Sunday, October 16, 2011

Psychiatrists should know what they're doing with medication

An editorial this month in the British Journal of Psychiatry is entitled 'No psychiatry without psychopharmacology'. It suggests there is insufficient prioritisation of psychopharmacology in psychiatric training. It asks for psychopharmacology to be affirmed as an integral and significant component of psychiatry, and a consequent expectation of a commensurately high level of knowledge and practice.

As I mentioned in my previous post, I've just come back from a conference in Newcastle. Paul Harrison, the main author of the editorial, gave a presentation at the meeting with the same title as the editorial. He thought that the low priority apparently given to psychopharmacology may be related to what he called the 'anti-pharmacological lobby'.  I suppose I would be seen as part of this lobby, but, despite what Harrison implies, I agree that psychiatrists should be well trained in psychopharmacology.

What I didn't hear in his talk, but is mentioned twice in the editorial, is unquestioned belief in the efficacy of psychiatric medication. To quote from the editorial, research shows that "contemporary psychotropic medications are effective". Again, it says that "the evidence that psychotropic drugs are beneficial when used in the right way and for the correct indications is unequivocal".

Good psychopharmacological training will highlight the weaknesses and bias of randomised controlled trials (eg. see my Bias in controlled trials webpage). The trouble with much prescribing is that it is beyond the evidence (and not even conforming to guidelines such as those produced by NICE). Psychiatrists are insufficiently critical of the evidence base for medication.


Madeleine, Holistic Psychotherapist said...

However, often psychiatrists are under immense pressure from the public and patients alike to drastically reduce medication, due to scaremongering about 'addiction' and 'subduing'(not to say this might never happen). I understand how hard it is to be constantly faced with this pressure, to be seen as the enemy. Yet, I have often witnessed patients deteriorating and suffering immense mental anguish due to being undermedicated.This is cruel and rarely talked about. Thankfully, I have met some very aware and well trained psychiatrists over the years.
What worries me more, still, is GPs prescribing psychiatric drugs.
Surely a campaign for better training (for both), as you suggest, is in order?

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Anonymous said...

There are some treatments that are extremely effective.

Practitioners' failure to recognize differences between "extremely effective" and "not effective" yet prescribing "not effective" medication as much as "extremely effective" ones suggests a lack of training or knowledge.

Dr. Katherine Morris said...

Ignorance isn't the answer to the reduction of the willy-nilly prescribing of psychiatric medications, good medicine is. The approach to mental health issues, as has been noted, tends to be collapsed into a “pharmaceutical deficiency” rather than an indicator of a health problem per se.

We regularly see patients who come to us either as a last resort, or as a first choice, because we look at the whole person, including their genetics, digestion, inflammation, infection, hormones, life situation, age, allergies, etc. before determining whether the person indeed needs medication, or if in fact they don’t. Many other physiologic problems present as psychiatric problems or symptoms and are, sadly, mistreated as such.

Dr. Katherine Morris
Education Director of The National Center for Whole Psychiatry
Chevy Chase, MD, USA

Oliver said...

In the U.S. the notion of psychopharmacology being underemphasized seems outlandish, if anything the exact opposite is the case (and continues to be, even though some pharmaceutical companies have begun stopping or slowing the development of psychotropic drugs).

Anonymous said...

My doctor knows what I'm on, asks me how I feel, and understands that frankly, I know more about him as to how drugs are affecting me since he has never taken any.

He doesn't push meds on me. He tells me to share my own research with his as to the safest, most effective, and drugs that have been around 30 years with no long-term side effects.

So if people are drugged up, get informed before you go back. All the psychiatrists know are "statistics" and then their own "statistics" they've noticed during their medical practice.