Opinion: Treating depression

POSTED: 01/10/12 3:10 PM

Ha, finally a psychiatrist in the Netherlands is waking up to the fact that treating depression with antidepressants is not always the right approach. We should not describe pills all that quickly because there are less far-reaching solutions available, and they ought to be used first, psychiatrist Bram Bakker wrote in an op-ed in the Volkskrant yesterday.

Let’s make clear here that we did not study psychiatry or psychology, but we have discovered in the course of our life that depression is a choice. If one is ready to accept this premise as true, then it becomes clear that one could also choose not to be depressed. From personal experience, we happen to know that this is simply a fact.

Bram Bakker is not there yet, but with his op-ed he is on the right way. Let’s follow his reasoning from here on:

“You hear increasingly about people who intend to stop taking their antidepressant. This is largely the result of the negative publicity of the past couple of years about the use of this medication.

Antidepressants are used not only to treat depression, but also for fear disorders, eating problems and even pain complaints. Are too many people taking antidepressants or just not enough? There is something to be said for both points of view.

A couple of decades ago more people suffered from depression than today. The famous Swiss psychiatrist Jules Angst, 85, and still active as a researcher in this field, said in a recent interview in Psychology Magazine that antidepressants have benefited people suffering from depression tremendously. There is solid scientific proof for this and in today’s discussions that is often forgotten.

 

Because there are still people with serious psychological complaints who unjustly do not take medication, one could defend the position that people ought to swallow many more antidepressants. That could give an unknown, but significant number of people a much more pleasant life. This message was for instance communicated by cabaretier Mike Bodde  in his bestseller Pill.

At the same time we know that antidepressants help a lot of people only a little bit at best. Half of them improve about fifty percent, I learned once. Antidepressants only work as long as they are taken regularly. Fifty percent of the people who stop taking the medication experience within half a year the same complaints that were the reason they started taking them in the first buy cheap valium uk place.

Many people want to stop taking antidepressants because of bothersome side-effects, like overweight and sex problems. Many of them don’t manage to quit because just lowering the dosis leads to new complaints. Many users say they wish they had never started with antidepressants had they known beforehand what the pills’ impact would be. This means that a lot of this medication is used by people who actually prefer not to use it.

The theoretical solution is simple: give antidepressants to people who will probably benefit from it, and stop giving it to people for whom the results were unsatisfactory.

The practice is more unruly. There is a lack of sufficient standards to determine whether somebody should, or should not use antidepressants. There is no lab-research available to establish this, and a brain scan will not help either for the time being. The diagnoses general practitioners and psychiatrists use are not very reliable. After all even the biggest ecxperts do not know exactly what depression really is. Another problem is that it is not possible to reliably predict the possible effect of an antidepressant. Sometimes they work just wonderful, another time they create nothing but misery.

Without forgetting that this medication has led to significant progress, I think we should be more reluctant with prescribing antidepressants. There are alternative solutions available and they are less far-reaching. These solutions ought to be applied first. Too often, this does not happen. Running-therapy and several methods of psychotherapy also work with mood-complaints. If these treatments turn out to be ineffective, prescribing an antidepressant remains a possibility. Netto this will result in less antidepressant-users.”

What we learn from Bakker’s expose is that diagnoses by general practitioners and psychiatrists are unreliable and that the effect of antidepressants is unpredictable. This is because even seasoned experts still don’t know what depression is. The way we understand it, people suffering from depression are currently used as guinea pigs. That’s not good, and Bakker is right with his plea for using other methods first.

However, nowhere in Bakker’s piece do we read that depression is a choice. To us, that is key to getting people out of their rut: understanding why they are depressed, and making them understand that the choice is theirs. This way, it is possible to get out of a depression at a moment’s notice, and without using antidepressants.

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