Even though this looks like a rebuttal to the article about antidepressants I posted, it says there is a lot to be done yet in this field. Too many patients with depression do not see a real mental health professional, just their primary care doctors, who have little training in menatl health. Then there is the stigma...a lot of people won't talk about it..then there is the problem with insurance companies..too many do not cover visits to mental health therapists.
He says, too, antidepressants CAN work for some people who have had depression for 2 years or more...but milder cases that are shorter?
What is nteresting about this uy is that he had a major trauma (his sister died in 9/1 attack on World Trade Center...and he was depressed...so turned to Rx.} Well..you are supposed to be depressed!!!!!!!!! It is such a cultural thing that you have to bounce back quick from trauma. It used to be...back in the 19th century...everyone was given 30 days to grieve...no one cared if you spent that 30 days bawling in your bedroom...you did what you had to do to work out the grief. People excted you to be non funtioning for 30 days at least.
To me, this is all very fascinating...how people are willing to mess with drugs.
A Doctor Disagrees
Antidepressants have helped not only my patients, but myself.
By Robert Klitzman NEWSWEEK
Published Jan 29, 2010
From the magazine issue dated Feb 8, 2010
The TV screen stayed black. Except for the occasional car whishing by outside, the room was silent. I stared at the white ceiling, unable to get out of bed. Two weeks earlier, on 9/11, my sister had died at the World Trade Center, where she worked. I had helped plan a memorial service for her and empty her apartment. Then my body gave out.
For the first time in my life, I didn't feel like doing anything—reading, writing, or even listening to music. I went to psychotherapy, and visited a synagogue, a church, and a Buddhist sanctuary, where we walked in circles and rang bells.
I didn't think an antidepressant would help me, but I decided to try one. Perhaps I should have experienced my grief longer, as a "growing experience." But I soon felt better, and was glad. I also changed how I thought about disease and treatment.
Last month, The Journal of the American Medical Association published an article that argued that for patients with mild or moderate depression, antidepressants work no better than placebos. Countless patients wondered if they should stop their medication. Others have insisted that Americans are overmedicating themselves.
What should we make of all this? First, some facts: antidepressants have clearly been shown to work for serious major depression. Most evidence shows that they are effective for dysthymia: milder but chronic depression that continues for two years or longer. The question is whether they work for milder depression that may be shorter or less intense.
That's important, since major depression affects almost one out of five people at some point in their lives. And most people with depression do not have severe forms of it.
My own sense, based in part on my own personal experience, as well as that of patients I have treated, is that antidepressants can definitely work for milder depression—not for everyone, but for many. Why, then, the debate and apparently contradictory findings?
In part, the answer hinges on what we mean by "milder" depression. Experiences of depression vary enormously in intensity, length, and impact: from momentarily feeling blue to more major symptoms. Medications, which take several weeks to work, will neither help nor be appropriate for a few days of depression that result from passing disappointments.
Just as Tolstoy wrote that "every unhappy family is unhappy in its own way," I would argue that every unhappy individual is unhappy in his or her own way. Depression, even if moderate, can last from minutes to years, and can change your ability to function in life radically—or not at all.
The JAMA article included minor depression but did not examine degrees of impairment in daily functioning or quality of life, or durations of symptoms before treatment was begun—all of which might influence these drugs' effectiveness.
Alas, this debate is polarized, with strong advocates—each with their own biases—on both sides. Drug companies want to market drugs as widely as possible. Many psychologists and social workers, who don't prescribe drugs, fear that increased antidepressant use will rob them of clients.
The debate about these medications obscures larger social issues as well. In general, most patients with major depression receive no treatment. Many patients have difficulty telling a doctor that they feel depressed because of fears of stigma and shame. Of those who get treatment, most obtain it from primary-care doctors, not mental-health professionals. Yet general practitioners receive little training in psychiatry. Many insurance plans cover little, if any, psychotherapy.
We need to educate physicians better about psychiatric symptoms and treatment, improve public attitudes, increase insurance coverage for appropriate mental-health treatment, and conduct research to understand more fully who exactly may benefit from various treatments.
Patients with milder depression may benefit from antidepressants, but won't know until they try them. Studies examine large group averages—not individuals. Still, caution makes sense. These drugs are not panaceas.
The meds I took worked for me. Eventually, I turned on the TV, and read, and wrote. But I still wonder how, and who else, these drugs may help.
Klitzman is a psychiatrist, the author of When Doctors Become Patients , and director of the Master's of Bioethics program at Columbia University.
Find this article at http://www.newsweek.com/id/232782
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Here are leters to the editor on the subject:
(NOTE: I, Joan, am coming to believe that the world needs really good psycho-therapists!!!!!!!!)
The dangers of not treating depression are so great that any responsible physician will err on the side of caution and prescribe antidepressants.
Elizabeth Hinds,
Morris, Minn.
As a psychopharmacologist who treats patients, I feel Sharon Begley does a disservice to those who live with depression. She bases her argument largely on two meta-analyses by Irving Kirsch and Guy Sapirstein. The psychiatric community understands that meta-analyses, which combine different medications and methodologies (as in Kirsch and Sapirstein's research), or which handpick studies and exclude others (as did, in my view, the recent JAMApaper published by Jay C. Fournier of the University of Pennsylvania and his colleagues), are susceptible to biased interpretations. The research that practitioners use to determine how to treat their patients is based on analyses that require statistically proven effectiveness. Those of us who treat patients on a daily basis understand that medications are not magic pills, and that treatment combining antidepressant medication with psychotherapy offers patients the best chance of recovery.
Julie Hatterer, M.D.,
American Psychiatric Association Council on Communications, New York, N.Y.
Antidepressants do work when administered to patients who really suffer from depression. The problem is that many people who are not clinically depressed are being administered medication. That's because Big Pharma dominates medical education and aggressively targets the public through advertisements, as if medication were candy.
Stergios Kaprinis, M.D.,
Thessaloniki, Greece
As a psychiatrist who has spent more of the last 35 years taking patients off antidepressants than putting patients on them, I was gratified by your article. Nonetheless, placebo-driven or not, these drugs can still be a valuable tool in our therapeutic armory. The key is to precisely determine which individuals are the right fit. In the struggle with emotional duress, it is always better to have more arrows in the quiver than fewer.
Isaac Steven Herschkopf, M.D.,
NYU School of Medicine, New York, N.Y.
I have suffered from severe depression for years. The combination of antidepressants and therapy has saved my life.
Jessica Knowles, Bethesda, Md.
'A Doctor Disagrees'
As a clinical social worker, I'm generally supportive of Robert Klitzman's disagreement with your article about SSRIs. However, his comment that psychologists and social workers fear having patients medicated because it will "rob them of clients" is libelous. My colleagues and I all have collaborative relationships with M.D.s to arrange medications for patients. Our goal is to help people improve their lives, not to unethically collect fees without a proper treatment plan.
Stephen Rosenbaum, Highland Park, Ill.
http://www.newsweek.com/id/233406
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