Psychopharmacology and Mental Health Trends – My Take

  • Every now and then I read some of the ubiquitous “threads” which discuss the trials and tribulations of those using psychotropic medications. The most frequent discussions are about antidepressants. The commentary uniformly highlights the failures that users are experiencing. This is because people are poorly educated about what to expect from these drugs. Expectations should be addressed at the prescriber level, but often aren’t. And antidepressant users – particularly first-timers – need to hear that these agents can help with depression, not cure it, and that NO drug has yet to crack the behavior code.
  • newsThe assessment and diagnosis of bipolar disorder is all over the map and so is its medication management. Clinicians have not been able to reliably agree on either. The tried-and-true lithium and divalproex options are more often eschewed in favor of still largely untested 2nd generation antipsychotics. Bipolar I and Bipolar II classifications are time worn and need to go. The most effective way to assess and diagnosis this disorder is to index presenting symptoms. Acuity, or the lack thereof, is an important first step pursuant to determining medication management strategies.
  • The next diagnostic fads will be internet and sex addiction. Treatment centers will pounce on this potentially lucrative market.
  • Many practicing mental health clinicians have “pet” diagnoses and use the DSM all but exclusively for reference and coding purposes.
  • Criteria and duration expansion of symptoms for Generalized Anxiety Disorder will usher in a sizeable subset of supposedly “anxious” people who will be unnecessarily prescribed benzodiazepines, when all they’re experiencing are the ups and downs of everyday life. To attain quality sleep, one must tire the body and mind. Tiring the body means moving the body; tiring the mind means using it productively in our everyday activities. It is a total myth that sleeping pills keep people asleep and for long term users, they’re no more than placebo.
  • Schizophrenia is a horrible circumstance and the “cure” so to speak, can be as bad or worse than the disorder itself. I can readily understand why schizophrenics refuse their medications.
  • The DSM-5 coming your way in 2013 has not been adequately field tested, and some of its content has not been subjected to independent review.
  • Neuroscience is more fascinating than it is practical.
  • Child and adolescent psychiatry is hamstrung by developmental factors and “nature vs. nurture” issues in youth. Co-occurring disorders in children and adolescents are the rule rather than the exception, meaning that some children can technically meet criteria for several disorders at the same time making medication management a debacle in many instances.
  • Prozac turns 25 years of age this year. Not a single antidepressant released since statistically outperforms it, day in and day out, in user after user.
  • The only pure psychotropic new release in the year 2012 was Quillivant XR. It’s the first-ever oral solution for ADHD. It is no more than a Ritalin-type liquid, so although new, this drug is by no means novel. The last few years have been tough sledding for psychotropic medication research and development. It’s proving to be tough to build a better mousetrap.
Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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