Pills not best remedy for depression
Monday, July 12, 2004
In 2000, 38 million prescriptions for antidepressants were written worldwide. Usage continues to skyrocket. Although selective serotonin reuptake inhibitors (SSRIs), including Prozac, Zoloft and Paxil, comprise the third most prescribed class of medication, major depressive disorder is still the second greatest cause of disability in developed countries.
Because such a large proportion of mankind is taking SSRIs, we should be asking many questions about them. A study in Iceland found that psychiatric hospitalizations increased by 4 percent and suicide trends were unchanged, despite 16 percent annual increases in SSRI usage for a 12-year period. The New York state attorney general is suing the manufacturer of Paxil for withholding evidence of increased suicidal behavior in children.
Considering how the media promote sex, it is testimony to our desperation that almost 40 million people choose a medication that suppresses their sexuality in the hope of feeling better. It's ironic that this side effect widens the gap between fantasy and people's lives. That alone is depressing.
In the short run, today's health industry economizes on treatment by prescribing SSRIs alone. But we must look at the long run. The most effective treatment for depression combines talk therapy and medication. Talk therapy alone can produce changes in the brain similar to those caused by medication, in a way that increases our humanity and without side effects. But that is not an option for most people.
We must consider the cumulative effect of millions of prescriptions taken worldwide. Today we are medicating children for manic-depression, despite the fact that many leaders, artists and thinkers throughout history exhibited symptoms of it. We are depriving the future of the potential contributions of these children. In ways that we cannot foresee we are tinkering with the future.
Even as we extol social diversity, we do not tolerate it in ourselves. Instead, we swallow medications to make our unique and unruly selves conform to the television characters we idolized when we were kindergarteners. Compared with those bland fictions, we can never measure up. We conclude we are "dysfunctional" when our lives are untidy, our thoughts contradict our feelings and we struggle. We compare our uncertain insides to their confident outsides. It is a false picture.
We have lost sight of the great internal struggles it takes to be fully human and true to self. Jeremiah railed against God, Dante wrote the Inferno and Biblical heroes promised God their firstborns. Today we would lock those men up and give them a pill.
SSRIs can be helpful when someone is truly depressed and without alternatives. But the diagnosis must be exact and therapy must connect feelings to life events and honor them as the road to wisdom. Loneliness, grief, suffering and anguish are not depression. These emotions deserve our respect, impel us to live more meaningfully and push us closer to other people. They signal the path to creativity, wisdom and God. Cutting ourselves off from their guidance impoverishes us.
For 25 years, we have sanctioned chemically altering our psyches. Even if the pharmaceutical companies had released all their test results, we would not have enough information to continue blindly. The cumulative effect of millions of prescriptions has escaped our attention.
We have always claimed that our brains and emotions make us superior to other creatures. But when a huge segment of mankind is silently and voluntarily altering those very faculties, we are cavalierly messing around with our essential humanity.
People view their unhappiness as an individual aberration. Yet because 40 million people are taking antidepressants, it is myopic to dismiss our global unhappiness as an individual problem. It is a social problem. We must ask why so many people on our small, spinning planet are so very unhappy. And then we must look for solutions that are better than little pills.
Eleanor Godwin lives in the Seattle area.