James M. Greenblatt M.D.

The Breakthrough Depression Solution

Is Medication the Answer to Depression?

There is more to depression than just symptoms and medications.

Posted Apr 18, 2011

We are a culture of extremes, making it hard to see the gray or find middle ground.

In the treatment of depression patients are exposed to one of two modes of treatment: traditional medicine or alternative treatment. Instead of this one-or-the-other approach, imagine what would happen if beneficial aspects from both of these viewpoints were combined to enhance psychiatric treatment for depression.

For many years, patients suffering from depression have shared their stories with me. The common thread between all their stories is that current psychiatric treatment is inadequate, frustrating and random. Countless times have my patients encountered the mentality of "let's just add a new medication to your growing list of medications."

As we move into the 21st century, reliance on medication in psychiatry has surged. Polypharmacy, or the use of multiple medications, is now commonplace. A study with mood disorder patients found that the percentage of patients taking 3 or more medications have increased from 3.3% during the period from 1974 - 1979 to 43.8% from 1990 - 1995.

In 1996, 13 million Americans were treated with antidepressants. By 2005, the number rose to 27 million.

More and more Americans are taking psychiatric medication despite the potentially life altering side effects. As patients come to see me, they often complain of loss of libido, and the lack of any feeling, i.e. the inability to feel sad or happy. Furthermore, in 2004 and again in 2007 the FDA warned of potential suicidal ideation from antidepressant use.

Yet, the fact remains that

  1. Scores of patients with depression continue to use antidepressants and other psychiatric medications at alarming rates
  2. Psychiatrists and other physicians are more than happy to prescribe these medications, often several at a time, to their patients.

It's time to ask, Do the benefits of medication outweigh the risks?

Based on studies from 1987 to 2004 it appears that 94% of the published literature on antidepressants show positive, beneficial results. But that is not the whole story. The reality is that the number of positive antidepressant studies is closer to 51%. Approximately 1/3 of FDA-registered antidepressant trials with negative results were never published. That means that about half of the trials failed to show any benefit exceeding that of a placebo, an inactive pill that contains no medication at all.

When I sit across from patients every day who complain about not feeling any better despite being on multiple medications, many of which give them side effects, it's clear that medication is not a panacea.

But giving up on medicine completely and only relying on nutritional supplements as potential cure-alls is not the answer either.

Through this blog, I will discuss solutions to depression that challenge you to

  1. Look beyond the traditional standard of care
  2. Consider each individual's unique biochemistry before treatment
  3. Understand the multiple physical causes of depression and changes in mood

In my book, The Breakthrough Depression Solution, I end with the sentiment that it's time.

It's time to admit that current treatments are inadequate and there is more to depression than just symptoms and medications. Most importantly it's time for providers to find the most effective approach to eliminating symptoms in depression.