What Is Cosmetic Psychopharmacology?


When Stacy, a New York City-based computer saleswoman, was at a recent business dinner, her newest client turned to her and said, “You are medicated, right?”

She smiled nervously, not sure of how to respond. (She is, in fact, taking medication for depression has gotten stronger, and we have seen more technical justification for prescribing medications for lower levels of illness.”

“My sense is that there are a number of people who may not meet the full criteria for major depressive disorder but are still experiencing dysfunction in their lives, and in addition, they just don’t experience pleasure in many different activities where they might have at one time,” says Victor Reus, MD, professor of psychiatry at the University of California San Francisco.

And such people “can experience significant symptomatic improvement, feel better, or perform better with medication,” he says. “Is that cosmetic? It’s not taking a pill to feel better than well, it is trying to treat subclinical deficits and may enhance normal performance.

“I don’t think they are taken recreationally, and most don’t work in terms of taking them now or then. These are medications that you have to take on an ongoing basis to have any effect whatsoever,” Reus says.

The one thing everyone agrees on is that medications are not a magic bullet.

“I understand the great temptation in that people imagine this is the ‘quick fix’ — as in less pain, more gain,” says New York psychoanalyst Gail Saltz, MD.

“There used to be [marijuana], then alcohol, then cocaine, and now there are Rx pads,” she says. “The downside that people aren’t made so aware of is that some of these anxiety drugs are truly addictive — meaning that people have to keep taking increased amounts to get the same feeling and they can’t stop without going through withdrawal.”

Antidepressants aren’t addictive, she says, but they do flatten a lot of people. “You don’t feel depressed, but you don’t feel joyful either,” she says. “They close the amplitude of emotions, so there are no lows or highs. This is why antidepressants were historically reserved for people undergoing major depression.

“Even if it makes you feel ‘better,’ taking an antidepressant is a Band-Aid if you have not looked underneath,” she says. “I am not against medication, but I don’t give medication to someone who isn’t also in therapy.”

One of the problems with medicine today is fragmented care, she says. People may see a psychopharmacologist for medication every three months and a therapist or social worker weekly or every other week to talk through their issues, and some may see one and not the other.

Stacey agrees. “I take medication, but I am also in therapy,” she says. “I felt better that night at dinner when I found out that everyone was on it, but I still want to stop taking it eventually. I don’t see it as a long-term solution, but it is helping me function better in the interim as I seek out that long-term answer or strategy to my worries.”