As noted in the guideline, studies examining combination treatment with psychotherapy and pharmacotherapy have shown mixed results. Although this has continued to be true in subsequently published studies (66, 67, 72, 73), a recent meta-analysis suggested that a combination of psychotherapy and pharmacotherapy is more effective than pharmacotherapy alone (74). Combination therapy may be particularly useful in improving treatment adherence (73, 74) and might be of some use in targeting particular symptoms or patient subgroups (75–77).
Insulin isn't psychoactive.
Meanwhile, I have no problem with people deciding they'd like to be under psychoactive influences 24/7 and get themselves a nice addiction
Drugs may work well, but I do think their benefits are trumpeted out of all proportion to preventive and behavioral treatments that are often just as good. Not in every case, but often.
"Luminous beings are we, not this crude matter." -- Yoda
The Centers for Disease Control and Prevention reports that 1.7 million Americans die and 25 million are disabled each year by chronic diseases caused or made worse by unhealthy lifestyles. And a 2005 study in The New England Journal of Medicine predicted that average life expectancy in the United States would decline in the next 20 years as a result of unhealthy lifestyles, reversing a trend dating to the 1850s. The American College of Lifestyle Medicine has 150 members in a wide array of specialties — nutritionists, ophthalmologists, gastroenterologists and oncologists, among others. Helping their cause is a new publication, The American Journal of Lifestyle Medicine, which appears every other month with peer-reviewed research on the way daily habits affect health.
“Bottom line is we want to promote the science, education and practice of lifestyle medicine,” Dr. Kelly said.
While they agree on the importance of questioning patients about their lifestyles and giving tailored advice on how to make improvements, there remains disagreement about who should provide such counseling and with what sort of training. Nor is there a widely accepted prescriptive approach for encouraging patient compliance.
“We know lifestyle interventions can be very powerful,” often more effective than drugs or surgery, said Dr. JoAnn Manson, a professor of epidemiology at Harvard’s School of Public Health and a member of the editorial board of the new journal. “But we need to provide the scientific evidence on how to incorporate that knowledge into practice.”
Doctors may vaguely recommend that patients lose weight or get more sleep, for example, but they do not necessarily know how to help them do it...
...“I don’t think it’s appropriate to segment it off,” said Dr. Thomas W. Rowland, chief of pediatric cardiology at Baystate Medical Center in Springfield, Mass., who routinely counsels children and parents on how to adopt healthy lifestyles. “It needs to be a fundamental part of every doctor’s practice” and therefore a part of every medical school’s core curriculum.
Still, he acknowledges that there are significant obstacles, because lifestyle counseling is time-consuming and is seldom compensated by Medicare or health insurers.
Reimbursement is a chief concern of the American College of Lifestyle Medicine. The group plans to lobby Congress to that end. And it wants Congress to require that patients be informed about the relative effectiveness of lifestyle changes before receiving certain medications — including blood pressure, acid reflux and cholesterol drugs — and before undergoing procedures like back surgery, bypass surgery and stent placement.
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