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According to big pharma TV spots, we're all sad, tired and apathetic - but who should decide if one little pill is all we need. Rachel Gering, LMSW takes a look at our prozac nation. by Rachel M. Gering


You’ve seen them. The dimly lit ads asking if you feel sad, lonely, lethargic. The shots of people looking morose. One even uses a dejected looking dog. These ads are of course designed to alert you to the symptoms of depression and urge you to ask your doctor for some little pills to make you feel better.

This increasing trend of antidepressant ads has concerned mental illness practioners. Patients are not qualified to self diagnose, but these ads suggest they should. And with managed health care limiting our specialist options, family practitioners are on the front line.  The truth is that most people who complain of depression are not clinically depressed and therefore do not necessarily need to be taking medication.  Alternatively, patients may often need to be under the care of a mental health professional.
 
Should you take medication to treat your depression?  Should you get into therapy?  More antidepressants are prescribed by family practitioners than psychiatrists.  These medications are often the first treatment offered to people who are depressed.  Managed care companies in the U.S. like this approach because antidepressant medications are less expensive than psychotherapy.

Numerous studies have come to similar conclusions about effectiveness. Cognitive-behavioral psychotherapy and antidepressant medication are equally effective. Combined psychotherapy with medication is also more effective than medications, but some studies suggest that the combination is no more effective than psychotherapy alone. Studies also suggest that the relapse rate is higher among depressives treated with combined treatment than with just psychotherapy. Many studies have found a higher dropout rate among those receiving medication, either because of side effects or because the medication has not helped.

Treating depression with medication is tricky because you have to find the right one for yourself.  Like birth control pills, not every drug works for every person, you have to find the right fit.  Family doctors are not always aware of possible side affects and do not necessarily have the time to customize treatment.  Many of the clients I see usually go through that initial trial and error phase and it can be frustrating, as well as, uncomfortable.  *Wendy, age 28, was prescribed Zoloft for anxiety and depression but after a month of taking it realized that while her presenting symptoms subsided, she felt lethargic, uninterested in the usual things that made her feel excited.  For example, Wendy could always count on going to the gym to lift her spirits or hanging out with friends to have a good laugh.  Not after taking the Zoloft though.  She was stuck in what felt like a humorless sleepwalk all of the time.  As soon as I noticed this, I had her contact her psychiatrist and he switched her prescription.  Her symptoms, including her depression and anxiety, resolved as a result of the change of medication.

Providers of health care and mental health care tend to use the tools they are trained to use. This can sometimes create problems. Milton Erickson, MD, said it best: "If the only tool you have is a hammer you tend to treat everything like a nail." It may be no coincidence that the authors of the studies cited here are psychologists. Psychologists are able to provide psychotherapy but not medications. It's also no coincidence that most primary care physicians prescribe antidepressant medications before they refer for counseling or psychotherapy. They have a prescription pad handy - but they do not have much time to spend talking with their patient. We tend to use the tools that we have. The art and science of mental health are not yet refined enough to be able to predict which treatment will be more effective for a given person.

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