Basically OK? On antidepressants? Here’s what the pharmacist thinks
Image by chris.corwin via Flickr
Everyone who gets depressed gets depressed in their own way. If you’ve known the “noonday demon” first hand you know this is true. You’d also know this simple truth if you’ve known anyone attacked by the demon from job, family, or neighborhood. While depression has much in common no matter who is suffering, depressions happen specifically.
For years now soporific drug company advertisements for anti-depressant medications—remember the little cute Zoloft egg—paint the malady as a kind of emotional common-cold.
But last month an empirical bombshell about depression hit the wires; JAMA reported a study confirming that antidepressants get more effective with more severe depression. In fact,
(t)he magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms.
Wow. What to do now? Sure, you had the blues when you started, but never more than mildly or moderately so. If you’re on antidepressants and have basically been doing OK, what should you do?
For many people the first person to ask is the pharmacist. Pharmacists actually do more than put the right pill in the right bottle, they also answer questions. The American Pharmacists Association posted a release on their website titled Antidepressants may not work for milder forms of depression. It includes information on what pharmacists need to know and what patients need to know. Here’s a summary of the advice—with a few editorial comments—the question-answerers are getting:
- differences between antidepressants and placebo increase as the severity of the depressive symptoms increase.
- marketing materials from drug companies ignore that most studies on the effectiveness of antidepressants come from studies of severe depression.
- the placebo effect (i.e., hope!) accounts for the benefit experienced in cases of mild to moderate depression.
- antidepressant medications can be especially risky in young people where there is an increased risk of suicidal ideation.
- long term use of antidepressant medications is associated with increased risk for type 2 diabetes.
- evidence-based psychotherapy is the reasonable recommendation for mild to moderate depression.
- we need more research (doh!) because the JAMA study only looked at two antidepressants.
And here is what they are being encouraged to tell patients with questions,
What your patients need to know: Tell patients who are prescribed antidepressants that a recent study suggests that these agents have a clear benefit for patients with more severe symptoms but the effects of these agents are unclear for patients with less severe depressive symptoms. Tell patients who are currently taking antidepressants not to stop their treatment and to discuss the findings of this trial with their prescriber.
via Pharmacist.com | Antidepressants may not work for milder forms of depression.
In other words, depression is not like the common cold. The drug companies are wrong. Life is more complicated than simplistic marketing messages.
What depression is and what to do about it remains something every person needs to figure out with the people caring for them. For some interesting further reading take a look at HEAD CASE: Can psychiatry be a science? from last weeks New Yorker or Depression’s Upside from this Sunday’s NY Times Magazine (and sorry for this NY-centric conclusion, but when it comes to innovative ways to think about and treat depression, well, we’ve kind of cornered the market!).
Post Your Comment
You must be logged in to post a comment
T/S Members
Log in with your True/Slant account.
…one thing I noticed was the failure to distinguish true organic depression from “situational” depression…the latter is depression due to the individual’s “situation” — e.g. a death in the family, being fired from a job, unhappy marriage, etc…antidepressants are meant to treat organic depression…unfortunately, many — probably most, actually — patients currently prescribed antidepressants fall into the “situational” category…patients need to be better informed regarding this…taking a pill won’t cure a bad situation but will expose a patient to a variety of risks…
If I remember correctly, years ago depression was further specified as “reactive depression”(rrtzmd’s ’situational depression’) or endogenous depression. I agree strongly that “taking a pill won’t cure a bad situation.” As a therapist I would be in favor of reserving the word and the diagnosis of depression for those “true” endogenous depressions.
However, I think Todd’s post goes a step further than that – that life hands us ups and downs, and that some of the downs are brutal, painful, or read like a backstory to a Lost character – but that the solutions are also to be found in the story, not necessarily in any quick fix – no cool techie therapy gadget, nor a pill can take the place of figuring out how to take up the reins of one’s life and drive well, hard and all the way home.
“One pill makes you larger, one pill makes you small and the ones that mother gives you don’t do anything at all.” It seems that too many of us want an instant fix instead of doing the real work it takes to resolve a situation. Whether you reach for a pill, smoke or drink to fix what ails you, you’re trying to take a detour around the section of bad road life has laid before you. Only it doesn’t actually work in the long run. Worse yet, the pharmaceutical industry has been having a field day with a “build it and they will come” approach to research and development. In the past you were forced to deal with your issues but today we’re being told that it is unacceptable to have a bad day and that we’re entitled to an instant remedy. And that’s bull. It’s the same as the demand for antibiotics to treat the Rhino virus or the flu. Doctors should just say no instead of pandering to both suppliers and patients.
Talk about antidepressants, three thoughtful comments can definitely be a mood lifter (and welcome to T/S rtzmd … Heather and I assume the Captain of teamkrumville, always great to see you here).
Over the years I’ve found the situational/reactive vs organic/endogenous distinction increasingly unhelpful. I can’t imagine a decontextualized depression nor one that is non-organic. Having seen some people resiliently rise above horrific losses while others succumb to the routine trials of expectable loss I try to approach every case in it’s own terms; when did it start, how severe, what does it feel like, what does it mean, etc.
I find it fascinating that “common sense” gets built by drug company adverts when there is research contradicting the message. Charles Barber’s book “Comfortably Numb” and “The Loss of Sadness” by Horwitz and Wakefield are real eyeopeners about this.
[...] Basically OK? On antidepressants? Here’s what the pharmacist thinks – Todd Essig –… [...]
[...] Basically OK? On antidepressants? Here’s what the pharmacist thinks – Todd Essig –… [...]
I have suffered depression most of my life and before there were any real recognition of the illness. Shy, moody, antisocial, temperamental and bad tempered were words that followed me around in life. Listening to advice I addressed the fear directly, forced myself to make speeches, went to events and parties, faced the aggressive and hid the blushing and counted to ten thousands of times. I also found myself in numerous street and bar fights when a rage was released. When confronted with lows and tragedies it wasn’t that it put me in a depression, brought me down but instead it left no feelings at all. I felt as I always felt, isolated and alone. I say this because when a business failed all the encouragement meant as little as the successes that followed. So while situational depression is there it really means little to someone truly suffering depression.
Drugs saved my life because as I got older my mood became darker…at the height of my professional success my thoughts turned very dark and I knew I needed help. It took months to find the right drug, it really is trial and error but the veil did lift. In group therapy,
which took a year for me to agree to, I learned cognitive tools to deal with the negative thoughts, to recognize them and fight against them.
When I hear Scientology rage against the science while using techniques of psychology to keep their kooky group together I want to scream at their ignorance.
Yet here is the rub…the drugs moderate not cure…I will never feel normal…but with the drugs I can read and concentrate, I can write, laugh and communicate. The anger is not unreasonable, the battle less difficult, but it is still there. When busy I forget to take medication and it is my wife, not me, who spots the change.
The science is just beginning and it is far far from perfect and drug companies are making a ton on drugs not designed for mood but something else with mood lifting side effects. Much more needs to be done…but at least now it is out there so teens like I was could be helped.
Thanks for sharing your story libtree, at least a very, very (VERY) small part of it. Life really is complicated and I’m glad you found some people who have been able to help you with your unique challenges, and talents!
And I share your rage at the sheer destructive idiocy of Scientology, as well as at any ideology or system (like our current health-care delivery system) that squashes people and blocks care and potential. Let’s hope the teens coming up really will have easier access to better and better care.
In response to another comment. See in context »