STIRRING CONTROVERSY WHEN LIVES ARE AT STAKE!


In one of the many responses to Sharon Begley’s cover story in NEWSWEEK magazine, (Feb.8,2010) “THE DEPRESSING NEWS ABOUT ANTIDEPRESSANTS” – Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse: Therese J. Borchard, author of BEYOND BLUE, states that as a writer and someone who feels her life was saved by antidepressants, she found last week’s cover story “irresponsible.” Though she is someone who respects the subjects Begley usually writes about and often appreciates her perspective, she takes issue with both the title and subtitle of this one. Had the subtitle alone stressed that, in general, antidepressants work better for those with severe depression than for those who suffer from mild to moderate depression and had she then gone on to omit saying that taking them can be worse than taking a placebo, her article would have been far less misleading. Case in point: Borchard knows that her personal experience has not been validated by the findings of the recent study from which Begley based her conclusions.

To her credit, although Begley admits at the outset that addressing the placebo effect is a dilemma for her, and even adds that:  “To be sure, the drugs have helped tens of millions of people.”  Her disclaimer is that she “is not advocating that patients suffering from depression stop taking their drugs.” She does, however, conclude they may not be the best first choice.  In so doing, she has left many of her readers (patients and physicians alike) wondering why the findings from each new study released to the public leaves us more confused, less confident, and, worse still, questioning whether or not the findings themselves are, in fact, harming us?

The implications surely have the potential for being dangerous. After all, if someone believes that a medication is helping him to function, to live life more fully, and not be burdened by the overwhelming darkness of depression and then is told that scientific studies claim that the reason is merely because he or she believes it is helpful and that it does NOT, in fact, change something for the better in the chemistry of the brain, the patient could easily stop taking the medication, relapse into depression and become less functional and more disabled than before taking the drug(s).

In fact, I would venture an educated guess that if anyone asked a patient who suffered from overwhelming feelings of anxiety or severe depression (neither of which is a temporary feeling but rather a paralyzing, long-lasting one) whether taking medication is helping them, more often than not, you’d hear, “It’s saving my life.”

Although I do not treat patients who are psychotic or those who suffer from severe mental illness, I do work with patients who, at times, need medication to help take the edge off from feelings of debilitating anxiety and/or depression. And while, as a psychotherapist, I cannot prescribe such medications, I work with psychiatrists who do, and often the correct dose of the right drug in combination with the talk therapy – which I do offer – makes all the difference in the world. (And that includes tricyclics as well as serotonin re-uptake inhibitors [SSRI’s].

In my work with patients for more than twenty-five years I have, of course, known patients who have had to try several drugs before the one that proved to be helpful was found.  And, as with any medication, antidepressants can have side effects, for some people minor and tolerable, for others not. But that alone can’t be the criteria upon which we base whether or not medications are, in fact, helpful.

Also, since most of my work is with patients who usually do not require medication and are helped by talk therapy, proper nutrition , sufficient sleep, exercising and/or studying relaxation techniques such as Yoga or T’ai Chi, as well as being taught other means by which to help quiet themselves when moments of anxiety or depression interrupt an otherwise okay day, I find myself asking why I, too, had such an intensely negative reaction to Begley’s article. I must admit that my response was only further fueled yesterday when I read in the Wall Street Journal’s Feb.5,2010 issue that GlaxoSmithKline PLC is stopping their research into new antidepressants and will be focusing instead on “diseases for which it believes it can develop more valuable drugs.” In their case – a company that has developed some of the largest selling antidepressants on the market during the past twenty years and now finds that generic drugs have replaced the number of sales of all their brand named ones – their reason is clearly driven by how much profit they see themselves making, and that, too, is infuriating when we realize they are talking about an issue concerning our nation’s mental health.

In taking a personal inventory, I realize that I also have very real reasons for my reactions.

For those of you who have read my memoir, FOUR ROOMS, UPSTAIRS: A Psychotherapist’s Journey Into and Beyond Her Mother’s Mental Illness, you know that when I was growing up in the 1940s and early 50s, the primary treatment available to my mother when she entered one of her “states” was electric shock therapy and/or hospitalization. Her depressive episodes demoralized and destroyed her as it did the rest her family who loved her. And not until years later – and fortunately she did live to experience the benefits of some of the new medications – did she experience any real periods of relief. But, by then she was too old and had been at the mercy of doctors who gave her anything but confidence – to be helped by talk therapy. Swallowing pills was not emotionally intrusive, was most assuredly beneficial, and was the route she chose to take.

So, while the jury is still out and many more studies will, no doubt, be conducted that will contradict the latest findings – because that is, after all, what always does seem to happen – I hope that more and more physicians (as opposed to the pharmaceutical industry) share their stories, along with the numbers of lives they know have been saved by patients taking anti-depressants, so that science editors and others will be more mindful the next time they attempt to share such findings when what it accomplishes is to stir controversy, sell copies, and create chaos.

Do let me know your thoughts and opinions on this very important topic.

Best regards ~ Linda

2 Comments

  • Amanda Wick says:

    I will put the disclaimer that I have not red the Newsweek article, just your quotes of it. But my guess is that this isn't that big a story to most people who have been watching these studies – when I was in college 10 years ago, studies were coming out saying that antidepressants alone only helped those with severe clinical depression and the best treatment for depression was psychotherapy and medication, if medication was even helpful. If people out there with depression think their drugs are helping them, then, placebo effect or not, hopefully they'll keep taking them.

    But if this article (hopefully) leads to the realization that our mental health public and private insurance dollars would be better spent on psychotherapy for treatment of depression, rather than throwing money at these pharmaceutical companies that come out with the next "magic pill," then something good will hopefully come out of it.

  • admin says:

    Blogger Linda Appleman's response:

    Dear Amanda:

    You write:
    "But if this article (hopefully) leads to the realization that our mental health public and private insurance dollars would be better spent on psychotherapy for treatment of depression, rather than throwing money at these pharmaceutical companies that come out with the next 'magic pill,' then something good will hopefully come out of it."

    Unfortunately, the article was not about the importance or value of psychotherapy. The magic pills, so to speak, that they're working to release are for physical diseases — important ones, for sure — but ones for which the innocent public is more likely to run out (in desperation) and purchase any new drug. That is why I stressed (as did a number of physicians and other authors) the danger in releasing the current findings re. medications for the treatment of depression.

    Thanks for your comments, though. You're a thoughtful consumer … but … perhaps I didn't stress enough what the title of my blog implies, and that is the danger in making blatant statements for the sake of stirring controversy and in so doing selling more magazines. Such cover stories can be not only mis-leading but, in my opinion, extremely dangerous!