Wednesday, June 17, 2009

Psychologists Prescribing Antidepressants?

Here's another question from a visitor:

Your views on psychologists' obtaining the right to administer antidepressant.

I don't have any problem with this. If psychologists, or anyone else, were to have prescribing privileges, I do think there should be an educational program with a licensing exam, with continuing education requirements for maintaining licensure, etc., to ensure that the prescribers are up-to-date and knowledgable about the medications and risks, etc. At that point, it could be up to an informed patient to decide whether to trust and accept a prescription from a psychologist. As far as I'm concerned, this is a fair balance between regulation and individual rights in a freedom-oriented society.

I think some psychiatrists' opposition to psychologist prescribing has a lot to do with wanting to hold on to more influence, authority, power, or perhaps a greater sense of importance or exclusivity. There may be elements of narcissism and insecurity which underlie this position. It reminds me of the history of modern medical opposition to midwifery.

While many patients need complicated regimes of medication, may have complex comorbid medical problems, and may therefore require a highly specialized expert in psychopharmacology to prescribe for them (actually, the level of expertise in this area among psychiatrists is very inconsistent), the majority of patients who might benefit from antidepressants require a very simple regimen. Such a regimen does not require many years of advanced education to competently administer. It seems a waste of time and health-care expense for those individuals to have to seek out an MD for their prescriptions.

Furthermore, many antidepressant prescriptions are currently written by a gp who may have only seen the patient for a few minutes--if psychologists were prescribing, this would most likely be in the context of knowing the patient very well, with hour-long appointments, and offering very good follow-up care.

There are risks associated with prescription antidepressants, and there are bound to be patients who run into problems after being prescribed antidepressants from a psychologist. But I am doubtful that these risks would be higher than if antidepressants were only available from an MD, particularly if prescribing privileges required passing a licensing exam, etc.

1 comment:

Anonymous said...

I agree with these views.

I think the relationship between Psychiatrists and prescribing psychologists could be analogously modeled using the relationship between G.P.s and nurse practitioners.

In many rural areas nurse practitioners are replacing G.P.s because of the high demand and low supply of physicians. The lack of G.P.s compared to nurse practitioners can be attributed to the length of medical training, the cost of medical training and the strict regulations applied to medical school admissions.

I presume that there is also a high demand and low supply of psychiatrists in the same areas and meeting the needs of these underprivileged/remote areas could be better served by filling empty psychiatry positions with prescribing psychologists. (As long as the quality of care for the patient was not compromised).

What would be ideal to develope a Master's program for psychology that includes a prescribing, theory, and practice component akin to the nurse practitioners Master's program.

However, if we do not allow psychologists to prescribe there should be an increase in the number of spots in medical school in order to meet the health care demands of the country. Also, I would endorse more collaboration between psychiatry and psychology, or medical fields and social science fields in general.