An Introduction to Psychopharmacology: Where Psychology Meets Pharmacotherapy

You can’t discuss mental health in America without taking an honest look at the scope of the crises. While there are encouraging statistics that indicate more people are talking about mental health and beginning to seek help, the data still reveals some concerning trends.

For instance, the U.S. Substance Abuse and Mental Health Services Agency reported in 2020 that 41.4 million American adults received either inpatient or outpatient mental health care services, or were prescribed medication to treat some form of mental illness. This represented a substantial increase from previous years.

What’s concerning is that the same survey showed that 52.9 million Americans reported having a mental illness – 11.5 million more than received treatment. For one reason or another, millions of Americans in need of mental health services just aren’t getting them.

But what can mental health professionals do to bridge the gap?

Dr. Craige Wrenn, Professor of Pharmacology at Drake University, posits that giving mental health professionals more tools and the legal authority to use them is part of the solution. To this end, he believes psychologists could be empowered by developing their knowledge of psychopharmacology — the study of how pharmaceuticals are used in combination with psychotherapy to help patients achieve optimal wellness.

• What Every Psychology Student Should Know About Psychopharmacology
• The Power of Combining Psychotherapy with Pharmacotherapy
• Prescribing Psychologists are Improving Access to Advanced Mental Health Services

CareersInPsychology.org had the privilege of speaking with Dr. Craige Wrenn, Pharmaceutical and Administrative Sciences Department Chair and Professor of Pharmacology at Drake University. A dedicated faculty member since 2004, Dr. Wrenn shared his thoughts on the important role psychopharmacology will have in offsetting the impact of practitioner shortages and addressing the nation’s mental health crisis.

Dr. Craige Wrenn of Drake University, Pharmaceutical and Administrative Sciences Department Chair and Professor of Pharmacology

After earning his Ph.D. in Pharmacology from Vanderbilt University, Dr. Wrenn joined Drake University in 2004 as professor of pharmacology. In the nearly two decades since, his research work has focused on neuropharmacology and neuroscience. Recognized as a leading scholar in the field, he has been awarded Hartig Distinguished Professor - 2011, Mentor of the Year - 2013, and the Troyer Research Fellowship - 2015.

What Every Psychology Student Should Know About Psychopharmacology

As the name suggests, psychopharmacology is a complex multidisciplinary field in which mental health professionals combine their talents in assessment and psychotherapy with knowledge of therapeutic pharmacology. With that, they can take what they know about a patient’s mental and physical condition to select the right medication to complement therapy. But this isn’t always a straightforward process.

Take, for example, SSRIs (Selective serotonin reuptake inhibitors). SSRIs are frequently used to treat depression, but they can also be helpful in certain cases of OCD, PTSD, and different forms of anxiety and panic disorders. Not every SSRI is the same, however, nor will the same one always work for patients with seemingly similar psychological struggles.

That means mental health practitioners prescribing these medications must take a whole range of factors into consideration:

• How the drug moves through the body
• Its potential for causing adverse side effects
• How it interacts with other medications
• Dosage
• The patient’s biological state and medical history (overall health, age, weight, etc.)

These are factors any medical doctor would have to analyze before prescribing a medication. But for mental health practitioners, the questions don’t end there.

Prescribing psychologists must also consider how neurological changes brought on by the drug will affect a patient’s mental state and behavior. Will the medication affect the success of the patient’s ongoing psychotherapy treatment? Is the patient suffering from multiple mental illnesses that could cause dangerous mental states? Does the patient need medication for everyday use on an ongoing basis, or for a defined period to get through a mental health crisis?

Dr. Wrenn sums up this delicate blend of disciplines by saying, “In psychopharmacology, we’re concerned with the connection between brain and behavior and then using that knowledge to treat mental illness.”

Ultimately, psychopharmacology shares the same goals as other areas of psychology – to improve mental health and help people live better lives.

And according to Dr. Wrenn, that’s exactly why students should get excited about studying psychopharmacology. By gaining an in-depth knowledge of how medications can be used to enhance various therapeutic techniques, future and current mental health practitioners will be equipped to deliver life-changing mental health services to a wider range of patients.

The Power of Combining Psychotherapy with Pharmacotherapy

People suffering from mental illnesses don’t always need therapeutic medications, but in some instances, combining medication with techniques like talk therapy or cognitive behavioral therapy can lead to better outcomes.

Dr. Wrenn cites depression as an example of a mental illness that often responds well to a multidisciplinary approach:

“The data for many illnesses, and depression is a good example, shows that you get the best outcomes when you combine psychotherapy like talk therapy with medications. We see better outcomes with that combination than with either approach alone.” 

One study published in JAMA Psychiatry in 2020 found that in a series of clinical trials looking at patients undergoing acute-phase pharmacotherapy for major depressive disorder (MDD), the addition of psychotherapy significantly reduced the likelihood of reoccurrence. With depression consistently counted among the more common mental health disorders people seek treatment for, these findings suggests that pharmaceutical interventions combined with psychotherapy have the potential to be a powerful tool for psychologists everywhere.

Prescribing Psychologists are Improving Access to Advanced Mental Health Services

Therapeutic medications can certainly bolster psychotherapeutic treatments, but only certain kinds of mental health professionals can prescribe them. Psychiatrists and other medical doctors can. Currently, only five states offer psychologists the option of becoming prescribing practitioners, and only after going through specialized psychopharmacology training.

Psychologists can evaluate patients, diagnose mental disorders, and carry out therapeutic treatments like talk therapy, but broadly speaking, state licensure for psychologists does not grant the legal authority to prescribe medications.

In most cases, when patients demonstrate the need for medication, psychologists would typically make referrals to psychiatrists and physicians with prescriptive authority. But having to refer patients to other providers can pose a challenge. As Dr. Wrenn points out, not everyone has easy access to prescription-writing mental health practitioners:

“Only about half of the counties in the United States have psychiatrists. About two-thirds of the counties in the United States have psychologists. This disparity between access to psychiatrists and access to psychologists is even worse when you go out into the rural areas.” 

The Kaiser Family Foundation’s Mental Health Care Health Professional Shortage Areas (HSSAs) report for 2021 illustrates the pressing need for more practitioners with prescriptive authority. According to the report, Texas alone needs almost 700 more psychiatrists to meet the state’s mental health care needs, while California is close behind with a shortfall of about 600.

So how can the mental health community begin to close this gap? How can mental health practitioners get medications to marginalized, isolated Americans with schizophrenia, bipolar disorder, and other kinds of mental illness?

Giving psychologists formal psychopharmacology training and the legal means to use it is destined to be part of the answer.

The Master of Science in Clinical Psychopharmacology at Drake University represents the leading edge of this solution. It’s through this program that Dr. Wrenn and his colleagues are able to teach these vital skills to licensed, post-doctoral psychologists with the express intent of helping them become prescribing providers.

This program, and others like it, put practicing psychologists back in the classroom to develop skills around pharmacotherapeutics. The program teaches psychologists how to assess the pharmaceutic needs of patients, and how to design and implement combined treatment plans as part of interprofessional care teams that make the most of each professional’s unique skillset.

As valuable as that training is, it can only be used to deliver patient care in states where psychologists can be granted the legal authority to prescribe medication. Today, just five states allow psychologists to become prescribing practitioners after receiving in-depth psychopharmacology training:

• Louisiana
• New Mexico
• Illinois
• Idaho
• Iowa

It’s a modest start, but Dr. Wrenn remains hopeful.

“The future that I'm envisioning, when I think about this, is a future in which more people are able to lead happy and meaningful lives because they have access to the health care that they need for their mental illness.”