Can psychologists prescribe psychotropics?
The pressure from psychologists to prescribe psychotropics seems to keep increasing, according to the APA. The psychiatrists’ resistance is fierce.
I don’t recall observing this sort of struggle in other specialties, e.g. between neurologists and clinical psychologists. I wonder if we are asking the wrong question above. Perhaps we should ask if psychiatrists are sophisticated enough to distance themselves from other groups who aspire to prescribe drugs.
Do we know enough about the mechanisms of action of psychotropic drugs? Do we have any solid knowledge of psychiatric pathophysiology? Sadly, the answer to these questions is no.
It’s not only a matter of increasing research funding. The average psychiatrist has already shifted his/her focus from the medical aspects of psychiatry to the more social and behavioral aspects, where he/she is guaranteed to find serious competition from other professionals who come with solid and extensive training in areas like psychotherapy, where the purely medical background has only minor relevance. On the other hand, while discussing medications in psychiatric circles, neurophysiological, molecular or computational/cognitive aspects are only casually addressed, if ever. There is already a significant rift between neuroscience and the practice of psychiatry. This fact may be a contributing factor for other health workers’ eagerness to replace psychiatrists in the prescription area.
Partially relinquishing their medical status through their cognitive choices puts psychiatrists at a feeble position to hold their ground in these matters.
The Brain Shop 
April 4, 2008 at 21:35
I finished my psychiatry residency 45 years ago. Forty years ago about 10 percent of my patients were on meds and analytical psychotherapy was the majority, similar to a psychologist. Now meds are 100% and psychotherapy is mainly supportive with some behavioral desensitation, depending on diagnosis. The resistance to psychologist prescribing is partially financial, but, in my opinion, their lack of medical knowledge is very important. Symptoms sometimes have a physical cause and I wonder if they would have the background to differentiate akathisia from anxiety or hypothyroid depression etc.
JLU
April 6, 2008 at 00:23
Thank you for your thoughtful comment. I have to agree.
I don’t think psychologists should be authorized to prescribe medications. Medication management requires a full biopsychosocial approach, and they lack the “bio” component. A simple course of pharmacology (no matter how thorough) can not make up for that gap.
On the other hand, I take their attempts as a healthy eye-opener. Why? Because the resulting struggle is calling for us psychiatrists to establish a better relationship with neuroscientists.