Wednesday, March 5, 2008

Drop the Antidepressant?

Last week, many of the national television, print, and Web media had a story about antidepressants only helping persons who were severely depressed. So, should folks taking these medicines (118 million prescriptions in the US for this family of medicines in 2005 makes for a lot of folks) stop taking them?

There are good reasons not to drop antidepressants based on this one news item.

First, like all science, one report seldom makes for a definitive conclusion. It is sensible to discuss the report with one's physician before the next antidepressant refill prescription is made but wait and see how the medical researchers, pharmaceutical companies, and the Food and Drug Administration respond. And, don't expect that a report contradicting the bad press on antidepressants will necessarily get the same media attention.

Second, there are indications for antidepressants other than for treating depression. The report did not address using these medicines for assisting with pain control, treating anxiety disorders, and other uses. All that was questioned was the treatment of depression that is less than severe.

Third, going "cold turkey" off most antidepressants can make one feel bad for days to a few weeks. This drug withdrawal is not usually dangerous but can make one feel very anxious, irritable, out of sorts - all sorts of symptoms that might have been present before one started on the antidepressant but in this case, these symptoms are due to the body readjusting (too quickly) to the withdrawal of the antidepressant. One's physician should be willing to work out a slow tapering of the antidepressant over a period (ideally) of several months in order to avoid these withdrawal symptoms.

So, don't ditch the antidepressants due to one news story. Discuss any such decision with your doctor.


e-Patient Dave said...

HOGWASH on that report! Good for you for saying one report doesn't make for a definitive conclusion. I sniff a somewhat arrogant presumption that there's only one legitimate use.

When I got my diagnosis of Stage IV cancer in 1/07, I was mildly depressed (according to my physician). Together (in true edoc / e-patient fashion) we concluded that I would go on a small dose of an antidepressant. He reviewed with me that science used to distinguish between situational depression ("my mother died" etc) and endogenous depression (no such event, just something in one's chemistry). But, he said, it turns out there's no useful difference between the two conditions biologically, and the same treatments work for both.

I got a mild dose, which worked well at keeping my attitude up. I used it throughout my treatment. When I started tapering off (with his knowledge) it didn't go well at first, so I guess it MUST have been having an effect. We weaned me more slowly, and now I'm off.

Thank you so much for speaking out on this!

Signed, Only Slightly Outspoken :)

Steven W. Strode, MD, MEd, MPH said...

Dear e-patient Dave,

Thank you very much for sharing your opinion and your story. I hope you are doing well with your cancer treatment.

e-Patient Dave said...

Hi, Dr. Strove - good to meet you.

Yes, I'm doing very well, thanks. My last drop of HDIL-2 (high dosage Interleukin-2) was last July, and my February CT scan shows that my lesions continue to shrink (another 31% since September). The immune system is pretty amazing.