Earlier this year, Clinical Psychology Review published a meta-analysis of 22 studies showing a substantial increase in the rates of treatment for mental health problems between 1987 and 2008 driven largely by prescriptions for antidepressant medications. During the same period, not only was there a 35 percent decline in the use of psychotherapy, but negative attitudes toward therapy increased and positive attitudes decreased by 28 percent. The authors attribute this decline in the reputation of therapy to the prevalence of meds and the cultural shift they engendered in the very way people think about depression—it’s now widely, if not universally, considered a biological problem needing biological treatment. In other words, Hello, pills. Bye-bye, talk therapy.
This news isn’t entirely surprising. After all, in the age of Big Pharma, meds have flattened all before them in their virtual conquest of the mental health field. Over the years, antidepressants have come to be sold as virtual panaceas for just about any emotional trouble to which humans are prone. According to many observers, however, these drugs are wildly overprescribed, often for conditions that wouldn’t be captured even in DSM’s ever more capacious net, including general unhappiness, stress related to life circumstances, and chronic but hard-to-diagnose physical complaints. In fact, a study published last year found that in 2009, 58 percent of people prescribed an antidepressant didn’t have any psychiatric diagnosis at all—we can assume they just didn’t feel good in one way or another and the doctor didn’t know what else to do for them.
But even if meds are overprescribed, they still work for something called depression, don’t they? The claims made for this 21st-century philosopher’s stone are real and true because they’re backed up by science, right? Well, the scientific bona fides behind antidepressants doesn’t look so bona these days. Although there have been thousands of double-blinded, placebo-controlled trials, most have been done by (spoiler alert!) the drugs’ manufacturers with, shall we say, a stake in this game—hundreds of millions of dollars, maybe billions. They must sell pills and they might, just might, be tempted to publish only positive results here, cherry-pick a few conclusions there, quietly deep-six trials that don’t demonstrate what they want demonstrated, spread made-up theories for public consumption that they probably never really believed (the so-called “chemical imbalance” theory).
So are antidepressants worthless? Almost nobody in the mental health field, even the harshest critics, would go that far. Most therapists have seen struggling clients—unable to make headway in therapy because they could barely function at all through the fog of depression—take a pill and actually feel better enough to engage in the old-fashioned talking cure. And yet, if we’re honest with ourselves, watching an antidepressant accomplish what our skill and dedication couldn’t may be hard to swallow—like a little defeat for the home team by a corporate behemoth so much bigger, stronger, and richer than we are. Does Goliath really get to beat David in the end?
Not necessarily. This issue of the Networker aims to integrate our field’s clinical know-how with an evenhanded review of research results along with some generous dollops of historical perspective—all with the goal of arriving at a fuller truth of when and how psychopharmacology can enhance therapy and, in some cases, visa versa. In a culture in which billions of dollars have gone into persuading us to choose the quick, efficient miracle pill, our contributors make the case that—however useful an adjunct medication may be as a component in the treatment of depression—scientists have yet to concoct an adequate substitution for that complex, yet fundamentally old-fashioned human interaction we call psychotherapy.
Richard Simon, PhD, founded Psychotherapy Networker and served as the editor for more than 40 years. He received every major magazine industry honor, including the National Magazine Award. Rich passed away November 2020, and we honor his memory and contributions to the field every day.