Psychiatrists Defend Psychiatric Drug Use

Are psychiatric drugs as bad as Tom Cruise says they are?

In an unusually candid interview on last Friday's Today Show, Cruise called psychiatry a false science. Cruise's religion, Scientology, has long opposed the use of psychiatric drugs.

In keeping with these beliefs, the Hollywood star spoke out against the use of drugs to treat depression, childhood ADHD, and psychosis. What do doctors say?

A Life or Death Decision

Last weekend, psychoanalyst Mark I. Levy, MD, got an email from a former patient. The patient said her 20-something daughter — on medication for bipolar disorder — saw the Cruise interview. Levy is a psychoanalyst, a forensic psychiatrist, and an assistant clinical professor of psychiatry at the University of California, San Francisco.

"This was tremendously destructive. All the daughter needed to hear was that her medicines are poisoning her brain; that this is part of a psychiatrist conspiracy — and she went off her medications," Levy tells WebMD. "Some 15 percent of people with untreated bipolar depression die of suicide. It is a medical condition with a high risk of death. And, in addition to suicide, bipolar patients who launch into mania can act in very self-destructive ways. This is one specific application where psychiatric medication is critically important."

Yes, Levy says, psychiatric medications — as do all drugs — carry risks as well as benefits. But there can be very serious consequences to not taking them, too.

Nada Stotland, MD, MPH, professor of psychiatry at Chicago's Rush University, notes that there is a great deal of scientific debate over the merits of certain psychiatric drugs — but no more debate than seen over drugs used in many other fields of medicine.

"Tom Cruise said there is no scientific basis for psychiatric drugs. But there is an increasing scientific basis," Stotland tells WebMD. "For example, we can see differences between brain images of someone who is depressed and someone who is not depressed. And if we give medications, the brain of the depressed person goes back to looking like a person not depressed."

Such experiments don't prove that psychiatric medications are the only way to treat depression. But they do show a positive effect.

"There are good studies that psychotherapy can produce similar imaging results as seen with antidepressants," Levy says. "I do not prescribe drugs willy-nilly. But for most psychiatric disorders, the best treatment is medication plus psychotherapy. One or the other, alone, is not as effective."

Special Problems for Psychiatric Drugs

Stotland does not ignore the fact that there are some very real problems with psychiatric drugs. One is that they may be prescribed by doctors who do not fully understand the subtleties of psychiatric diagnosis.

"Psychiatric medications should be prescribed after an accurate psychiatric diagnosis is made," Stotland says. "They should be prescribed by someone who knows what they are doing. Patients should be closely followed up. And the drugs should be prescribed in the context of continuing medical care."

Psychiatric medications, Stotland says, are not the answer to all the problems posed by mental illness. Unfortunately, she says, private insurers often pay only for drugs — and not for psychotherapy.

"Our health insurance discriminates against care for mental illness, and it especially discriminates against psychotherapy," she says. "Some insurers say you have to give a psychiatric medicine before they will pay for psychotherapy — that is wrong."

Stotland says psychiatric drugs are just as useful — and have just as much medical justification — as cancer drugs. It upsets her that there is not as much outrage over Cruise's remarks as there would be if he attacked cancer chemotherapy.

"If a movie star was to say cancer treatment has no scientific basis and hurts people, everyone would be outraged," Stotland says. "We should be similarly outraged by Mr. Cruise. Every time we pick out psychiatry to discredit, we are really hearkening back to the dark ages and before. We all need to be more scientific and more up to date. There are many sources for good information, including our own National Institutes of Health, universities from coast to coast, advocacy associations composed of people with mental illness and their family members — all of whom have credentials. It is a terrible disservice for a person without such credentials to rant and rave and to tell other people to stop taking their medicine."

By Daniel J. DeNoon, reviewed by Michael W. Smith, MD

SOURCES: Nada Stotland, MD, MPH, board member, American Psychiatric Association; and board member, National Mental Health Association; professor of psychiatry, Rush University, Chicago. Mark I. Levy, MD, assistant clinical professor of psychiatry, University of California, San Francisco. American Psychiatric Association. Church of Scientology.