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Psychodynamic Psychopharmacology

Psychodynamic Psychopharmacology


Psychodynamic psychopharmacology


Dynamic factors in psychopharmacology


A series of meta-analyses of FDA databases (examining an unbiased sample, including negative, unpublished studies) shows that, although antidepressant medications are effective, the placebo effect accounts for between 76% and 81% of treatment effectiveness.4-6 Placebo does not mean imaginary or untrue. Placebos produce real, clinically significant, and objectively measurable improvements in a wide range of conditions, including psychiatric disorders.7,8 And, placebo responses produce measurable changes in brain activity that largely overlap medication-induced improvements.9 The patient’s desire to change and a positive transference to the doctor and his or her medications can mobilize profound self-healing capacities—capacities that appear to be even more potent than the medication’s active ingredient.


In 1912, Freud11 noted that the unobjectionable positive transference (consisting of such things as the patient’s belief in the doctor’s salutary intentions, the wish to use the doctor to get better, and the desire to win the doctor’s love or esteem by genuinely trying to get better) was, in the end, a key factor in the patient’s ability to overcome symptoms. This unobjectionable positive transference, or what we call today the therapeutic alliance, is one of the most potent ingredients of treatment.11,12 In a large, placebo-controlled, multicenter trial of treatments of depression, Krupnick and colleagues13 showed that patients were most likely to respond when they received the active drug and had a strong therapeutic alliance. Those least likely to respond when given placebo had a poor therapeutic alliance. Patients who received placebo and who had a strong treatment alliance had a significantly more robust therapeutic response than patients who received an antidepressant but had a poor therapeutic alliance. Taken together, these 3 groups of studies (placebo response, readiness to change, and alliance) examined the relative effectiveness of biologically and symbolically active aspects of the medication.4-6,10,12,13 They show that effects of meaning are at least as potent as effects of biology.


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