The Use and Misuse of Psychiatric Drugs (ePub)

"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."

--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.