Shirah Vollmer MD

The Musings of Dr. Vollmer

Psychopharmacology Excitement

Posted by Dr. Vollmer on August 27, 2011

   Don Levin, I knew that name was familiar. I met him today at a speaker training meeting for a new and potentially exciting psychopharmacological agent, Viibryd. I looked at him, like I knew him from somewhere, and over the course of about thirty seconds, I said “are you the New York Times guy?” When he said “yes” I  started stamping my feet with excitement. Sure enough, his side of the story is so different than the New York Times, http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?_r=2&scp=1&sq=psychiatry&st=cse, that although I appreciated the opportunity to rant, https://shirahvollmermd.wordpress.com/2011/03/09/i-repeat-where-did-the-listening-go/, I felt bad for feeling so negative about him and the state of my profession. Although I did not get the opportunity to go into detail with him, the gist of his message was that he faced a career transition and he made his best judgment under those circumstances, which were not outlined in the article. Meanwhile, we were both excited to learn that maybe the stalled psychopharmacology world is beginning to start up again. Prozac came out in 1988 and the world changed. Since then, we have stalled, such that after twenty-one years, the wonders of Prozac have fallen like the wonders of antibiotics. The first few years were exciting, and then it became old news. Don’t get me wrong. It is still exciting to see people go from suffering to enjoyment, as a result of a multimodal intervention which includes psychotherapy and psychopharmacology. It is still exciting to teach primary care physicians how they can help people have a better quality of life. Yet, the learning curve in this psychopharmacology world came to a flat line. Almost all of the newer medicines on the market imitated the wonders of Prozac. The nuances were helpful, but not that thought-provoking. As a result, both the field of psychopharmacology and the psychiatrists who identified themselves as psychopharmacologists, were losing their luster. We, as a field, are ripe for a new paradigm to treat depression and anxiety. Viibryd might provide this, which means there is hope not just to treat patients who have not responded to our current armamentarian of drugs, but there is hope to reinvigorate my profession. Dr. Levin, I apologize for using you as the springboard to talk about listening. Having met you, I now respect your decision to take a turn in your career which made sense to you at the time. The complexities of that decision, which you only hinted at, changed the notion that you somehow wanted to stop listening. It was really nice to meet you.

6 Responses to “Psychopharmacology Excitement”

  1. Shelly said

    No……! Shirah! You sold out! You are acting star-struck. Stick to your guns and the bottom line, that medication and psychotherapy are the cornerstones of psychiatry. Don’t cave! What good is medication alone, if one cannot learn how to change one’s behavior patterns? I know of a bipolar adult who is so crippled by his disease–he is only treated by medication alone and no therapy because that is all that the socialized medicine his country offers–that his wife and children are suffering more than he is. Stand up for psychotherapy!

    • shirah said

      I did not mean to cave about the importance of psychotherapy. I only meant to say that when a new medication comes out, with a different mechanism of action (MOA), then there is great excitement to that. In that excitement, one hopes, like with all new things, that this medication is going to be a game-changer. When the novelty wears off, it could be like Prozac; a major step forward for the field, but we must still remember our basic principle that the doctor/patient relationship is an essential part of any treatment plan. This relationship often involves psychotherapy. Sometimes, it is a very trusting connection. The problem with the stereotypical psychopharmacologist is that they see so many patients, the warmth of the connection is lost.

  2. mimi said

    who is in that photo?

  3. Novalee said

    As a self-professed brain geek (with insomnia) I get almost giddy when new hope hits the market. I remember being so excited at the thought of the nootropic Amineptine being approved, given how many have benefited. Something tells me that smart drugs are going to be squelched…However, the research I’ve done on Vibryd looks promising…

    • Thanks, Novalee. I am not sure what Amineptine, but maybe you mean Amitryptiline. Yes, we have had some excitement over the years, but the last twenty have been a dry spell. Thanks for your comments.

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