The Use and Misuse of Psychiatric Drugs: An Evidence-Based Critique
—Roger P. Greenberg, Ph.D. Distinguished Professor and Head, Psychology Division Dept. of Psychiatry & Behavioral Science SUNY Upstate Medical University, NY, USA
The message of this book is that psychiatrists have some very good drugs, but can expect bad results when they are over-used, prescribed outside of evidence-based indications, or given to the wrong patients. While acknowledging that many current agents are highly effective and have revolutionized the treatment of certain disorders, Joel Paris criticizes their use outside of an evidence base. Too many patients are either over-medicated or are misdiagnosed to justify aggressive treatment. Dr. Paris calls for more government funding of clinical trials to establish, without bias, the effectiveness of these agents. He has written this book for practitioners and trainees to show that scientific evidence supports a more cautious and conservative approach to drug therapy.
After describing the history of psychopharmacology, including its early successes, Dr. Paris reviews the relationship between psychiatry and the pharmaceutical industry. This problem has received considerable popular attention in recent years and Dr. Paris documents initiatives to increase transparency and decrease the influence of pharmaceutical marketing on diagnosis and prescribing habits.
Dr Paris then examines some major controversies. One is the fact that newer drugs have not been shown to be superior to older agents. Another is that while the number of prescriptions for antidepressants has increased dramatically, meta-analyses show that their value is more limited than previously believed. Still another is the widespread prescription of mood stabilizers and antipsychotic drugs for patients, including children and adolescents, who do not have bipolar illness. Polypharmacy is an especially contentious area: very few drug combinations have been tested in clinical trials, yet many patients end up on a cocktail of powerful drugs, each with its own side effects.
Dr Paris briefly considers alternatives to pharmacology and again calls for more clinical trials of these approaches. He also discusses the current trend to medicalizing what many would describe as normal distress and states succinctly: Some things in life are worth being upset about.
Part I OVERVIEW.
1 The History of Psychopharmacology.
2 The Science of Psychopharmacology.
3 The Pharmaceutical Industry.
Part II DRUGS IN PRACTICE.
4 Antipsychotics: For Better or For Worse.
5 Mood Stabilizers and Mood Instability.
7 Prescribing for Children and Adolescents.
Part III PERSPECTIVES.
9 Alternatives to Drugs.
10 Medicalizing Distress.
11 The Future of Psychopharmacology.
Joel Paris is an active researcher, primarily in personality disorders and child & adolescent psychiatry, and both this and his considerable practical expertise enable him to argue intelligently both for and against the use of psychotropic medications. His background as a medical investigator and broad experience in teaching young psychiatrists about the use of drugs help him to make neutral judgments about complex issues.
“The Use and Misuse of Psychiatric Drugs deserves a place in every health sciences library.” (Metapsychology Online Reviews, 8 January 2013)
"In the book’s foreword, Tyrer describes this book as a ‘‘well balanced sober account of a serious issue that affects almost all of us in one way or another’’ and I would agree with that. The book is well written, easy to read, and makes good bedtime reading despite the serious nature of its topic. Epidemiologists will find it useful as background to the use of these medications, even if observational studies were neglected. ... Paris is not afraid to tackle controversial topics and make forcefulstatements about issues where improvement is needed. I highly recommend this book to anyone who would like to know more about this topic." (Annals of Epidemiology, 2012)