On Prescribing Rates of Psychotropics

Two slightly differing views of prescription rates in the United States. Taken together, they remind us that what goes on with the prescribing of psychotropic medications is quite complicated. The first from Charles Barber, author recently of Comfortably Numb: How Psychiatry Is Medicating a Nation.

An 2006, an astonishing 227 million prescriptions for antidepressants were dispensed in the United States — up 30 million from 2002. Altogether the United States accounts for about two-thirds of the global market for antidepressants. Other proven and practical approaches to managing milder forms of depression, such as diet changes, exercise or cognitive behavioral therapy, haven’t gotten the attention they deserve in our high-tech zeal for the drugs.

Another view from Peter Kramer, author of Prozac Nation.

According to a study from the MIT Sloan School of Management, on a per capita basis, by the year 2000 Swedes and Canadians had begun taking more antidepressants than we do. Greece, Italy, Spain, and (again) Sweden used a larger proportion of new, on-patent antidepressants than did the United States. The authors concluded that on the variables studied, the United States “is often ‘in the middle’ relative to other countries, and is not an outlier.”

Kalea Chapman, Psy.D.

The Norming of America

A post from Wired on the over-medication of America. It dovetails nicely with another observation at Furious Seasons. The Furious Seasons post may be a flat-out rant, but it’s rant worth reading. Excerpts from both. First Wired:

Sometime in the 1990s, the concept of better living through chemistry turned a corner, thanks to drug companies’ efforts to synthesize antidotes for every possible mood swing. So writes Yale lecturer Charles Barber in his new book, Comfortably Numb: How Psychiatry Is Medicating a Nation. An OCD sufferer himself, Barber spent a decade working in places like New York City’s Bellevue Hospital. He knew something was wrong when he discovered that his colleagues’ perfectly functional, $300-an-hour Upper West Side clients were taking the same potent pills as his own schizoid, homeless, crackhead patients.

Hard Facts and Cold Comfort

A divide in the practice of psychology.
One of the nice things about psychology is that it encompasses a variety of approaches. The therapists do have an eye on current research, and will incorporate findings into practice, where possible. An article by Mary Sykes Wylie in the Psychotherapy Networker on trauma researcher Bessel van der Kolk nicely addressed one of the key rifts in psychology today. That rift is between research and practice, science and art. Art, because for all the manualized treatments, doing psychotherapy is largely an intuitive endeavor that has more in common with the humanities than the sciences. People will disagree strenuously on this point.

Mixing sciences and humanities.
Attempts at taking a scientific approach to psychotherapy research are problematic because so much of what goes on has to do with people’s subjective experience. (See also the humor-driven view of research.) Outcome research is reduced to symptom inventories — questions that ask you to rate your depression on a scale from one to seven. Attempts to harness science in the service of psychotherapy are problematic because science and research make generalizations about groups while psychotherapy is involved in the intimate treatment of individuals and attending to what makes them unique.

Torture Update

Psychologists’ role in interrogations.
Here’s some recent news, courtesy of Ken Pope, from the psychologists in interrogations issue written about previously on this blog. The text is excerpted from a statement on California Senate Bill 219 by Leonard S. Rubenstein, President of Physicians for Human Rights, and does a nice job of highlighting the problem with the American Psychological Association’s position:

It is this background that leads us to support the resolution you are offering. It states clearly that all health professionals should not participate in torture or cruel, inhuman and degrading treatment. Moreover, it follows the approach the American Medical Association and the American Psychiatric Association took after careful study, which holds that to be true to ethical commitments, physicians should not participate in the interrogation of individual detainees at all — even an interrogation that doesn’t involve torture or cruel treatment. These organizations adopted this stance in recognition that the traditional standard — no participation in torture and cruel treatment — is inadequate. I would like to review the reasons for this stance.