Book description
"Dr. Paris has written an honest, balanced presentation of the
ways in which psychiatric drugs are evaluated and prescribed. He
highlights the complexity of the task, the limits of what is known and
the mixed picture that research often produces. His conclusions are
refreshing because they are built from an even-handed, pragmatic
assessment of the empirical evidence. The result is a stimulating look
at the world of treatments for emotional disorders that acknowledges the
usefulness of both biological and psychosocial explanations where
appropriate. His recommendations provide helpful roadmaps for patients,
practitioners and researchers alike. The book is sure to serve as a
welcome catalyst for the continuing debates about which treatments are
likely to produce the best outcomes."
-Roger P. Greenberg, Ph. D. Distinguished Professor and Head,
Psychology Division Dept. of Psychiatry & Behavioral Science SUNY
Upstate Medical University, NY, USA
The message of this book is that psychiatrists have some very good
drugs, but can expect bad results when they are over-used, prescribed
outside of evidence-based indications, or given to the wrong patients.
While acknowledging that many current agents are highly effective and
have revolutionized the treatment of certain disorders, Joel Paris
criticizes their use outside of an evidence base. Too many patients
are either over-medicated or are misdiagnosed to justify aggressive
treatment. Dr. Paris calls for more government funding of clinical
trials to establish, without bias, the effectiveness of these agents.
He has written this book for practitioners and trainees to show that
scientific evidence supports a more cautious and conservative approach
to drug therapy.
After describing the history of psychopharmacology, including its
early successes, Dr. Paris reviews the relationship between psychiatry
and the pharmaceutical industry. This problem has received
considerable popular attention in recent years and Dr. Paris documents
initiatives to increase transparency and decrease the influence of
pharmaceutical marketing on diagnosis and prescribing habits.
Dr Paris then examines some major controversies. One is the fact that
newer drugs have not been shown to be superior to older agents.
Another is that while the number of prescriptions for antidepressants
has increased dramatically, meta-analyses show that their value is
more limited than previously believed. Still another is the widespread
prescription of mood stabilizers and antipsychotic drugs for patients,
including children and adolescents, who do not have bipolar illness.
Polypharmacy is an especially contentious area: very few drug
combinations have been tested in clinical trials, yet many patients
end up on a cocktail of powerful drugs, each with its own side effects.
Dr Paris briefly considers alternatives to pharmacology and again
calls for more clinical trials of these approaches. He also discusses
the current trend to medicalizing what many would describe as normal
distress and states succinctly: Some things in life are worth
being upset about.
Joel Paris is a professor of psychiatry and former
department chair who has taught in a large university for 40 years. A
researcher (with over 150 publications), a clinician, and the editor
of a major journal, he has written/edited 12 books. He writes in a way
that can readily be understood by clinicians.
Joel Paris is an
active researcher, primarily in personality disorders and child &
adolescent psychiatry, and both this and his considerable practical
expertise enable him to argue intelligently both for and against the
use of psychotropic medications. His background as a medical
investigator and broad experience in teaching young psychiatrists
about the use of drugs help him to make neutral judgments about
complex issues.
