Enlightenment Bulletin Board :: View topic - Antidepressant Safety Debate May Include Adult Patients

The yearlong debate over whether antidepressant drugs increase the risk of suicide in some children may soon widen to include adults, as English and Canadian scientists are reporting findings from three new analyses of suicide risk in people over age 18 who have taken the medications. The new findings are mixed, and apparently contradictory, and likely to encourage both patient advocates who believe that antidepressants like Prozac have hidden dangers, and manufacturers who insist that the medications are safe, experts said. One of the reports, an analysis of data on antidepressants from previous studies, found that adults taking the drugs were twice as likely to attempt suicide as those receiving a dummy pill or other treatments, but no more likely to complete the act. The two other reports found no significant link between the medications and suicide. Suicide attempts occurred in less than 0.5 percent of the more than 200,000 people included in the three studies.

Though I am not a physician, I am a mental health professional with 20 years of experience providing therapy often consulting with psychiatrists prescribing medications for depression.

DO NOT stop your anti-depressant medication without consulting an experienced physician, preferrably a psychiatrist. Just because this warning is out doesn't mean the medications are dangerous. Each person should evaluate their prescriptions with expert advice.

Sometimes medication works amazingly well, sometimes they are moderately helpful, sometimes they don't seem to help. Anti-depressant medication should be reserved for times with psychotherapy isn't the only answer. Psychotherapy also changes chemical imbalences. Thinking changes chemical balences and imbalences. Medication is helpful only when attempting to change thoughts and feelings isn't enough.

The fact is that psychotherapy is the preferred first method to treat most depression. Someone with thoughts about suicide or unable to function should be considered for immediate anti-depressant medication. A person who is in immediate risk for suicide with a specific plan should be seen in a hospital emergency room or crisis center.

Often the justification for anti-depressants is a period of sleeplessness that results in the person being unable to think clearly enough to benefit from psychotherapy. The responsible therapist will refer a severely depressed client to a physician for a medication review. Severe depression includes serious sleep and eating disturbances (too little or too much) as well as depressed thinking that interferes with daily functioning.

Medication should not be initiated without also initiating psychotherapy. Psychotherapy helps usually within 6 to 20 sessions. These numbers are not absolute, but a guide that indicates a second opinion might be helpful. Today, insurance companies often offer that second opinion by authorizing payment in blocks of sessions the therapist has to justify. Psychotherapy is most effective when short-term or episodic.

For long-term stubborn problems, episodes of 6 to 20 sessions repeated periodically over a number of years is often as effective or more effective than continuous therapy. Continuous therapy sometimes lulls the therapist and the client into a belief system that therapy is necessary even though progress is not made. On-going therapy may be indicated for those who are unable to stay out of the hospital or function adequately without it. Usually, the situation is obvious enough that the insurance company or physician and others involved agree continuous therapy is necessary.

Any psychiatric medication requires periodic review by a physician with extensive experience with the medication. Not everyone will need anti-depressant medication for the rest of their lives.

David E. Johnson, MSW, LICSW
Licensed Independent Clinical Social Worker