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admin | to meditate in silence | 21.07.2014
A special report on WBUR’s CommonHealth blog pits two prominent adversaries against each other on an important issue.
Whitaker says his research which examines for the first time the long-term effects of psychiatric drugs, shows that these medications are often making diseases such as depression and schizophrenia worse, not better. Psychiatric medications are constantly evolving and change, as discoveries of the brain are uncovered. Antipsychotics (or Neuroleptics) are used to treat Schizophrenia, Manic Depressive Disorder (Bipolar), etc. If a brand name is discontinued (no longer made), there may be a number of other pharmaceutical companies that create the generic version or have yet to. To be classed as a psychiatric medication, a chemical entity has to have as its primary function an effect on mentation.
Modern ideas about psychiatric medications depend on a model of diagnosis and selection rather than, for instance, a general trial and error procedure to see what medication may be helpful – while the latter seems odd, without a clear understanding of what drugs were doing biologically, this has been the practice in the past. Although medications have been used since antiquity to influence human behavior, it was not until the late 1950s that psychiatry moved toward the paradigm of biological remedy instead of symptom based medications. The model is a familiar one in other areas of medicine: Researchers find some anomaly (perhaps even a cause) that is associated with a condition and this new knowledge results in a drug meant to affect the biology of those afflicted.
Antidepressants – These fall into two general classes, the tri-cyclic antidepressants (TCA) and the selective serotonin reuptake inhibitors (SSRI).
Anti-psychotics – these are the mainstay of treatment for schizophrenia, bi-polar disorder and other, serious mental conditions. To what extent are patients mentally diseased and to what extent are they merely ‘different’?
Psychiatrists often run up against the Hippocratic Oath’s dictum of primum non nocere (first, do no harm). The hope is that continued research in neuro-anatomy and physiology will bring more cause and effect relationships to light. Understanding the psychopathIs it a question of evil or mental disorder when someone intentionally kills, rapes or abuses others? Introducing the ProblemAs a psychologist I will try to understand the relationship between human thoughts, feelings and actions. Defining antisocial behaviorIt is hard to understand, and we call it by many names: Psychopathy, sociopathy, antisocial and dissocial personality disorder, evil, insanity or madness. Our way into the antisocial mindWith help of psychological theory we will try to understand the psychopathic mind.
An introduction to serial killingOne might say that serial killing differs from other kind of killing, but what are the most common reasons for killing?

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He points to a major increase in the number of people getting federal disability benefits for mental illness who are taking these medications as a sign that the drugs are, in fact, contributing to chronic mental illness in America. In order to post comments, please make sure JavaScript and Cookies are enabled, and reload the page. They are prescribed subsequent to a diagnosis by a physician qualified to treat mental illness, but how does it work?
Before this, psychiatric drugs fell into two general classes – those that induced sedation and those that elevated mood. Primarily these are based on receptor sites in the brain that are either stimulated or attenuated by a medication. Again, there is an overlap with other conditions and these agents may be used in lower dosages to treat depression. For instance, amphetamines are commonly prescribed for attention deficit hyperactivity disorder (ADHD).
Partially this is because treatments are often given without patient consent (and even against the wishes of a patient). The idea of reshaping ‘who we are’ in a fundamental way feels deeply invasive and unethical.
Doctor Joanna Moncrieff puts forth the idea that dependence on drug therapies has given psychiatrists an unsupported confidence and led to more and inappropriate treatments.
They do not yet have the tools to look deeply into the neuropathology of a specific patient’s brain and correct aberrant conditions directly. The public seems keenly aware that medications may be misused to enforce societal norms in an unethical fashion. Meanwhile, psychiatrists will continue to diagnose and treat patients with both the art and the science available. In today's psychiatry, the benefits and risks of drug therapy will be considered for each patient. They are prescribed subsequent to a diagnosis by a physician qualified to treat mental illness. Opiates (along with barbiturates) and amphetamines were the staples of outpatient care and ‘talk therapy’ was the mainstay of treatment. Also, some medications marketed for a specific diagnosis can find uses outside of these categories. Another criticism stems from the historical practice of a ‘chemical straitjacket’ – medications prescribed primarily to make a patient easier to handle.

For this reason, the diagnostic standard has become one of deciding if symptoms are severe enough to alter one’s normal lifestyle. Her paper, Drug Treatment in Modern Psychiatry: The History of a Delusion (2002) describes an overreliance on medications that do not help patients so much as they allow the practice of psychiatry to view itself as helpful. The case is less so when someone complains of depression or believes in other than ‘normal’ societal values. There is always a risk of altering mentation in an unwanted direction or of a patient becoming addicted to a ‘remedy’.  The risks are made greater because most drug treatments do not directly cure mental illness, but rather, are given chronically to control symptoms.
The US Food and Drug Administration first started warning about increased risk of suicide in patients prescribed anti-depressants (both TCA and SSRI) in 2004.
The ideal is to understand the physiological mechanisms that cause disease and find treatments (both drug and other therapies) that have meaningful and reliable outcomes.
For inpatients, dramatic ‘challenge’ treatments would include insulin shock therapy and electro-shock therapy, but neither falls into the category of medications as primary agents.
The advent of chlorpromazine and the elucidation of neurotransmitters began to change the way psychiatrists viewed medications. Imipramine, the first tri-cyclic anti-depressant discovered, has found use in treating childhood bedwetting (nocturnal enuresis). Psychiatry still suffers from a history that includes pre-frontal lobotomy and movement disorders induced by Thorazine.
In a real sense, this is how doctors decide if a condition rises to the level of necessitating intervention.
As late as 1970, homosexuality was considered by the American Psychiatric Association as a mental illness.
There is current controversy surrounding the use of methylphenidate (an amphetamine) for ADHD – the worry is that the drug isn’t helping young students so much as making them less disruptive in a classroom; aiding the teacher more than the patient. This trend has continued and the search for more biologically rational (and physiologically based) medications continues today. The deserved criticisms of psychiatry shouldn’t overlook the fact that the discipline has progressed and will continue to do so.

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