We’re Not Over-Medicated; We’re Under-Cared For
So says Judith Warner in a New York Times op-ed in which she challenges some common misconceptions about antidepressants. The conventional wisdom, which is now buttressed by a recent study, is that antidepressants (among other psychotropic medications) are an ineffective and even harmful crutch, and doctors too quick to prescribe them.
The truth, as always, is a bit more nuanced. Barbara O’Brien has a good post on it, so I’ll let her do the talking:
… I wanted to call attention to this article in the New York Times by Judith Warner on antidepressants. This week a study on Paxil and imipramine said the antidepressants worked no better than a placebo on people with mild or moderate depression. Lots of studies have said this. However,
Antidepressants do work for very severely depressed people, as well as for those whose mild depression is chronic. However, the researchers found, the pills don’t work for people who aren’t really depressed — people with short-term, minor depression whose problems tend to get better on their own.
[...]
Warner goes on to document that, in America, people with clinical depression are more likely to be undertreated than overtreated.
6 Responses to “We’re Not Over-Medicated; We’re Under-Cared For”
IMHO, all psychopharmaceutics should not be given out unless time limited and with oversight. Today they are given out like candy by GP's with little to no oversight, and for the mildest of symptoms.
I think that this goes back to one big controversies in psychiatric medicine: can all depression be called a chemical imbalance. There was, and may still be, a group that thinks that all mental illnesses can be solved with a pill.
More common sense would say that there's a big difference between hereditary imbalances, and those caused by the situation. That is, some people are depressed because they were born with a predisposition toward depression, and others are depressed because, say, their spouse just died. If it's something that you're born with, medication is just trying to corrected the imbalance. If it's caused by the outside world, then the best use of medication would be to keep the person from committing suicide.
Depression is not normally an illness! It's a natural slap in the face that's meant to make us re-think our living patterns and adjust to our new circumstances. It can be partly avoided by sitting down on occasion and rethinking your goals and circumstances at regular intervals, and shortened by purposely re-planning your life after a major change. So again, it comes down to the situation at hand: if depression is preventing someone from making the changes that they need to, then the drugs could be helpful; if someone is simply trying to avoid those changes, then the drugs would simply prolong the inevitable.
More common sense would say that there's a big difference between hereditary imbalances, and those caused by the situation. That is, some people are depressed because they were born with a predisposition toward depression, and others are depressed because, say, their spouse just died.
Exactly. And only a qualified mental health professional can help a person figure out which one it is.
“And only a qualified mental health professional can help a person figure out which one it is.”
Very well put, Kat. I agree.
ProfElwood brings up a valid point with the predisposition. However, we must remember that predisposition doesn't necessarily mean prediagnosis. With the right life circumstances, someone with a predisposition probably won't develope clinical depression. I think that the medical industry is way too quick to diagnose and treat with pharmaceuticals; and too slow to address the actual problems causing the depression. As you stated, qualified professionals are required to sort those out.
Unfortunately, the drug companies have an interest in keeping that decision from being objective, and are allowed to market their wares directly to the professionals. There needs to be an opposing force balancing that influence.
One of the worst examples of that is the free samples pharmas give to doctors. Although I have to say that back when I was in financial crisis so badly that I did not have money to pay for my Zoloft, free samples saved my life.