From Placebo to Panacea

FROM PLACEBO TO PANACEA

With the latest generation of psychoactive drugs, has pharmacologyat last triumphed over mental illness? A close look at worldscientific literature would suggest otherwise. The sobering truthis that many claims about the efficacy of drug therapies foreverything from depression to schizophrenia have been exaggerated.What, then, accounts for the inflated confidence clinicians and thelay public alike often have in the new generation of "wonderdrugs"? Find out in From Placebo to Panacea.

From Placebo to Panacea is not an indictment of drug therapy.Rather, it is a reasoned analysis of the efficacy of psychoactivedrugs as compared to other forms of treatment--backed by hardempirical data. Above all, it is meant to function as a therapist'sand patient's guide to making more informed decisions whenconsidering treatment options.

The book begins with an in-depth discussion of salient problemswith standard methods of measuring the usefulness of psychoactivedrugs. Next is an exploration of a wide range of factors that canbias test results, both technical (e.g., patients participating indouble-blind trials can usually tell whether they are receiving aninactive placebo or a psychoactive drug) and psychosocial. Alsoconsidered are problems arising from current systems for diagnosingmental disorders, including complications resulting fromcomorbidity.

Subsequent chapters focus on drug therapies for specific disordersin both adults and children. The authors cover depression andbipolar disorders, schizophrenia, anxiety disorders, borderlinepersonality disorder, attention deficit, and hyperactivity. Eachchapter carefully considers the published findings on the disorderunder discussion, as well as questions of side effects, suicide,and potential long-term benefits.

A final chapter synthesizes the findings from previous chaptersinto a comprehensive picture of the current state of psychoactivedrug therapy. Throughout, the book provides valuable suggestionsfor ways of improving and building upon existing knowledge.

Offering an empirically based appraisal of the strengths andlimitations of drug-based treatment for psychiatric disorders, FromPlacebo to Panacea is must reading for psychiatrists,psychologists, and other mental health professionals, as well aspsychopharmacologists and drug development researchers andpatients.

"The long list of treatment failures, ranging from insulin coma tolobotomy, speaks for itself . . . skepticism should prevail withrespect to all evaluations of research, particularly if theyinvolve the welfare of large numbers of persons."--Seymour Fisherand Roger P. Greenberg

Is the new generation of psychoactive "wonder drugs" really aseffective as it is purported to be? And, perhaps most significant,in an age of managed care, what are the dangers of uncritical faithin the usefulness of these drugs? From Placebo to Panacea examinesthese questions. It separates fact from fiction, and injects a noteof healthy questioning into the otherwise unreserved chorus ofpraise for psychotropics. From Placebo to Panacea:
* Examines the clinical research into outcomes of common drugtherapies for most major mental disorders in adults and childrenOffers analyses of the effectiveness of most common psychotropicsin both controlled trials and clinical settings
* Explores technical and psychosocial factors that frequently biastest results in favor of drug therapies
* Provides critical, empirically based appraisal of the strengthsand limitations of drug-based treatment for psychiatric disorders
* Compares the relative effectiveness of drug therapy versusnondrug therapies and placebos Partial table of contents:

CONCEPTUAL ISSUES.

The Curse of the Placebo: Fanciful Pursuit of a Pure BiologicalTherapy (S. Fisher & R. Greenberg).

Treatment Implications of Psychiatric Comorbidity (M.Greenberg).

Costly Compromises: A Critique of the Diagnostic and StatisticalManual of Mental Disorders (R. Carson).

EFFICACIES OF PSYCHOACTIVE DRUGS FOR ADULTS.

A Critique of the Use of Neuroleptic Drugs in Psychiatry (D.Cohen).

A Focused Empirical Analysis of Treatments for Panic and Anxiety(W. Danton & D. Antonuccio).

EFFICACIES OF PSYCHOACTIVE DRUGS FOR CHILDREN.

Are We Justified in Treating Children with PsychoactiveDrugs?

(R. Fisher & S. Fisher).

Stimulant Pharmacotherapy for Attention- Deficit/HyperactivityDisorders: An Analysis of Progress, Problems, and Prospects (C.Whalen & B. Henker).

OVERVIEW.

What Are We to Conclude About Psychoactive Drugs?: Scanning theMajor Findings (S. Fisher & R. Greenberg).

Indexes. SEYMOUR FISHER, PhD, was, until his death in 1996, Professor in theDepartment of Psychiatry and Behavioral Sciences at the StateUniversity of New York Health Science Center in Syracuse. Dr.Fisher received his doctorate in clinical psychology from theUniversity of Chicago. His previous books include Development andStructure of the Body Image, Sexual Images of the Self, ThePsychology of Adaptation to Absurdity, and (with Roger P.Greenberg) Freud Scientifically Reappraised (Wiley).

ROGER P. GREENBERG, PhD, is Professor and Head of the Division ofClinical Psychology in the Department of Psychiatry and BehavioralSciences at the State University of New York Health Science Center,Syracuse. He also has an active private practice in clinicalpsychology. He is the author of more than 125 published articlesand books, including The Scientific Credibility of Freud's Theoriesand Therapy (with Seymour Fisher), which, upon its publication, wasselected by both the National Library Association and PsychologyToday as one of the best books in the behavioral sciences. From Placebo to Panacea With the latest generation of psychoactive drugs, has pharmacology at last triumphed over mental illness? A close look at world scientific literature would suggest otherwise. The sobering truth is that many claims about the efficacy of drug therapies for everything from depression to schizophrenia have been exaggerated. What, then, accounts for the inflated confidence clinicians and the lay public alike often have in the new generation of "wonder drugs"? Find out in From Placebo to Panacea. From Placebo to Panacea is not an indictment of drug therapy. Rather, it is a reasoned analysis of the efficacy of psychoactive drugs as compared to other forms of treatment—backed by hard empirical data. Above all, it is meant to function as a therapist’s and patient’s guide to making more informed decisions when considering treatment options. The book begins with an in-depth discussion of salient problems with standard methods of measuring the usefulness of psychoactive drugs. Next is an exploration of a wide range of factors that can bias test results, both technical (e.g., patients participating in double-blind trials can usually tell whether they are receiving an inactive placebo or a psychoactive drug) and psychosocial. Also considered are problems arising from current systems for diagnosing mental disorders, including complications resulting from comorbidity. Subsequent chapters focus on drug therapies for specific disorders in both adults and children. The authors cover depression and bipolar disorders, schizophrenia, anxiety disorders, borderline personality disorder, attention deficit, and hyperactivity. Each chapter carefully considers the published findings on the disorder under discussion, as well as questions of side effects, suicide, and potential long-term benefits. A final chapter synthesizes the findings from previous chapters into a comprehensive picture of the current state of psychoactive drug therapy. Throughout, the book provides valuable suggestions for ways of improving and building upon existing knowledge. Offering an empirically based appraisal of the strengths and limitations of drug-based treatment for psychiatric disorders, From Placebo to Panacea is must reading for psychiatrists, psychologists, and other mental health professionals, as well as psychopharmacologists and drug development researchers and patients. FROM PLACEBO TO PANACEA

With the latest generation of psychoactive drugs, has pharmacology at last triumphed over mental illness? A close look at world scientific literature would suggest otherwise. The sobering truth is that many claims about the efficacy of drug therapies for everything from depression to schizophrenia have been exaggerated. What, then, accounts for the inflated confidence clinicians and the lay public alike often have in the new generation of "wonder drugs"? Find out in From Placebo to Panacea.

From Placebo to Panacea is not an indictment of drug therapy. Rather, it is a reasoned analysis of the efficacy of psychoactive drugs as compared to other forms of treatment—backed by hard empirical data. Above all, it is meant to function as a therapist's and patient's guide to making more informed decisions when considering treatment options.

The book begins with an in-depth discussion of salient problems with standard methods of measuring the usefulness of psychoactive drugs. Next is an exploration of a wide range of factors that can bias test results, both technical (e.g., patients participating in double-blind trials can usually tell whether they are receiving an inactive placebo or a psychoactive drug) and psychosocial. Also considered are problems arising from current systems for diagnosing mental disorders, including complications resulting from comorbidity.

Subsequent chapters focus on drug therapies for specific disorders in both adults and children. The authors cover depression and bipolar disorders, schizophrenia, anxiety disorders, borderline personality disorder, attention deficit, and hyperactivity. Each chapter carefully considers the published findings on the disorder under discussion, as well as questions of side effects, suicide, and potential long-term benefits.

A final chapter synthesizes the findings from previous chapters into a comprehensive picture of the current state of psychoactive drug therapy. Throughout, the book provides valuable suggestions for ways of improving and building upon existing knowledge.

Offering an empirically based appraisal of the strengths and limitations of drug-based treatment for psychiatric disorders, From Placebo to Panacea is must reading for psychiatrists, psychologists, and other mental health professionals, as well as psychopharmacologists and drug development researchers and patients.

"The long list of treatment failures, ranging from insulin coma to lobotomy, speaks for itself . . . skepticism should prevail with respect to all evaluations of research, particularly if they involve the welfare of large numbers of persons."—Seymour Fisher and Roger P. Greenberg

Is the new generation of psychoactive "wonder drugs" really as effective as it is purported to be? And, perhaps most significant, in an age of managed care, what are the dangers of uncritical faith in the usefulness of these drugs? From Placebo to Panacea examines these questions. It separates fact from fiction, and injects a note of healthy questioning into the otherwise unreserved chorus of praise for psychotropics. From Placebo to Panacea:

• Examines the clinical research into outcomes of common drug therapies for most major mental disorders in adults and children Offers analyses of the effectiveness of most common psychotropics in both controlled trials and clinical settings
• Explores technical and psychosocial factors that frequently bias test results in favor of drug therapies
• Provides critical, empirically based appraisal of the strengths and limitations of drug-based treatment for psychiatric disorders
• Compares the relative effectiveness of drug therapy versus nondrug therapies and placebos