Sunday, October 16, 2011
Psychiatrists should know what they're doing with medication
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.