Do Psychiatric Medications Work?

"Why I’m not sure that psychiatric medications work"

| Meds |

I have a confession to make.  I don’t think what I do each day makes any sense.
Perhaps I should explain myself.  Six months ago, I started my own private psychiatry practice.  I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions.  I figured that an independent practice would permit me to be a more effective psychiatrist, as I wouldn’t be encumbered by the restrictions and regulations of most of today’s practice settings.

My experience has strengthened my long-held belief that people are far more complicated than diagnoses or “chemical imbalances”—something I’ve written about on this blog and with which most psychiatrists would agree.  But I’ve also made an observation that seems incompatible with one of the central dogmas of psychiatry.  To put it bluntly, I’m not sure that psychiatric medications work.
Before you jump to the conclusion that I’m just another disgruntled, anti-medication psychiatrist who thinks we’ve all been bought and misled by the pharmaceutical industry, please wait.  The issue here is, to me, a deeper one than saying that we drug people who request a pill for every ill.  In fact, it might even be a stretch to say that medications never work.  I’ve seen antidepressants, antipsychotics, mood stabilizers, and even interventions like ECT give results that are actually quite miraculous.
But here’s my concern: For the vast majority of my patients, when a medication “works,” there are numerous other potential explanations, and a simple discussion may reveal multiple other hypotheses for the clinical response.  And when you consider the fact that no two people “benefit” in quite the same way from the same drug, it becomes even harder to say what’s really going on. There’s nothing scientific about this process whatsoever.
And then, of course, there are the patients who just don’t respond at all.  This happens so frequently I sometimes wonder whether I’m practicing psychiatry wrong, or whether my patients are playing a joke on me.  But no, as far as I can tell, I’m doing things right: I prescribe appropriately, I use proper doses, and I wait long enough to see a response.  My training is up-to-date; I’ve even been invited to lecture at national conferences about psychiatric meds.  I can’t be that bad at psychiatry, can I?
Probably not.  So if I assume that I’m not a complete nitwit, and that I’m using my tools correctly, I’m left to ask a question I never thought I’d ask: Is psychopharmacology just one big charade?
Maybe I feel this way because I’m not necessarily looking for medications to have an effect in the first place.  I want my patients to get better, no matter what that entails.  I believe that treatment is a process, one in which the patient (not just his or her chemistry) is central.  When drugs “work,” several factors might explain why, and by the same token, when drugs don’t work, it might mean that something else needs to be treated instead—rather than simply switching to a different drug or changing the dose.  Indeed, over the course of several sessions with a patient, many details inevitably emerge:  persistent anxiety, secretive substance abuse, a history of trauma, an ongoing conflict with a spouse, or a medical illness.  These often deserve just as much attention as the initial concern, if not more.
Although our understanding of the pathophysiology of mental illness is pure conjecture, prescribing a medication (at least at present) is an acceptable intervention.  What happens next is much more important.  I believe that prescribers should continue to collect evidence and adjust their hypotheses accordingly.  Unfortunately, most psychopharmacologists rarely take the time to discuss issues that can’t be explained by neurochemistry (even worse, they often try to explain all issues in terms of unproven neurochemistry), and dwindling appointment times mean that those who actually want to explore other causes don’t have the chance to do so.
So what’s a solution?  This may sound extreme, but maybe psychiatry should reject the “biochemical model” until it’s truly “biochemical”—i.e., until we have ways of diagnosing, treating, and following illnesses as we do in most of the rest of medicine.  In psychiatry, the use of medications and other “somatic” treatments is based on interview, gut feeling, and guesswork—not biology.  That doesn’t mean we can’t treat people, but we shouldn’t profess to offer a biological solution when we don’t know the nature of the problem.  We should admit our ignorance.
It would also help to allow (if not require) more time with psychiatric patients.  This is important.  If I only have 15-20 minutes with a patient, I don’t have time to ask about her persistent back pain, her intrusive brother-in-law, or her cocaine habit.  Instead, I must restrict my questions to those that pertain to the drug(s) I prescribed at the last visit.  This, of course, creates the perfect opportunity for confirmation bias—where I see what I expect to see.
We should also make an effort to educate doctors and patients alike about how little we actually know.  The subjects in trials to obtain FDA approval do NOT resemble real-world patients and are not evaluated or treated like real-world patients (and this is unlikely to change anytime soon because it works so well for the drug companies).  Patients should know this.  They should also know that the reliability of psychiatric diagnosis is poor in the first place, and that psychiatric illnesses have no established biochemical basis with which to guide treatment.
Finally, I should say that even though I call myself a psychiatrist and I prescribe drugs, I do not believe I’m taking advantage of my patients by doing so.  All of my patients are suffering, and they deserve treatment.  For some, drugs may play a key role in their care.  But when I see my entire profession move towards a biochemical approach—without any good evidence for such a strategy, and without a fair assessment of alternative explanations for behavior—and see, in my own practice, how medications provide no real benefit (or, frequently, harm) compared with other treatments, I have to wonder whether we’ve gone WAY beyond what psychopharmacology can truly offer, and whether there’s any way to put some logic back into what we call psychiatric treatment.
Steve Balt is a psychiatrist who blogs at Thought Broadcast.
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What is Biofeedback & Bowel Disorders


Biofeedback & Bowel Disorders: Teaching Yourself to Live without the Problem

What is biofeedback?

Biofeedback is a neuromuscular reeducation tool therapists can use to tell if certain processes in our bodies are working correctly. It is a painless process that uses a computer and a video monitor to display bodily functions of which we are usually unaware. Special sensors measure these functions, which are displayed as sounds we can hear, or as line-graphs we can see on a computer screen. In this way, we receive information (feedback) on how our bodies work.
The therapist helps us to use this displayed information to modify or change abnormal responses to more normal patterns. That may mean increasing a response, decreasing a response, or learning to coordinate two responses more effectively.

How can biofeedback help?

Bowel control is a bodily function that can be shaped by biofeedback. Bowel control is something most of us master in our early childhood years. Once control is established, we think very little about these processes. That is, until something goes wrong.
Disease, trauma, or age-related changes in the body may interrupt our ability to command this crucial body function. Biofeedback techniques help us reestablish these learned patterns. The technology allows us to retrain defective processes, and to restore more normal function.

Does biofeedback work for everyone?

Biofeedback and home strengthening exercises are non-surgical, non-invasive therapy options that have been shown to reduce symptoms in many of people. Participating in this therapy can help restore a sense of personal control. However, the benefits of biofeedback vary from person to person.

What disorders may be treated by biofeedback?

Biofeedback therapy may be used to treat several bowel disorders such as incontinence, constipation, and painful spasms of the pelvic floor muscles.

When should biofeedback therapy be used?

Here to Help

It is important to consult a qualified physician when considering treatment options. One or more of a variety of diagnostic tests may be necessary. Before treating for incontinence, a thorough assessment of the muscles and nerves in the pelvic floor should be carried out.
In order to implement a neuromuscular reeducation program that best fits one's needs, detailed information relating to his or her symptoms needs to be given to the physician and therapist. Once an evaluation has been made, the correct treatment option can be implemented.

Who administers biofeedback therapy?

Biofeedback may be administered by a well-trained and qualified physician, nurse, or physical or occupational therapist. However it is not available in all medical centers.

How long does biofeedback therapy last?

Therapy sessions may vary in number and length. A person with a non-neurological problem may require an average of six to eight treatment sessions over a three-month period. Treatment sessions may be scheduled weekly and decrease in frequency as improvements occur.
Home practice is the key to improvement. It is impor


How to Make Interpersonal Changes

This is a terrific article on diet and exercise changes; this model of change explained here, Transtheoretical Model of the Stages of Change (Prochaska and DiClemente, 1983). focuses on the individual’s readiness to change any behavior.


New Meditation for Everyone Class to Begin

Please join Christina and learn the ancient technique of meditation. Meditation is a user-friendly, affordable, and always accessible way to manage stress and improve our physical well-being. Research has consistently proven that mindful meditation guides us to better sleep, less physical complaints, and reduced interpersonal tension. Christina Neumeyer, M.A., a Licensed Marriage and Family Therapist, incorporates into this popular class Cognitive Behavioral Therapy skills, as well as an informative discussion on factors that lead to depression, anxiety, and insomnia. Please bring a mat or towel to class.

Monday 6:00 pm - 7:30 pm; 3 sessions starting March 4, 2013, ending March 18, 2013
Tuition: $44.00
Instructor: Neumeyer
Location: San Dieguito Adult School 


The Hurriedness of Childhood Today

The divide between success and failure is so great now. One doesn't seem able to make a reasonable life out of existing in the middle.

We know that fewer slots are available for college admission, and even fewer for scholarships, requiring each student to have an extra edge to standout.

Musical expertise allows for that - an edge. We want girls to be comfortable with their body image - sports allows for that. In our adult mind, the sooner the better.

And we've been sold on this uniquely American idea that we must find our passion...and if our 15 year old hasn't done that yet, when will they? When a 12-year old says, "I don't play soccer very well and it's too late to learn," this message has come from somewhere.

I remember taking my son, aged 5 at the time, to play indoor soccer at the local YMCA. He cried at the buzzer and wouldn't leave my side. I felt embarrassed and somehow like I'd failed, as all the other little boys excitedly jumped right in. That was the maddest I'd ever been with him, bringing on such remorse and shame for my reaction that I really never pushed that hard again.

We are raising Renaissance tots, sort of the whole child that is capable to grow a garden, speak a second language, play an instrument, lotus and kiai. But, the darker side is pressure to perform. 

The difference between my childhood and the childhood of today, is the idea that today is incredibly and irrevocably important. Each and every moment counts (maybe this is partially wonderful!)  and mustn't be "wasted." If I, as a parent, screw up today, or don't take advantage of an opportunity, the consequences are dire. And, how better to do that than pack every moment with interesting, brain stimulating's actually hysteria. Where once these activities were affordable to a wealthy few, it's no longer money-driven but time-driven.

Enrichment and creative stimulation aren’t always organized, structured, or quantifiable.

I was at the local park with five neighbor boys when someone walked by and asked if we were some sort of camp, that’s how odd it is to see unorganized children “messing around.”

Parents seems caught up in the hurriedness of childhood simply because they believe it keeps their kids safer (prophylaxis against bad choices, i.e. drugs, gangs, etc) and more secure (better job, music, sports opportunities) in the long run. Remember “the Devil's Hands Are Idle Playthings”?

Parents have taken this profoundly to heart because our world feels risky and more uncertain than ever. At the core of this belief system are well-intentioned parents who are afraid that allowing children to “goof off,” or malinger aimlessly, results in danger and


What research actually shows is that children “norm” out…so the awkward 5 year old will eventually catch up to his peers, yet, his parents worry that he will be labeled, ostracized, bullied, unchosen.

Hence, most of my practice sees parents who a transmitting their anxiety to their children. 
Maybe one son is more quiet than the others, “more attached” and refuses sleepovers. Parents compare and contrast; this is human nature. So, a concerned Mom will bring him in for counseling in the hopes that he will detach sooner than his own temperament is allowing. As mom and dad become more anxious, child becomes more anxious. While he may not have felt conscientious about his lack of desire to join a team, he now begins to sense the he should want to join a team., creating anxiety and maybe even latency depression. There’s much more pathologizing and labeling personality traits, maybe even quirky behaviors as abnormal; something as harmless as doodling, hating sports, or having just one or two friends. Parents now wonder, will he grow up and be the next crazy killer?

Childhood is specifically about a variety of exposures…it’s a sampler of things to come. I often hear parents pressif you join the soccer team, you must finish the season. No quitting allowed.” That’s absurd and I challenge any adult to honor such a code of commitment. 
No, he’s not letting down his teammates…no other kids on the team are even remotely aware of who is present.  If he’s under the age of 10, he’s below the age of reason, let him quit ten sports teams before he finds the one he likes well enough to warrant leaving his cozy home and things for. 

Problem solving and executive skills come from having no rules, being without a map, and applying one’s own moral compass, basic education, and well-rounded sense of “I am loved.”


New Artist's Way Class, Wellness Week

The Artists Way
Mondays, January 14th-April 8th
12 week course in Vista, CA
Contact Joan Keefe @ 760.518.5047


Wellness Week - Tons of free stuff for seven days

(Flu shots, BMI, Yoga, accu)

Check out my new Pinterest Page


Volunteers Needed

Have you always wanted to volunteer at Solutions, but can never find the time because of work, kids, life? We have an opportunity for you! WE NEED HELP with this year's Point in Time Count -- it is an annual event that occurs around the country and is a census of the nation's homeless. In San Diego, it is occurring on January 25th from 4:45 AM - 8:00 AM. If you can volunteer, please email You will also need to attend a training at Solutions on January 21st from 6:30-7:00 PM. THANK YOU!


Hair and Skin Pulling & Picking: Trichotillimania

with Joan Kaylor, MSEd, NCC, LPC, DCEP

Wednesday, January 30th, 2013
11:00am PT / 12:00pm MT
 1:00pm CT  / 2:00pm ET
Anyone who has ever been touched by pulling or picking has experienced the pain and devastation of not being able to stop, or of not being able to help a child, spouse, partner or loved one suffering with these problems.  The frustration of hands that are out of control is just as horrendous as any chemical addiction, perhaps worse because we don't have to buy our substance of choice. We have it with us at all times. 

Joan Kaylor, who herself is pull-free after living with trichotillomania for many years, will share strategies for maintaining motivation through recovery, how to stop judging yourself, setting attainable goals, and how to continue using strategies even when you think they aren't working (or aren't working fast enough). This webinar is correctly named "Take Back Your Power from BFRBs" because you can take back your power. 


Tax Preparation for Low Income, Free Diving

Extreme-Sport, Free Diving  
(amazing footage and a real test to the human outer limits)


Parents Get Help from Teen Support Group

North County Parent Support for Teens and Children

Google Doodle Kids Contest

Doodle 4 Google

Doodle 4 Google is an annual program that invites K-12 students in the United States to use their artistic talents to think big and redesign our homepage logo for millions to see.

This year, we ask students to exercise their creative imaginations around the theme, “My Best Day Ever…” One talented student artist will see their artwork appear on the Google homepage, receive a $30,000 college scholarship, and a $50,000 technology grant for their school along with some other cool prizes!


Volunteers Needed

In 2008, two young Christian sisters wanted to help the homeless people they see frequently in Carlsbad Village, so they founded the grassroots efforts of Fill-a-Belly. Every Tuesday night, the homeless gather in the park for a potluck feast and fellowship.

Project List

Click below for details Category Date Openings
Fill-a-Belly - Serve Dinner 01/15/13 16      
Fill-a-Belly - Serve Dinner 02/19/13 16      
Fill-a-Belly - Serve Dinner 03/19/13 16      
Fill-a-Belly - Serve Dinner 04/16/13 16      

Food Needs for North County Residents 1/15/13

Do you know someone who struggles to fill their pantry with enough food every month? Let Interfaith Community Services and CalFresh help! The San Diego Food Bank will be on-site at Interfaith's Inland Service Center in Escondido, conducting CalFresh sign-ups on January 15th from 8:30am to 12:30pm. Intake will be done on a first-come, first-serve basis and is open to everyone.


Maybe gun violence on tv will go the way of cigarettes

     Watching a Friday night Lakers game on TNT with my kids last night was a real eye-opener. We don't watch much television. My kids are not allowed tv during the week. On the weekends, we watch a few selected tv shows (mostly DVR'd). I have previewed whatever they are allowed to watch.
     In the evenings, once kids are in bed, I may see a few minutes of news. That's about it.
So, sitting there last night, watching the Lakers - which is painful enough! - about 7pm (prime time, right?) I was appalled at the R-rated movies that were advertised, one after another. The gun violence was horrendous.
     Cigarettes were always a common part of tv shows in the 60's and 70's. Everyone smoked in sitcoms and family shows and tobacco companies were allowed to advertise commercials.   At some point, RJ Reynolds, and others, were tasked to minimize advertising as it was harmful to children. Will the same turn of events occur with gun violence? Can you imagine a day without guns allowable on tv? Interesting thought!


Grey Market Adoption, Patient Advocacy

"Searching For The Truth About My 'Grey Market' Adoption"

Great patient resources here!


Anxiety as a Silent Killer

Anxiety is the most mysterious of mental and emotional conditions.
Most people who suffer from anxiety are high-functioning, super bright folks (children and adults, both).

Looking at any of our current entrepeneurs, successful business leaders -Steve Jobs, Bill Gates- you will see anxiety. Anxiety is a wonderful thing. It keeps us sharp and emotion that alerts our bodies to "get ready and perform."
Without anxiety, nothing effective or interesting would happen! We'd be a bunch of resting, overly happy slugs. :)

Anxiety rears its ugly head when the waves get too big...something unusual that the brain perceives as "too much" - sort of an alarm that the system is tilting, overloaded.

How to treat anxiety: Cognitive Behavioral Therapy (CBT) has proven to be the most effective intervention for treatment. Moderate exercise lowers anxiety. Meditation and Mindfulness lowers anxiety. Furthering personal knowledge and understanding of the fight or flight response. The development of self-soothing and anchoring techniques.
Medication may be helpful, even necessary (please see a Psychiatrist for medication education).

Children and Adults: Anxious symptoms may look like this: picking skin, pulling hair (one's own eyebrows, eyelashes), coughing, throat-clearing, counting, ritual patterns, panic attacks, racing heart, waking with heart palpitations, stomach or intestinal distress, loss of appetite, or compulsive masturbation.

The good news? Anxiety responds very well to treatment with an expert clinician!