Our Love Affair with Psychotropics

Psychopharmacology: We Can Fear It. We Can Fight it. Could We Integrate With It?

Rich Simon

PharmaCoverEarlier 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. The July/August 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.


Topic: Psychopharmacology

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Wednesday, July 16, 2014 2:05:53 AM | posted by Mary Miller
As a med prescriber AND therapist with 30 years of psychiatric experience in a number of different settings, I have seen meds work in general alone (ADHD inattentive type), I have seen therapy work alone, and I have seen meds AND therapy needed. I don't think there is ONE answer. It depends upon the person, the problem, the situation and the history of ALL factors essentially.There is no ONE answer for everyone or situation. We should be THANKFUL there are so many CHOICES of therapy, meds and types of providers. MHM, APRN

Monday, July 14, 2014 12:12:09 AM | posted by Christina Veselak
I'm sure that most therapists reading this article were taught in school, as I was 30 years ago, that if we believe our client's symptoms are due to a biochemical imbalance, our only option is to refer them to psychiatrists for medication. As a mental health nutritionist, I have found that many biochemical symptoms can be easily, safely and effectively reduced by stabilizing blood sugar levels, getting hormones balanced, and using amino acids, which work in 10 minutes vs 6 weeks! I so believe in feeding the brain what it really needs before tweaking it with meds. I think it is so sad that as psychotherapists, we are not seriously taught what our brains actually need in order to function optimally. The Standard American Diet just does not cut it!!! I have also helped many people use amino acids to taper off prescription drugs with many less side effects than if they were trying to do it without any neurotransmitter support. We live in such a reductionist society. I think that most complex situations are a combination of biochemical imbalances (we know that childhood trauma can lower serotonin levels for life until addressed) which we can usually address nutritionally, and life issues which require therapy. Just like addiction is a bio-psycho-social-spiritual illness where all four legs needs to be addressed at approximately the same time for successful recovery to take place, I think the same is true for most other mental and emotional disturbances.

Sunday, July 13, 2014 10:47:48 PM | posted by Colleague Last Name
Like donnac3 I have been moving over the last ten years more and more to a combination of neurofeedback and therapy. Many of my referrals these days are clients for whom medications haven't worked, clients who are nervous about long-term medication, and clients for whom medication works but side effects are problematic or a barrier to safe conception. It's wonderful to offer them an option to medication..

Typical results are elimination or reduction in dosage and/or number of medications taken.

I also get referrals from other therapists for neurofeedback alone as adjunct treatment. Typical feedback I get back from the referring therapists is that the client is more able to effectively use the work done in therapy.

Catherine Boyer, MA, LSCW
New York Neurofeedbacka>

Sunday, July 13, 2014 8:43:38 PM | posted by jenniferb5
As a psychologist and a person who suffers with OCD "big pharm" may have gone too far in it's attempts to profit (as does every other company in the U.S. and nationally). However, many of these medications work, and "talk therapy" doesn't work. In the field of psychiatry, psychology and neuroscience there should be a call to action to figure out what works for what. Frankly, a lot of it is obvious. However, the NIMH insists on wasting money redoing the same experiments over when the results have existed both clinically and in the research for decades. Enough already. We need both and we need the NIMH, who is poorly funded at this point to get it's priorities set straight. Our best researchers (neuroscientists) can't get funded anymore and are being forced to work at drug companies. So, what are we (as a nation) doing to support these researchers? What are our universities (Columbia, NYU and so on) doing to support their best professors and researchers? Complain all you want but if all we have left is "pharm" to support our best neuroscientists, it will be our fault for not being more on top of the NIMH. You want the answers to these questions. You will never get them because we are losing are very best. Thank you NIMH. :)

Sunday, July 13, 2014 8:23:47 PM | posted by Paul Feiger
For the last 10 years I have been using the client's hypnosis to deal with anxiety, depression, ptsd, and any number of behavioral problems. The success rate (determined by the client) has been very high. I know that the chemicals used to treat patients can have a very beneficial short time effect. It is getting to the core problem which is the most important matter. Talk therapy is very beneficial with, what used to be called, Axis I disorders. Personality disorders, not even recognized by insurance companies for payment of services, are more wide spread and hypnosis has been found to be the most effective process in treating these disorders..

Sunday, July 13, 2014 3:59:18 PM | posted by donnac3
I am trying to shift people to neurofeedback + therapy. High success rate with regular treatment, no side effects and no dependence issues. Clients feel empowered because they did it. I am distressed at the number of kids put on heavy-duty psychotropics with no research to even support it. I'm afraid it will take some pricey lawsuits to impact this dangerous practice.

Sunday, July 13, 2014 3:50:32 PM | posted by Marylein Davies
I am watching clients who have been on meds for years including antidepressant and antianxiety meds want to go off and find this almost impossible even of the taper is very slow.

Sunday, July 13, 2014 3:44:35 PM | posted by teresac
As a therapist, I have seen great outcomes with meds, but ONLY meds + psychotherapy for long lasting change. I don't agree with prescribing meds as the only treatment. The way I explain it to my clients is that it can be very hard to start to learn to think in a different way. Oftentimes medication makes that easier. Once it becomes easier, the path is about learning and practicing a new way of thinking. My clients usually stay on meds for a year or less. Once they have learned and practiced their new way of thinking, they can often go off medication and it's much easier to continue that practice. I think of it more in terms of neuroplasticity and changing the brain. You can do it without medication, it's just a lot harder. And if there is an easier path with a higher success rate, I say go for it.

Sunday, July 13, 2014 3:08:31 PM | posted by laurah4
As a medication prescriber, I find the risks and lack of full healing from medications are less acknowledged. Therapists may easily refer difficult clients and are using the information that dual-treatment concepts are more efficacious. And the prescribing community often believes the neurotransmitters are paramount. However, over a lifetime, there are side effects, loss efficacy, lack of truly determining causes of underlying mental/emotional distresses and the client ends in illness when therapy is shortened. I see the very medications to treat anxiety (BZDs). cause anxiety, addiction, confusion, dissociation, emotional lability. I see the frantic demands for a new medication to magically take depression away, and they don't and it leads to a somatic disease of "something is wrong with me". I see Bipolar medications have side effects leading to non-compliance and ill health. I see antipsychotics cause psychosis in someone that is not. Do Not Ever short good, deep therapy!

Sunday, July 13, 2014 2:44:08 PM | posted by First Name Last Name
I've seen various forms of psychotherapy work "miracles" for people. I've seen a lot of failures and many mediocre results. I've seen many forms of psychotropics work "miracles" for people. I've seen a lot of failures and many mediocre results. Don Acorn LCSW LADC CCS