Psychotherapy and Drugs: A Dangerous Combination?

Recent comments by baz on previous post have drawn me away from the endless reading that is slowly destroying my life and harkened me back to the original idea in relation to that post. My original thought was this:

The use of drugs simultaneously with psychotherapy has value but must be carefully managed. Inducing behavioral change in a patient whose mental state is under the influence of powerful drugs may instantiate the desired behavior change that can easily be lost once the drugs are discontinued simply because the behavior change was created in that context. 

Today I read this: 

Beware small positive studies. By Neuroskeptic.

When selective serotonin reuptake inhibitors (SSRIs) were introduced for depression, effect sizes greater than 1.0 were reported, which created their legacy as a wonder drug. Over the course of 20 years, the mean effect size of SSRIs decreased to around 0.3. A similar trend was demonstrated for cognitive-behavioral therapy.

Psychiatry, Psychology, and Philosophy

6/11/2012 3:31PM

One of the more puzzling features of the mental health profession is the refusal to engage in a rigourous analysis of their own assumptions. It is as if they ignore the warning of Bertrand Russell when he advised that one of the first goals in philosophy is to recognise that a problem exists. Psychiatry is wedded to an excessively reductionist view of behavior , it is as if they have never encountered the concept of emergent properties let alone realised that a bottom up approach to understanding a complex system is almost always doomed to fail when there are many variables in play. The brain is the penultimate complex system. (Perhaps, given we don't know what brains do it may turn out that the processes are very simple, like a series of reiterations of very simple processes.) The psychologists catch and grab and whatever therapy comes along until it is eventually seen to be just another therapy offering little more than the placebo effect. Carl Rogers may deserve more credit than he is given today. Paradoxically the placebo effect may be the principle benefit in many therapeutic interventions but of course neither psychiatrists or psychologists would admit that because that would constitute a problem for them. No-one likes having the foundations of their concepts challenged. It is painful and could demand a complete re-appraisal of a conceptual structure. Hard work.