Clinical Implications of the Drug-Centered Approach

Abstract

This chapter outlines applications of the drug-centered approach to the practice of psychiatry. Some psychiatrists who are critical of the contemporary focus on pharmacotherapy might argue for psychiatrists to return to the era when their primary role was as psychotherapists. That is not the position taken here. Rather, the author proposes that psychiatry should remain the medical specialty whose expertise is in understanding and prescribing psychoactive substances but that its members do so from the perspective of the drug-centered model articulated in Chap. 4. The implications of a drug-centered, as opposed to disease-centered, approach to medications are examined for several major classes of psychoactive compounds. Similar themes emerge: (1) short-term efficacy with increased relapse risk when drugs are stopped, combined with a conceptualization of mental disorders as chronic, commonly leads to recommendations for long-term pharmacotherapy; (2) considerations of possible withdrawal effects are frequently ignored; and (3) each class of drugs is prescribed for ever-widening lists of indications. These factors have contributed to growing numbers of people taking multiple drugs for indefinite durations. The benefits of shifting to a drug-centered approach are explored and the chapter concludes with suggestions for integrating such an approach into psychiatric practice.