By John Messmer
Penn State Family and Community Medicine
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine
It seems like everyone is talking about depression these days. That's good in a way. It takes away the stigma that used to be associated with "mental disorders" so people suffering from depression can feel more confident in asking for help. On the other hand, bickering among celebrities about depression could trivialize the problem while warnings of dangers from antidepressants could delay treatment and prolong suffering. What is the general public to do?
It's important to realize that scientific knowledge is not a system of absolute truths. This is particularly true in medicine and especially in psychiatry. If knowledge were absolute, treatment for any diagnosis could be looked up by anyone without special training -- just match a drug or procedure with a disease.
In the last century, medical research has discovered more about disease treatment than in all of mankind's prior history. When medical information is discovered, that information is shared among other scientists and practitioners who evaluate and re-evaluate whether the discovery is correct. In the old days, progress was slow and incremental. An incorrect treatment could be applied for years until it was found to be ineffective. Medical information today is generated at a much higher speed and is available to scientists and laypeople much more quickly.
With instant communications worldwide and 24/7 news coverage, media outlets want to have the latest news now. The problem is that medical news is treated like fact. It is rare to provide in-depth analysis of a medical news item, particularly if such analysis reduces the newsworthiness of the information. This gives the general nonscientific public the impression that scientists can't make up their minds. It looks as though something that was good for us last week is the worst thing for us this week.
In studying depression, conflicting data is hard to avoid. One cannot measure depression as easily as blood pressure or cholesterol. It's even harder in children who do not show depression the same way as adults. This makes studying treatment for depression tricky and causes conflicting data on the effectiveness of treatment. Just because one study is published that says certain medications do not work for a problem, it does not mean that is now the new truth. Physicians must analyze the data and compare it to prior studies and their own experience to determine the validity of the data. Too often, people with an axe to grind use these studies to prove that medication is not effective or worse, is dangerous for depression. When these people have no actual training in the issue but through their celebrity cause people to pay attention to their opinions as though they have merit, it is a major disservice to the public.
Physicians treating depression know that in the early stages of treatment people may act on suicide plans. This was known even before the selective serotonin reuptake inhibitors (SSRI's) were discovered. In the 1970s, overdose with then- available antidepressants could be fatal so physicians were taught to dispense a less than fatal supply of medication until the patient's improvement could be reassessed. Unfortunately, the media and even the FDA are making it seem that antidepressants actually cause suicide, raising a fear of antidepressants that could prevent people from accepting treatment. For the most part, research shows and practicing clinicians agree that treatment of depression reduces the risk of suicide.
Because every person is different, some people do not respond to the first medication. Some people need two or more medications to get better and many also need ongoing counseling in addition to medication while some may respond to counseling alone. Some people will even get better without treatment, but that does not mean others should not use medication.
In the evaluation and treatment of depression, just as with high blood pressure, diabetes, heart disease and cancer, the best advice is to work with a trusted physician to get evaluation and treatment recommendations tailored to your specific needs. Medical news and discussions in the media do provide a little information, but a little information can be a dangerous thing.