Year end is a time for countdown lists. Just as 2016 was about to vanish forever, I decided to have a look at what the year’s best-selling medications were. To my surprise, riding high on the list was a psychiatric medication known as Abilify (aripiprazole). I’d expected to see medications targeting cancer, heart disease and diabetes, but to find an antipsychotic jostling for the global top spot was a shock. To see if this was just a one-off, I broadened my search to look at all-time best-sellers and discovered that three of the most profitable medications were indeed psychiatric drugs, namely Abilify, Seroquel and Zyprexa.
While psychiatric medications have their place, they are hardly wonder drugs or miracle cures. The extent of their effectiveness is nearly always contested, and many produce side effects – weight gain, depression and involuntary movements, to name a few – that are often experienced as worse than the problems the drugs claim to treat. These drugs are not bestsellers because they are particularly good at making people well, they are just very well marketed.
For many psychological complaints (feeling low, hearing voices, insomnia) there are also talk therapies (cognitive interventions). These, in many cases, are far more effective than drugs and are free from the awful side effects.
At this point in the discussion of medication versus talk therapy, we often reach a happy compromise and say something like, “the best solution is to offer both drugs and talk therapies in combination”. However, there is emerging evidence that, in some cases, drugs actually don’t provide any additional value; there are even studies suggesting the exact opposite.
For instance, a well-controlled study published in 2016 in the journal Psychotherapy and Psychosomatics focused on the treatment of social anxiety disorder, also known as social phobia. This is the most common of all the anxiety disorders and is essentially a debilitating fear of social or performance situations. This recent study assigned social phobia patients to one of four conditions: talk therapy, medication, placebo or combination therapy (drugs and talk therapy).
The study found that over the longer term, talk therapy was far more effective than medication and it was even superior to combination therapy.
One proposed explanation for this counterintuitive finding is that the medication might interfere with the patient’s ability or motivation to actually learn the coping skills that are part of the talk therapy. In other words, patients come to depend on the drugs rather than on themselves. It is like the medication is robbing people of the opportunity to grow and develop new insights. It is exactly this type of learning and the associated insights that lead to getting better and, importantly, staying better.
This idea that medication is the best way to go, or even always a useful way to go, needs a critical re-examination. The current profitability of psychiatric medications is not rooted in their overwhelming effectiveness.
Often, medication is prescribed because there is a shortage of trained professionals able to deliver the talk therapies that have proven most effective for certain conditions. The answer isn’t prescribing more and more medication; we must provide more well-trained therapists and focus on prevention.
Consider that in the United States and the United Kingdom, increases in the prescription of psychiatric mediations have not led to a decrease in the prevalence of psychiatric disorders. On the contrary, there has been an increase in mental health problems. Despite the occasional success story, often short-lived, perhaps the overall societal impact of psychiatric mediation is negative.
Give a person an antidepressant and they may feel OK for a while, but help them develop a new outlook on life and they can feel OK forever.
Dr Justin Thomas is an associate professor at Zayed University
On Twitter: @DrJustinThomas
A Bad Moms Christmas
Dir: John Lucas and Scott Moore
Starring: Mila Kunis, Kathryn Hahn, Kristen Bell, Susan Sarandon, Christine Baranski, Cheryl Hines
Two stars
THE SPECS
Engine: 6.0-litre, twin-turbocharged W12
Transmission: eight-speed automatic
Power: 626bhp
Torque: 900Nm
Price: Dh1,050,000
On sale: now
Explainer: Tanween Design Programme
Non-profit arts studio Tashkeel launched this annual initiative with the intention of supporting budding designers in the UAE. This year, three talents were chosen from hundreds of applicants to be a part of the sixth creative development programme. These are architect Abdulla Al Mulla, interior designer Lana El Samman and graphic designer Yara Habib.
The trio have been guided by experts from the industry over the course of nine months, as they developed their own products that merge their unique styles with traditional elements of Emirati design. This includes laboratory sessions, experimental and collaborative practice, investigation of new business models and evaluation.
It is led by British contemporary design project specialist Helen Voce and mentor Kevin Badni, and offers participants access to experts from across the world, including the likes of UK designer Gareth Neal and multidisciplinary designer and entrepreneur, Sheikh Salem Al Qassimi.
The final pieces are being revealed in a worldwide limited-edition release on the first day of Downtown Designs at Dubai Design Week 2019. Tashkeel will be at stand E31 at the exhibition.
Lisa Ball-Lechgar, deputy director of Tashkeel, said: “The diversity and calibre of the applicants this year … is reflective of the dynamic change that the UAE art and design industry is witnessing, with young creators resolute in making their bold design ideas a reality.”
THE SPECS
Engine: 4.4-litre V8
Transmission: Automatic
Power: 530bhp
Torque: 750Nm
Price: Dh535,000
On sale: Now
liverpool youngsters
Ki-Jana Hoever
The only one of this squad to have scored for Liverpool, the versatile Dutchman impressed on his debut at Wolves in January. He can play right-back, centre-back or in midfield.
Herbie Kane
Not the most prominent H Kane in English football but a 21-year-old Bristolian who had a fine season on loan at Doncaster last year. He is an all-action midfielder.
Luis Longstaff
Signed from Newcastle but no relation to United’s brothers Sean and Matty, Luis is a winger. An England Under-16 international, he helped Liverpool win the FA Youth Cup last season.
Yasser Larouci
An 18-year-old Algerian-born winger who can also play as a left-back, Larouci did well on Liverpool’s pre-season tour until an awful tackle by a Sevilla player injured him.
Adam Lewis
Steven Gerrard is a fan of his fellow Scouser, who has been on Liverpool’s books since he was in the Under-6s, Lewis was a midfielder, but has been converted into a left-back.
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Opening Rugby Championship fixtures:Games can be watched on OSN Sports
Saturday: Australia v New Zealand, Sydney, 1pm (UAE)
Sunday: South Africa v Argentina, Port Elizabeth, 11pm (UAE)
A MINECRAFT MOVIE
Director: Jared Hess
Starring: Jack Black, Jennifer Coolidge, Jason Momoa
Rating: 3/5
Living in...
This article is part of a guide on where to live in the UAE. Our reporters will profile some of the country’s most desirable districts, provide an estimate of rental prices and introduce you to some of the residents who call each area home.
NO OTHER LAND
Director: Basel Adra, Yuval Abraham, Rachel Szor, Hamdan Ballal
Stars: Basel Adra, Yuval Abraham
Rating: 3.5/5
'Tell the Machine Goodnight' by Katie Williams
Penguin Randomhouse
The specs: 2018 Maserati Levante S
Price, base / as tested: Dh409,000 / Dh467,000
Engine: 3.0-litre V6
Transmission: Eight-speed automatic
Power: 430hp @ 5,750rpm
Torque: 580Nm @ 4,500rpm
Fuel economy, combined: 10.9L / 100km
Engine: 80 kWh four-wheel-drive
Transmission: eight-speed automatic
Power: 402bhp
Torque: 760Nm
Price: From Dh280,000
In numbers: PKK’s money network in Europe
Germany: PKK collectors typically bring in $18 million in cash a year – amount has trebled since 2010
Revolutionary tax: Investigators say about $2 million a year raised from ‘tax collection’ around Marseille
Extortion: Gunman convicted in 2023 of demanding $10,000 from Kurdish businessman in Stockholm
Drug trade: PKK income claimed by Turkish anti-drugs force in 2024 to be as high as $500 million a year
Denmark: PKK one of two terrorist groups along with Iranian separatists ASMLA to raise “two-digit million amounts”
Contributions: Hundreds of euros expected from typical Kurdish families and thousands from business owners
TV channel: Kurdish Roj TV accounts frozen and went bankrupt after Denmark fined it more than $1 million over PKK links in 2013
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