Psychiatrists as neurologists … or biologists?

Martin & Elworthy report that the biggest reason for prescribing electroconvulsive therapy (ECT) less frequently than before is the perception among psychiatrists that ‘more effective medication’ now exists. ¹ Unfortunately, the authors collude with this exaggerated view, claiming that ‘psychiatric medications have undoubtedly become more effective over recent years’. Their bold statement references a 2002 story in The New York Times.

Meta-analysis shows that the current first-line treatments for depressive disorder, selective serotonin reuptake inhibitors, are marginally less effective than older tricyclic antidepressants (TCAs), while serotonin-noradrenaline reuptake inhibitors show no statistically significant advantage over TCAs. ² One newer drug, reboxetine, does not work at all, ³ yet is inexplicably still licensed as an antidepressant.

Lithium remains the only true mood stabiliser: it is the only drug with efficacy in treating acute manic and depressive symptoms and in prophylaxis of manic and depressive symptoms in bipolar disorder.⁴

One has to conclude that the prevailing delusion that treatments across psychiatry have become more effective has been mediated by the pharmaceutical industry. Psychiatrists should take their evidence from meta-analyses in peer-reviewed journals, not from advertising representatives and certainly not from the newsstand.