David López, psychiatrist: ‘Maybe a group of friends would be better for you than an antidepressant’

Antidepressant consumption has skyrocketed in recent years in almost the entire world. In Spain, between 2020 and 2021, it grew by 10%, and in Mexico, the consumption of these drugs and anxiolytics doubled during the coronavirus pandemic. The consumption of benzodiazepines and other tranquilizers is also increasing, with data estimating that one in ten Spaniards have taken them in the last month. Psychotropic drugs are omnipresent medications, sometimes normalized, such as the pill passed between two friends to sleep better, or controversial, such as stimulants used to treat children with ADHD. Although they are seen as part of the same group of medicines, they are very different substances that must be used with knowledge, for the corresponding ailment, and only for the necessary time.

To offer a general and educational overview of these drugs, David López, a psychiatrist and founder of the mente A mente medical center in Madrid, has written Hablemos de los psicofármacos (Let’s Talk About Psychotropic Drugs), a book in which he reviews their characteristics, what they should be used for and what they should not be used for, and in which he tries to open a path between those who demonize them and those who use them or prescribe them too lightly.

Question. There is a huge polarization around psychotropic drugs. There are scientists who say that they do more harm than good and professionals who argue that psychiatric problems can be resolved with therapy and by improving people's social conditions.

Answer. I believe that there is no absolute truth. There are people who take medication and are satisfied with their treatment. Generalizing and saying that everything can be solved with social policies or with therapy or with medication, in the end is tribalizing. All of these ways of dealing with a problem can be valid and even have a synergistic effect. In the book I talk about drugs and not about politics, because it is not my field.

Q. How can you achieve the best result with all those tools?

A. You have to analyze which one is more appropriate for each situation. Medication can be more useful to treat some symptoms, and therapy for a person to make some decisions in their life that they don’t know how to face. Medication is not going to help you make a decision like starting a separation process, but there are people who are depressed because they have a bad relationship with their partner. When you are depressed, you don’t function well, and medication can help you get out of that depression to be able to make decisions about your life, with the help of therapy, and solve the problem that caused the depression. The treatments are not exclusive.

Q. In your consultancy, what are people’s main concerns about psychotropic drugs?

A. On the one hand, psychotropic drugs are understood as a single group, and there are many of them. The fact that one psychotropic drug has a side effect does not mean that another will have one. And sometimes, the effects of a drug are confused with symptoms of the disease. You meet someone on the street who suddenly stops saying hello and they tell you that they are taking medication. And you say, oh, of course, it’s the medication, when without it they might not even have been able to leave the house. A significant part of the stigma attached to psychotropic drugs comes from benzodiazepines. They are addictive and are involved in many traffic accidents, because although people may feel fine when driving, they impair their reflexes.

And there are also people who are afraid that if they take a drug they are recognizing their illness, and that if you start taking a drug you will have to take it forever and there will be no other solution to your problem. This is not the case. The problem that does exist is that if you do not treat that illness in time — for example, depression — you are destined to suffer from it for the rest of your life because there is a greater probability that it will become chronic.

Q. In your book, you say that lack of time makes it convenient for psychiatrists to prescribe drugs, because sometimes it is the only treatment they can offer with the little time they have.

A. If you notice, it’s not very different in other specialties. There’s a joke we make about dermatologists, that every time you go they give you a corticosteroid cream and if it doesn’t go away, then they look at other things. It’s an empirical treatment. If I examine you and see that you have depression and the treatment for depression is psychotherapy, I can offer it to you, but you have a nine-month waiting list and to be able to do six sessions you’ll have to wait a year and a half or two years. And, as I explained to you before, the longer a person is depressed, the worse their progress will be. The other alternative is to take an antidepressant, which is what I have at my disposal. Maybe a partner or a job or a group of friends would be better for you, but a psychiatrist can’t give you that.

Q. Benzodiazepine use in Spain is one of the highest in the world. Why?

A. In other countries they would also be given out if they were not restricted. There have certainly been campaigns among the population and doctors to limit their use, as is the case with antibiotics, although I do not believe there is a single cause. Benzodiazepines are very effective and produce a pleasant sensation when taken. It is not like an antidepressant, where you only notice nausea or intestinal discomfort after several days. If you have insomnia, you feel sleepy, and if you are nervous, you calm down. They are enticing, like alcohol or tasty food. And also, when they are prescribed, they come in boxes containing many tablets, which are not necessary for the treatment of a specific episode of anxiety or insomnia. People accumulate medication at home and then they can give it to a neighbor or a relative because it has worked well for them.

Then there are people who visit the family doctor, who has seven minutes per patient, and say that they have been fired from their job, that they have no money, that they are having a terrible time, can you give me another prescription? And the doctor has three minutes left for the consultation. What do they do? Do they argue with the patient, do they say no, do they become aggressive, as sometimes happens? In the end they write the prescription. And there is also the issue of the electronic prescription. With that, you can establish that every month, you are given the box of medicine. A medication is prescribed, the electronic prescription is registered, and a treatment that should be subject to time limits, as each box costs €1, is accumulated, the patient continues to take it, and to give it to relatives when they too have a problem. It is an issue that we have to solve together, with more professionals, so that there is more time for consultation, more self-help material, or by limiting the prescriptions or the size of the boxes.

Q. So it is better to do what other countries do, where consumption is lower?

A. Benzodiazepines are very useful at certain times, so I don’t think it’s right to ban them. And since there are very long waiting lists and no alternative resources, such as relaxation groups or groups to teach sleep regulation skills, they are a useful tool if a person can’t sleep, for example, and has to continue going to work and being productive.

Q. There are many people, particularly women, who take these drugs to regulate their mood.

A. These are people who are suffering, who are in pain, who are having panic attacks, and who are in a hurry to resolve these problems, and they are given a prescription because there are not many alternatives. The drug can be beneficial at first but end up being harmful. There are statistics that show they are most commonly consumed after the age of 45. It may be due to the social burden on women and post-menopause, but it is also due to a cumulative effect. Some women have been taking them since they were 30. The problem is maintaining the prescription continuously. Other alternatives should be sought, the reasons why they have been taking these drugs for so long, and they should be referred to psychiatrists who can offer other possibilities.

Often, they are taken in order to be able to sleep, so you would have to find ways for the patient to sleep without that medication, and first of all, check that there is no depression, a general disorder that causes insomnia. And then, withdraw the drug very gradually, to avoid the rebound effect, because otherwise, the insomnia can return in a more acute form. You can withdraw it in stages, for example. Divide the tablet into 10 parts and reduce it by one tenth of a tablet every week, or every 15 days or every three days. The patient becomes more confident and realizes that he or she sleeps just as well with a lower and lower dose, until they stop taking it.

Sign up for our weekly newsletter to get more English-language news coverage from EL PAÍS USA Edition