Sounds fair to me. What’s strange to me is that MAHA has some justified scepticism about psychiatric medication and its adverse effects, but absolutely no curiosity about the adverse effects of psychedelic drugs - which RFK wants to legalize within 12 months against the advice of the FDA. It just seems like institutionalized contrarianism - if SSRIS were available in a Costa Rican retreat and called Karmahuasca they’d be gobbling it up
As a psychopharmacology enthusiast, the actual truth about drugs is rich and fascinating. It's time to treat each other as intelligent and advance our shared scientific knowledge. People can handle sophisticated knowledge. This is evident from how much the public loves neurotransmitter stories. People have a thirst to learn about mental health, the public institutions should educate them, not treat them like children.
Psychiatric medications are safe and effective when used for the right indications under the care of a qualified clinician, and the expected benefits render the expected risks acceptable to the average patient. This does not mean that psychiatric medications are risk-free, universally effective, or right for every person. Psychiatric medications allow many people to better manage their symptoms and live more functional lives; for some, the effects are transformative. Like all medications, they can also cause harm, including serious adverse effects in a minority. Some of these adverse effects, especially with long-term use, remain poorly studied. The public deserves access to psychiatric medications in a manner that pairs available evidence with person-centered care. Their use requires transparency about uncertainties, mechanisms, trade-offs, and alternatives. We support individuals and families making informed choices.
I would replace “…to the average patient” with “to many patients” or even “to some patients”.
The fact is, the average patient these days is not adequately informed of risk, and is often desperate for any intervention that might help. I worry that by saying that the risk is acceptable to the average patient, it implies that a reasonable patient would accept the risk unless there is some concrete reason not to. But I think it’s equally reasonable to decide psychiatric medication is too risky or poorly understood in most cases.
So for those reasons, I would prefer the language I suggested.
In general, thank you. I appreciate how well thought out this statement is and I wish the field would listen to you.
Your proposed wording is good. I would change only one thing. Open it with this, as the first sentence: Psychiatric medications are not risk-free, universally effective, or right for every person.
You hit a home run with that. It is strong and pitched to adults. You'll give them something to work with.
I would also like to see more discussion specifically regarding the risks of weight gain, coercion and patients rights to refuse, and risks of Type II Diabetes and akathesia.... for some reason these are always downplayed....
I would absolutely add that they can sometimes terribly difficult to taper off of and that, the longer you stay on them, the harder it may be. I was never told this and, yes, I’ve been angry about that at times during my now 20 month and counting taper.
Might add that long term efficacy is also poorly studied.
In a longer statement it might be worth saying that it’s not really known how most psychiatric medications work. Well, their effects on various neurotransmitters are known, but there’s a big empty explanatory space between that and symptom change. Presumably something about predictive processing and complex system dynamics.
I’m fascinated by the tone deafness or bullheadedness or just sheer idiocy that would push a professional body to double down that way. Is anyone there thinking this through based in reality?
I agree with your statement, but directly saw parallels to how hormonal contraception is publicly debated. Both SSRIs and the pill have been a very important stepping stone for their respective field and have changed many lives for the better, but both can be inappropriate for you or have severe side effects that are often not taken seriously. That makes it an emotionally loaded topic and depending on personal experience it's either labelled as "good" or "bad". More nuanced statements are needed, but for that the idea of precision medicine needs to become more widely known/understood.
I would add, or find a way to add, that we as a society and culture of health services have become over reliant on medication. That psychofarmaca are known to be only effective if paired with adequate and additive treatment and counselling. And there above should re-establish the role of the psychiatrist as a holistic practice. Let doctors have the freedom to choose treatment programmes in and outside of care facilities. Let them retake primacy over pharmacological industry and insurance companies and make those last two facilitate the recovery process of people instead of their own margins.
I totally agree with the meaning of your message, but I exact wording just isn't right for the American public. They aren't medically trained. There is a reason voters took to Trump at the original debates over the overly-politicized competition on the right and left (this is not an endorsement of him). I think psychiatry and medicine in general needs to be able to sound less formal and more human - less like a journal article and more like a blog or a conversation with a friend. I would form sentences that probably wouldn't pass a formal philosophical sniff test but are largely true: "Mental health medications have been widely studied, and most of the time, they cause more good than harm. But this isn't always true. It is important to talk to a provider who is willing to be transparent and honest about both the risks and benefits of medication. If someone is saying they are always safe or always dangerous, they probably aren't a great source. Let us know how we can help."
This is probably far too informal, but I hope the point stands. I find patients listen when I talk to them on their level (this isn't always the same level). And I've seen many glaze over when I talk to long or start using terminology that isn't meaningful to them. Hope this helps.
Thanks for this Dr. Aftab. I would add a statement encouraging people to have a frank discussion with their doctor about potential risks and benefits of any treatment offered. If their doctor is upset by this request the person should consider getting another doctor.
I agree with your phrasing. It's far more objective and humane. As someone who has taken many medications and experienced the positives and negatives, I affirm this. Unfortunately I would argue that the negatives outweighed the positives for me and I wish I had full informed consent and tapering information.
The APA is extremely tone-deaf and propagandistic in their statements. It is like they are advertising the drugs to people. They should understand that the more they present uncritically, the more valid grievances people will have with psychiatry.
Sounds fair to me. What’s strange to me is that MAHA has some justified scepticism about psychiatric medication and its adverse effects, but absolutely no curiosity about the adverse effects of psychedelic drugs - which RFK wants to legalize within 12 months against the advice of the FDA. It just seems like institutionalized contrarianism - if SSRIS were available in a Costa Rican retreat and called Karmahuasca they’d be gobbling it up
Institutionalized contrarianism is right on the mark!
As a psychopharmacology enthusiast, the actual truth about drugs is rich and fascinating. It's time to treat each other as intelligent and advance our shared scientific knowledge. People can handle sophisticated knowledge. This is evident from how much the public loves neurotransmitter stories. People have a thirst to learn about mental health, the public institutions should educate them, not treat them like children.
Psychiatric medications are safe and effective when used for the right indications under the care of a qualified clinician, and the expected benefits render the expected risks acceptable to the average patient. This does not mean that psychiatric medications are risk-free, universally effective, or right for every person. Psychiatric medications allow many people to better manage their symptoms and live more functional lives; for some, the effects are transformative. Like all medications, they can also cause harm, including serious adverse effects in a minority. Some of these adverse effects, especially with long-term use, remain poorly studied. The public deserves access to psychiatric medications in a manner that pairs available evidence with person-centered care. Their use requires transparency about uncertainties, mechanisms, trade-offs, and alternatives. We support individuals and families making informed choices.
(More suited to the general public IMO)
All that jargon at the beginning , while true, alienates me as part of the general pop.
I would replace “…to the average patient” with “to many patients” or even “to some patients”.
The fact is, the average patient these days is not adequately informed of risk, and is often desperate for any intervention that might help. I worry that by saying that the risk is acceptable to the average patient, it implies that a reasonable patient would accept the risk unless there is some concrete reason not to. But I think it’s equally reasonable to decide psychiatric medication is too risky or poorly understood in most cases.
So for those reasons, I would prefer the language I suggested.
In general, thank you. I appreciate how well thought out this statement is and I wish the field would listen to you.
Your proposed wording is good. I would change only one thing. Open it with this, as the first sentence: Psychiatric medications are not risk-free, universally effective, or right for every person.
You hit a home run with that. It is strong and pitched to adults. You'll give them something to work with.
I also second this!
Love this! You’re also demonstrating that you hear many patients’ concerns by opening with this phrase, making them want to read further
I would also like to see more discussion specifically regarding the risks of weight gain, coercion and patients rights to refuse, and risks of Type II Diabetes and akathesia.... for some reason these are always downplayed....
I agree with all six words, and the period, used in your second sentence.
I would absolutely add that they can sometimes terribly difficult to taper off of and that, the longer you stay on them, the harder it may be. I was never told this and, yes, I’ve been angry about that at times during my now 20 month and counting taper.
Might add that long term efficacy is also poorly studied.
In a longer statement it might be worth saying that it’s not really known how most psychiatric medications work. Well, their effects on various neurotransmitters are known, but there’s a big empty explanatory space between that and symptom change. Presumably something about predictive processing and complex system dynamics.
This is not specific to psychiatric medications.
It seems like this statement would apply to many categories of medications if not most.
A good statement, yours.
I’m fascinated by the tone deafness or bullheadedness or just sheer idiocy that would push a professional body to double down that way. Is anyone there thinking this through based in reality?
eloquently said
I agree with your statement, but directly saw parallels to how hormonal contraception is publicly debated. Both SSRIs and the pill have been a very important stepping stone for their respective field and have changed many lives for the better, but both can be inappropriate for you or have severe side effects that are often not taken seriously. That makes it an emotionally loaded topic and depending on personal experience it's either labelled as "good" or "bad". More nuanced statements are needed, but for that the idea of precision medicine needs to become more widely known/understood.
I would add, or find a way to add, that we as a society and culture of health services have become over reliant on medication. That psychofarmaca are known to be only effective if paired with adequate and additive treatment and counselling. And there above should re-establish the role of the psychiatrist as a holistic practice. Let doctors have the freedom to choose treatment programmes in and outside of care facilities. Let them retake primacy over pharmacological industry and insurance companies and make those last two facilitate the recovery process of people instead of their own margins.
I read stuff like this from the APA and I just sigh, deeply out of touch
Your modified statement is simply more true and provides the nuance the public is more than capable of handling
I totally agree with the meaning of your message, but I exact wording just isn't right for the American public. They aren't medically trained. There is a reason voters took to Trump at the original debates over the overly-politicized competition on the right and left (this is not an endorsement of him). I think psychiatry and medicine in general needs to be able to sound less formal and more human - less like a journal article and more like a blog or a conversation with a friend. I would form sentences that probably wouldn't pass a formal philosophical sniff test but are largely true: "Mental health medications have been widely studied, and most of the time, they cause more good than harm. But this isn't always true. It is important to talk to a provider who is willing to be transparent and honest about both the risks and benefits of medication. If someone is saying they are always safe or always dangerous, they probably aren't a great source. Let us know how we can help."
This is probably far too informal, but I hope the point stands. I find patients listen when I talk to them on their level (this isn't always the same level). And I've seen many glaze over when I talk to long or start using terminology that isn't meaningful to them. Hope this helps.
Thank you! Good point!
Thanks for this Dr. Aftab. I would add a statement encouraging people to have a frank discussion with their doctor about potential risks and benefits of any treatment offered. If their doctor is upset by this request the person should consider getting another doctor.
I agree with your phrasing. It's far more objective and humane. As someone who has taken many medications and experienced the positives and negatives, I affirm this. Unfortunately I would argue that the negatives outweighed the positives for me and I wish I had full informed consent and tapering information.
The APA is extremely tone-deaf and propagandistic in their statements. It is like they are advertising the drugs to people. They should understand that the more they present uncritically, the more valid grievances people will have with psychiatry.