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During the last two decades, the stigma against taking psychiatric drugs
seems to have been considerably overcome but the stigma against “seeing a
shrink” (psychological or psychiatrist) is still strong. Moreover, while
Cognitive-Behavioral therapy has developed during this period, it hasn’t had a
breakthrough in terms of highly publicized effective techniques or in terms of
cheap or easy treatment. In other words, anti-depressant drugs haven’t had a
lot of competition. Also, most people do not realize how little training and
experience primary care doctors, in general, have in dealing with serious
psychological disorders, including depression. Yet, as you know, if you have
read the rest of this chapter, depression is a very complex and potentially
dangerous disorder. It isn’t something to be diagnosed in a few minutes.
Since anti-depressants take 30 days before having full impact, a significantly
depressed person needs frequent and careful monitoring immediately and
during the first several weeks. The treating physician needs to get a detailed
mental health history (mental problems or illness often accompany
depression) and he or she should strongly encourage the patient to also get
psychotherapy as well as drugs. Depression is not an easily treated disorder.
The doctor/therapist should be expected to maintain long-term contacts with
their depressed patients, at least every week for a few months and maybe
much longer. Depression frequently comes back.
Ideally, a health care service for depression would have enough coordinated
psychiatric and psychological specialists to carefully diagnose each case of
depression, assessing the possible psychological, personal, circumstantial,
interpersonal and physiological or genetic causes of the disorder. As a part of
this evaluation there should be a careful assessment of the risk of self-injury
(see earlier sections of this chapter). This initial evaluation is not a trivial frill;
it is crucial. This process should usually involve psychological testing and a
detailed history as well as medical tests. The general practitioner is not this
kind of specialist. (Light cases of depression could, I suppose, be handled
more casually—but how can anyone identify a light case just by talking to a
person for a few minutes?)
Another serious problem is that the general public has NOT understood or
paid close attention to the research about the frequency of suicide and the
obvious connection between depression and suicide. For instance, we often
don’t like to think about suicide as being an integral part of depression.
Suicide is the eighth leading cause of death in the US. It is the third leading
cause in 15 to 24-year-olds and the fourth most common cause of death
between ages 10 and 14. This is serious—60% of high school students have
had thoughts about killing themselves, 9% have tried. At every age,
especially in old age, depression must not be dismissed and taken lightly. The
“just take these pills and call me in three months” is not acceptable
comprehensive review of this field of research
Not only has the risk of suicide underlying depression been taken too lightly,
the generally positive public opinion about the effectiveness and safety of
anti-depressants seems to have a major disconnect with the scientific
evidence. There have been many, many studies. Of course, some of the
studies have shown anti-depressants to be effective, sometimes. These drugs,
