Can medication help me?
This material and these links are provided to inform and educate. They do not constitute medical advice with respect to any specific case. If you have concerns about how these debates affect you, you should talk them over with a qualified health professional.
Do psychological problems have a basis in the brain?
Medication is widely prescribed by general practitioners and psychiatrists for a range of mental health problems. Indeed many medical practitioners take it for granted that giving these medications is beneficial for a wide range of emotional and behavioural problems. The idea behind the use of these medications is that psychological problems are caused by physical problems in the nervous system, particularly in the biochemistry of the brain; so correcting these biochemical abnormalities should solve the problem. Unfortunately, this idea is completely flawed.
Giving biological explanations for psychological problems makes people less empathic and caring
One result of the medicalization of psychological problems is it makes people less empathic towards those who are in distress – and that includes mental health professionals. If we believe that someone’s problems with anxiety, depression or an eating disorder (for example) are due to some genetic fault or disturbed brain chemicals, we will look for a biological answer and not feel the need to extend warm and compassionate care to the affected individual. If, on the other hand, we understand that the problems of individuals have their basis in life events, childhood neglect, parental instability and abuse, bullying at school or traumatic events, we are more likely to empathize with their plight and respond with warmth and care. Lebowitz and Ahn (2015) of Harvard University showed that mental health clinicians in the USA felt less empathic towards individuals whose cases were described to them where the causes were attributed to biological factors as compared to painful life situations. They observe: “Biological accounts of psychopathology can exacerbate perceptions of patients as abnormal, distinct from the rest of the population, meriting social exclusion, and even less than fully human.”
The value of medication is not clear cut
Of course, if biological explanations resulted in treatments that were genuinely helpful, then that would be welcomed. In reality, though, it is much more complicated than that. Many psychiatric medications provide no better relief than a placebo (a pill containing an inactive substance), so their effects are psychological rather than biological. There are also significant disadvantages to relying on medication to deal with psychological problems.
So will medication help you?
Before you use these medications to help you with your problems, it is best to be fully informed about the conflicting perspectives and the quality of the research evidence. The information is in the public domain and you can investigate this for yourself. Below is some basic information as well as links to articles and websites that draw attention to and help you evaluate some of the problems with psychiatric medication, and concerns that in some cases it can do more harm than good.
Medication – Pros and cons
Examples of pros
An antidepressant can be helpful for some people who find it gives them a lift that helps them get back to normal functioning again.
Psychotherapists sometimes find that medication damps down emotional responses in a way that helps clients face painful emotions that they otherwise might avoid. This can apply to painful feelings of sadness or despair associated with depressed mood, or overly energized states in which people behave wildly and irresponsibly, associated with the hypomanic or manic phase of bipolar disorders.
Examples of cons
Some people respond to an antidepressant with no obvious benefits. When the antidepressant does not help they may feel even more pessimistic about getting better and this makes them more depressed. By damping down emotions medication can make people feel like “zombies” living with no real sense of meaning in their lives. This makes it more difficult for them to access their experience and can prevent them learning to manage their emotions better either by helping themselves or though engaging in psychotherapy. Medications often have unpleasant side effects which make those who take them feel worse. When this happens it can be hard to know which symptoms are the primary ones and which are simply the result of taking the medication.
There has been a misleading overemphasis on medication as a treatment for psychological problems
There is considerable controversy in academic and professional circles about the effectiveness of these medications and the risks associated with taking them. Medications are produced by pharmaceutical companies with huge advertising budgets which are used to promote them to doctors. However this advertising often omits to mention the full range of evidence about (1) the limits of their effectiveness, (2) the existence of troubling side effects, (3) the extent to which they are addictive, or (4) the existence of alternative treatments that do not involve the use of drugs.
In the last few years an increasing disillusionment with the medication approach to psychological problems has been expressed. Many researchers and psychiatrists are coming to the conclusion that the narrative about ”Miracle Drugs” that have revolutionized treatment of mental illness is simplistic, inaccurate and grossly misleading.
Several studies on the treatment of different psychological problems have failed to show that those treated with medication do better in the long term. For example, in a Dutch study on the treatment of Borderline Personality Disorder with Schema Therapy and Transference focused psychotherapy (Giesen-Bloo et al, 2006) that ran for three years, those on medication recovered more slowly and recovered less than those not on medication, even though actual symptom levels at the beginning of the study were the same for those on medication and those not taking it.
Layard and Clark (2014) review mental health care in the United Kingdom and conclude that there has been a massive overemphasis on medical approaches involving medication and a neglect of psychological therapies. They argue that proper provision of psychological therapies would result in large savings for the health care system. This is because evidence-based psychological treatments can produce lasting change that impacts not only only mood and emotions but on a wide range of apparently physical problems which have their roots in psychological stress.
For several diagnoses (including schizophrenia and ADHD) there is an increasing number of studies that provide evidence that people who remain on medication for a long period are less well off a few years later than those who never took medication or who took medication for a short period and then come off it.
In a study of treatments for social anxiety disorder, a state of the art Cognitive Therapy treatment was compared to the use of the SSRI medication, Paroxetine. Cognitive Therapy was more effective than Paroxetine and also more effective than a placebo (inactive pill). Adding medication to the Cognitive Therapy treatment did not improve the outcome. In fact, at 12 months follow up there was a lower recovery rate for those who had received medication with Cognitive Therapy, than for those who received Cognitive Therapy without medication.
Recent critical evaluation of the effectiveness of antidepressants has shown that in many trials these drugs did not perform any better than a placebo (a pill containing an inactive substance) in relieving depression. See a Newsweek article on this there.
This 2018 book by Johan Hari provides a very readable and up to date account of this. Read excerpts from the book published in the Guardian here.
Below are several articles that review the debate. Click on any one to read the full article:
Psychiatrist and neuroscientist, Richard Friedman, comments on the damaging results of psychotherapy research being marginalized by research on pharmaceuticals. He refers to the view that mental illnesses are diseases of the brain as “reductionist and simplistic” and remarks, “There is often no substitute for the self-understanding that comes with therapy.”
September 2014: In this article in Clinical Psychology Forum, Psychiatrist Phil Thomas highlights an article in the British Journal of Psychiatry that talks of “the end of the psycho-pharmacological revolution.” He quotes a prominent psycho-pharmacologist:,
“A massive experiment has failed: despite decades of research and billions of dollars invested, not a single mechanistically novel drug has reached the psychiatric market in more than 30 years”
This is evidence of a crisis at the scientific heart of psychiatry related to its failure to validate a single psychiatric diagnosis [as a biological disorder] and to develop effective drug or physical treatments based in scientific knowledge.
Psychological problems may sometimes result from medical illnesses (such as multiple sclerosis) and, when this is the case, it is important to identify and treat the medical condition. However, in the majority of cases, psychological problems are not secondary to a medical illness, and a medically based treatment is not appropriate. Thomas concludes that we “need to redefine the role of doctors in mental health care.
June 2016: Read Allan Frances, a distinguished Psychiatrist from the USA with a long career in mainstream psychiatry in the Huffington Post
For decades it has been accepted that medications used to treat severe mental illness have serious side effects. But just how serious? This 2016 review article from the British Psychological Society’s Clinical Psychology Forum shows that they can directly cause many serious medical conditions that are life threatening. People on these medications year after year are likely to die younger.
Read this well written review from 2014.
You don’t need drugs to change brain processes – they can be changed by many things including psychotherapy and mindfulness meditation
Of course, the brain is affected by emotional distress or behavioural problems. Everything we do at any time has an impact on brain activity – eating a meal, watching a movie, going to sleep, taking exercise, sitting worrying, sitting meditating, chatting to a friend, planning a holiday, watching a fight – your brain will certainly be involved and respond differently in each case. So taking drugs is not the only way and often not the best way to try to change brain activity. There are many ways that people can learn to better manage their moods and emotions which have a measurable impact on brain activity. There are more and more studies showing this for psychotherapy and meditation practices.
In the past decade or so researchers have been examining the impact on the brain of effective psychotherapy using imaging techniques such as the fMRI. Using this technique, Paquette et al (2003) found significant brain changes following CBT treatment of spider phobia. They conclude:
These findings suggest that a psychotherapeutic approach, such as CBT, has the potential to modify the dysfunctional neural circuitry associated with anxiety disorders. They further indicate that the changes made at the mind level, within a psychotherapeutic context, are able to functionally “rewire” the brain.
A 2017 study found a similar effect for OCD (Obsessive Compulsive Disorder). See the summary of this study whose authors conclude that psychological treatrment led to “measurable changes in the brain that correlate with reduced symptoms.” Positive and measurable effects like this have been shown even for a severe disorder like Schizophrenia. In a 2017 study of patients with schizophrenia, Mason and colleagues showed that cognitive-behaviour therapy resulted in improvement in connections in the brain involved in processing social threat. These changes could still be detected several years later. See this summary of the study which concludes, “This is the first time that changes in the brain associated with CBT have been shown to be associated with long-term recovery in people with psychosis.” See the scientific article in Nature here.
In a 2015 study by Kuyken et al compared mindfulness meditation practice with antidepressant medication in people who had had chronic repetitive episodes of depression. They wanted to see how well these two treatments did in preventing relapse.; Just less than half of the people in each group relapsed and became depressed again – though rather less people relapsed in the meditation group (44%) than in the medication group (47%). This means that the non-drug meditation practice was just as effective as taking medication. The authors also found evidence that “In patients who report childhood abuse, MBCT-TS [Mindfulness training] might confer greater benefit than maintenance antidepressants in prevention of depressive relapse or recurrence.”
Pharmaceutical companies are massive multinational corporations with huge incomes and marketing budgets. Over the past half century psychiatric medications have been some of their best selling products and have made huge profits for them. The marketing of these medications has often based on a set of ideas that are simplistic and inaccurate. You may be one of the many people who have been told one or more of the following by a medical practitioner:
What your doctor
The reality is much more complicated:
Not a brain disease
The brain disease theory of mental disorders completely ignores the context in which people are or have been living. For example, people in conflictual marriages often become depressed. The depression is not the result of a brain disease but of living in an unhappy, often abusive, situation. The same is true of people raised in families where there is a lot of quarreling, shouting and harsh punishment. In such cases it is not useful to try to cure a “brain disease” without addressing the unstable and abusive conditions that are evoking emotional distress. No research has been able to establish identifiable diseases of the brain in the way that other branches of medicine identify diseases like diabetes, malaria or influenza. Of course some diseases do affect the brain. These include syphilis, AIDS, and illnesses like beri-beri or pellagra caused by eating an inadequate diets. But most people suffering from depression, anxiety etc do not have these kinds of diseases.
Not a chemical imbalance
Research into whether mental disorders can be accounted for on the basis of simple imbalances in brain neurochemistry failed to find any evidence for this – and this has been widely known for at least two decades.
No simple link between genes and emotional and behavioural problems
The route from gene to gene expression is so complicated and so deeply affected by environmental conditions that it is misleading to imply there is a clear genetic cause for any mental disorder – see Michael Rutter’s (2006) Genes and behaviour: Nature-nurture interplay explained). You can read a review of this book and another review here.
Do not correct a chemical imbalance
In fact many of these medications do the opposite. They disturb normal brain function. In the process they may provide temporary relief from some symptoms but this relief often does not last. There is increasing evidence that long term recovery is more difficult in people treated with medication for disorders as wide ranging as schizophrenia, depression, anxiety and ADHD.
Habit forming and create dependency
Most psychiatric medications cause the brain to change in an abnormal way to compensate for the effect of the drug. When the drug is withdrawn, the brain is thrown off balance and there are often significant withdrawal symptoms. Some doctors may tell you this is the disease returning – but very often it is not. It is the result of withdrawal of an addictive substance. If you look on the package insert of many of these drugs they will list the problems associated with withdrawal. What this means is that these drugs are addictive.
Significant risks of harm
In the short term, these drugs can have a range of unpleasant side effects, some so unpleasant that people refuse to continue taking them. Some antidepressants can actually make some people violent or even suicidal – the opposite of what is needed. Furthermore, several medications have been shown to cause irreversible damage to the brain and its function if taken on a chronic basis over several years. For more, go to Medication risks and misuse: Research update below.
Pharmaceutical companies distort the data from research in order market their products
There is increasing evidence that many research findings on the effectiveness of medications were distorted for marketing purposes. For example, trials in which the drug was found to be ineffective were simply not published. In some cases dangerous side effects encountered in clinical trials were under-reported, not reported at all, or actively denied by company representatives.
For a comprehensive report on just how calculating pharmaceutical companies can be, see this exposé of Johnson and Johnson’s marketing of Risperidone (Risperdal) in the Huffington Post where that famous corporation is referred to as “America’s most admired law-breaker.”
This does not mean that psychiatric medications cannot help people with mental health problems at all. However their value has been considerably exaggerated by pharmaceutical marketing and their risks minimized.
What do Psychiatrists in South Africa think about this?
Visit the website of the South African Society of Psychiatrists to find out. SASOP treatment guidelines published in 2013 recognize the role of various forms of psychotherapy in treating a range of mental health problems, sometimes as a first line of treatment.
Robert Whitaker’s Anatomy of an epidemic (2010) provided a comprehensive documentation of the systematic cover up of the serious negative side effects of many psychiatric medications by pharmaceutical companies and prominent psychiatrists who were receiving hundreds of thousands of dollars from those companies.
Robert Whitaker’s website provides links to abstracts of large numbers of academic research studies cited in the book. See also his blog in Psychology Today where he continues to document further aspects of the risks of psychiatric medication and the under-reporting of dangerous side effects.
The publication of Anatomy of an epidemic (2010) led to the founding of the Foundation for Excellence in Mental Health Care in the USA which sponsors research that is not influenced by the agendas of pharmaceutical companies. Their website provides links to the work of large numbers of psychiatrists and mental health professionals including blogs and academic articles.
See both sides of the argument in this report on a presentation by Robert Whitaker and Andrew Nierenberg at the Massachusetts General Hospital January 19, 2011.
|Joanna Moncrieff, a psychiatrist at University College, London, has written extensively about the misuse of psychiatric medication. See her books:The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment (2009).
Read her 2013 article in Clinical Psychology Forum, a publication of the British Psychological Society.
Joanna Moncrieff’s 2013 book, The Bitterest Pills: The Troubling Story of Antipsychotic Drugs See also her 2013 critique of the UK NICE guidelines for treatment, available free online
|Ben Goldacre, a British medical doctor, has been a powerful critic of the drug companies. His website is a rich source of information and featrues his best-selling books Bad Science and Bad Pharma. He has a regular column in Britain’s Guardian newspaper and articles from there have been collected in his I think you’ll find it’s a bit more complicated than that.|
|Marilyn Wedge. Those concerned about the impact of psychiatric drugs on children will find Marilyn Wedge’s website a valuable resource. Her books, Pills are not for pre-schoolers and A disease called childhood (2015) are well researched and critical of the indiscriminate use of drugs with children.|
David Healy, an Irish Psychiatrist who works at a psychiatric hospital in Wales provides another source of information about the latest research findings. Healy was appointed head of the mood and anxiety program at the University of Toronto’s Centre for Addiction and Mental Health in 2000. However after giving a conference presentation showing how SSRI antidepressants caused suicidal thoughts in several patients he was warned not to present such data at conferences if he valued his career. Shortly after that the invitation to work at University of Toronto was withdrawn (See Whitaker’s book Anatomy of an epidemic, page 306).
This site associated with David Healy’s work provides a lot of information about drug side effects. You can enter the name of any drug and see how frequently specific side effects have been reported. You can also report side effects you experienced on taking a drug. Healy explains why this kind of information is usually suppressed by pharmaceutical companies and how this web site is working to counter that by collating reports of consumers’ experience.
Peter Breggin, is a psychiatrist in Ithaca, New York. See his website. Compared to him, Robert Whitaker and David Healy are relative newcomers to the campaign for investigating psychiatric drugs and exposing their negative side effects and addictive properties.
His present focus is how to help people get off psychiatric drugs safely. See his recent book is Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and Their Families.
Breggin’s Toxic Psychiatry was published in 1991 (reprinted in 2010). See also Talking back to Prozac (1994), and Talking back to Ritalin: What doctors aren’t telling you about stimulants and ADHD (2001). To see all 10+ of his books on this theme, go to www.amazon.co.uk and search under “Books” and “Peter Breggin.”
See a comprehensive summary of Breggin’s work in Wikipedia. He and his wife Ginger are founders of the nonprofit Center for the Study of Empathic Therapy, Education, and Living
http://www.toxicpsychiatry.com provides a rich source of information about the consequences of long term use of psychiatric drugs particularly for more severe forms of mental illness.
http://www.mindfreedom.org/ is an advocacy organization and website that works on behalf of people who have experienced severe mental illness which appears to have been exacerbated by treatment with psychiatric medication and electroshock therapy.
Side effects of medications
- 2016: There has been widespread under-reporting of negative side effects of antidepressant medication, including suicide attempts and aggressive behaviour elicited by taking these drugs.
- 2016: A systematic review of the side effects of the newer antidepressants (SSRIs, SNRIs) found that they are not any safer than the older antidepressants and that their long-term use “is likely to yield important side effects…. The likelihood of treatment-emergent adverse effects are related to the duration of AD treatment, which has been found to be the case regarding weight gain, diabetes, and osteoporosis.”
- 2009: A study of the emotional numbing that results from from taking SSRI antidepressants found that while patients reported benefits from the reduction of painful emotions, many complained that they now felt indifferent and experienced “reduced inspiration, imagination, motivation and passion for and enjoyment of creative activities” or that their personality had changed, and they felt like “a zombie” or “a robot” or “a shell.”
- 2014: Lithium, often used to treat bipolar disorder, can cause serious kidney damage if given in too high a dose.
- 2012: Ability to drive can be impaired by some of these drugs.
- 2016: Serious problems with impulse control (shopping, gambling, binge eating, high risk sexual behaviour) can sometimes occur as a side effect of taking Aripiprazole (Abilify) an atypical antipsychotic drug, sometimes also used to treat depression.
- 2016: Significant reductions in bone mineral content and bone mineral density can be caused by stimulant medications used in the treatment of attention deficit hyperactivity disorder (ADHD) in childhood and adolescence
- 2016: Use of antidepressants increased the risk of failure of dental implants by 4 times. Each year of antidepressant use doubled the odds of failure.
- 2016: Mortality is twice as high in patients with Alzheimers who are given anti-psychotic medication, compared to those who don’t take such medication.
- 2016: Significant breathing difficulties that in some cases prove fatal can result from taking opioid painkillers while also taking Valium, commonly given for anxiety, and other medications that depress activity in the central nervous system.
- 2017: People who experience panic attacks experience more side effects of antidepressants than people who don’t have extreme anxiety. This is because people who have panic attacks usually focus excessive attention on bodily sensations so that small changes feel greater to them.
- 2017: Antidepressant use nearly doubles the risk of hip fracture among community-dwelling persons with Alzheimer’s disease
- 2017: A study at the University of Maryland in Baltimore found that prolonged use of SSRI antidepressants by children and adolescents resulted in a significantly higher risk (nearly two-fold) of developing Diabetes type 2.
Risks in pregnancy
- 2016: When pregnant women take Paroxetine (Paxil), an antidepressant, in the first trimester of pregnancy, it increases the risk of cardiac malformation in the child download the full article here.
- 2016: Measurable negative effects were reported on the brain function of newborn babies whose mothers had been taking a Serotonin Reuptake Inhibitor (SSRI) antidepressant.
- 2016: SSRI’s (antidepressants that include Prozac) are absorbed through the placenta and enter the circulation of the developing embyro. A large study in Finland found that a mother’s taking SSRI during pregnaancy was associated with an increased risk of speech and language disorders in the child later on.
- 2016: A large study in Wales, Norway and Denmark found that mothers taking an SSRI antidepressant during pregnancy had a slightly (but detectably) greater risk of stillbirth or having a child with congenital heart problems.
- 2017: Researchers at a Children’s Hospital in Vancouver, Canada found that when pregnant women took an SSRI antidepressant it interfered with the development of important brain cells in the corpus callosum.
- 2017: A study in Denmark published in the British Medical Journal found evidence that when pregnant women continued to take anti-depressant medication during pregnancy their children were more likely to develop a mental health problem years later, problems that included autism, depression, anxiety disorders and ADHD.
Inappropriate use of psychiatric medications
- 2016: Most available antidepressants are ineffective, and some may be unsafe, for children and teenagers with major depression, according to a study published in The Lancet.
- 2015: A study published in the British Medical Journal showed that large numbers of people with intellectual disabilities are prescribed antipsychotic drugs especially to control behavioural problems even though the patients do not have a mental illness download the full article here.