You mentioned Abilify. I wrote an article on the lack of science behind that pill for depression. See here. And as for antidepressants? We simply don’t know enough about them.

I hope that you find those articles useful. Your readers may also be interested in them.

http://healthlifeandstuff.com/2009/08/abilify-is-in-no-way-a-first-option-for-depression/

http://healthlifeandstuff.com/2009/07/do-we-know-anything-about-antidepressants/

I’m sure you and I are both biased as a result of our specific degrees and career paths Nonetheless, I really appreciate the dialogue. This is an important issue that deserves intelligent debate.

In my experience, psychiatrists really run the gamut in terms of their training and the services they provide. I know some psychiatrists who are excellent psychotherapists, who use psychotherapy and medication for the majority of their patients. I know other psychiatrists who do no psychotherapy whatsoever and view themselves purely as psychopharmacologists. I have met many psychiatrists (mostly younger ones) have little or no training in psychotherapy. I think compensation should be based on the types of services actually rendered, meaning psychiatrists who play the dual role of therapist and psychopharmacologist deserve higher compensation than those who play only one of these roles.

In any event, I agree with you that all psychiatrists deserve better compensation. Maybe a pay increase would compel more talented young doctors to go into psychiatry.

Thank you for your comment. I think you might not realize how much training psychologists actually have. I spent 7 years in a very demanding Ph.D. program in Clinical Psychology, followed by a residency which I am still in the process of completing. Clinical psychology Ph.D. programs are highly competitive, highly selective, and lengthy (average time to completion is 7 years). We also have to do a 1-2 year residency. So the length of time we spend in training is equivalent to the 4 years med school plus 4 years residency that psychiatrists complete. I won’t go into specifics, but doctoral students in psychology certainly rack up their share of student debt as well!

I’m not saying that psychiatrists should be reimbursed less. Rather, I’m saying that psychologists should be reimbursed more. Clinical psychologists are doctoral-level professionals with highly specialized training, and they should be compensated as such. Master’s level mental health professionals, such as clinical social workers and licensed mental health counselors, have considerably less training (usually only 2 years). It would make sense to reimburse them at a lower rate than psychiatrists.

It is such a shame that it’s hard to recruit med school graduates into psychiatry. We could certainly use more psychiatrists.

The phrase “necessary but not sufficient” is so perfect in this case. For me to live a “normal” life (yes, I know, normal is just a setting on the washing machine, but it works in this context), I need meds. But it’s not enough. Sort of like weight restoration- necessary but not sufficient for full recovery.

A great book I just read that reminded me of this post a bit was “Lincoln’s Melancholy” by Joshua Wolf Shenk, which talked about how learning to deal with your mental health issues can be empowering.

Thanks,
Carrie

It sounds like your story is a perfect illustration of the points I’m making. Like you, most people taking SSRI’s find that these meds allow them to function and bring them to the point that their brains are working well enough to engage in therapy. But also, like you, most people on SSRI’s find that they don’t completely resolve their symptoms. In this way, meds for bipolar disorder, major depression, and OCD,are analagous to weight restoration in AN.

Many people, due to the nature of their illnesses and family history, will probably need to stay on SSRI’s for the rest of their lives. Even so, evidence-based therapy can take them from “functional” to “fulfilled.” It sounds like this is what you’re working towards. For people in this category, medication is necessary but not sufficient. There’s absolutely nothing wrong with lifetime medication treatment if that’s what you need. SSRI’s are a great tool, and successful management of mental illness involves good self-care, therapy, mindful awareness of symptoms, and using all of the tools at your disposal to help yourself.

It is such a shame that advertising has turned off people who could genuinely benefit from medication. I see this a lot, too.

Thanks for your input, and best of luck.

- Sarah

I’m lucky in the sense that I have the resources (and yes, the sheer stubbornness) to access the care that I need. I have done both CBT and DBT work and found them to be tremendously helpful. Without my meds, I would be so depressed and anxious I wouldn’t get out of bed except that I would hope I might get hit by a bus while I was out. My therapy is a long way from over- though I’ve been seeing a therapist for the greater part of the last 8 years, much of that time was pretty useless. I don’t know if I’ll be able to discontinue the SSRI after I have developed a strong repertoire of coping skills. Given my history (both personal and family), I highly doubt it. I don’t like it, but I’m becoming much more okay with that fact.

The irony is that advertising for psych meds has made some of the people who desperately need them (read: some of my relatives) unwilling to take them as all of the ads have left a bad taste in their mouths. Yet many people find themselves medicated unnecessarily due to lack of resources/knowledge/time.

Thanks for your comment. You are right – the course of treatment for mental illness is often determined along class lines. Finances dictate the course of treatment not only on the end of the pharmaceutical companies and insurance carriers, but also on the end of the consumers who are unable to afford comprehensive health care. This is completely unacceptable. All Americans, regardless of race, age, ethnicity, or socioeconomic status, deserve local, high-quality, affordable, evidence-based mental health treatment including psychiatrists, psychologists, and other mental health professionals. Part of the problem is that the government, the insurance companies, and society in general do not share my conviction that psychological treatment is a necessity, not a luxury.

I think it is dangerous, however, to presume that inadequate or insufficient mental health treatment (e.g. low dose of medication prescribed by primary care physician) is better than no treatment at all. All psychotropic medications have side effects, some of which are very serious, and people who are taking them deserve to be under the care of a psychiatrist who provides adequate follow-up. I believe that many of the suicides that have occurred in patients, supposedly as a consequence of taking antidepressants, could have been prevented with thorough evaluations by specialists and frequent, thorough follow-up care.

None of these issues are the patients’ fault or the patients’ responsibility. Patients are simply trying to do the best they can do with the limited finances, resources, and information they have. If I were uninformed about mental health treatment and lacked the finances for specialized care and therapy, I’m sure I would use my internist for psychotropic medication as well if I thought I needed it. The point is that it shouldn’t have to be this way. The government, the pharmaceutical industry, the insurance companies, and healthcare professionals have the resposibility to work together to devise a better plan for comprehensive, high-quality, evidence-based mental healthcare for all American citizens, regardless of their ability to pay.