The use of psychotropic drugs in survivors of human trafficking
As psychiatrists who are also Christians, we evaluate and treat patients who have experienced many types of trauma, including trauma in childhood, adolescence, and trauma extended into adulthood. Prolonged, chronic trauma can be particularly damaging, affecting the minds, brain, spirits and bodies of victims, sometimes causing persistent physical and mental health problems, even when people are living under the Grace and Lordship of Jesus Christ.
- For survivors of human trafficking, mental health consequences include:
- Mood disorders (such as Major Depressive Disorder, Bipolar Disorder)
- Anxiety disorders (such as Post-Traumatic Stress Disorder, Panic Disorder, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder)
- Personality disorders (such as Borderline Personality Disorder, Avoidant Personality Disorder, Dependent Personality Disorder)
- Dissociative Disorders
- Substance use disorders.
Established standards guide the diagnosis and treatment of such conditions. Those guidelines indicate best practices for the use of when psychotropic medications in these cases.
Mental health care for such patients should be interdisciplinary and include a careful psychiatric evaluation by a psychiatrist with expertise in treating traumatized persons. This is particularly important, since many patients have symptoms that could be caused by:
- Medical disorders
- Psychiatric disorders
- Substance use
- Life stressors including relationship or job problems
These overlapping symptoms can include:
- Somatic complaints (such as headaches, stomach and bowel symptoms, and genitourinary symptoms)
Differentiating the cause of such symptoms requires medical expertise since it is frequently difficult to sort out whether the psychiatric disorder began before the trafficking episode (such as Attention Deficit Disorder starting in childhood), or is the result of trauma experienced during the trafficking scenario.
Either way, ethical treatment for many of these conditions will often involve both psychotropic medications (such as antidepressants, mood stabilizers, anti-anxiety medications, sleep medications, stimulants, antipsychotics) and intensive psychotherapy. As psychiatrists, we hold that it would be inhumane and a departure from established best practice to withhold needed medications, psychotropic or otherwise, from survivors of sex trafficking, or anyone else for that matter, simply because they are at high risk for substance use disorders.
Naturally, prescribers must be aware of the possibility of abuse and diversion in any high-risk population, being judicious in their use of benzodiazepines, stimulants, or opiates. Good clinical judgment will take into account the many factors that affect survivors of trafficking, including their partners and living situations.
Use of antidepressants, mood stabilizer, antipsychotics, and many other commonly prescribed medications in psychiatry practice should not be prevented in this population, since these may be lifesaving treatments for serious psychiatric and medical conditions.