The Use and Misuse of Psychiatric Drugs

"e;Dr. Paris has written an honest, balanced presentation of the ways in which psychiatric drugs are evaluated and prescribed. He highlights the complexity of the task, the limits of what is known and the mixed picture that research often produces. His conclusions are refreshing because they are built from an even-handed, pragmatic assessment of the empirical evidence. The result is a stimulating look at the world of treatments for emotional disorders that acknowledges the usefulness of both biological and psychosocial explanations where appropriate. His recommendations provide helpful roadmaps for patients, practitioners and researchers alike. The book is sure to serve as a welcome catalyst for the continuing debates about which treatments are likely to produce the best outcomes."e; 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.

"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-handedpragmatic 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, USAThe message of this book is that psychiatrists have some verygood drugs, but can expect bad results when they are over-usedprescribed 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.

Foreword.Introduction.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.6 Antidepressants.7 Prescribing for Children and Adolescents.8 Polypharmacy.Part III PERSPECTIVES.9 Alternatives to Drugs.10 Medicalizing Distress.11 The Future of Psychopharmacology.References.Index.