Is it safe to get mental health medication from an app?

Virtual mental health care options (including filling prescriptions for mental health medications) are steadily increasing, from virtual appointments with clinicians in traditional practices to mental health apps. Their popularity is also increasing.

According to a American Psychiatric Association May 2021 Poll the percentage of American adults who said they would use telehealth for mental health services increased from 49% in 2020 to 59% in 2021. Young Americans are even more likely to consider virtual mental health options , with 66% of adults aged 18-29. they would use telehealth for mental health.

And as many as 20,000 mental health apps exist, according to a American Psychological Association 2021 Report.

“Of all the medical specialties, psychiatry is the one that best lends itself to remote audio or video consultations”, said David Spiegel, MDpsychiatrist and Wilson Professor of Medicine at Stanford University School of Medicine in California, as well as director of Stanford Medicine’s Center on Stress and Health. “We rarely perform physical exams, so careful maintenance is crucial but can be done remotely.”

But can virtual mental health care provide all the services that in-person care can? Is it safe for a clinician to prescribe mental health medication during a telehealth visit or through a mental health app?

Previously, providers had to assess patients in person before they could prescribe certain medications. At the start of the COVID-19 pandemic, the federal government relaxed these rules and started allowing some suppliers registered with the Drug Enforcement Agency (DEA) (PDF) at prescribe medication virtually, with no current end date.

Mental health apps can receive approval from the US Food and Drug Administration, although it is not required. These applications, if not connected to a hospital, are not eligible for DEA registration approval, but practitioners may apply for such approval, in accordance with the DEA.

Some mental health apps have been called out for questionable (and potentially illegal) prescription drug prescribing practices.

Online prescription and therapy app Cerebral is currently under federal investigation for possible violations of the DEA Controlled Substances Act (which regulates the medical use, addiction or abuse potential, and safety of drugs and other substances) related to ADHD medication amphetamine and dextroamphetamine (Adderall), The Wall Street Journal reported in June.

In a blog post now deleted published on May 4, Kyle Robertson, then CEO of Cerebral, announced that the company “suspend the practice of prescribing controlled substances as ADHD treatment such as Adderall and Ritalin for new patients, effective Monday, May 9.

Robertson left Cerebral soon after, according to a Press release of the society.

What happened with the Cerebral case begs the question: is it safe to get a prescription for a mental health condition like anxiety, depression, or ADHD from an app? And if so, what do you need to keep in mind to ensure that the care (and medication) you receive is safe and appropriate?

4 Steps to Take Before Getting Mental Health Medicine Through an App

According Peter J. Freed, MD, psychiatrist and assistant professor of clinical psychiatry at Columbia University in New York, and media adviser for the Hope for Depression Research Foundation. Dr. Freed has expertise in psychopharmacology, or the use of drugs to treat mental health issues.

Apps may have less restrictive policies on prescribing drugs, which patients should be wary of, Freed says.

If you’re considering an app for medication to manage your mental health, think about the same factors you would when choosing in-person care and watch out for red flags, advises Kenneth Dekleva, MDpsychiatrist at the Peter O’Donnell Jr. Brain Institute at UT Southwestern in Dallas, who has expertise in telehealth.

“This includes quality of care, training, experience and board certification, and academic affiliations with major medical centers,” says Dr. Dekleva.

If you’re using a mental health app like Cerebral, Hers, or Minded, all of which allow users to get medication prescribed by licensed healthcare professionals, here’s how to do it safely:

1. Establish a relationship with your provider before getting a prescription

If you use an app to receive mental health care, Dr. Spiegel recommends that you develop a strong relationship with your psychiatrist or provider over several sessions before agreeing to prescribe medication, if possible.

“If you’re using telemedicine remotely through an app and you’ve developed a relationship with a licensed psychiatrist in your state who has carefully evaluated you, that’s okay,” Spiegel says.

Freed agrees, adding that if a patient only receives a brief question-and-answer session from a provider before being prescribed a medication rather than a thorough assessment over multiple visits, they should be wary, especially if he feels his conversation is rushed. “If the interview looked like a formality, it definitely was,” Freed warns.

2. Talk to your provider first about the medications you are prescribed, potential side effects and alternatives

Your conversations with the provider who is going to prescribe a medication for you should include a discussion of the details of that medication, whether it is right for you, possible alternatives, and potential side effects.

Whether you receive care in person or virtually, the National Alliance on Mental Illness (NAMI) suggests discussing the following points with your provider before they prescribe medication for your mental health:

  • If medication is the right option for you right now – and the types of medication available for your condition
  • Your experiences with other psychiatric medications, including those you are already taking
  • Your medical history, including whether you have other chronic health conditions and whether you take medication for them
  • Potential side effects you may experience if you choose to take psychiatric medication and how to manage them

3. Do Make sure your supplier is reachable and responds to your questions and concerns

Mental health apps are often promoted for their accessibility, and it’s important to make sure your provider is easily accessible through the app if you have any concerns between visits. If a provider of a mental health app doesn’t respond to your questions or concerns outside of appointments, that’s a red flag, Spiegel says.

Before you get prescribed medication, ask your provider if they’re available outside of appointments to discuss medication issues like refills or emergencies, and how to reach them in scenarios like these, according to experts from Nami.

4. Check if your supplier has financial relationships with pharmaceutical companies

It is useful to know if your supplier make money when they prescribe medication or treatment, Freed says. They may not be objectively considering the pros and cons of certain medications for your needs if they do, Freed says. The same goes for in-person care.

Between 2016 and 2017, according to a study published in January 2020 in Mental Health Administration and Policy and Mental Health Services Research.

Physicians who receive compensation from drug manufacturers associated with a specific drug appear to be more likely to prescribe that drug more often than physicians who do not receive such compensation, according to a analysis published in December 2019 by ProPublicaan independent investigative newsroom.

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