Grief vs. Depression: Over-medication Redux

Eric has once again sparked a new post with his comments on my rant this Sunday in favor of antidepressants. He agrees that depression still retains a stigma today, and causes a level of suffering, that merits more attention from health care professionals, rather than less, as popular opinion seems to hold.

(Speaking of popular opinion, I Googled the CNN story that sparked my first post, and found quite a lot of tripe, most of it quoting one silly anecdotal story in the article, about a woman whose life was supposedly damaged by a careless prescription.)

But Eric includes an interesting proviso:

I don't know if meds should be prescribed for people suffering emotional tragedies, such as the death of a loved one[...]

Grief is a good example of a disorder which might inspire over-medication. This is also, sadly, a question I have already faced more than once in my young career. Let's look at it.

By the standards of the field, prescribing for bereaved patients is questionable, at best. The Diagnostic and Statistical Manual of Mental Disorders, the clinical touchstone for the field, says that grief and depression look very much the same, but aren't.

However, the DSM specifies that, if the symptoms of grief continue for more than two months, or are extreme (suicidal thoughts is one example), then the subject might be suffering from depression. At this point, we can presume that professionals are justified in investigate this possibility, and possibly prescribing accordingly.

The book describes examples of extreme symptoms fairly carefully. And it is that kind of care, built into the handbook for the field, that strengthens my conviction. If health practitioners simply apply the basic standards of the trade, combined with their own common sense, there will be very little over-medicating. Then the bandwagoneers could turn their considerable energies to figuring out how to resolve the war in Iraq. Everybody wins.

Some might say that I am assuming too much common sense on the part of all health care professionals. But it's only what should be assumed.

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.