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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

The Dangers of a Little Knowledge

Allan N. Schwartz, LCSW, Ph.D. Updated: Feb 1st 2008

Recently there have been a number of articles in some of the top newspapers in the United States reporting that anti depressants do not really work and that the improvements that people feel in their moods is nothing more than the "placebo effect." A placebo is a "sugar pill" used as a control in psychological and psychiatric experiments. In other words, it is a harmless pill that has no therapeutic or medicinal value. The "placebo effect" refers a person believing they feel better after having taken a sugar pill. In other words, the person who has taken the sugar pill believes they have taken a medicine and are convinced that the pill helped their mood improve. This so called placebo effect is used to support the claim that anti depressants have no value except in the way they help drug companies earn huge profits.

Of course, there are those people who read and misinterpret this type of information. Using a "little knowledge" gleaned from the newspaper and Internet, they make decisions about their health and well-being. In this case, people who might need and benefit from anti depressant medications because they are very depressed will refuse to even try them.

I remember someone from long ago who experienced extreme depression and panic but refused to try anti depressants because he read some comments on Internet community boards that these medications are addicting and that it is impossible to get off of them once you are no longer depressed. It took an extremely long time in psychotherapy and lots of effort on the part of the psychiatrist to convince this person that the medication would be safe and worth trying. He finally agreed to take an anti depressant and, to his amazement, he vastly improved, returned to social functioning and to work.

This is why I sometimes have a problem with these newspaper and Internet articles and message boards. The reasons for my "problem" is that newspapers and the Internet can provide the reader with a distorted and inaccurate view of the way things really are. For example it was more than a year ago when the press informed the public that children and teenagers who take anti depressant medications become suicidal. Despite the fact that there were very few cases of suicidal thinking among children and teens there was a sharp decrease in the numbers youngsters being treated with anti depressants. The result was that the suicide rate sharply increased for this population.

My point is not that newspaper reports should be dismissed but that patients need to consult the medical experts before making and definitive decisions. Please do not rely on "a little bit of knowledge."

The fact that large pharmaceutical companies earn millions of dollars for the medications they produce does not invalidate the usefulness of those medicines.

People greatly benefit from anti depressant and anti psychotic medications. In fact, they benefit to the degree that their quality of life vastly improves. There is a steady stream of research that documents the fact that medications combined with psychotherapy help people resume normal and well adjusted lives.

Your comments are welcome and encouraged.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    Freedom of Speech - Allan N Schwartz - Mar 22nd 2009

    Hi Randy,

    Because I take very seriously the things that my readers point out about my writings, I re-read my article and tried to find the place where I either implied or stated that people do not have the right to their opinion. Sorry, but I could not find it at all. If you could perhaps point out the specific place where the alleged remark was made, I could make corrections or explain what I meant.

    You see, Randy, the problem here does not have to do with freedom of speech but the freedom of the media to provide false or misguided information. People cannot make sound decisions if they are provided with information that has been twisted, distorted or half correct. Opionons? You stated your opinions about psychotherapy. OK. I do not agree with you but that is fine.

    Yes, there is, in our country, a tendency to rely too much on medications for everything. Yes, I suppose there has been a tendency to over prescribe anti depressants. In actuality, those of us who are psychotherapists, such as Clinical Psychologists, Clinical Social Workers and Marriage and Family therapists, all the non MD types, favor using such non medicine techniques as Cognitive Behavioral Therapy, Psychodynamic Therapy, and Marriage and Family Counseling. All of these are non medicine procedures. It is only when and if someone is in very bad condition, as in heading towards suicide that we send them to Psychiatrists for medicine.

    Finally, yes, human behavior does not fit into neat diagnostic categories and this is unlike biology and human physiology. That is why the types of practitioners I mentioned above rely on helping people modify their behavior and thinking so that they may make healthier adjustments to the real world than they already have made. You see, they come to us because they have run into many problems and feel miserable. We work on helping them find ways of problem solving that end in them feeling better.

    Dr. Schwartz

    anti-depressant medications are over-prescribed - randy - Mar 21st 2009

    I read over your article about the 'dangers of a little knowledge' and I take issue with some of your points; and I think others were poorly made.

    First of all, you seem to be questioning the right of people to express their opinion, about any topic. And this is, of course, a basic right called 'freedom of speech'. People do not need to attend medical school, or become psychotherapists, to see that something might be wrong and express that opinion. this, in fact, is their legal right.

    Anti-depressant usage has increased dramatically within the last 20 years. The introduction of prozac and other anti-depressants into our culture seems to have convinced too many people (including many doctors and psychotherapists) that medication is often the easiest way to solve a personal or social problem, that we should cease trying to solve certain problems on our own, and that we need, not only legions of doctors and psychotherapists to help us live, but we also need medications for every little quirk or problem we might experience as we trek through the mystery of life.

    Who could question the use of appropriate medications for people who are truly depressed or truly psychotic? The trouble is that, in many cases, the scope of these definitions is stretched to include much less dangerous, and in some cases very normal, problems. And that is where objections to such a widespread use of these medications applies.

    In my opinion, the whole field of psychotherapy, to the extent it bases itself upon a medical model, should be scrutinized as there is much in the profession of psychotherapy that does not fit cleanly into the diagnostic/treatment regimens of many medical conditions, and yet the profession continues to force such cases into its treatment schemes, often for extended periods of time.

     There is also much disagreement within the mental health field regarding which treatment is best for which problem, what is a true 'disorder', etc., etc. With things being so unsettled, how can psychotherapists make sweeping statements about anything? Let's face it, much of what psychotherapists do is simply a matter of individual judgment and opinion.

    Clarification - Allan N Schwartz - Oct 22nd 2008

    It is always good to know that people are reading these posts and thinking about them. However, because communication is, at best, a fragile process, it is easy for all of us to misinterpret. So, let me try to clarify the point I was attempting to make about "a little bit of knowledge."

    In no way am I implying or even suggesting that medication is the only way to achieve relief from depression and anxiety. Physical exercise, meditation, yoga, deep breathing, visualizations, many types of psychotherapy, accupuncture and even some of the alternative herbal or naturalistic over the counter medicines have been found to be helpful.

    What I am attempting to make clear is that all consumers make informed decisions about their treatment and not allow themselves to be influenced by the latest "fads" as published in the press and mass media.

    The patient I refer to in the article was unable to eat, suffering huge weight losses and becoming increasing sick, and that was when he first consulted me. We worked together, using cognitive behavioral psychotherapy, but, there was no improvement. When the issue of talking to a psychiatrist about the possibility of medicine, her adamantly refused. He bought into the stuff he read on the message boards in the internet about anti depressants being addicting and dangerous.

    When his situation grew desparate he finally consented to at least consult a psychiatrist. Then, he reluctantly tried an anti depressant. Within a month his symptoms improved. Today he is off of medications and functioning quite successfully.

    Was it the medicine alone that helped him? NO! It was the combination of medicine and psychotherapy that helped because the medicine allowed him or freed him enough to use the psychotherapy.

    Would this be the right treatment for "everyone?" NO.

    I hope this helps and look forward to more dialogue in this important issue.

    Dr. Schwartz

    Concerning the Editor's comments - B. Litchke - Oct 21st 2008

    Concerning the Editor's comments following Mr. Berditzmann's letter; it certainly would have made sense if Mr. Berditzmann's letter had actually been read. It's disturbing and a matter of concern to see a Straw-Man fallacy when an Editor feels compelled to comment. Nowhere were any of the accusations the Editor claims, to be found within Berditzmann's letter. For example: It is Mr. Schwartz who puts forth an essay, of which the topic is concerning "peoples knowledge regarding anti-depressants". What's nothing short of incredible, is the fact that this is somehow overlooked by the Editor. Simply read Schwartz's essay, then, the commentary by Berditzmann, and that is all one need do, to see the pertinent matter which has been commented on. In addition, we see the Editor has alleged that Berditzmann made a direct reference to a particular published work by Elliot Valenstein. Where? Might the Editor be thinking or referring to some other commentary? Who knows. There is no mention anywhere to the alleged book that the Editor has cited. I just thought the response by the Editor was quite peculiar and concerning. To be sure, I re-read Mr. Schwartz; Berditzmann; and the Editor's pieces very carefully and saw the disparity between what Berditzmann actually said and the allegations the Editor issued regarding what he believed Berditzmann had said. It's right there in black and white. Best Regards, B. Litchke

    unqualified, unsupported, unproven - Bill berditzmann - Oct 20th 2008

    I agree with some of the points in your essay Mr. Schwartz. In particular, that, like you, I too have "problems" with some Internet and print articles. In fact, I can use your very essay as a clear example of unqualified, unsupported, unproven, and most importantly, patently untrue assertions and claims (no actual clinical proof of course) with regard to the psychotropics you make reference. To really acquire a lot more than "a little knowledge" about what we actually really know today about these substances I would earnestly advise you to seek out Eliot Valenstein as a good starting point for acquiring true and complete knowledge and understanding as to the facts and actual results of just what these substances do and don't do.

    Editor's Note: If I could figure out a way to sigh in text I would do it here.  The reference to Valenstein above is to Elliot Valenstein, Ph.D., an emeritus research psychologist and neuroscientist.  The reference is also to a book by Dr. Valenstein, probably the one titled Blaming the Brain: The Truth about Drugs and Mental Health, which has as its thesis that biochemical theories of mental illness are at best unproven hypotheses and that correspondingly, most psychoactive medication is quack medicine.  It has become fashionable to bash out at pharmaceutical companies who have been guilty of practicing distorted science.  Also, there is some truth at the core of Dr. Valenstein's claims as I understand them (from the abbreviated Wikipedia description ; not having read Blaming the Brain myself just yet).  But if the pharmas and their representatives have pushed us too far in the biochemical direction in some cases, it would be an equal error to be a pharmaceutical luddite and push back that far in the opposite direction, making the opposite claim that there is no legitimate biochemical componant or brain dysfunction to mental illnesses.

    The funny part here is that Dr. Schwartz is a psychotherapist  - not a medical doctor - He has never been licensed to dispense medication and has never been in a position to profit from pushing patients towards medication when it was not in their interests.  To suggest that he is one of these people who buys wholehearted into pharam biological claims and discounts the value of alternative non-medical treatment for mental illness is just a wrong claim.  

    Benefit or just money - J - Feb 8th 2008

    Hi

    I have read your article on antideppransts. I am taking one as well. Its good if they help. But I am just digussted that there is no proof how these work. How come patients are not told you can try some natural medicines such as st. john wort and b vitamins. When a person is under high worries some vitamins such as vitamin b and many others are required in higher doses. I have seen from my experience that doctors wait until the condition get worse and then give a preccription medicine, rather than trying natural supplements. When i took the anti deppressant it helped me alot after lots of side effects, but since i have read many websites and books they are proofing that these medication have similar effect on your brain just like stimualnts.

    I see nowadays medicine as a business, to make money from patients. Take this medication or that one. If patients are cured with cheaper natural remedies there won't be big profits for the pharmceutial compaines as same for a medical doctor. These are addicting so the patient cannot get off them and take them for rest of the life. Its all about the money.

    FDA and companies want to make money, how do the population know is the research true or not about these. What about the indregidents put in the pill such as propylene glycol or polyethlyene glycol. My doc told me it is very low and thus is not toxic. I asked them about side effects and what not, how they work, some proof, he says i just take care of the active indregients. He tells me nothing about the drugs and side effects. Tells me to call the company. He doesnt know how they work and some proof. Today's medicine and mental health have taken one thing such as one condition and then treating it with drugs. These drugs suppress the condition and making it worse and tiggering other dangerous reactions . Then for side effects you can take another drug. this will bring endless amount of income.

    My question is why are natural treatments are not advertised widely, is it just because there is not much profit to make off them. What about people who have died of side effects, what about vioxx scandal, its all about money, FDA does not care about the consumers safety it just approves for money,

    Natural treatments can do so much without side effects that they are not patentable so not enough money to make off them.

    Relpy Soon

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