Monday, July 5, 2004

Pills often no help in battling depression

Your voice: Bruce E. Levine

"UC studies drug for depressed women" (June 28) reported that a new antidepressant affecting the neurotransmitters serotonin and norepinephrine is being investigated. The article included a sidebar informing women how to participate in the study. But it excluded important facts that might give a woman pause before enlisting.

It neglected the fact that antidepressants, such as Effexor, which affect serotonin and norepinephrine, already exist, and that science is now challenging the effectiveness of all antidepressants. A 2002 analysis in Prevention and Treatment of 38 studies on Effexor, Prozac, Paxil, Zoloft, Celexa and Serzone concluded that when compared to a placebo, the "effects of the antidepressants are clinically negligible."

Despite what is suggested on TV commercials, science has not established that serotonin or any other neurotransmitter imbalance is related to depression. The American Medical Association's Essential Guide to Depression states: "The link between low levels of serotonin and depressive illness is unclear." Elliot Valenstein, professor emeritus of neuroscience at the University of Michigan, in Blaming the Brain, tells us, "There is no convincing evidence that depressed people have a serotonin or norepin-ephrine deficiency."

And, just as military recruiters often neglect to spell out the dangers of enlistment, this article omitted the collateral damage that often accompanies antidepressants. While antidepressants can take the edge off emotional pain, common adverse effects include headaches, nausea, fatigue, memory and sexual problems, and withdrawal (euphemistically termed "antidepressant discontinuation syndrome"). And in 2003 the British equivalent of the Food and Drug Administration told physicians to stop using Effexor and other antidepressants for those under 18, citing the risk of suicidal behavior and hostility.

One last fact, and an observation. A 2001 Rand Corp. survey revealed that the majority of physicians diagnose depression in less than three minutes. If doctors stepped off this diagnostic assembly line, they would discover that - rather than faulty biochemistry - nearly all depressed patients have obvious reasons for depression to include: abuse, neglect, trauma, a marriage without affection, a job devoid of meaning, or some other psychological, social, spiritual pain.

This would take a brave doctor indeed - one who could rebel against insurance companies, managed care case managers, drug company sales representatives, and a world itself that has gone quite crazy.


Bruce E. Levine is a Cincinnati clinical psychologist and author of Commonsense Rebellion: Taking Back Your Life From Drugs, Shrinks, Corporations, and a World Gone Crazy.

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