By Franklin Cook, SPNAC Editor
I’ve been reading a lot lately about antidepressant medications, with the idea that I was going to summarize some of the recent debate about whether they are part of the problem or part of the solution regarding suicide. But I have abandoned the idea of writing a summary such as that in this small forum because, for one thing, some of the “debate” about antidepressants and suicide is very polarized, with one camp applauding them as a miraculous intervention to alleviate the suffering of suicidal people and the other decrying them as part of a murderous conspiracy being perpetrated against us all by Big Pharma. Instead, I’ve decided for now that I need to merely try to articulate my conclusions from my reading without elaborating upon them or pointing to supporting documents (in other words, to offer my unadorned opinion, which I don’t often do in the pages of SPNAC, but which seemed an important starting place for me on this topic, while I’m waiting for the New Yorker or the Atlantic or Harper’s to commission me to write a full-fledged essay on the topic).
Here is what I think can accurately be said about antidepressant medications, depression, and suicide:
- Depression is an illness with its source in the biological structure, content, and processes of people’s brains (internally driven phenomena) AND in the structure, content, and processes of people’s “ways of thinking” about ideas and experiences (externally driven phenomena).
- There is a clear and direct link between depression and suicide.
- Medicines (antidepressants) have been developed that — for some people — alleviate the biological symptoms of depression, including their tendency to attempt suicide.
- In some people, the medicines don’t work or don’t work very well, and in others they cause negative side effects, including increasing in some cases people’s tendency to attempt suicide.
- The effects of antidepressant medication on the brain are not understood as well as they ought to be understood relative to how widely the medicines are used.
- The scientific inquiry about antidepressants is a dynamically evolving endeavor, and there is insufficient consensus about some of the most important questions at hand.
- The clinical usefulness of these medicines has been negatively affected by their marketing and distribution, which has overreached the science supporting their use.
And here is what a list of remedies for the current situation might look like:
- The use of antidepressant medication must be supported as a treatment option.
- Clinical guidelines for safe administration of antidepressants must be strengthened, and clinicians must be trained and otherwise equipped to administer them safely.
- Strict safeguards must be put in place — not via a “warning label” but via an improved standard of practice or even a legal mandate — to keep people who are prescribed antidepressants safe from suicide.
- Effective patient and public education about depression and its treatment — including the role of antidepressant medication — must be instituted.
- Effective treatments must be developed, implemented, and supported that address not only the biological sources of depression but also people’s “ways of thinking” that contribute to depression.
- Research on depression — as well as on both biological and other interventions and treatments — must be done much more strategically, ambitiously, and independently.
- All marketing of antidepressant medications ought to be suspended while a thorough, independent review of the scientific knowledge about and marketing practices for them is undertaken and recommendations for implementing the remedies above (or better ones) are instituted.
[The abridged URL for this post is http://tinyurl.com/AntidepressantMeds .]