Do psychotropic drugs cure mental disease?

Apr 23 2005

Joanna Moncrieff (University College of London and David Cohen (Florida International University) discuss what is the actual role of psychotropic drugs as to mental disease in the May-June issue of Psychotherapy and Psychosomatics.

They criticize the core assumption that psychotropic drugs help to correct a biochemical abnormality that represents a biological substrate of a specific disease process. Theoretical assumptions about how psychotropic drugs 'work' are rarely discussed explicitly.

In a 'disease-centred model,' drugs are believed to work by acting on a disease process. In contrast, in a 'drug-centred model,' the characteristic physiological, behavioural and subjective effects of drugs are used to define drug action. The therapeutic value of a drug stems from the usefulness of these effects in clinical situations.

The disease-centred model appears dominant but has weaknesses: (1) it cannot logically justify the use of drugs since major pathophysiological hypotheses were derived from selectively observed actions of drugs; (2) comparisons between drugs believed to have specific effects in certain conditions and drugs thought to have non-specific effects fail to support it; (3) outcome measures for various disorders include items responsive to non-specific drug effects; (4) studies with healthy volunteers describe characteristic drug-induced states independently of a psychiatric diagnosis; (5) animal tests show effects with agents not usually thought of as specific treatments for the conditions modelled by tests.

This article offers suggestions to develop a drug-centred model and discusses its potential impact on clinical practice.

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