Therapeutic Efficacy of Cash in the Treatment of Anxiety and Depressive Disorders: Two Case Studies

A report from the Bonkers Institute for Nearly Genuine Research that discusses two cases in which complete relief from depression was achieved following the administration of large sums of money to the patients. Methodius Isaac Bonkers, M.D., Principal Investigator

Depression and anxiety are the most common mental disorders in America, affecting more than 60 million patients every year. Pharmacological interventions dominate the medical management of these disorders and may include selective serotonin reuptake inhibitors (Prozac), norepinephrine reuptake inhibitors (Strattera), monoamine oxidase inhibitors (Emsam), benzodiazepines (Valium), azaspirodecanediones (BuSpar), and any number of similarly efficacious drugs or drug combinations prescribed in accordance with strict FDA guidelines, or not, based on the treating physician's better judgment.

Since mental illness is a lifelong condition with no known cure, the successful psychopharmacological management of disorders such as depression or anxiety can be challenging. Treatment with medication almost inevitably results in side effects requiring additional medications leading to additional side effects necessitating still more medications in a self-perpetuating cycle that finally ends when the patient dies or the insurance runs out.

This report discusses two cases in which complete symptomatic relief was achieved following the administration of large sums of money to the patients. The comparative safety, efficacy, and tolerability of cash is assessed. Based on our findings, the clinical utility of monetary incentives in the form of cash deposits or lump sum payments directly to patients should be reappraised as a viable alternative therapeutic modality for the treatment of mild, moderate or severe cases of anxiety with or without co-occurring depression. Cash payment should also be considered the treatment of choice for all major depressive disorders including mild, moderate and severe clinical or sub-clinical depression, depressed moods, or any and all dysthymic, cyclothymic or depressive symptoms appearing with or without comorbid anxiety disorders.

Case report 1:

The patient is a 52-year old male with a history of depression. He reported feeling sad at various times throughout his life but did not seek treatment until age 51, when the factory where he had worked for 23 years was permanently shut down, costing him his pension and health insurance the same year his wife was diagnosed with terminal cancer. The patient was initially prescribed Paxil 20 mg, but after complaining of sleeplessness and expressing suicidal ideation, the dosage was increased to Paxil 40mg with Ambien 10mg prescribed for insomnia. Depressive symptoms improved somewhat, but constant diarrhea, headache and nausea grew intolerable, so a switch from Paxil to Zoloft 50mg was tried. Within 5 weeks the therapeutic effects of Zoloft became readily apparent: the patient stopped worrying about the future and no longer seemed concerned about his wife's failing health. Numerous treatment-emergent side effects were observed but the patient was reassured by his physician that chest pain, skin rash, constipation, tremor, dry mouth, hypertension and palpitations were not life threatening. One month later, pharmacotherapy was discontinued because the patient refused further treatment, claiming to be cured after winning $200,000 in the Illinois State Lottery. A computed tomographic brain scan confirmed the patient had indeed fully recovered (see images below).

[image] Brain scan of depressed patient.
[image] Brain scan of lottery winner

Case report 2:

The patient is a 27-year old female diagnosed with generalized anxiety disorder. She reported feeling nervous and fearful most of the time, constantly worried about one thing or another, and doubted her fitness as a single mother of four children aged 1-4. The patient responded well to Xanax 0.25mg with only minor side effects including dizziness, impaired coordination, and blurred vision. One month into treatment, the positive effects of Xanax 0.25mg diminished noticeably, but symptoms again improved when the dosage was doubled to 0.5mg. Two weeks later, following a traffic accident for which she was ticketed, the patient reported feeling more anxious than ever, complained of nausea and vomiting in addition to increased dizziness and blurred vision, and now exhibited signs of depression as well. After several difficult weeks the patient was weaned off Xanax, whereupon combination therapy with Lexapro 10mg and Cymbalta 60mg was initiated. At the regularly scheduled 3-month follow-up examination, all symptoms of anxiety and nervousness had completely disappeared. The patient reported zero medication side effects, explaining that she had discarded the unopened packages of Lexapro and Cymbalta upon learning she had inherited $250,000 from a distant relative. Laboratory tests were unable to verify any causal link between the inheritance of a quarter of a million dollars and the patient's subsequent recovery, but ongoing clinical evaluation and comprehensive reassessment confirmed significant improvement from baseline. Positive outcome was corroborated by visual examination of a mood ring worn by the patient (see images below).

[image] Suffering from chronic anxiety, patient's mood ring appears green, indicating tension.
[image] After inheriting $250,000, patient's mood ring appears blue, indicating tranquility.

Analysis and Conclusions

The brain chemistry of depression and anxiety is not fully understood. However, a growing body of evidence supports the view that people with these disorders have an imbalance of the brain's neurotransmitters. (Lexapro Product Brochure, Forest Pharmaceuticals, 2007.)

Psychiatric medications relieve symptoms of depression and anxiety by restoring chemical balance within the brain, but exactly how these drugs restore the brain's chemical balance while simultaneously wreaking havoc on every other organ in the body remains a mystery. Equally mysterious is the mechanism by which cash payments provide therapeutic benefit to depressed and anxious patients. The receipt of a large sum of money may somehow stimulate, increase, block, adjust or otherwise act upon the level, supply, transmission, inhibition, secretion or bodily excretion of dopamine, serotonin, norepinephrine, acetylcholine, gamma-aminobutyric acid, dihydrogen monoxide, propylene glycol or some other chemical compound yet to be discovered.

Elation and euphoria are the most common side effects associated with cash. The favorable side effect profile and high response rate compared to placebo are the main advantages of cash over standard pharmaceutical treatment, while the major disadvantage of cash would appear to be its prohibitive cost. However, retrospective analysis supports the hypothesis that over the long haul cash is not only safer but also more cost-effective than any medication currently on the market.

A depressed and/or anxious patient is typically maintained for an indefinite period of time on two or more psychiatric drugs simultaneously, in addition to numerous other medications prescribed to control side effects ranging from diabetes to high blood pressure to urinary incontinence to insomnia to everything in between. The cost of maintaining a patient on a standard treatment regimen of half a dozen or more prescription drugs might easily surpass $1,200 per month, amounting to roughly $150,000 over the course of ten years, or nearly $300,000 after 20 years. Seen in this light, a lump sum payment of $100,000 or even $200,000 would be a genuine bargain by comparison. Cash-strapped state Medicaid programs squeezed by escalating pharmaceutical costs would be well-advised to adopt formulary guidelines and preferred drug lists authorizing pre-approved cash payments as a treatment alternative.

In a random survey, 3,964 Medicaid patients were asked whether they would prefer to receive various combinations of prescription drugs for the rest of their lives, or a single lump sum payment of $250,000. The vast majority (99.93%) chose the cash option. A total of 3 patients (0.07%) elected to continue receiving medications in lieu of cash. All three of these patients appeared to be truly sick, and in each case the illness was iatrogenic (i.e., resulting from treatment).

Of course, this is a satire.