Psychotherapy as an epigenetic 'drug': Psychiatric therapeutics target symptoms linked to malfunctioning brain circuits with psychotherapy as well as with drugs
Open accessAbstract
WHAT IS KNOWN AND OBJECTIVE: Psychotherapy has traditionally competed with psychopharmacology. As drugs have become the more dominant treatment in psychiatry and primary care, this approach is increasingly criticized as limited in scope, lacking in robust outcomes and too heavily influenced by the pharmaceutical industry. Our objective is to show that recent advances in neurobiology are clarifying that learning and environmental experiences, such as psychotherapy, change brain circuits as do drugs. The leading notion of how therapeutic effects occur in psychiatric disorders is that they happen when symptoms are reduced by improving the efficiency of information processing in hypothetically malfunctioning brain circuits. COMMENT: With this formulation of psychiatric symptoms and their relief, it is not surprising that both psychotherapy and psychopharmacology can be clinically effective for treating psychiatric disorders, or indeed that combining them can be therapeutically synergistic. Psychotherapy, including a new spinoff of cognitive behavioural therapy called trial-based therapy, like many other forms of learning, can hypothetically induce epigenetic changes in brain circuits that can enhance the efficiency of information processing in malfunctioning neurons to improve symptoms in psychiatric disorders, just like drugs. WHAT IS NEW AND CONCLUSION: Psychotherapies can be conceptualized as epigenetic 'drugs', or at least as therapeutic agents that act epigenetically in a manner similar or complementary to drugs. These findings are leading to a paradigm shift in psychiatry such that psychotherapy is experiencing a come-back as various standardized, brief, goal-directed psychotherapies are being integrated with drug treatment of psychiatric disorders by psychopharmacologists who have traditionally relied on a drugs-only approach.
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Psychotherapy has been suggested to function as an 'epigenetic drug' capable of inducing epigenetic modifications by exercising its effects on neurobiological circuits which are ultimately reflected on a clinical symptom level.
“Psychotherapy has been suggested to function as an”
From The applied implications of epigenetics in anxiety, affective and stress-related disorders - A review and synthesis on psychosocial stress, psychotherapy and prevention (2020) · cites this paper as Stahl, 2012
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Cites
Baxter, L. R. (1992) · Archives of General Psychiatry · doi:10.1001/archpsyc.1992.01820090009002 · Cited by 1,293 · see citing works
Nemeroff, C. B., Heim, C. M., Thase, M. E., Klein, D. N., Rush, A. J., Schatzberg, A. F., Ninan, P. T., McCullough, J. P., Weiss, P. M., Dunner, D. L., et al. (2003) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2336126100 · Cited by 829 · see citing works
Cognitive Behaviour Therapy for Psychiatric Problems
(2015) · Oxford University Press eBooks · doi:10.1093/med:psych/9780192615879.001.0001 · Cited by 328 · see citing works
Experience-Dependent Epigenetic Modifications in the Central Nervous System
Sweatt, J. D. (2008) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.09.002 · Cited by 302 · see citing works
Schramm, E., van Calker, D., Dykierek, P., Lieb, K., Kech, S., Zobel, I., Leonhart, R., & Berger, T. (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.5.768 · Cited by 170 · see citing works
Epigenetic Mechanisms in Psychiatry
Nestler, E. J. (2009) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.10.030 · Cited by 71 · see citing works
Schramm, E. (2007) · American Journal of Psychiatry · doi:10.1176/appi.ajp.164.5.768 · Cited by 46 · see citing works
Stahl’s Essential Psychopharmacology
Doyle, B. B. (2015) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.14bk09672 · Cited by 45 · see citing works
Lynch, F. L., Dickerson, J. F., Clarke, G., Vitiello, B., Porta, G., Wagner, K., Emslie, G., Asarnow, J., Keller, M., Birmaher, B., et al. (2011) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.9 · Cited by 45 · see citing works
de Oliveira, I. R., Powell, V. B., Wenzel, A., Caldas, M., Seixas, C., Almeida, C., Bonfim, T. D., Grangeon, M. C., Castro, M. M. C., Galvão, A., et al. (2011) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/j.1365-2710.2011.01299.x · Cited by 39 · see citing works
Methylated Spirits: Epigenetic Hypotheses of Psychiatric Disorders
Stahl, S. M. (2010) · CNS Spectrums · doi:10.1017/s1092852900000055 · Cited by 30 · see citing works
Self-citationKafka’s trial dilemma: Proposal of a practical solution to Joseph K.’s unknown accusation
Oliveira, I. R. D. (2011) · Medical Hypotheses · doi:10.1016/j.mehy.2011.03.010 · Cited by 21 · see citing works
Psychiatric Stress Testing: Novel Strategy for Translational Psychopharmacology
Stahl, S. M. (2010) · Neuropsychopharmacology · doi:10.1038/npp.2010.29 · Cited by 15 · see citing works
Self-citationCombining CBT and Medication: An Evidence-Based Approach
Sudak, D. M. (2011) · Wiley eBooks · doi:10.1002/9781118093368 · Cited by 10 · see citing works
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Research works printed but not linked: 3
- [1]1. Stahl SM (2008) Stahls essential psychophar- macology, 3rd edn. New York: Cambridge University Press.
- [2]2. Stahl SM Psychiatric stress testing: novel strategy for translatrionsl psychopharma- cology. Neuropsychopharmacology, 2010;35:1413-1414.
- [14]14. De Oliveira IR (2011) Trial-based thought record: accepted entry in common language for psychotherapy procedures. Available at: http://www.commonlanguagepsychother- apy.org. (accessed 25 July 2011). ª 2011 Blackwell Publishing Ltd Journal of Clinical Pharmacy and Therapeutics, 2012, 37, 249-253 253 Psychotherapy as an epigenetic 'drug' S. M. Stahl 13652710, 2012, 3,
Cited by
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Schiele, M. A., Gottschalk, M. G., & Domschke, K. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101830 · Cited by 156 · see citing works
Resilience: The Science of Mastering Life's Greatest Challenges
Southwick, S., & Charney, D. (2018) · doi:10.1017/9781108349246 · Cited by 153 · see citing works
Greenway, K. T., Garel, N., Jerome, L., & Feduccia, A. A. (2020) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2020.1772054 · Cited by 94 · see citing works
Culpepper, L., Muskin, P. R., & Stahl, S. M. (2015) · The American Journal of Medicine · doi:10.1016/j.amjmed.2015.07.001 · Cited by 77 · see citing works
Self-citationPeedicayil, J. (2012) · Journal of Clinical Pharmacy and Therapeutics · doi:10.1111/j.1365-2710.2012.01346.x · Cited by 32 · see citing works
- Authors
- Stahl, S. M.
- Affiliations
- University of Cambridge (GB)
- Corresponding author
- Stahl, S. M.
- ORCID
- Stahl, S. M.
- Venue
- Journal of Clinical Pharmacy and Therapeutics
- Publisher
- Hindawi Limited
- Published
- 2011-10-10
- Volume
- 37
- Issue
- 3
- Pages
- 249-253
- ISSN
- 0269-4727 (ISSN-L)
- OpenAlex
- W1647255995
- Cited by
- 67
- References
- 14
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 5 · 2023: 1 · 2022: 7 · 2021: 3 · 2020: 9 · 2019: 3 · 2018: 3 · 2017: 1 · 2016: 8 · 2015: 2 · 2014: 6 · 2013: 6 · 2012: 9
- FWCI
- 7.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Pharmacy and Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- psychotherapy, epigenetics, brain circuits, psychopharmacology, psychiatric treatment, cognitive behavioral therapy, information processing, psychiatric symptoms, combination therapy, brief psychotherapy
- MeSH terms
- Amygdala, Animals, Mental Disorders, Combined Modality Therapy, Humans, Neurons, Psychiatry, Psychotherapy, Psychotropic Drugs, Cognitive Behavioral Therapy, Epigenesis, Genetic, Precision Medicine
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