The other day I read McKay, Imel and Wampold’s article on psychiatrist effects. Whoa. The researchers found that some psychiatrist help more client’s than others.
But wait. It has nothing to do with the treatment. If a good psychiatrist and a bad psychiatrist give the same treatment, the good psychiatrist’s clients get better. The bad psychiatrist’s clients get worse. Yeah. Even when they give the same treatment one does better than the other.
The obvious question is “why?”
The article never says (although I offer a few thoughts below). All we know is something about the person of the psychiatrist fosters more healing. Let’s dive into some quotes.
While psychiatrist effects should not be ignored as they are at least as large, and probably larger, than medication effects, it is important to note that psychiatrist effects were not as dramatic for the observer-rated measure (i.e. the HAM-D) as they were for the self-report measure (i.e. the BDI).
Psychiatrist effects are as large as medication effects? Whoa! What does that say about medication?
Also, psychiatrist effects were more evident on self report measures. So it matters more to the client, than an outsider, who their psychiatrist is.
Closer inspection reveals that one-third of the psychiatrists demonstrated superior outcomes with placebo than one-third of the psychiatrists demonstrated with imipramine hydrochloride.
So a good psychiatrist with no meds is better than a bad psychiatrist with meds. Whoa.
psychiatrists whose patients tended to improve on imipramine hydrochloride were the same psychiatrists whose patients tended to improve on placebo. It appears that the effective psychiatrists augment the effects of the active ingredients of imipramine hydrochloride as well as produce benefits with a placebo. Therefore, it may be that the most effective psychiatrists augment the neurochemical effects of the drug.
Okay. So a good psychiatrist could give a drug or placebo and their patient would still get better.
Based on these findings it can be concluded that the person of the psychiatrist makes a difference in the response to anti-depressant medication. Therefore, the health care community would be wise to consider the psychiatrist not only as a provider of treatment, but also as a means of treatment.
The physician matters. The physicians themselves are a part of the treatment.
(Probably) why this happens.
So why does this happen? While the article doesn’t say, if you place this article in the larger field, a few things become obvious. One of the new discoveries in neuroscience and physiology is that when we feel stressed or go into fight or flight our bodies take all available resources and use them to survive. For instance digestion stops when you’re being attacked by a lion. No need to worry about digesting food when that energy needs to be used to fight off a lion.
The opposite is also true, when we feel most relaxed, safe and comfortable is when our cells repair, our bones grow, our immune response is optimal and other healing systems kick into high gear. This is something I talk extensively about on my podcast.
This means when we feel stressed our bodies are actively working against healing and when we are calm and safe our bodies are actively working to heal. So how do we get to this relaxed, safe and comfortable state? Humans get there through safe and supportive relationships.
What does this have to do with the psychiatrist effects? It’s safe to assume that these psychiatrist are exceptionally skilled at making their patients feel safe, cared for, and taken care of. They have excellent bedside manner, and that is the difference that makes the difference.
May we be that kind of therapist.
Psychiatrist effects in the psychopharmacological treatment of depression — Kevin M. McKay ⁎, Zac E. Imel, Bruce E. Wampold