Article by Hannah Douglass and Dr Robin Carhart-Harris
Psychedelic Therapy: A 'Middle Way' Forward for Psychiatry
Doctors issued 36 million prescriptions for antidepressant drugs in 2008, one decade later this number had more than doubled to a staggering 70.9 million. Two years previously, in 2016, a 6% annual increase in the number of prescriptions was recorded, the largest increase of any prescription item for the fourth year running.
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iith depressive disorders listed as the thirdleading cause of disability in 2017 and an estimated 10% of the population being afflicted by this debilitating disorder at some point in their lives. Why then, is the increase in antidepressant prescription rates not having more of an impact on the prevalence of depression? Not much more than half of patients show a clinically meaningful response to first-line antidepressant medications. Of the remaining non-responders many exhibit resistance to subsequent treatments. The most detailed and up-to-date meta-analyses suggest that antidepressants have only a modest superiority over placebo and questions remain over their side-effects and treatment adherence, plus systematic biases in their evidence-base related to the massive industrysponsorship and dissemination of antidepressant drug research. The pharmacological and cognitive revolutions in psychiatry and psychology, which culminated in the discovery of the selective serotonin reuptake inhibitors (SSRIs) and development of cognitive behavioural therapy (CBT), were heralded as successors to the obscurantism and dogmatism of psychoanalysis. However, whatever the limitations of psychoanalytic psychotherapy, the fact remains that most patients prefer talking-therapy over drug treatments, and yet,
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unlike antidepressant drugs, even the brief, evidence-based talking-therapies such as CBT are comparatively expensive, and schemes designed to improve access to them have not been hugely successful, with patients often sitting on waiting lists for several months before being seen. Added to this, psychotherapy appears to have no better efficacy than antidepressants and problems remain over its typically slow therapeutic action, poor treatment adherence and high rates of relapse. There has existed, for too long, a stark and artificial schism in mental health between the biomedical and person-centred approaches. It cannot be the case that one side of this divide is right and the other wrong, although such perspectives have been commonplace in mental health, particularly among a certain generation. Psychiatry has always been the black-sheep of medicine, as the focus of its practice is the intrinsically subjective human mind. Try-as-it might to convince the world that it is just as biological and objective as other domains of medicine, the fact remains that it cannot be: however intimately related there may be, the human mind and brain are categorically distinct phenomena and it is an error to neglect either side of this unique coin. With positive public engagement initiatives currently underway to change the way mental health is
