According to a May 2021 poll from the American Psychiatric Association the percentage of U.S. adults who said they would use telehealth for mental health services increased from 49 percent in 2020 to 59 percent in 2021. Younger Americans are even more likely to consider virtual mental health options, with 66 percent of adults ages 18 to 29 reporting they would use telehealth for mental health. And as many as 20,000 mental health apps exist, according to a 2021 report from the American Psychological Association. “Of all the medical specialties, psychiatry is the one that lends itself the best to remote audio or video consultations,” says David Spiegel, MD, a psychiatrist and the 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 conduct physical examinations, so a careful interview 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 a medication for mental health during a telehealth visit, or through a mental health app? Previously, providers were required to evaluate patients in person before they could prescribe certain medications. At the start of the COVID-19 pandemic, the federal government relaxed these rules and began allowing certain providers registered with the Drug Enforcement Agency (DEA) (PDF) to prescribe medications virtually, with no current end date. Mental health apps can receive approval from the U.S. Food and Drug Administration, though it is not required. These apps, if not connected to a hospital, do not qualify for DEA registration approval, but practitioners can apply for this approval, per the DEA. Some mental health apps have been called out for questionable (and potentially illegal) prescription drug prescribing practices. The online prescription and therapy app Cerebral is currently under federal investigation for possible violations of the DEA’s Controlled Substances Act (which regulates the medical use, potential for dependence or abuse, and safety of drugs and other substances) related to the ADHD drug amphetamine and dextroamphetamine (Adderall), The Wall Street Journal reported in June. In a now-deleted blog post published on May 4, Cerebral’s then-CEO, Kyle Robertson, announced the company would “pause the practice of prescribing controlled substances as a treatment for ADHD such as Adderall and Ritalin for new patients, effective Monday, May 9.” Robertson left Cerebral shortly after, per a press release from the company. What happened with the Cerebral case raises the question: Is it safe to get a prescription for a mental health condition like anxiety, depression, or ADHD from an app? And if you do, what should you keep in mind to ensure that the care (and any medications) you’re getting is safe and appropriate?
4 Steps to Take Before Getting a Mental Health Medication Through an App
Seeing a psychiatrist in a traditional practice setting is much different from seeing one virtually via an app, according to Peter J. Freed, MD, a psychiatrist and a media advisor for the Hope for Depression Research Foundation. Dr. Freed has expertise in psychopharmacology, or the use of medications to treat mental health conditions. Apps may have less restrictive policies about prescribing medications, which patients should be wary of, Freed says. If you’re considering an app for getting medication to manage your mental health, think about the same factors you would when choosing in-person care, and watch out for any red flags, advises Kenneth Dekleva, MD, a psychiatrist at UT Southwestern’s Peter O’Donnell Jr. Brain Institute in Dallas, who has expertise in telehealth. “This includes quality of care, training, experience and board certification, and academic affiliations with leading medical centers,” Dr. Dekleva explains. If you’re using a mental health app like Cerebral, Hers, or Minded, all of which allow users to be prescribed medications by licensed health professionals, here’s how to safely do so:
1. Establish a Relationship With Your Provider Before Getting a Prescription
If you’re using an app to receive mental health care, Dr. Spiegel recommends you develop a solid relationship with your psychiatrist or provider over the course of several sessions before agreeing to be prescribed medication, if possible. “If you’re using remote telemedicine through an app, and you have developed a relationship with a licensed psychiatrist in your state who has carefully evaluated you, that is okay,” Spiegel says. Freed agrees, adding that if a patient receives only a quick question-and-answer session from a provider before being prescribed medication rather than an in-depth evaluation over several visits, they should be wary, especially if they feel their conversation is rushed. “If the interview felt like a formality, it almost certainly was one,” warns Freed.
2. Talk to Your Provider First About the Medication You’re Being Prescribed, Potential Side Effects, and Alternatives
Your conversations with the provider who is going to prescribe a medication should include discussing details about that medication, whether it’s right for you, possible alternatives, and potential side effects. Whether you’re receiving care in person or virtually, the National Alliance on Mental Illness (NAMI) suggests discussing the following with your provider before he or she prescribes you a medication for your mental health:
Whether medication is the right option for you right now — and the kinds of medications that are available for your conditionYour experiences with other psychiatric medications, including any you’re already takingYour health history, including whether you have other chronic health conditions and take any medications for themPotential side effects you might experience if you opt to take a psychiatric medication and how to manage them
3. Make Sure Your Provider Is Reachable and Responsive 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 reachable through the app if you have any concerns between visits. If a provider on a mental health app is not responsive to your questions or concerns outside of appointments, this is a red flag, according to Spiegel. Before being prescribed medication, ask your provider whether they’re available outside of appointments to discuss medication-related concerns like refills or emergencies, and how to reach them in scenarios like these, per experts at NAMI.
4. Check Whether Your Provider Has Any Financial Relationships With Pharmaceutical Companies
It’s helpful to know whether your provider makes money when they prescribe medication or treatment, Freed says. They may not objectively be 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, more than half of psychiatrists in the United States received some form of compensation, such as speaking and consulting fees, from pharmaceutical manufacturers, according to a study published in January 2020 in Administration and Policy in Mental Health and Mental Health Services Research. Doctors who receive compensation from drug manufacturers associated with a specific medication appear to be more likely to prescribe that medication more often than doctors who don’t receive such compensation, per an analysis published in December 2019 by ProPublica, an independent investigative newsroom.
