Newsweek Gets It Wrong: The Debate About Antidepressants

I yearned to get better; I told myself I was getting better.  In fact, the depression was still there, like a powerful undertow.  Sometimes it grabbed me, yanked me under; other times, I swam free. – Author, Tracy Thompson.

One study estimates that 19% – – or about 200,000 of this country’s 1 million lawyers – – suffer from depression.  This isn’t just some statistic; this is about people – folks who happen to be lawyers for one reason or another.

Just what are these people supposed to do about their depression?  Many if not most law students, lawyers and judges that I know have taken or are currently taking antidepressant medications. And they seem to be in the majority of people in this country who do so.

The ranks of the medicated are swelling.  The number of Americans taking antidepressants doubled in a decade, from 13.3 million in 1996 to 27 million in 2005. One in ten Americans are prescribed these drugs making them the most prescribed medications in the country.  By comparison, 18 million people take Lipitor for high cholesterol. 

The biggest reason lawyers take these drugs?  Like everyone else, they’re hoping want to feel better, but equally if not more importantly, attorneys want to return to their pre-depression levels of productivity at work.  A profession that doesn’t suffer fools well and demands a lot out of mere mortals.

But is medication effective in treating depression and achieving this objective?

Late last week, I was walking down an icy sidewalk minding my own business.  I could see the usual cast of characters in my peripheral field of vision; clusters of lawyers yucking it up on their way back from lunch, a judge lost in his own thoughts and a corporate lawyer I know (not particularly well) who once told me privately that he takes antidepressants, his lawyer wife  did as well and  five other lawyers in his firm did.  I guess he felt comfortable telling me this because of my public disclosure about my own struggles.  I often feel like a priest in a confessional; I hear about lawyers most private of struggles.  Then, like such disclosures never happened, the curtain is opened and we each walk our own ways.

Walking by a newsstand late last week, I noticed the current cover story of Newsweek Magazine which read, “Antidepressants Don’t Work:  The Debate Over the Nation’s Most Popular Pills”.  The large print seemed to stick a proverbial finger in modern psychiatry’s eyeball and toss the question –along with people who suffer with depression- up in the air. 

The article focused on a recent study which concluded antidepressants essentially worked no better than placebos (sugar pills).  Oh, just great, I thought. What am I, who have taken medication for the past eight years, supposed to do now?  Start popping M & M’s instead of Cymbalta?

The writer of the Newsweek piece concluded

“If placebos can make people feel better, then depression can be treated without drugs that come with serious side effects, not to mentions costs.”

This conclusion is the latest in a long line of recent books leading the charge against the use of medication to treat depression. Charles Barber, in his book Comfortably Numb: How Psychiatry is Medicating a Nation, argues that antidepressants are doled out like Halloween candy in this society.  The motive: the big money made by the pharmaceutical industry.  This is an appealing take because Big Pharma is commonly portrayed as the villains in the popular press; guys in black hats and white lab coats stuffing greenbacks into their pockets.

In an article written for Salon, Barber wrote:

“One has to wonder:  Are we really that miserable?  Manipulated might be a better word for the miserable.  If we were to pick one factor that explains the dramatically increased number of antidepressants that now runs through our collective bloodstreams, it would be direct-to-consumer advertising, otherwise known as television commercials for drugs.” This point is well taken, but not surprising.  Pharmaceutical companies are in the business of making money.  Does such a motive make Lipitor any less effective?  Should commercials about it deter us from taking this drug?  I don’t so.

In fairness to Newsweek, they ran an accompanying piece which tried to give the other side of the coin.  It was penned by psychiatrist, Robert Klitzman who framed the question about the study’s conclusions in this way:

“What should we make of the [study]?  First, some facts: antidepressants have been shown to work for serious major depression.  Most evidence shows they are effective for dysthymia: milder but chronic depression that continues for two years or longer.  The question is whether they work for milder depression that may be shorter or less intense.  That’s important, since major depression affects almost one out of five people [in this country] at some point in their lives.  And most people with depression do not have severe forms of it.”

The response to Newsweek’s take on the study was sharp and quick.  In an Op-Ed in the New York Times, Judith Warner wrote this biting retort:

“Happy pills don’t work, the story quickly became, even though, boiled down to that headline, it was neither startling nor particularly true. Yet in all the excitement about ‘startling’ news and ‘sugar pills,’ a more nuanced and truer story about mental health care in America was all but lost.  The story begins to take shape when you consider what the new study actually said:  Antidepressants do work for very severely depressed people, as well as for those whose mild depression is chronic (dsythymia). However, the researchers found, the pills don’t work for people who aren’t really depressed – people with short-term, minor depression whose problems tend to get better on their own.  For many of them, it’s often been observed, merely participating in a drug trial (with its accompanying conversation, education, and emphasis on self-care) can be anti-depressant enough.”

As the article also points out, most people receiving antidepressants aren’t getting them from well-trained psychiatrists, but family doctors who don’t screen well for depression. One wonders how much training they get on  how to probably diagnose depression and whether they can keep up on all the research on the topic.  The result: we are, in some sense, an overmedicated nation; a country too quick to give sad or unhappy people pills that they shouldn’t be taking and don’t need. 

That conclusion, however, does not mean that these medications don’t work for many (though not all) people suffering from true clinical depression.  My take is that a family doctor who treats urinary tract infections and constipation shouldn’t be doling out Lexapro to a patient that he has spent 5 minutes with. Perhaps the problem isn’t just pharmaceutical companys bent on making a quick buck, but family doctors under managed care who don’t have any time to spend with patients and don’t know much about depression and the various medications used to treat it.

People feel ashamed and stigmatized by going to psychiatrists, but it could be a game-changer for many:  either you don’t have depression and shouldn’t be on medication or you do and you could finally get relief from some of depression’s more devastating symptoms.

There is no doubt that exercise, psychotherapy and some form of community and support will help people whether they are suffering from some transitory upset/sadness in their life (by the way, this helps people with depression too). However, for many people afflicted with clinical depression, it’s unlikely that they will have a real shot at containing or overcoming their depression without short-term or long-term use of medication. They won’t be able to muster the energy, commitment and motivation to engage in the other healthy stuff; to go for a walk, to work out their distorted and negative self-beliefs about themselves with a good therapist or join a support group.

Depression has a terrible undertow; its riptides are often unforgiving.  We need as many weapons in our arsenal to deal with it. People with transitory sadness or disappointments don’t need to become patients; they need to connect with other people or change their lives – maybe both.  Therapy or just working it out by themselves with supportive friends and family may be all they need.