Current Psychopharmacology: It's Much More Complex Than You Think

Psychiatric Times

May 2005

Vol. XXII

Issue 6

The discipline of psychopharmacology has expanded enormously during the last several decades. Psychiatrists and other physicians have been using medications for almost every diagnosis. The pressure from patients, families, insurance companies and the pharmaceutical industry to provide a quick fix for all maladies has been increasing. There is no doubt that our armamentarium has widened and that we have more medications for mental illnesses available. These medications are fairly efficacious and fairly well tolerated. However, as illustrated in several articles in this Special Report, while the treatment of mental illness with medications has definitely advanced, it is neither quick nor easy. Instead, it has become more complex and complicated.

The foremost illustration of the complexity of modern-era prescribing of psychotropic medications is the recent U.S. Food and Drug Administration "black box" warning regarding the use of antidepressants in children and adolescents. Some reports suggest that there is an increased risk of suicidality associated with antidepressants compared to placebo. While this issue remains unclear, the FDA felt compelled to warn patients, their families and their physicians about this possible risk.

In this Special Report, David A. Brent, M.D., provides us with insight on this issue, suggesting that patients and families should be educated about the benefits and risks of antidepressants, other therapies for depression and monitoring of various symptoms. He also recommends that physicians monitor and probe patients more frequently and more carefully about suicidal ideation, depression and side effects.

The potential increased risk of suicidality coupled with meaningful informed consent demonstrate that modern psychopharmacology is not just simple prescription writing, but rather a complex process.

The remaining articles of this Special Report discuss important issues: use of medications in the treatment of autism, multimodal integrated treatment for youth with bipolar disorder, and the effects of smoking and caffeine (frequently abused by the chronically mentally ill) on the metabolism of various psychotropic drugs. All of these articles illustrate the complexity of modern-era prescribing, which requires special skill, knowledge and continuous education.

In view of the complexity of modern psychopharmacology, one may see the recent pressures to expand prescribing of psychotropic medication privileges as rather misguided, and one wonders whether the restrictive approach to prescribing used in Great Britain would be more appropriate.

Acknowledgement

It is with much appreciation that Psychiatric Times acknowledges the invaluable guidance provided by Dr. Balon in planning and reviewing this Special Report. Dr. Balon is professor of psychiatry at Wayne State University School of Medicine in Detroit.