Antidepressants: Who Needs Them?

First, it is important to understand that major depression (or clinical depression) is a very common illness, affecting 7 percent of Americans in any given year.

Second, antidepressants are effective not only for depression, but also for anxiety disorders, which are common as well, and for other problems such as insomnia, chronic pain and migraine headaches.

Some people have argued that using antidepressants in the setting of depression is not a good idea because these only paper over the "real" problems in people's lives. In fact, depression is a "real" disease and needs to be treated directly.

Certainly, people with depression do often have issues that need to be dealt with, such as problems in their marriage, or difficulties in the workplace.

But trying to fix these without first treating the depression with medication is like trying to fill the empty bathtub without first replacing the faulty drain stopper. One's efforts are likely to be energy down the drain. Once the depression is treated, life's challenges can be tackled with more confidence and competence.

Antidepressant Fears: a Growing Problem?

In the last three years, the number of antidepressant prescriptions written for children and adolescents has significantly decreased.

This has occurred largely in light of concerns from the Food and Drug Administration about potential suicidal behavior induced by antidepressants, particularly of the SSRI type.

A "black box" warning was placed on all antidepressants in 2004 to alert patients below age 18 to these concerns, and this past May an order was issued to extend the warning to include patients age 18-24.

Additional reductions in prescriptions could follow. This would be unfortunate, because although there might be a transient increase in suicidal risk associated with emerging from deep depression and becoming energized enough to act on suicidal thoughts, the far greater risk lies in remaining untreated.

While no treatment in medicine is without its risks and drawbacks, we use those that are likely to do more good than ill. With antidepressants, we sometimes get miracles, and often get substantial improvement.

Treatment is like brilliant sun for someone who has been under a dark cloud. Beautiful and warm -- but watch out for sunburn.

Dr. James Potash is an Associate Professor of Psychiatry and Co-Director of the Mood Disorders Program (http://www.hopkinsmedicine.org/moods) at the Johns Hopkins School of Medicine in Baltimore, Maryland. He has no financial relationships with any pharmaceutical companies. If you have questions or comments, please email at moods@jhu.edu. To participate in our studies, call 1-877-MOODS-JH.

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