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They don't come anymore. There was a time when subtly attractive women, occasionally men, would linger in my waiting room hoping to catch my attention. Sure, come in. I have a few minutes.
These were the drug reps. Beyond their flattering attentions, they always had something to leave for me, a sample or a pen or a brochure with scientific studies. They don't come anymore. I didn't write enough prescriptions. I am a “low writer.” For them, a nonentity. But for Daniel J. Carlat, I am a member of the “lost” generation of psychiatrists approaching retirement age, those trained prior to the advent of the psychopharmacology explosion and whose points of view are primarily psycho-therapeutic, those who regard medication as adjunctive rather than the other way around. News for Carlat: we are not lost, not yet. But I know what he means.
The newer breed of psychiatrists have framed their careers and clinical work as the frontline troops for the pharmaceutical industry. As Carlat writes and as some of us in the profession know, the vast economic power of the industry has subverted the way we think about mental health. Abetted by the insurance industry, psychiatrists (Carlat eschews the term “psychopharmacologist”) have mostly become pill pushers who have bought into a narrative largely ungrounded in good scientific study. That antidepressants work because they selectively inhibit serotonin reuptake is inferential. It's a story we tell ourselves and our patients. Fact is, we do not know how any of these medications actually work. All we know is that sometimes they do, sometimes they work a bit better than placebo, and where people are in anguish you reach for anything.
If it's an FDA-approved drug, go for it. If there are well-credentialed physicians hawking its benefits, trust it. Yet, the FDA has curious guidelines that rely on studies designed and financed by the pharmaceutical industry. Meanwhile, the physicians have often gotten their credentials by performing drug company s