A View From The Handbasket

Thursday, March 23, 2006
From the "Not Getting the Point" Desk
Posted by neros_fiddle at 12:04 PM

This is a bit removed from the normal fare, but I couldn't let this go uncommented on. From today's Washington Post:

Antidepressants fail to cure the symptoms of major depression in half of all patients with the disease even if they receive the best possible care, according to a definitive government study released yesterday.

Significant numbers of patients continue to experience symptoms such as sadness, low energy and hopelessness after intensive treatment, even as about an equal number report an end to such problems -- a result that quickly lent itself to interpretations that the glass was either half empty or half full.

The $35 million taxpayer-funded study was the largest trial of its kind ever conducted. It provided what industry-sponsored trials have rarely captured: Rather than merely ask whether patients are getting better, the study asked what patients most care about -- whether depression can be made to disappear altogether.

In their eagerness to tap into some sort of "fight the power" anti-drug company demagogy, the Post ends up with a slant that's laughably irresponsible.

I'm no doctor, so this is merely my opinion. But depression is not a headache, or a cold, or a hangnail. It is a chronic condition, whose origins we are only beginning to understand. Much like alcoholism or other addictive behavior, it cannot be "cured."

By implying that antidepressants are a scam because they don't universally erase all symptoms of depression (the headline on the home page as I type this: Questioning Antidepressants), the Post does damage in two ways:

1) They spread the notion that depression can be (or, at least, should be) totally undone with a pill.

2) They tell people struggling with depression that the yardstick of their treatment success is whether or not they have completely erased all trace of depression from their lives.

Antidepressants are not a magic bullet -- they are simply one tool in the treatment process. Severe depression is a state that is extremely difficult to crawl out of, even to simply reach a lesser state of depression. I apologize for the painfully trite analogy, but here's how I see it:

Clinically depressed people are drowning in the deep end of a pool. Antidepressants are akin to a life jacket. They don't pull the patient out of the water and dry them off, but they give the patient a fighting chance to (with appropriate therapy) continue breathing and get to the shallow end of the pool.

Exactly what the best approach to take to successfully treat depression patients is still an area of contention. To continue with the terrible analogy, there are basically two schools of thought these days. Some argue for an active approach in which whenever it occurs to you that you're wet, you should resist that thought and focus on being dry.

Others, most famously Steven Hayes, believe that a more passive approach works better. When you find yourself distressed at being wet standing in the shallow end of the pool, the correct response is not, "Worrying about being wet is bad," it's "Yeah, I'm wet. So what? How do I respond to that?"

Hayes calls this "Acceptance and Commitment Therapy," and it's becoming the latest evolution in cognitive behavior therapy. As a depression patient (in case you hadn't guessed), I find it infinitely more effective than the previous "active" approach, which has a "deny reality" aspect to it I find unworkable.

The point of all this is that dealing with depression is a lifelong process of figuring out how to deal with the painful messages your brain insists on sending you. To expect this to be widely curable with a pill, and to minimize the considerable therapeutic value of those pills by complaining that they're *not* a 100% "cure," is missing the point on a grand scale and putting sensationalism over duty to readers.

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