Uptake
The Biscuit Report has an important, and very balanced, post on the subject of antidepressant medication. Biscuit has submitted several letters to the New York Times, and it's a shame that they haven't at least published the following paragraph:
There are no antidepressants on the market today (and perhaps none are possible) that take less than several weeks to have an antidepressant effect Anyone who has ever been through it could tell you that those weeks of waiting and wondering if the drug will work, if any drug will work, or if you are just to be left to rot inside you own personal mental hell, are excruciating. It doesn't matter how much doctors explain that it takes a few weeks, a depressed person responds by feeling immediately hopeful (wow, there is something actually wrong with me; there are drugs that can help) and then, when everything isn't instantly okay, more hopeless than before. When each minute is torture to live through, several weeks is too long, and the thought that the drugs might not work at all makes suicide a tempting option.
Antidepressants might not seem to be a very seasonal topic, but unfortunately they are. For anyone beyond the mildest stages of clinical depression, the cheerful, colorful clatter of the holidays can be unbearable. Healthy people will have trouble understanding why; let me suggest this: to feel absolutely nothing (besides fatigue) when surrounded by festivity is something like being buried alive. The shortness of daylight enhances the claustrophobia.
Comments
This may not strike a resonant chord for some, but I suggest reading Phillipians the fourth chapter and following the exhortation to think on all that is good, noble, pure, beautiful. It is hard work, it requires effort, and it requires help from a talented and trained therapist.
There are many components to depression, some of which antidepressant drugs, particularly SSRI's, can help to ameliorate. The drugs have to be chosen carefully, monitored rigorously for effectiveness, and discontinued promptly if not effective. Drugs alone are never the answer and few clinicians have the patience to monitor correctly or provide support through what has been correctly noted as those critical days while waiting for the drug to take hold. Each case is individual and a drug that works for one may not work for another.
Amy is correct when she says on Biscuit's site that "treating depression is damn serious business". Seldom is what is known from research applied rigorously in clinical practice. Any first year behavioral pharmacology student knows that dose response is statiscally distributed and that an effective dose may vary widely between subjects. And, in the case of sophisticated drugs like SSRI's some work and some don't in the same subject, there is wide variation in response. Very seldom is the breadth of the distribution curve available as useable data to the clinician, and very seldom do clinicians try to titrate dosage in each individual. And, seldom do clinicians keep trying until they find the drug that works. There is simply too much one size fits all work going on, and too much prescribing by practioners who are not really qualified to prescribe the drug. Amy's clinician seems truly remarkable in doing daily phone checks and multiple weekly sessions to monitor her response. Everyone knows someone whose GP or FP has put them on an SSRI, this is outrageous these drugs are not bon bons and should not be used without the type of care Amy has recieved at the hands of a highly skilled professional.
Posted by: George | December 24, 2004 09:39 PM