Thursday, April 17, 2014

The Downside of Antidepressants

I have occasionally remarked that, while anti-depressants are a good thing they are not that good of a good thing.

Today, Dr. Doris Iarovici of Duke University asks a similar question. She knows that many students take pills to regulate their emotions. She knows that many physicians think nothing of helping students to medicate the emotions that arise from difficult life situations.

For some it might be a good thing. But there is surely a downside.

Iarovici writes:

Antidepressants are an excellent treatment for depression and anxiety. I’ve seen them improve — and sometimes save — many young lives. But a growing number of young adults are taking psychiatric medicines for longer and longer periods, at the very age when they are also consolidating their identities, making plans for the future and navigating adult relationships.

Are we using good scientific evidence to make decisions about keeping these young people on antidepressants? Or are we inadvertently teaching future generations to view themselves as too fragile to cope with the adversity that life invariably brings?

Good point. When psychiatrists hand out medication for every emotional upset, they are telling young people that they cannot manage their lives by using their own mental resources.

Even though psychiatrists are uncomfortable about handing out so many brain-altering substances, students (among others) expect to receive them. The media has been trumpeting the message that Prozac et al. will save your life, even make you a new person. Better yet, insurance companies pay more for writing prescriptions than they do for longer conversations.

More students arrive on campus already on antidepressants. From 1994 to 2006, the percentage of students treated at college counseling centers who were using antidepressants nearly tripled, from 9 percent to over 23 percent. In part this reflects the introduction of S.S.R.I. antidepressants, a new class of drugs thought to be safer and have fewer side effects than their predecessors.

While bemoaning the fact that today’s patients are being induced to believe that they cannot function without some psychoactive substance, we must note that many of today’s psychiatrists do not know enough, have not had enough training to help patients make their way through complex life situations.

It’s nice to blame the insurance companies, but, for all we know, many psychiatrists are at their best writing prescriptions, and at their worst giving advice.

To illustrate her point, Iarovici describes a patient of hers, a young women who was trying to get off of anti-depressants. The patient was not happy with life without her anti-depressants, but still, Iarovici points out, was she really ill or was she facing a difficult life situation.

Surely, the young patient was depressed, but she was also suffering from anomie, the kind that is produced by disrupted routines and social dislocation.

Iarovici describes the anomie:

My patient had moved away from her husband to start graduate school, since his job kept him in another state. She’d expected the temporary separation to be hard but navigated it smoothly, focusing on school, with occasional visits.

In the summer, she moved in with him and was surprised to feel emotionally “muted.” It was nothing like her college depression, but she worried. She’d counted on the reunion being easy.

As she looked back, she acknowledged that moving again, leaving behind new school friends and routines, and not having the structure of school or work to fill her time might have challenged anyone. She noticed small ways in which she and her husband were growing in different directions, and this alarmed her. She wanted to resume medication, thinking that maybe the summer would have gone better with an antidepressant.

And also:

But my patient’s symptoms were only one part of a compelling life story: that of a young woman trying to balance personal aspirations with intimacy. She was discounting her emotional reactions to difficult life events. These struggles might be the very moments that precipitate personal growth.

She concludes:

We walk a thinning line between diagnosing illness and teaching our youth to view any emotional upset as pathological. We need a greater focus on building resilience in emerging adults. We need more scientific studies — spanning years, not months — on the risks and benefits of maintenance treatment in emerging adults. Maybe someday, treating people like this young graduate student, I won’t have to feel like we’re conducting an experiment of one.

Iarovici is certainly correct. But, one would like to know how many psychiatrists are trained to help their patients to build resilience and to manage their lives.

1 comment:

n.n said...

Parental Deficit Syndrome (PDS)