Psychopharmacology: A Discussion

By April Rosenblatt, Barkley McDonnell & Jamaica Wagner

Mackler, wrote this song to show the dangers of psychiatric medication, inspired by his experience

as a therapist

The Problem• Several years ago the school of psychology changed - the

medicalizing of the practice and the pharmacolizing of treatment.

• Record numbers of people diagnosed with mental illness and record numbers of psycho-pharmaceuticals administered to treat them.

• You would think that if pharmaceuticals worked to treat or “cure” mental illness the number of people diagnosed with mental illness would decrease- that is not the case.

Where Did It Begin ?

• What happened in the school of psychology?• Driven by a need to be taken seriously The

American Psychological Association began a push to re-medicalize psychology.

• Introduction of psychoactive drugs in the 1950’s which accelerated in the 1980’s

• Less focus on life stories, more focus on drugs that alter the brain to control symptoms

• They created more and more illnesses and diagnosis in the Diagnostic Statistical Manual and began treating them with drugs.

• It was not soon after that the pharmaceutical companies began to create more and more psychopharmaceuticals

• A new psychopharmaceutical was developed for each new diagnosis

• DSM II had 182 diagnoses,DSM III – 265, DSM IV-TR-365

• Pharmaceutical companies began providing money and gifts to those who will prescribe the drugs.

The truth behind psychotropic drugs and pharmaceutical companies

Illness Identity • In the article The Impact of Illness Identity on Recovery from

Severe Mental Illness Yanos, Roe, and Lysaker contend that tying ones identity to their illness can extend the course and severity of the illness.

• Once diagnosed the way a person conceptualizes their disorder, or thinks about it and themselves can change. They may, for example, begin to think they are weak or damaged as a result.

• Secondly, they point out that the diagnosis may have a negative impact on both self-esteem and hope. Hope – the belief that things will get better is necessary for recovery from any illness, especially mental illness.

• Some people may attribute negative stigmas they have heard about mental illness to their belief in themselves which effects both self-concept and motivation.

• With diminishing hope and confidence, depression can set in… which will undoubtedly lengthen the course of the mental illness.

Labeling• Mental illness can become a crutch and also a damaging label.

Whether the person is avoiding responsibility themselves or society is making the excuses, denial of responsibility stunts growth.

• For the chronically depressed they can give up responsibility for their lives – both their mishaps and their duties – because they are too depressed.

• A child diagnosed with ADD and told they have “impulse control problems” may never attempt to learn to control their actions because they have a disease that says they can’t.

Drug Dependency • What’s worse than “illness identity”? Drug

dependence. • When you couple illness identity with a schema that

one only functions normally when on a prescribed medication you undoubtedly extended the course of the mental illness to last an entire lifetime.

Effectiveness (or ineffectiveness)

• Once more the research shows that the drugs are not effective. Multiple trials of the most popularly prescribed anti-depressants and anti-psychotics showed little to know difference between the drugs and active placebos (which cause side effects).

• This shows that during the study the experience of side effects made the participants believe they were on the medication not the placebo and that belief led to a decrease in symptoms, not the drugs.

Long Term Damage• Even worse than being ineffective, some of these drugs can have long

term effects. For example, if you are depressed you may take a serotonin- norepinephrine reuptake inhibitor.

• These block the re-uptake of norepinephrine and epinephrine causing a surplus of these neurotransmitters, this is done to make you feel happier and less depressed.

• However, over time, the brain adapts to the drug and no longer works the way it should. If there is an excess of these neurotransmitters due to the drug the brain won’t produce as much.

• This is problematic when someone comes off the drug, less norepinephrine means more depression.

• A withdrawal of the anti-depressant which can be misconstrued as a relapse of depressive symptoms which means, more drugs.

• Drug trials are for short periods of time, and studies on long term effects show in some cases a shrinking of the brain and permanent changes to the prefrontal cortex.

The Corrupt Alliance of the Psychiatric-Pharmaceutical

Industry• In March 2009, the American Psychiatric Association announced that it

would phase out pharmaceutical funding of continuing medical education seminars and meals at its conventions.

• However, the decision came only after years of controversial exposure of its conflict of interest with the pharmaceutical industry and the U.S. Senate Finance Committee requesting in July 2008 that the APA provide accounts for all of its pharmaceutical funding.

• Despite its announcement, within two months, the APA accepted more than $1.7 million in pharmaceutical company funds for its annual conference, held in San Francisco.

• Not surprising. In 2002, the APA’s Anand Pandya said that without pharmaceutical industry funds, membership dues could escalate 455% from $540 a year to $3,000.

• Pandya is president of the National Alliance on Mental Illness (NAMI), which in 2009 was also asked to provide records of its pharmaceutical company funding to federal investigators.

• About 56% of its $12 million-a-year income comes from drug makers (more below).

• Within a month of the APA’s announcement, its conflicts came under criticism again with the release of a study that found that 18 of the 20 members overseeing the revision of clinical guidelines for treating mental disorders had financial ties to drug companies.

• The common diagnoses generate some $25 billion a year in pharmaceutical sales.

Statistics• Number of people on Social Security Dissability Insurance because of

Mental Disorders increased 2 ½ times between 1987-2007 from 1 in 184 to 1in 76 Americans

• For children that number increase 35% in two decades• Mental Illness is leading cause of disability in children, eclipsing physical

disabilities, cerebral palsy and down syndrome.• A survey by National Institute of Mental Health, found that between 2001-

2003 46% met criteria by APA for having a mental illness• After Prozac was released in 1987 the number of people treated for

depression tripled • 10% of Americans over age 6 take anti-depressants• Antipsychotics replaced cholesterol-lowering agents as the top-selling

class of drugs in the US

Activity Time!

Stop labeling kids with mental illness PSA

Attention Deficit Hyperactivity Disorder

• Diagnoses of Attention Deficit Hyperactivity Disorder are increasing at an alarming rate; approximately half of the child referrals in child mental health agencies account for children with Attention Deficit Hyperactivity Disorder.

• It is not uncommon to hear of the misdiagnosis of Attention Deficit Hyperactivity Disorder, wherein a child’s behaviors are attributed to ADHD when in actuality they are caused by or related to some other condition or trait (Atmaca et al., 2009).

Foster Care• 13.5% of children in child foster care were taking psychotropic

medications in 2001-2002.

• Files for 1,180 children living in the therapeutic foster care revealed that more than half were taking at least one psychotropic medication.

• Thirty-eight percent of the case files had no documentation of sent and 15 percent had forms signed by an unauthorized person. (doReis et.al ,2005)

On The Rise

• “Juvenile bipolar disorder” jumped forty-fold between 1993 and 2004, and that of autism increased from one in five hundred children to one in ninety over the same decade.

• In 2001, one in every ten of all office visits by teenage boys led to a prescription for a psychotropic drug.

• 10 percent of Americans over the age of 6 now take antidepressants, and 500,000 children take antipsychotic drugs.

• Between 14 and 26 percent of visits in which psychotropic medications were prescribed did not have an associated mental health diagnosis. (Raghavan et. al, 2005)

Alternatives to Medication • To support brain health• To combat mental illness• To support healing • To aid in prevention

We need to rethink how we approach mental illness. In the long-run, alternatives

minimize financial costs and bestow a more enduring impact.

YOUR BRAIN HEALTH MATTERS!

• The brain controls how you think, feel, act, & interact… it is involved in every decision that you make

• When you boost your brain’s health, it is much easier to gain control over your life… when your brain works right, you work right

• A troubled brain leads to a troubled life

• When you love your brain it will be much easier for you to love life

Brief Brain System Summary

• Prefrontal Cortex: Judgment, forethought, planning, & impulse control– Linked to a lack of clear goals, procrastination, a short attention span, poor

judgment, impulsivity, and not learning from the mistakes you make• Anterior Cingulate gyrus: Shifting Attention & flexibility

– When there is too much activity in this area, you tend to get stuck on negative thoughts or actions, tend to worry, hold grudges, and be oppositional & argumentative… a subsequent increase in obsessive & compulsive behaviors

• Deep Limbic System: sets emotional tone, involved with mood & bonding– When it is overactive, negativity can take over and lower motivation &

drive, decrease self-esteem, and increase feelings of guilt and helplessness. Abnormalities are associated with mood disorders

Brief Brain System Summary• Basal Ganglia: Integrates thoughts, feelings, & movements involved with

pleasure– Too much activity causes anxiety, and physical stress symptoms, such as

headaches, stomachaches, and muscle tension• Temporal Lobes: Memory, mood stability, and temper issues- “What Pathway”

– Trouble in the TL leads to memory & temper problems and mood instability • Parietal Lobes: Sensory processing and direction sense- “Where Pathway”

– Implicated in eating disorders and self-body distortion syndromes. • Occipital Lobes: Vision & visual processing• Cerebellum: Motor coordination, thought coordination, processing speed &

judgment. Large connections between this area and the PFC– Problems in this area cause poor physical coordination, slow processing,

and trouble learning. PFC health is directly impacted by cerebellum health

Brain Anatomy

COUNSELING

Counseling EnrichesAn Effective Counseling Approach

• Cognitive Behavioral Therapy- Favorable impact: attitudes related to illness identity are addressed - Psychoeducation: skills are taught/ instilled that give birth to cognitive

restructuring.- Coping techniques (problem-centered): are imparted thereby facilitating a

process of constructing a negotiating meanings. generates an internal dialogue that redefines how he or she feels about setbacks experienced as a result of having a mental illness and changes how strongly such setbacks impact perceptions of the self.

- Changes in appraisal of the stressor: the individual comes to experience and perceive oneself differently in relation to stressors and the sense of threat or suffering they generate

• Narrative Enhancement- An individual’s life story is transformed: personal strength, change, and success

over adversity are emphasized.- Disempowered narratives in witch themes dominate by internalized stigma

prevail, can be gradually reframed and revised. Subsequently, themes of agency and potential and personal strength come to predominate.

Counseling EnrichesNarrative Enhancement

• An individual’s life story is transformed: personal strength, change, and success over adversity are emphasized.

• Disempowered narratives in witch themes dominate by internalized stigma prevail, can be gradually reframed and revised. Subsequently, themes of agency and potential and personal strength come to predominate.

Exercise• Has been shown to be as effective as drugs for depression (with longer lasting

effects!

• Is the single most effective thing you can do to increase your brain function

• Boosts blood flow to the brain

• Encourages the growth of new brain cells, enhances cognitive ability in people of all ages, alleviates anxiety and depression, eases ADD/ ADHD symptoms and helps prevent/ delay dementia & Alzheimer’s Disease

• Boosts serotonin (the happy, anti-worry, flexibility chemical) in the brain and can help the brain get unstuck when in negative thought patterns… obsessive thinking, etc.

Coordination Activities• Strengthen the connections between those new cells created during aerobic

activity so that your brain can recruit them for other purposes- such as thinking, learning & remembering

• The coordination center of the brain is the cerebellum, which is linked to the PFC where judgment and decision making occurs.

• Engaging in coordination exercises activates the cerebellum, thereby strengthening your PFC and, ultimately improving your judgment so you can make better decisions

Relaxation Exercises (Yoga) & Meditation

• Soothes an overactive Basal ganglia = Reduced anxiety

• Meditative yoga can boost the prefrontal cortex thereby enhancing discernment, judgment, perception, and focus

• Relaxation techniques increase the production of GABA helping the brain/ individual relax. Anxiety can result from too much activity in the basal ganglia (low levels of GABA (gamma-aminobutyric acid). Which is an inhibitory neurotransmitter that calms or helps to relax the brain. Stress depletes the production of GABA resulting in being uptight, anxious or sad.

MusicListening to music• Can decrease depression, reduce anxiety and stress, lower blood pressure, maintain

cognitive function in the elderly, lower heart rate, relieve pain, improve sleep, and increase focus in children with ADD & ADHD

Singing• Stimulates temporal lobe function (facilitates learning, memory, & mood stability)• Expands the lungs and pumps up the flow of oxygen to the brain thereby boosting brain

functionMoving with music• The coordination centers are linked to the decision-making, judgment, and impulse control centers, music may be able to improve self-control Music Training• Integrates nearly all the senses and involves almost every known cognitive process.

It is one of the best brain boosting activities.

Social Interaction & Bonding

• Helps to calm the hyperactivity in the deep limbic system and enhance mood

• A lack of social connections causes negative changes in the brain that can lead to trouble in you life

• Important to health and wellbeing

NutritionBrain Healthy Nutritional Rules

1. Think high-quality calories in versus high-quality energy out 2. Drink plenty of water and not too many of your calories3. Eat high-quality lean protein throughout the day4. Eat low-glycemic, high-fiber carbohydrates5. Focus your diet on healthy fats6. Eat from the rainbow7. Cook with brain healthy herbs and spices to boost your brain8. Limit caffeine9. Take a daily multiple vitamin, fish oil, and natural supplements for specific needs10. Eat right for less

Important Health Numbers• Vitamin D level

• Omega-3 fatty acid levels • Hormonal levels

– Thyroid (THS and free T3– Testosterone– Estrogen and Progesterone (for women)– DHEA-S level

• HgA1c• Fasting blood sugar• Insulin level• Complete blood count • Comprehensive metabolic panel

Important Health Numbers• 2 hour glucose test (if hypolglycemia Symptoms are present)

• Cholesterol• C-reactive protein• Homocysteine• Blood Pressure• The 12 most modifiable risks you might have• Number of hours you sleep• BMI• Daily caloric needs• Daily caloric intake• Heavy metal toxicity• How many hidden food allergies you have

References• Angell, M. (2011) The Illusion of Psychiatry, The New York Review of

Books. Retrieved on February 28, 2012 from http://www.googlebooks.com

• Angell, M. (2011) The Epidemic of Mental Illness: Why? The New York Review of Books. Retrieved on February 28, 2012 from http://www.googlebooks.com

• Amen, D. and Smith, D. (2010). Unchain your brain: 10 steps to breaking the addictions that steal your life. California: MindWorks Press.

• Atmaca, M., Ozlar, S., Topuz, M., & Goldstein, S. (2009). Attention deficit hyperactivity disorder erroneously diagnosed and treated as bipolar disorder. Journal of Attention Disorders. 13(2), 197-198

• Brandeis University (2006, January 3). Psychotropic Drug Prescriptions For Teens Surge 250% Over 7 Year Period. Science Daily. Retrieved February 15, 2012 from http://www.sciencedaily.com/releases/2006/01/060103114004.htm

• DoReis, Susan. Zito, Julie M. Safer, Daniel J. Gardner (2005) Multiple Psychotropic Medication use for Youths: A two state comparision. Journal of Child and Adolescent Psychopharmacology. 15 (1) 68-77

• Meyers, L. (2006) Psychologists and psychotropic medication, American Psychological Association.

Retrieved on February 15, 2012 from http://www.apa.org/print-this.aspx

• Raghavan, Ramesh. Zima, Bonnie T. Anderson, Ronald M. Leibowitz (2005) Psychotropic medication use in a national probability sample of children in the child welfare system. Journal of child and adolescent psychopharmacology. 15. 97-106

• Yanos, P.T., Roe, D., & Lysaker, P.H. (2010) The Impact of Illness Identity on Recovery from Severe Mental Illness. National Institutes of Health, 13(2), 73-93. Retrieved on October 29, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/