Louisville Medicine Volume 69, Issue 8 - Page 10

AUTHOR John J . Wernert , MD
FEATURE

THE PSYCHOLOGY OF PSYCHOPHARMACOLOGY : PRESCRIBE OR NOT ?

AUTHOR John J . Wernert , MD

The corporate practice of medicine predominant in our work world today has created yet another uncomfortable dilemma for doctors . Regardless of your medical specialty , if you see patients on a regular basis then you are routinely faced with individuals struggling with overwhelming anxiety , depressive feelings , poor quality sleep and trouble concentrating . Now two years into this lingering pandemic , and many of our patients present near a breaking point . The somatic nature of psychological problems is well documented in the medical literature , but most patients don ’ t make the connection between their brain and bodies . The patients are seeking relief from their symptoms , and you as the prescriber are worried about adding or increasing medications that may worsen the underlying condition or create dependency . What to do ?

Humans do not function well as isolated individuals . The lurching from pandemic home restriction to return to normal socialization has accentuated many agoraphobic tendencies , especially in younger age groups . We are fundamentally biosocial beings – and many psychological problems are more “ social ” than “ bio .” Mental health disorders always show up at the interface of bodily function and the world of relationships and community . Understanding people requires not only looking “ at ” them , but “ with ” them at the stressors in their world . Health care is too often about clinicians taking action rather participating in an “ interaction ” with another person . Think , “ What does the symptom mean ?” – and let the patient teach you .
Sadly , the noble tradition of assessing someone ’ s emotional needs has been usurped by the biological model that all mental disturbances are based on imbalances of brain chemicals and are correctable by medications . Big Pharma has taken advantage of this perception and have the resources to market directly to consumers . While watching just one football game last Sunday , I counted eight commercials for psychiatric medications . This would have been unheard of 10 years ago . Patients now come to see you having diagnosed their own problem and are ready to tell you what medicine they should be on .
Psychotropic medications are capable of therapeutically affecting mind , emotions and behavior – but can cause many uncomfortable side effects . Psychotropics account for 48 % of severe drug adverse reactions in the U . S ., affecting millions of Americans . 1 Particularly , the use of antidepressants has exploded in the past 20 years and has been continually on the rise since Prozac was introduced in 1988 . Non-psychiatric prescribers wrote for 80 % of all antidepressants , often without a specific diagnosis . Antidepressants do not help the symptoms of grief , adjustment or ordinary states of sadness . In fact , long term ( greater than a year ) use of SSRIs ( selective serotonin reuptake inhibitors ) may prolong or intensify depression causing a lingering bad mood known as “ tardive dysphoria .” The use of atypical antipsychotics have also skyrocketed since 2003 when the FDA approved their use as an adjunctive treatment for severe depression . Yet follow up studies failed to demonstrate their benefit but the Pharma marketing continues and the prescriptions climb . Significant weight gain , lethargy and cognitive impairment are all common side effects that patients experience . Anxiety complaints are the most common behavioral symptom in primary care with 20 % of the American adult population now reporting moderate to severe anxiety . The dangers of long term use of benzodiazepines are well described and restrictions on prescribing have reached the levels we experience with prescription opioids and stimulants . This begs
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