Today, we delve into the complicated world of psychiatric diagnoses and their impact on treatment.

Welcome everyone to this episode of the Carlatt Psychotherapy Podcast.

I'm Mark Ruffalo, editor-in-chief of the Carlatt Psychotherapy Report.

And I've got with me today a guest, Dr. Nasir Gami, of Tufts Medical Center and

Harvard Medical School. Dr. Gami is director of the psychopharmacology consultation clinic

at Tufts, leading expert in bipolar illness and lithium therapy and has written extensively on the philosophy of psychiatry.

Today, I've got some questions for him about psychotherapy, about the diagnostic hierarchy and

psychiatry and a few other topics. So welcome to the podcast, Dr. Gami. It's great to talk with you today.

Thanks, Mark. Nice to be with you. Yes. So my first question for you is you have argued in some of your writings that the oft-repeated claim that medication plus psychotherapy is better than either alone is untrue and that it should not be generally accepted.

Can you tell us why you make this point?

Well, my claim is not that it's untrue inherently.

My claim is that it's not true inherently.

The view that it's obviously true is either unproven or demonstrably

false. It could be, though, that in some cases the combination is helpful, and that's something

that needs to be proven and has been shown in some things. For instance, it depends on what

condition you're treating. Let's

take a simple example, like acute mania. There's no research that shows that adding psychotherapy

to the antipsychotics for acute mania is more effective than antipsychotics alone.

So that one example is enough to disprove the general thesis. Even acute depression, depending on what kind of depression you're looking at. Acute bipolar depression, antidepressants don't work at all. So adding psychotherapy to antidepressants doesn't make that any better. Neither of them are proven effective. Acute unipolar depression, which is a place where people often talk about this, there's some evidence that the combination can be more effective than antidepressants alone in some studies, but then not in other studies.

And if you dig into that research, my general summary of it would be that most people don't make this summary.

I think this is a correct interpretation that is underappreciated.

When you look at very severe depressive episodes,

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