advertising. Drugs that were once used only in severely disturbed
psychotic patients were now approved by the U.S. Food and Drug
Administration and prescribed for bipolar disorder and as adjunctive
treatment of depression, and also used for an increasing number of
“off-label” (not approved by the Food and Drug Administration) indi-
cations—agitation, sleep problems, autism, dementia, and so forth.
They were more and more widely used in elderly people, and also in
increasingly younger children, to treat symptoms of everything rang-
ing from irritability to social withdrawal. Like antidepressant medi-
cations, antipsychotic drugs currently generate billions of dollars per
year in sales. Few would have predicted that psychiatric medications
would become the economic juggernaut they are today?
While images of neurotransmitter deficits or imbalances under-
lying conditions like depression and psychosis may make for com-
pelling advertising, the complexities of brain biology speak against
such simplistic hypotheses. Although the symptom-reducing effects
of antidepressant and antipsychotic medications may be mediated in
part via their effects on particular neurochemical systems (serotonin,
norepinephrine, dopamine, glutamate, and so on), any long-term ben-
efits are likely related to complex effects on intracellular G-protein-
coupled receptor pathways impacting gene expression, neurogenesis,
and changes in synaptic connectivity. It is also the case that such psy-
chiatric medications will be most helpful when used in conjunction
with psychotherapy and other practices that contribute to learning
and consolidating desirable behaviors. While it may be the case that
certain drugs facilitate changes in neural connections by perturbing
brain physiology, real transformation comes from intention, action,
and practice.
A prominent tradition in theorizing about the psychology of emotion