Thursday, July 02, 2015

Do psychiatric medications correct a chemical abnormality in the brain?

I don't think David Taylor, Director of Pharmacy and Pathology, South London and Maudsley NHS Foundation Trust & Professor of Psychopharmacology, King's College, London can be a prescriber. This may be why, in his BJPsych Advances article, he suggests that psychiatrists don't infer that people with a diagnosis of schizophrenia need antipsychotics to block a surfeit of dopamine. If so, why is this what some psychiatrists tell patients? Medical students may even be taught to explain to patients that this is the reason they need antipsychotics. Perhaps Taylor needs to be more explicit that psychiatrists are wrong to tell people that medications correct a chemical imbalance and, if he does some medical student examining, mark students wrong when they suggest this.

I do agree with him that, "Rarely is there any certainty about [psychiatric] diagnosis". I think psychiatrists will still regard quetiapine as something to do with dopamine by calling it a dopamine multifunctional receptor antagonist (DAmF-RAn). They will just believe that they can use it for more conditions besides schizophrenia. I accept that the rationale for psychiatric prescribing is often not properly thought through (eg. see previous post).

Framing the model of drug action as drug-centred rather than disease-centred is primarily a critique of the biomedical model (eg. see my book review). It emphasises the non-specific effects of medication. I suspect that Taylor still thinks psychiatric medications correct a chemical abnormality in the brain. In that sense, he is not drug-centred, even disease-centred. What he means is that he doesn't accept simplistic hypotheses of biochemical imbalance. All well and good, but the critique of the biomedical model is more fundamental. There may be no difference between the chemical processes underlying mental illness and our "normal" behaviour.

1 comment:

Chrys Muirhead said...

I thought Prof David Taylor was in the pay of big pharma, as in he receives payments as a consultant or key opinion leader by pharmaceutical companies. Please do correct me if I'm wrong? He may have seen the error of his ways, and the conflicts of interest, and cut the ties, making do on just his academic monies and generous pay from SLaM.

Mr Taylor's links with drug companies means, to my way of thinking, that he is compromised in what he says regarding the prescribing of psychotropic drugs. Despite his many titles before and after his name. Let him keep taking the handouts for he may have a habit to feed. As in, to bolster up his self esteem because he isn't able or qualified to write prescriptions.

Who knows the reason why some men, who appear to have a modicum of intelligence, have hidden their consciences behind the KOL name and kept on scapegoating the people for whom the drugs don't work, to silence the pain of life. I think that Taylor knows fine well that the biomedical model of mental illness is unproven (or pants). But the cash helps him in blinding the obvious.