Friday, February 15, 2008

Depression I: Overmedicated?

I’ve read several articles lately about depression, which is an area of particular personal and professional interest. For several years I have been under the influence of "Against Depression" by Peter Kramer, MD, which makes an impassioned and persuasive case for the treatment of depression, and particularly the legitimacy of pharmacologic treatment of depression. It is a perspective and explanatory model that I am still informed by in my treatment of depression.

The question of excessive medication is something I also ponder frequently both in the context of mental health treatment, and generally. I therefore was interested to read this this article in the NYT by Judith Warner. One of my core values is moderation, and avoidance of polarization, so I like the basic thrust of this article. Like Kramer, Warner recommends, and I agree, that we look a little closer at our beliefs about “designer drugs” for depression and other mental health disorders. I followed the links to the articles in SLATE by Peter Kramer, which I recommend if you’re interested in walking the line between the poles in the treatment of depression and the place of pharmacotherapy in the treatment of it and various other diseases.

Warner’s article alone is a bit too dismissive of those who allege overmedication. While I agree that patients very rarely accept the use of chronic daily medicine blithely, an example of overuse is found in the marketing and use of sleep aids (Ambien, Sonata, Lunesta, anyone?), and there are others. I have also seen innumerable patients for whom anti-depressants have been recommended, though often not accepted, in scenarios accompanied by lines such as “well, there’s nothing really wrong with you but you don’t feel well, so you must be depressed.”