Let’s not attack antidepressants

Not everyone benefits, but meds can work miracles for some, Camillo Zacchia says.

That was quite a headline on Page 1 last week: “Expert attacks growing use of antidepressants” (Montreal Gazette, May 13). According to psychiatrist Peter Gotzsche, 98 per cent of prescriptions for antidepressants, tranquillizers and antipsychotics are not really necessary. It’s a pretty strong statement. It is also totally ridiculous.

I am neither for nor against medication. It’s simply a treatment option that can and should be considered at times. As a psychologist, I do not prescribe meds. However, I spend considerable time discussing them with clients. At times, I urge them to talk to their physician about a trial, or about an increase or decrease of dose, or the possibility of switching a pill that, while helpful, is causing unwanted side effects.

The reality of antidepressant medication is that for some people they are miraculous, for others they do basically nothing, for a rare few they can actually do harm and for most people, they help to varying extents. Ultimately, responses to antidepressants are idiosyncratic. This means no one can predict how an individual will respond. The only way to answer the question is to try them and see how you, a unique organism, respond.

For a very small percentage of individuals, antidepressants can actually trigger a manic or hypomanic episode, causing all hell to break loose. This is possible in individuals who have a bipolar disorder. This should not be confused with the hordes of people who claim to be bipolar, but who instead simply have volatile moods. A bipolar disorder is rare, but antidepressants should be used with caution and monitored closely in individuals with this condition in their family history.

For many clients, however, antidepressants can transform their lives. There is simply no denying this. Antidepressants work miracles for some depressed or anxious individuals. It is especially important to try for more severe cases where the person is overwhelmed with the intensity of emotion and therapy alone isn’t providing enough relief. Sometimes when there is too much noise in the background, it is hard to pay attention to a conversation. But regardless of severity, many people just seem to be completely altered with them. They don’t get as angry, they don’t get as down, they don’t freak out as easily. For these people, it’s a slamdunk. Meds help a lot. Period.

About a third of patients respond very well to antidepressants and another third benefit somewhat. This is a good thing. But the problem is that the rest just don’t. They often get switched back and forth from one variant molecule to another. Doses are increased, lowered and combined with other medications to “potentiate” their effects. While one should not give up too soon — I have seen many people benefit from one pill significantly after not responding to another — sometimes we start flogging a dead horse. Some people will simply not respond.

Finally, there are people who, while not in the miraculous response category, nevertheless do benefit significantly. The effects may not be life transforming, but they do function better with medication. In such cases, the question should be one of cost-benefit.

Emotions are normally our allies, but this is not true for everyone. For some of us emotions are so strong they control us and lead us down a path of suffering and loss of normal function. In such cases, medication can and must be considered. Antidepressants often help us become a little less reactive to events, thus keeping emotions at a more balanced level.

But the fact remains no one can predict how each individual will respond.

Antidepressant medication is neither good nor bad. It is the individual’s response that determines which adjective applies.