“60 Minutes” ran a segment last Sunday on electroconvulsive therapy (ECT), better known as shock treatment. Kitty Dukakis was interviewed as a long-time recipient and advocate of ECT for her severe depression. The piece was almost entirely positive, save for brief mention of memory loss as an unfortunate side-effect. This was soon left behind by […]


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 […]

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 […]

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, […]

Talk doesn't pay: Comments on the NY Times article

I’d like to take this opportunity to comment on the article that appeared in today’s New York Times: “Talk doesn’t Pay, So Psychiatry Turns to Drug Therapy.” Gardiner Harris writes about psychiatry’s shift from talk therapy to drugs, and profiles psychiatrist Donald Levin of Doylestown, PA (a suburb of Philadelphia), who felt financially unable to […]

“Antidepressants are just a crutch”

Yesterday I evaluated a new patient, a young woman who wondered whether medication might ease her depression. She was in therapy elsewhere, and although seeing me was her idea, she was apprehensive about adding an antidepressant. I did end up recommending one, at which point she asked: “Aren’t antidepressants just a crutch?”

I relish this […]