Therapeutic and Structural Dimensions in Psychiatric Prescribing: Bridging Psychedelics and Antidepressants.

Abstract: As practitioners seek more personalized approaches, exploring how patients' environments, relationship templates, and mindsets factor into symptom burden can help broaden understanding of how psychotropic medications facilitate recovery. Despite increasing focus on medications to provide relief, there is an important and undeniable influence the therapeutic environment has on shaping outcomes, particularly for the patient-clinician alliance. While environmental dimensions are relevant for informing possible placebo or nocebo responses, they also build upon the pharmacodynamic and neurobiological effects of medications. By heightening neuroplasticity, some antidepressants may amplify the effects of nonmedication factors in patients' lives, including the patient-prescriber therapeutic relationship. There are important parallels between antidepressants and psychedelics in emerging literature. For instance, the preparatory and integrative work with a provider can be crucial in determining outcomes. This paper will draw from the extant literature to discuss the therapeutic relationship in psychiatric practice, including in acute care settings and instances in which psychotropic prescribing is a key aspect of treatment.