The way the research is going, ailments like mild to moderate depression and anxiety can be treated most effectively with evidence-based treatments such as cognitive behavioral therapy. Not only that, but the therapists need not be all that skilled save for basic training… not only that, but some studies have shown that patients who use a workbook without any therapist at all show benefits from CBT.
So three months of therapy, or, perhaps, just a $20 workbook, can do the work of medication or years of intensive therapy. I can personally vouch for this, having been in therapy and on various medications for 8 years before one three-month session of prolonged exposure dramatically alleviated my PTSD symptoms.
Compare the $960 I spent on prolonged exposure (administered by a lowly Ph.D. student) to the $10,000+ I spent on medication and therapy by so-called ‘‘experts’’ that didn’t work.
The science isn’t good for business. Is it any wonder this information is not more widespread?
Also, re: mental health parity and safety and efficacy standards. The standards are piss-poor for other medical studies as well. The simple matter of fact is that a lot of drugs, psychotropic or not, are approved by the FDA based on shit science. It’s a racket that’s not in any way limited to the mental health field.
I completely believe medication can be effective in certain circumstances, and I’ll admit I find the result on schizophrenia surprising. It actually brings to mind the studies about how schizophrenics in the Western countries have the poorest outcomes worldwide. It has always been assumed this is due to family structure and the intrusiveness of case-management intervention… but now I have to wonder if access to medication might have something to do with it as well.
By the way there is a practice, especially on the international market, of “shopping” for study results. While it is required that certain methods of testing be used, and that methods be uniform across testing sets, it is not required that every test set be submitted. Since the amount of money needed to run a small study is trivial to a multinational drug company, half a dozen testers can be contracted in multiple countries, and the methods selected on the basis of results in line with the manufacturer’s desire can then be duplicated in more stringent markets. It does not produce “fraudulent” results, but when comparing at the levels needed to show “improved effectiveness” it can be quite helpful.
It would be far more reasonable to have drugs tested in progressively wider studies based on increasing subject populations by third party investigators as a part of the approval procedure, and also require corporations to divulge all test results known to them.
I am not anti drug, nor even anti Pharmaceutical Corporations. But I think what is implied by FDA Approval should be a very stringent set of criteria, meeting very strict standards for transparency, and duplicability.
Can anyone provide information about the specific studies that the author cites to support his claims? In particular, which stuidies are cited to support the claim that people do better without pharmacotherapy for schizophrenia or that children treated for ADHD using stimulant medication are at risk to develop mania?
I’m sympathetic to concerns about psychiatric medications, and I was mentored in graduate school by the foremost researcher on response expectancy and antidepressants, but I’m highly dubious about claims made by someone who describes ADHD as tapping your pencil and annoying your teacher.
If there really were something to the claims made in this thread, the American Psychological Association would be all over it, since it could essentially flip the balance of power in terms of mental health treatment between psychologists and psychiatrists.
Many psychiatrists would love no-drug therapy too, since it would be more time-intensive and mean higher fees, as well as improving the competitive picture, since other physicians would be less likely to offer intensive non-drug treatment.
Ah yes, the old “they don’t want you to know” explanation.
Contrary to this conspiratorial mindset, physicians do indeed want to know the best ways to treat patients. There are certainly been abuses in the promotion of off-label uses of pharmaceuticals, but the expansion of indications for drugs not yet FDA-approved for certain disorders is not confined to psychoactive drugs, and is typically accompanied by (at least initially) clinical indications that such drugs are effective and possibly safer than existing, approved ones. Doubt has been cast on whether Seroquel is a good option for psychosis in Alzheimer’s patients, but the early study results suggested that it worked. It’s not like the drug company just went out and told lies to boost sales.
I wonder if many people hit by severe depression are really wildly interested in investing long periods of time in therapy, or if they prefer the option of using antidepressants to get back on their feet before possibly going for these therapies.
And it may sound groovy to be able to just do away with antipsychotics, but then maybe we should be prepared for a big expansion of space in mental institutions.
I think most current psychiatrists would be scared shitless at the idea of having to do empirically supported non-pharmaceuatical behavioral health therapies, or even having to go back to the very empirically not supported psychotherapy historically associated with psychiatry, since most of them haven’t been trained at all to do so.
As for billing, I think it’s much more lucrative to see four people in a hour for med management than it is to see one person for an hour for therapy, unless you have a population of people who can pay out of pocket for higher rates.
I have been skeptical of the mental health industry ever since hearing about the Rosenhan experiment. The idea that doctors are giving mind altering drugs to the developing brains of toddlers, yes toddlers, is infuriating. I heard this in a documentary, so I do not know if it is true, but I understand these drugs have not even been tested on minors. Furthermore, doctors just experiment by giving children different cocktails until they are “better”. This is science?
I think the main thesis of the book was that drugs did, in general, help people with very severe mental ailments. The issue is the vastly larger population of people whose mental ailments are not as severe, and that long term use of drugs on these populations does not produce better results over time vs minimal or non-drug therapies.
I wonder why make it sound like they were prescribing LSD. Are you opposed to giving any medication to toddlers?
No, that’s clinical practice, not science. THere’s a difference, yet when it comes to mental health issues, all the lay people I know think that I, as a psychologist, would love to “experiment” on this or that crazy person that they know. Believe me, a single person experiment on the crazy person you know wouldn’t mean a thing. I’ve got no interest in doing that, and if I’m going to be involved in clinical treatment of the crazy person you know, I’m going to be paid to do it.
But to get back to your point, clinical practice typically gives latitude to physicians to work to find the best therapy regimen for you as an individual. Do you really object to that? What if the Claritin that my son’s pediatrician just suggested that we take doesn’t work to address the symptoms? Should we allow him to “EXPERIMENT”, or should we say, well, nice try. Too bad it didn’t work.
I think the pharmaceutical industry must hate it that there sre people ot taking their products ever day. Every day a person lives with pills, they are losing money.
The most ridiculous drug commercial I’ve ever seen is for a drug to boost your perscription anti-depressant. Yes, if your anti-depressant doesn’t work, don’t try to find one that does. Take another pill, and don’t forget the pills to counteract the side effects. And the pills to counteract the side effects of the pills to cunteract the side effects of those pills.
Not LSD, but chemicals that, from what I understand, have unknown long term effects in the brain. I am not an expert, but I look skeptically on an industry that gives such chemicals to the completely underdeveloped 4 year old brain. If the science is around showing this is a safe practice for children, I would like to see it. I am not against giving medication to any toddlers, but pardon me if I do not trust the ability of doctors to consistently, accurately diagnose problems when the fix is a batch of untested chemicals.
I do not object to that, and I understand that is the practice to treat problems in adults. But giving different antidepressant cocktails to the developing brains of children because they do not talk in school enough is another thing.
Can you speak to the results of clinical testing on children, especially the very young, and any identified possible long-term problems? As I said, I am arguing from limited knowledge from a documentary.
Since it appears that the brain does not finish developing until about age 25, the logical extension of your argument is that children should not be prescribed medications until age 25.
First, which untested chemicals are you concerned about? If your concern is the general testing of medications for children, I and everyone share your concern, which is why greater steps have been taken by the FDA to increase drug trials for children.
Secondly, if you don’t trust your pediatrician or psychiatrist, find another one. If you don’t trust pediatricians or psychiatrists generally, there’s no point in asking them to conduct more studies, is there? The results will automatically be dubious, right?
However, I think your concern is not about medications generally, but rather “mind altering substances” and “chemicals” used to treat mental health conditions. It seems that you are drawing distinctions based on some other criteria that weights medications differently based on the symptoms being targeted.
Or if they tap their pencil, right? I’d prefer to hear arguments that are based in reality, rather than some nonsensical point.
No. Perhaps you should argue from a broader knowledge base first.
If you google, you can find information to help expand your own knowledge base. For instance, here is some FDA information on drug trials in children.
If that website is not accurate, I apologize and retract. All of these drugs are used to treat children.
My concern is giving chemicals that change the way the brain functions to underdeveloped brains when we know little about the long-term effects of these chemicals. And when a child goes to 3 psychiatrists and gets 3 different diagnoses with 3 different chemical treatments, that lessens the credibility of the industry.
Are you saying there is not a sizable portion of our society that rushes to the doctor to get a pill when their kid does not act “normally”?
Yes, or more specifically with 24 year olds, in the sense that they are both not fully developed. You’re the one employing “less than full development” as a criterion. Are you suggesting that you know what level, under full development, is justifiable as the point at which off-label application of pharmaceuticals can begin.
What is this a list of? You said that untested chemicals are being used. These medications have been tested, but not for children.
So, I ask again, why are you concerned only with medications for mental health disorders? There is a high proportion of off label use of medications, like cardiovascular medications, in children. Are you unconcerned about that?
What is the effect of child motrin on the developing brain? If it is unknown, should we prohibit its use?
I know that a sizable proportion of children who meet criteria for many mental health disorders are not involved in any treatment at all. I am saying that the idea that many parents rush out to get medications for their kids just because a teacher said so is complete bullshit. If it is not, please provide me with evidence for your position. By the way, if you come back with any figure about how much or how often a given medication is prescribed, please also cite the population base rate for that disorder in order to make a claim of overprescription.
That is my point. These drugs are commonly used on children. As far as I know they have not been fully tested for use on children. I think that is cause for concern.
Because that is the subject of the thread.
From the director of Columbia’s Center for the Advancement of Children’s Mental Health:
Here are some data for the skyrocketing use of drugs since 1990.
If I say there is an overprescription problem, you will say there are way more untreated cases of mental health disorders in children than are being treated with medication. I agree with you. My consistent claim is that the drugs we are using are not as effective as society believes and that they are not fully tested to use on children.
I don’t think there is an over-arching conspiracy going on, but word of the effectiveness of CBT for anxiety and depression really doesn’t seem to be getting out. Maybe “you can feel better without spending a truckload of money and seeing a shrink for decades and taking expensive, dangerous pills” just needs better P.R.
With regard to ADHD, I’ll never say that it is not a problem for certain children in academic settings (short of calling it a “brain disorder”) and that medications do not help many of them, but there is little question about it being overdiagnosed.
To wit: I was in a high functioning middle school science classroom a few weeks back. We were interested in the problems of a particular student, but in an aside the teacher told me that 70% of the boys in one of her classes were taking meds for ADHD. Yowza.
For some parents and their children, the stimulants seem to have become an academic performance enhancer.
I think the main concern of the book is that the outcomes over time (to the extent these can be usefully compared across western cultures) for people with mental issues of moderate severity, do not seem to be better for target populations being treated with psycho-active drugs vs those treated with non-drug methodologies.
Beyond this, I think there is a valid concern that we do not know enough about the effects of drugs on developing brains to be as insouciant as you appear to be about the effects of these medications on children. That a mental health professional like yourself, who stands as something of a gatekeeper in determining appropriate therapies has this attitude is honestly kind of worrisome for people.