The Use and Misuse of Psychiatric Drugs

The Use and Misuse of Psychiatric Drugs PDF

The Use and Misuse of Psychiatric Drugs PDF
Preface

Preface:

“Dr. Paris has written an honest, balanced presentation of the waysin which psychiatric drugs are evaluated and prescribed. Hehighlights the complexity of the task, the limits of what is knownand the mixed picture that research often produces. His conclusionsare refreshing because they are built from an even-handed,pragmatic assessment of the empirical evidence. The result is astimulating look at the world of treatments for emotional disordersthat acknowledges the usefulness of both biological andpsychosocial explanations where appropriate. His recommendationsprovide helpful roadmaps for patients, practitioners andresearchers alike. The book is sure to serve as a welcome catalystfor the continuing debates about which treatments are likely toproduce the best outcomes.”
Roger P. Greenberg, Ph.D. Distinguished Professor andHead, Psychology Division Dept. of Psychiatry & BehavioralScience SUNY Upstate Medical University, NY, USA

The message of this book is that psychiatrists have some verygood drugs, but can expect bad results when they are over-used,prescribed outside of evidence-based indications, or given to thewrong patients. While acknowledging that many current agents arehighly effective and have revolutionized the treatment of certaindisorders, Joel Paris criticizes their use outside of an evidencebase. Too many patients are either over-medicated or aremisdiagnosed to justify aggressive treatment. Dr. Paris calls formore government funding of clinical trials to establish, withoutbias, the effectiveness of these agents. He has written this bookfor practitioners and trainees to show that scientific evidencesupports a more cautious and conservative approach to drugtherapy.

After describing the history of psychopharmacology, includingits early successes, Dr. Paris reviews the relationship betweenpsychiatry and the pharmaceutical industry. This problem hasreceived considerable popular attention in recent years and Dr.Paris documents initiatives to increase transparency and decreasethe influence of pharmaceutical marketing on diagnosis andprescribing habits.

Dr Paris then examines some major controversies. One is the factthat newer drugs have not been shown to be superior to olderagents. Another is that while the number of prescriptions forantidepressants has increased dramatically, meta-analyses show thattheir value is more limited than previously believed. Still anotheris the widespread prescription of mood stabilizers andantipsychotic drugs for patients, including children andadolescents, who do not have bipolar illness. Polypharmacy is anespecially contentious area: very few drug combinations have beentested in clinical trials, yet many patients end up on a cocktailof powerful drugs, each with its own side effects.

Dr Paris briefly considers alternatives to pharmacology andagain calls for more clinical trials of these approaches. He alsodiscusses the current trend to medicalizing what many woulddescribe as normal distress and states succinctly: Some things inlife are worth being upset about.

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