New York Times on Drug Therapies for Depression

The New York Times Retro Report looks back at Prozac, the first successfully marketed medication of the class of medications known as SSRI's used to treat depression.

Check out the 9-minute video and then let's talk.

I discuss depression and the various therapies used to treat it almost everyday. Some of my patients take medications to treat depression, many have in the past, some struggle and discuss in their therapy whether to take the plunge and others seek help lowering their dosage or deciding to stop taking medication for depression altogether. (I've written quite a bit here about my thoughts on psychiatric medications.)

All par for the course for a therapist, so I was, in a sense, surprised that I was surprised when I watched the video. The conversation--concerns about over-medication, suggestions when it came on the scene that Prozac was the beginning of a move towards medicating "ordinary sadness," the notion of cosmetic pharmaceuticals, the moral and treatment implications of advertizing medications directly to consumers, the debate over medication therapy versus psychotherapy for the treatment of depression and other "mental illnesses," over-diagnosis--it all felt so... retro. And that was quite the surprise.

We really haven't been talking about these issue--these issue that are so deeply relevant to my therapy practice, that are of such concern to good treatment, the matter of what's valued (and therefore paid for) by insurance companies, what sort of therapies receive research funding, how people engage the matter of stigma in making decisions about mental health. These vital questions were, in the wake of Prozac, a part of a national conversation which has largely receded into the fringes, even as countless newer medications have been approved as drug therapy for depression. The thought hit me, as I saw everyone from David Letterman to Tom Brokaw weigh in on the relative virtues of Prozac that perhaps the drug companies and the psychiatrists and researchers who profit from these medical therapies have achieved the ultimate (ironic) pubic-relations victory--they shut everyone up.

Anti-medication versus pro-growth

It's important that I make my stance on the question of drug therapies clear: I have witnessed in my therapy practice the benefits of drug therapies in those who come to me for help with depression, anxiety and other challenging issues. (And as a reminder, I am not a pharmacologist, and don't prescribe meds or give medical advice.) I have seen people get help, I have seen people get no help, and I've seen some symptoms of what seems likely to me to be negative effects of drug therapies. I think these medications are over-prescribed and that patients are often encouraged to remain on them as a long-term proposition rather than working towards reducing and ultimately refraining from taking them altogether.

Fundamentally this is for me a question of patient choice. As with any matter that's brought to me for counsel, I seek to help individuals better understand (and execute) what it is they want and set their path for how to get there.

But perhaps that's just the concern. In the wake of Prozac's initial emergence on the scene, there was a very real dialogue in the public square about the relative virtues or dangers of these medications and, in some meaningful corners of that space, the role that psychotherapy should play in the treatment of depression and anxiety. We need much more conversation.

Prozac, as the Times' piece makes clear, was just the beginning, not just of a new class of drug therapy for depression, but of a new popularity of medications in the treatment of emotional "disorders" and in the business and marketing of medications period. It was an early experiment in what has proven to be enormously lucrative for drug companies: offering a lot of hope in a tiny, profitable pill. Prozac was followed by dozens of medications promising to help not just with depression but social anxiety, social phobias, premenstrual issues, low sex drive, attention issues, difficulty sleeping, difficulty staying awake and on and on. As some of the users of Prozac and similar medications found a lack of success or a dropping off of success with those medications, medications such as Abilify that had formerly been used to treat much more dangerous mood disorders have been approved to treat depression.

And almost nobody is talking about it.