Sunday, July 15, 2007

Depression: Don't Trash the Meds Along with Big Pharma

Nice article on CNN last Monday reporting that anti-depressants are now the most prescribed drug in America. Trying to be balanced, they quote one doctor saying,

"Depression is a major public health issue," said Dr. Kelly Posner, an assistant professor at Columbia University College of Physicians and Surgeons in New York City. "The fact that people are getting the treatments they need is encouraging."
and another one saying,
"Doctors are now medicating unhappiness," said [Dr. Ronald] Dworkin. "Too many people take drugs when they really need to be making changes in their lives."
Not surprising – the controversy will continue to rage for a long time. I gave a lecture a couple of months ago about popular misunderstandings regarding depression. I’ve heard many lay people say that we are over-medicating our population. I agree there’s some of that going on – doctors writing prescriptions because a) it usually makes befuddling and distressing symptoms disappear, and b) they get so many gifts from the pharmaceutical companies that it profits them to prescribe such medicines.

Nevertheless, I believe strongly that we still attach a stigma to depression, and because of that, the incidence of that disorder is vastly under-reported. Even with under-reporting, the numbers are towering. In any given year, between 20 and 25 percent of Americans experience a major depressive episode (the National Institutes of Mental Health cite the low number; some independent sources lean toward the higher). Their suffering is painful and relentless.

I’m a holistically oriented person and therapist, and I love the stories of those who have successfully pulled themselves out of hard emotional times by their own efforts. But depression is a disease, and in most people who experience it, it affects the body, the brain, the mind and the spirit in profoundly cruel, and progressive, ways. (I recommend Peter Kramer's comprehensive book, Against Depression on this point.)

I’m not entirely comfortable backing medications produced by questionable pharmaceutical companies. And no, we shouldn’t be throwing pills at patients the moment they feel down. But I’ve seen depression at work, and I have seen the medications be amazingly helpful. (Especially in combination with talk therapy – a proven formula. Frequently, medication can be reduced or eliminated after such a course of treatment.)

Jumping on the popular bandwagon of condemning medications is just another way of saying “Snap out of it” – the kind of treatment that has exacerbated mental illness since time immemorial.


Eric Little said...

I agree--and even wrote a blog entry about it (4/25). I don't know if meds should be prescribed for people suffering emotional tragedies, such as the death of a loved one, but I know what unmotivated depression feels like (ever jog and cry at the same time?), and I don't think anyone should have to go through that.

Muffy St. Bernard said...

When it comes to jogging and crying, I imagine there are several reasons why that could happen -- inappropriate crying isn't just caused by a single type of problem.

For that reason, I'd hope that counsellors -- and patients as well -- would spend some time trying to figure out the reasons for the crying. "Unmotivated" may mean a complete lack of motive...or it may mean a motive that hasn't been examined yet.

Some people certainly need medication. Some people have a chemical imbalance. But there are many, many people who -- for whatever reason -- aren't exploring their depression in the first place, or people who are getting medication just because they aren't happy. Maybe they have some very good REASONS for being depressed or unhappy? The world's a pretty depressing place.

In addition, I worry that the meds discourage us from wondering about environmental factors; how toxic is our air, our water, our food, and might it cause the cocktail of chemical/emotional problems that we're seeing more and more of?

It's impossible to compare misery or suffering, just as it's impossible to approve of or condemn medication under all circumstances. But I DO believe that (many) doctors and (many) patients lean on anti-depressants to the exclusion of all else, which seems a very short-sighted approach in my opinion.

Eric Little said...

I am depressed now--because I feel, rightly or wrongly--that the validity of my experience has been questioned. I was trying to give a short response to thinkulous's post, and I perhaps did not explain enough about that experience. I can remember the exact instant, the precise place, where my crying occurred--the quality of the sunlight. I cried because the weight on my chest (my metaphor for my depression) was not going away--that even as I was doing something that normally released endorphins and made me feel better, it had no effect on my misery at all--which made that weight even heavier.

I could go on and on, but I'm taking this too personally (and I know it was not personally meant), so I'll just mention three books that go into the subject from a literary perspective:

"Darkness Visible" by William Styron.

"Unholy Ghost: Writers on Depression," edited by Nell Casey.

"The Noonday Demon" by Andrew Solomon.

Eric Little said...

Addendum: "The Noonday Demon" is much more comprehensive in its discussion of depression than I let on there. Sorry.