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Drugs, Medicines and Mental Health
By Drew E. Permut, Ph.D.
Around the turn of the last century, medical researchers, alarmed at the explosive growth of morphine addiction, set out to develop a painkiller that would be just as effective, but without the addictive potential. Much time and effort was put into this enterprise; and eventually a new product was developed which promised to solve the problem. The new medication was named heroin.

Half a century later, a new remedy was introduced to help alleviate the problem of chronic anxiety that more and more patients seemed to be reporting. With the availability of Miltown and then Valium tablets, physicians could for the first time do more than just sympathize with their patients' problems. They could now actually offer a pharmacological aid to their patients who were suffering from nervousness, tension, or difficulty coping. These new medications worked marvelously well, but there was an unanticipated side effect: addiction.

It is against this historical backdrop that we can begin to consider the implications of the latest revolution in psychopharmacology. Within the past two decades, a new generation of highly effective antidepressants has been developed. Known by the trade names of Prozac, Paxil, Zoloft, Celexa, Lexapro, and Effexor, these medications generally work faster and with fewer side effects than the older medications, which were more difficult to employ or monitor. As a consequence, they are being prescribed at a dizzying pace not only by psychiatrists, but even more routinely, by internists, family practitioners, and gynecologists. Nearly everyone, it would seem, can benefit from a little dose of antidepressants.

Let me be clear. I am not opposed to the responsible use of these medications. There are times in the counseling process when it becomes evident that clients cannot concentrate, think, or work on their problems unless they can get some relief from their agitation or depression. Indeed, like most psychologists, I have had many instances where clearly no progress would have been possible had I not referred them to a physician for medication in the course of their psychotherapy. These medications often work well, are better tolerated than many other antidepressants, and enable clients to function. Thus I welcome their use, when necessary, in the treatment process.

But the decision to utilize medication for emotional problems is not to be taken lightly. Consider this fact: six of the top ten medications now prescribed in this country are antidepressants, mood stabilizers, or anti-anxiety agents. This is a staggering statistic. What it implies is that these medications are not seen as just better antidepressants. They have become the latest panacea.

When medications are used to solve problems, they soon cease to be medications. This is the real definition of a drug- and it is what drug abuse is all about. It matters very little that the drug is prescribed by a physician or bought on the street. It doesn't even matter that the drug is addictive or not. What matters is that it is used not to treat a specific disease entity or dysfunction, but to 'feel good.'

Drug abuse is an attitude. It consists of the notion that life's problems do not have to be faced, that they can be avoided by not feeling the pain. If we can avoid the pain of life by taking a pill, why not do it? When we see inner-city youths adopting this stance we shake our heads knowingly, aware that this mindset can only lead to disaster. But it is not that different from expecting that taking a little Zoloft or Xanax will automatically improve your life. Remember that most of the morphine addiction created in the late nineteenth century was not experienced by ne'er-do-wells on the streets. It was mostly middle-class women taking morphine-laced elixirs. Sometimes these elixirs were prescribed by their physicians, other times they were purchased from traveling 'medicine' salesmen. But usually, these women suffered from no specific malady - except despair.

The problem is not the medication, but the way it's used. Psychologists should welcome these new and more effective drugs because they offer help to clients who might otherwise suffer unnecessarily. But we also know that real improvement rarely comes from medication alone. Our problems must be confronted and worked through, not just medicated.