee to do so with you. Glad to see you back, Jack.