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The
era of modern psychiatric medications was inaugurated by the accidental
discovery and rapid widespread use of the anti-psychotic or anti-schizophrenia
drug, chlorpromazine(Thorazine). Antidepressants such as amitriptyline(Elavil)
and imipramine(Tofranil) began to be widely used about the same time around the
middle of the twentieth century, as did anti-anxiety agents such as
chlordiazepoxide(Librium) and diazepam(Valium). Since that time there has been
fairly steady progress in the development of psychiatric medications that are
safer to use and less likely to produce bothersome side effects. The
main classes of psychiatric medications are:
- Anti-anxiety agents(minor tranquilizers)
- Antidepressants
- Antipsychotics(major tranquilizers,
neuroleptics)
- Mood stabilizers
- Psychostimulants
While necessary and in a general way useful, such
categories, like current categories of psychiatric diagnoses, can be also be
misleading, since medications tend to have a spectrum of effects rather than a
single, narrowly defined action. Antidepressants, for example, commonly have
potent anti-panic and anti-anxiety effects, even in individuals who are not
depressed.
The impact of medications upon the practice of
psychiatry and mental health practice in general has been profound and in very
many respects beneficial. But the widespread use of medication to treat problems
previously dealt with by psychotherapy has in many instances led to an under-use
of psychotherapy.
Though it may be surprising to many, modern psychiatric
training programs no longer routinely provide adequate instruction in psychotherapy to
psychiatrists in training - though they may teach considerable skills in the
diagnosis and drug treatment of mental and emotional disorders.
An unfortunate tendency has developed,
driven in part by third party(insurance) reimbursement arrangements, for
so-called "split therapy," in which a psychiatrist prescribes
medications and a non-medical psychotherapist, often a Master's level counselor,
provides whatever psychotherapy the patient is able to obtain. While this
arrangement often works quite well, it presents obvious opportunities for
confusion and less than ideal treatment, especially in difficult and complicated
cases. The ideal situation for the patient requiring both medications and
psychotherapy is a psychiatrist skilled in both areas and thus able and in a
position to balance and adjust the treatment approach in a sensitive and ongoing
fashion according to the often changing needs of the patient.
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