NEJM and the pharmascolds

The New England Journal of Medicine (NEJM) called the question: Has criticism of the pharmaceutical industry, and of physician relationships with that industry, gone too far? Are self-righteous “pharmascolds” blocking the kind of essential collaboration that brought streptomycin and other lifesaving treatments to market? The editorial by Dr. Jeffrey Drazen and the lengthy three–part […]

America's top selling drug is an antipsychotic

I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S. (I try to stay calm and collected here, but that’s a fact worth boldface.) To be a top seller, a drug has to be expensive and also widely used. Abilify is both. It’s the 14th most prescribed brand-name medication, […]

Undermedicated

A patient I see for psychotherapy, without medications except for an occasional lorazepam (tranquilizer of the benzodiazepine class), told me his prior psychiatrist declared him grossly undermedicated in one of their early sessions, and had quickly prescribed two or three daily drugs for depression and anxiety. He shared this story with a smile, as we’ve […]

Psychotherapy as generic conversation — Sloppy thinking in psychiatry 4

This fourth installment in my “sloppy thinking” series turns to psychotherapy, or what passes for it in some psychiatric practices. A very brief history: Sigmund Freud, a neurologist, invented psychoanalysis and its offshoot, psychodynamic psychotherapy, about 120 years ago. It was, first and foremost, a treatment that involved talking — not merely a conversation that […]

Polypharmacy — Sloppy thinking in psychiatry 2

My second post in this series on sloppy thinking in psychiatry is devoted to polypharmacy, the medical term for prescribing multiple medications at once, especially for the same problem. Polypharmacy is at best a risk thoughtfully taken because nothing simpler and safer will do. At worst it’s a dangerous error, exposing patients to unnecessary hazards […]

Chemical imbalance — Sloppy thinking in psychiatry 1

There’s a lot of sloppy thinking in my field. This troubles me. While psychiatry inevitably deals with the speculative and poorly understood, this surely cannot excuse faulty logic and intellectual laziness. Worse yet, this laxity of thought extends across the field, from biological psychiatry to psychotherapy, and from the general to the specific. My next […]

Do antidepressants work?

There is an active debate underway in the popular literature about whether antidepressant medications actually do anything chemically helpful for depressed patients. No one doubts that many patients report feeling better, and that most evidence less depression on standardized rating scales, following treatment. But much of that improvement appears to be due to psychological factors, […]