Ethical Issues in Psychopharmacology

Mental illnesses affect men and women, children and the elderly, and communities and entire nations. Neuropsychiatric disorders, moreover, are the second-leading cause of disability throughout the world. Psychiatry centers on the care of people living with these severe and burdensome illnesses, and over the past 3 decades in particular, our profession has sought advances both in the neuroscience of these illnesses and in the development of novel, evidence-based treatments-including psychopharmacological interventions.¹

Psychotropics are now among the most commonly prescribed of all medications, and the widened use of these agents has improved the lives of millions of individuals living with mental illness. Nevertheless, greater reliance on psychotropics has created ethical and societal concerns. Some concerns relate to the risks of pharmacological interventions, such as the paradoxical finding that depressed children who take antidepressants may have an increased risk of suicidal behavior relative to those receiving placebo. Moreover, there are potentially serious adverse metabolic effects (eg, hyperglycemia, diabetes) associated with atypical antipsychotics. There are also concerns about the widespread application (some would say overprescription) of psychotropics-a controversy that is further fueled by the fact that nonpsychiatric providers are the source of most psychotropic prescriptions in the United States.

There is no consensus that cosmetic psychopharmacology is absolutely unethical, and parallels have been drawn with plastic surgery for physical enhancement.

New ethical issues have arisen around the use of psychotropics (such as stimulants) to enhance the cognitive performance of healthy individuals. Readers are referred to a recent review of the “cosmetic” use of neuroenhancers by Geppert and Taylor.²

Internal server error