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Doody's Review ServiceReviewer: Aaron Plattner, MD (Pine Rest Christian Mental Health Services)
Description: In this book, the author describes how to safely withdraw patients from psychiatric medications while explaining why he believes that discontinuing psychiatric medications is a healthy choice.
Purpose: Identifying himself as "the conscience of psychiatry," the author works to move psychiatry away from a heavy emphasis on pharmacological treatment to empathy therapy. The author believes that not only do psychiatric medications fail to work, but the potential for significant side effects is great enough to warrant prescribing psychiatric medications only for a short period of time. He then details the proper ways to withdraw patients from psychiatric medications. However, the author does not provide enough evidenced-base research data to support his theory that the risk/benefit ratio of psychiatric medications is such that a vast majority of patients would benefit if they were withdrawn from them.
Audience: The author aims the book at "the spectrum of prescribers, including those who have a much more favorable view of psychiatric medications than I do." Since I have not met any prescriber of psychiatric medications who does not have "a much more favorable view of psychiatric medications" than the author, I would say the audience includes any healthcare provider who prescribes psychotropic medications. The author has written several books and articles citing his stand on psychopharmacology, but a brief literature search of some of his main points revealed surprisingly little support from other healthcare providers. The author also references his own work some 50 times in the book and a literature search of his research failed to find sufficient research from other clinicians. For example, he introduces the concept of "intoxication anosognosia," which he presents as fact, but another literature search failed to turn up any data outside the author's opinion to support this terminology.
Features: After delineating reasons to withdraw patients from the different classes of psychiatric medications (including antipsychotics, antidepressants, stimulants, sedatives, and mood stabilizers), the author reviews the process of drug withdrawal using different therapeutic approaches. He concludes the book with various cases of psychiatric medication withdrawal in various patient populations. Each chapter ends with key points, but there is a glaring absence of graphics beyond squares of highlighted text. The book includes an appendix of psychiatric medications, an index, and information about the author's center for the study of empathic therapy as well as other books he's authored.
Assessment: I have encountered the arguments of antipsychiatry groups, including the documentary "Psychiatry: An Industry of Death," but this is the first book I've seen written solely by a psychiatrist. I do agree that there are patients who are taking higher levels of psychiatric medications and/or too many different psychiatric medications than they might need and thus would benefit from lower doses and/or fewer medications. This book does assist with appropriately reducing medications for this specific population. Further, no one will argue that psychiatric medications do not pose a risk of side effects and, if improperly prescribed, can cause damage, and that therapy can be helpful, but the author's suggestion that proper psychiatric treatment should largely exclude psychiatric medications is an oversimplification of a complex problem. As an inpatient psychiatrist, I frequently encounter psychiatrically ill patients who do not have resources for therapy. Further, patients with the opportunity to engage in therapy often refuse to engage with their therapist. The author fails to provide treatment options for this population of psychiatrically ill patients.