I do not doubt that pharmaceutical companies are profit-driven creatures, nor do I doubt that they are quite willing to manipulate data to their advantage, just as much as they willing to do whatever they can to manipulate the prescribing habits of the physicians they visit and visit and visit. What I do not believe is that these studies really tell us anything about whether and more importantly how to use the palette of drugs that we have at our disposal to address psychiatric illness.
These studies don’t tell us anything much because they lump depressed patients together into one big basket, and they give everyone the same one or two drugs regardless of their specific symptoms and history. The problem here is that there are at least four different types of depressions, based on neurotransmitter type, and that these types can overlap, co-exist and come and go over time. No one drug addresses them all, and all types must be addressed in any affected individual if they are to feel “well.” (These four types are norepinephrine/stress depressions, serotonin inherited depressions, dopamine pleasure depressions and GABA bipolar depression.)
The fact is medications do work very well indeed when they are selected and mixed properly, and when they are mixed with appropriate education and therapy. The problems with the use of psychiatric medication in this country are not primarily about the medications, some of which can be just slightly short of miraculous, but with a fearful under-educated population and with a grossly inadequate system of training mental health prescribers.
Consider that twenty-five per cent of the population has treatable neurotransmitter disorders, and that 60 per cent of them will never be treated, partly because of how the media “fairly” presents psychoactive drugs in a good vs bad light. Of those treated, eighty per cent will be treated by general practitioners, and therefore much less likely to be treated in a discriminating enough manner. There is a chronic shortage of psychiatrists; insurance companies have created reimbursement schemes and working conditions such that only 50% of psychiatric residencies are filled with American graduates. What psychiatrists there are rarely perform therapy themselves, and in my view this makes their prescribing much less accurate and their treatments less effective.
If you have suffered from depression don’t let articles like this one in the Times undermine your faith in the possibility that medicine might be of help to you. Look for a psychiatrist who takes the time to talk to you and is willing to explain why he is prescribing a particular medicine to you and exactly what symptoms he expects to improve. Drug company-funded studies suffer from a plethora of constraints and limitations and reveal little about the real clinical world. Your doctor on the other hand needs to be flexible enough to find the medicine you need and articulate enough to explain to you why you should take it.