NIMH should fund more psychotherapy research

The psychiatrist Richard Friedman makes a strong argument that we are not investing enough in psychotherapy research. First, although we have spent a lot of money on basic neuroscience, it hasn’t produced any new treatments:

With few exceptions, every major class of current psychotropic drugs — antidepressants, antipsychotics, anti-anxiety medications — basically targets the same receptors and neurotransmitters in the brain as did their precursors, which were developed in the 1950s and 1960s.

Moreover, most if not all mental health problems involve more than just synaptic dysfunction.

a complete understanding of neurobiology is unlikely to elucidate the complex interactions between genes and the environment that lie at the heart of many mental disorders. Anyone who thinks otherwise should remember the Decade of the Brain, which ended 15 years ago without yielding a significant clue about the underlying causes of psychiatric illnesses.

Finally, psychotherapy can help with many problems and patients say they prefer psychotherapy to medications.

First, psychotherapy has been shown in scores of well-controlled clinical trials to be as effective as psychotropic medication for very common psychiatric illnesses like major depression and anxiety disorders; second, a majority of Americans clearly prefer psychotherapy to taking medication.

So: the National Institute of Mental Health (NIMH) should be funding more research on psychotherapy!

But two cautions.

First, Friedman isn’t arguing that we should reduce funding for neuroscience research. The brain is the most important yet least understood organ in the body. Eventually, we will understand the brain. When that day comes, that understanding will be transformative.

Second, patients say they prefer psychotherapy to medication. But that doesn’t mean they will do it. Psychotherapy requires a lot of time and effort. Some mental health patients have lives of disorder and suffering such that attending even a brief series of psychotherapy sessions is impossible. Pills are easier and that convenience shouldn’t be despised.


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