Published 29 May 2009, doi:10.1136/bmj.b1963
Cite this as: BMJ 2009;338:b1963

Analysis

How do psychiatric drugs work?

¹ Department of Psychiatry and Behavioural Sciences, University College London, London W1N 8AA, ² School of Social Work, Florida International University, Miami FL 33199, USA

Joanna Moncrieff and David Cohen argue that changing our view of the action of psychiatric drugs would help patients to become more involved with decisions about treatment

Drugs for psychiatric problems are prescribed on the assumption that they mostly act against neurochemical substrates of disorders or symptoms. In this article we question that assumption, proposing that drugs’ action be viewed rather as producing altered, drug induced states, a view we have called the drug centred model of action. We believe that this view accords better with the available evidence. It may also allow patients to exercise more control over decisions about the value of pharmacotherapy, helping to move mental health treatment in a more collaborative direction.

The widespread use of psychiatric drugs is justified by the idea that they work by correcting, or helping to correct, underlying biological abnormalities that produce particular psychiatric symptoms. We have called this view the disease centred model of psychiatric drug action (table). Most drugs used in medicine can be understood as working according to a disease centred model—even analgesics, for . . . [Full text of this article]

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