Rethinking Psychiatric Medication: The Drug-Centered Model
As a clinical psychologist, I don't prescribe medication. Medication management is outside of my scope of practice. As always, this blog is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. However, many of the people I work with are prescribed psychiatric medications, and care coordination for mental health is an ethical imperative. This post shares some perspectives on the “drug-centered model” of psychotropic medication—a way of thinking about psychiatric drugs that differs from the more common “disease-centered” explanation.
What Is the Drug-Centered Model?
Most of us have heard that psychiatric medications “fix chemical imbalances” in the brain. For example, antidepressants are often said to correct “low serotonin.” This explanation comes from what’s called the disease-centered model of treatment: the idea that drugs work by targeting the root biological cause of a mental health condition.
Several researchers have suggested an alternative—the drug-centered model. This perspective views medications as psychoactive substances that change how our minds and bodies function, with effects that may help with symptoms but also involve tradeoffs.
What Does the Drug-Centered Model Mean?
Psychiatric medications act more like coffee, alcohol, or cannabis than antibiotics. They do not necessarily correct an underlying disease. Instead, they put a person into a different mental or physical state, which can feel helpful or sometimes uncomfortable.
For example:
Antidepressants can blunt intense emotions, easing despair but sometimes dulling joy.
Antipsychotics reduce brain activity overall, quieting hallucinations but potentially flattening motivation.
Stimulants sharpen focus, which helps with attention difficulties but can disrupt sleep and appetite.
The key is that these drugs add something new, rather than simply fixing something broken. A comprehensive understanding of their effects on both body and mind is essential for informed decision-making.
Why the Debate Now?
In recent years, evidence has challenged the old “chemical imbalance” story. For example, some reviews found no convincing proof that low serotonin causes depression. At the same time, long-term studies show many psychiatric drugs come with significant side effects, including weight changes, emotional blunting, and persistent sexual side effects such as Post-SSRI Sexual Dysfunction (PSSD). PSSD can occur even after discontinuing selective serotonin reuptake inhibitors (SSRIs) and may include reduced libido, erectile dysfunction, or anorgasmia.
This evidence does not mean medications are useless. Many people find them life-changing—or even life-saving. It indicates the need for a more balanced, transparent approach to prescribing and using psychiatric medications. Clear, informed consent discussions are crucial so patients understand both benefits and potential risks.
Nature, Nurture, and the Role of Medications
Psychotropic drugs often spark an implicit, age-old debate: is mental health shaped by biology (nature) or by environment and experience (nurture)? Traditional thinking about psychiatric medications tends to frame them as “fixing” a biological deficit, which leans heavily toward the nature side of the argument and can promote shame, stigma, and stuckness—the sense that “something within me is broken,” that “mental illness is a result of bad genes,” or that “I have to take medication forever.”
Modern research, however, shows that mental health is rarely the result of either nature or nurture alone. Instead, it emerges from a constantly evolving, inextricably linked interplay between biological, psychological, and social factors. Genes influence how we respond to stress, trauma, and learning experiences, while life experiences can modify brain chemistry and gene expression.
Understanding psychiatric drugs through this lens helps clarify their role: they are tools that modify the system we are born into and continue to shape through life experiences. They do not operate in isolation, nor do they “correct” a purely biological problem. Recognizing this interplay encourages a more holistic, nuanced approach to mental health, where medications are just one part of a broader plan that includes therapy, lifestyle interventions, and social support.
Why Does This Matter?
Understanding medications in this way changes the treatment conversation:
Informed choices: Patients can weigh whether the benefits of a drug are worth the potential side effects when they understand it creates a new mental state rather than “fixing” a chemical imbalance.
Less stigma and blame: If a medication does not provide relief, it does not mean a brain is fundamentally broken. It may indicate that the drug is not the best fit.
A more honest conversation: Drug-centered thinking allows discussions such as, “This medication might dampen distressing feelings, but it could also cause emotional numbness or other side effects—let’s monitor how it affects you.”
By combining these insights with information about persistent side effects like PSSD, providers and patients can engage in meaningful informed consent discussions, ensuring treatment choices are fully understood and personalized.
Finding a Functional or ACT-Trained Psychiatrist or Prescriber
If you are considering medication or are already taking psychiatric drugs, it can be helpful to work with a prescriber who takes a functional, whole-person approach or is trained in Acceptance and Commitment Therapy (ACT). Here are some ways to find the right provider:
Look for functional psychiatry approaches: These prescribers consider biological, psychological, and lifestyle factors together, not just symptoms, and often collaborate with therapists, nutritionists, or other health professionals.
Check ACT training: Some prescribers are trained in ACT, which can help integrate medication management with skills to improve values-based living, emotional flexibility, and coping strategies.
Ask about their philosophy: When contacting a provider, you can ask how they approach medications—do they view them as one tool among many, and do they emphasize informed consent about benefits, risks, and long-term effects?
Prioritize collaboration: A good prescriber should welcome input from you and your therapist, monitor side effects carefully, and adjust treatment based on your goals and experiences.
Use professional directories: Organizations like the Association for Contextual Behavioral Science list ACT-trained providers, and functional psychiatry practices often have online directories or referrals.
Finding a prescriber who aligns with these approaches can help you make medication decisions that are informed, transparent, and integrated with therapy and lifestyle strategies for long-term well-being.
Moving Forward
The drug-centered model does not suggest eliminating medications. It encourages:
Personalized treatment: Matching medications to individual needs and goals rather than assuming one-size-fits-all.
Shared decision-making: Helping patients and providers weigh the benefits and tradeoffs together.
Integration with functional approaches: Combining medication, therapy, lifestyle adjustments, and ACT skills to support whole-person health.
Comprehensive informed consent: Ensuring patients understand the full range of effects—both intended and unintended—on body and mind, including potential persistent side effects such as PSSD.
Acknowledgements
I specifically want to thank Rob Purssey and Kirk Strosahl for introducing this work to me as well as the researchers, clinicians, and authors whose work on psychotropic medications, the drug-centered model, and functional psychiatry informed this post. Their dedication to advancing knowledge and promoting thoughtful, patient-centered care makes discussions about mental health and medication more transparent and accessible.
I also want to acknowledge the clients and patients who inspire these conversations, reminding us that mental health care is most effective when it respects individual experiences, values, and choices.
References
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