An article published in time magazine cites a paper published in The BMJ suggests that SSRI’s (Selective Serotonin Retake Inhibitors), commonly referred to under the heading of “anti-depressants” have no real proof behind claims that they work to treat depression. One reason for the claim that they don’t work is based on the fact that we don’t know the mechanism by which they may work. And, of course, there are a significant number of reports of cases in which they do not work or indeed make matters worse.
In my clinical experience, most who find some success in treating depression express the palliation of symptoms as just that rather than a resolution of symptoms or a cure. Often times the characterization of the effect is that of placing a “blanket” over everything – the good and the bad, and of course, during the period of depression, anything to reduce the bad is welcome even at the expense of the good.
By definition, in the DSM IV (soon to be V), depression onset occurs in one’s early 20’s or late teens if it is inherited. In can occur from a change in brain chemistry created by external forces such as drug abuse, head trauma, and even food allergies, but an predisposition is identified early in life. So, why all the prescribing of “anti-depressants” for depression in post late teen and early 20’s years? Well, for some people who have experienced an event that would cause depression or grieving such as the loss of a loved one or divorce, the use of SSRI’s provides benefit, particularly in getting through the period of grieving. But, so often men and women continue to use SSRI’s for year after a triggering event. Why? Typically these events occur around the same period in life – the mid 30’s and older. This period of time happens to be the same period in which our natural production of hormones begins to decline. Of these, testosterone is one that contributes to one’s sense of well-being, energy and happiness. In fact, in the 1950’s exogenous testosterone supplementation was used to treat females with depression.
Unfortunately, especially with the time pressures of managed care, too often the evaluation of depression is limited to simply connecting a patient’s complaint of depression with a drug categorized as an “anti-depressant”.