Research on a ‘drug-centred’ approach to psychiatric drug treatment: assessing the impact of mental and behavioural alterations produced by psychiatric drugs

Abstract

Aims:This article explores an alternative understanding of how psychiatric drugs works that is referred to as the drug-centred model of drug action. Unlike the current diseasecentred model, which suggests that psychiatric drugs work by correcting an underlying brain abnormality, the drug-centred model emphasises how psychiatric drugs affect mental states and behaviour by modifying normal brain processes. The alterations produced may impact on the emotional and behavioural problems that constitute the symptoms of mental disorders. Methods:Arguments are put forward that justify the consideration of the drug-centred model.The research necessary to support the prescription of drugs according to such a model is explored. Results:Evidence from neurochemistry and comparative drug trials do not confirm the disease-centred model of drug action. Since psychiatric drugs are recognised to have mind and behaviour-altering properties, the drug-centred model constitutes a plausible alternative. The drug-centred model suggests research is needed to identify all the alterations produced by various sorts of drugs, both acute and long-term, and how these might interact with the symptoms and problems associated with different mental disorders. This requires detailed animal and volunteer studies and data from patients prescribed drug treatment long-term, along with placebo-controlled and comparative 3 trials that look at the overall impact of drug-induced alterations on well-being and functioning as well as symptoms. Research is also needed on alternative ways of fulfilling the function of drug treatment. The moral aspect of using drugs to modify behaviour rather than treat disease needs honest and transparent consideration. Conclusions:It is hoped this discussion will encourage the psychiatric and pharmaceutical research community to provide more of the information that is required to use psychiatric drugs safely and effectively.

The antidepressant standoff: why it continues and how to resolve it

“…Given this utilization, the hundreds of double-blind placebo-controlled AD trials (Cipriani et al, 2018), and the prominent recommendation of ADMs in clinical guidelines, one would expect that ADMs are universally considered effective and worth their side effects. Surprisingly, that is not the case: fierce debate on their effectiveness continues in the scientific literature, media, and Internet (Moncrieff, 2018a). Here we explore the positions of the advocates and critics and examine why the debate continues and how it is best resolved.…”

Do DSM classifications help or hinder drugdevelopment?

“…For example, amphetamine-like compounds improve temporary concentration and sociability in healthy individuals and in Alzheimer’s disease or post-stroke apathy/social withdrawal. 18 Likewise, DA-blocking psychotropics reduce reactivity to environment stimuli or internal emotions in healthy individuals and in almost all disorders classified by DSM . Also, effective psychotropic drugs such as benzodiazepines have been developed much before the modern diagnostic systems existed, and were prescribed, transdiagnostically, to individuals who do not qualify for any DSM diagnosis, individuals suffering from insomnia, anxiety, depressed mood or psychotic agitation.…”

Medicine and meaning—How experienced therapists describe the role of medication in recovery processes in bipolar disorder

“…While many studies point to the value of pharmacotherapy in both acute and maintenance treatment of people with bipolar disorder (Bowden et al., ; Geddes, Burgess, Hawton, Jamison, & Goodwin, ), critical voices claim there is a marked tendency to overestimate the effectiveness of such treatment and to downplay its harms (Healy, ; Moncrieff, ; Whitaker, ). Unlike most medical drugs that act on physical mechanisms that produce symptoms, there is no convincing evidence that current psychiatric medications target the biomedical processes underlying mental disorders (Gøtzsche, ; Moncrieff, ). In fact, we do not yet fully understand the mechanisms behind symptoms such as depression or mania, let alone know the causative processes that underlie a severe mental illness such as bipolar disorder.…”

“…Furthermore, to consider an intervention that changes an individual's behaviour and thinking is a more complicated enterprise than assessing the effects of a medication with clear biomedical effects. This complexity exists because our mental processes are what makes us who we are—they are integral to our personhood and our sense of self (Moncrieff, ). As such, there is clearly a need for rigorous research that can contribute to building an independent and comprehensive knowledge base that would include both the benefits and costs associated with psychiatric drug treatment.…”