What's the appropriate use for antidepressants?

Take a look at this article: Pfizer launches “Zoloft for Everything” ad campaign

Yes, I realize it’s a parody, but it’s far too close to reality for my comfort. For what should antidepressants be considered the appropriate treatment? “Real” clinical depression? How do we determine if a person’s emotions are genuinely the result of a physiological condition?

See a psychiatrist?

Depression isn’t always a black-and-white diagnosis. Antidepressants may or may not help. The way to tell is to try them, under the care of a psychiatrist, and see if they help. I would advise that you and your loved ones watch carefully along with the psychiatrist to see whether the antidepressants are helping. Evaluting their impact is often subtle.

I take antidepressants for a mild but ongoing depression. I can certainly live my life just fine without them, but there’s a lot less joy to it, I’m not as much fun to be around, and I’m less productive. I know I’m not adding much to the debate here other than to give an example of a non-critical use of antidepressants. Is there a threshold of depression that a person has to meet to be a legitimate user of antidepressants?

True depression is normally not associated with a particular event. Doctor will prescribe anti-anxiety agents for events like the loss of a spouse (something I don’t agree with, myself!).

Depression is a physical illness. Zoloft is not a cure all, and shouldn’t be used as such.

A physical illness without specific physiological symptoms? When was it actually shown to be physical illness? I’m gonna need some cites here.

It’s only a physical illness in the sense that your emotions are tied to physical chemical changes in your brain. But that says nothing. There is no physical test to diagnose a “chemical imbalance” in the brain. It’s a chicken and egg problem; when you are depressed, there are changes in your brain chemistry, but a doctor can not tell you which caused the other.

It basically comes down to a judgment call - that’s why Zoloft requires a prescription, because you need a doctor to determine if it’s the right course of action. Like December said - it’s not black & white. And a lot of doctors recommend talk therapy first, and only try medication if that doesn’t work.

BTW, a common misconception is that SSRIs like Prozac and Zoloft are “happy pills”. They are not. They only make a depressed person feel “normal”. From what I understand, if a non-depressed person were to take them, he might feel some annoying side-effects, but would not experience any kind of euphoria.

They are also used for ailments not directly related to depression ie: migraines, chronic pain, etc… Do you want to include this in the discussion?

Although I’m not thrilled with the idea of moderating emotions like grief which, although unpleasent, are part of life and must be dealt with, I can see situations where the use of such medications may be justifiable. For instance, if someone loses a spouse but has small children they must take care of then medication may, in some instances, provide needed assistance in keeping them functional enough to continue to be a parent to their children.

I know from experience that sudden death in the family can be paralyzing, or nearly so. When I had to deal with the sudden death of my sister I had the “luxury” of being able to weep and mope and otherwise act out in the care of my husband (who was actually my boyfriend at the time). But if I had had toddlers? Gosh, the thought of having to take care of children AND cope… This isn’t an argument to drug people into zombie-hood, just that in some circumstances medications can be tools to enable people to do things that must be done regardless of circumstances.

Broomstick: As mentioned earlier, properly prescribed anti-anxiety and anti-depressants – and there is a difference – do not drug people into zombie-hood. In my limited experience, competent doctors don’t prescribe these things for immediate tragedies in a person with no prior history of problems, and who is appropriately grief-stricken or sad. It’s when the crying becomes continuous and uncontrollable, for example, or when the situation leads to a panic attack (which is much more than just being scared) that meds become a possibility.

Chronic anxiety might be a person who is afraid most of the time even when there’s nothing specific to be afraid of. Clinical depression might be when a person is sad most of the time and is unable to be happy or enjoy anything that he would normally enjoy.

Only a professional can diagnose depression. I highly recommend a specialist (psychiatrist) for treatment. My understanding is that there is movement away from the regular weekly fifty minute-hour sessions to twenty minute sessions perhaps once a month – with medications. A deeper depression may require more intense attention.

Anti-depressants can take six weeks to have an effect. You may need to try two or three different meds to find the right one. The same holds true for shrinks. If you don’t feel comfortable with the first one you see after a reasonable time, get a referral to another.

Above all, don’t blame yourself in any way for having this illness. It is not a character flaw.

This site may be helpful: http://www.symptoms-of-depression.com/index.php3

I am not a doctor but I a longterm patient.

Anti-depressants treat a lot of things besides depression, like pain(physical)as was said above. Zoloft is FDA approved, & just recently Prozac, for PTSD. Paxil & Zoloft treat panic disorder. Luvox & Prozac for OCD. Older antidepressants (like Elavil) treat adult ADHD. Wellbutrin was found to make smokers lose their habit, so it was put out as Zyban ,at five times the price.

Anti-depressents should be prescribed to those that would be helped by them. Isn’t that the point of medicine? If you want to deal with your pain however you want, you are free to do that. But don’t deny people the right to choose different ways which may include medication. Not all of us consider medication to be a bad thing. And almost all of us consider medication to be better than uncontrolled drug use, self-injurt and suicide.

I say this as a so-far-unmedicated bipolar. I tried the whole medication thing and came to a bunch of conclusions as to why it wasn’t the right thing for me. And I did resent how they pushed it on me (They essentially wouldn’t give me any sort of consouling if I didn’t take their drugs). But I’d never dream of telling someone not to take medication. Why should I deny them something that can make their life a little bit less hellish than mine?

Mental illness is a tricky thing. How much of it is a “medical problem” and how much is something that is “my fault”? Who knows? I’d personally say neither. I know there is something funny going on with my brain. Normal people don’t reach the point where they have to sneak out of class early every day because they can’t sit for two hours without crying. But I can’t really see it as a medical problem. More like a brain and heart that just arn’t quite suited to the world right now. Lots of people don’t respect my point of view. And maybe one day I’ll come to some big realization and change my mind. But right now I just can’t help but think everything is so much more complicated than most people say it is.

Mental illness is very context sensitive. The sorts of disorders that people get vary according to time, place, and social circumstances. In this sense, it’s not like cancer or a broken bone or whatever metaphors people use. That doesn’t mean they arn’t real. It means that they are a pathology that is created both by brain chemistry and by environment. It’s all nuanced and complicated. There are no easy answers. But taking pills isn’t an “easy way out”. at least not for the individual involved.

SSRIs are also used to treat anxiety disorders in companion animals.

Oh yes.

It’s a fascinating question, since it’s not understood why they’re helpful for such conditions.

There’s evidence that suggests that antidepressants have analgesic properties apart from their effects on cognition and emotion. To what degree are these drugs being prescribed because they make people less concerned about their pain and to what degree are they used because they actually reduce pain? When it’s considered that attention and concern is a major aspect of pain… well, it becomes complicated very quickly.

** Problems:

First, we have to note that there are a lot of doctors whose competency is… questionable.

Secondly, antidepressants have been shown to reduce the duration and severity of “normal” grief… and some physicians are in favor of considering bereavement a treatable condition.

Thirdly, who decides what is “appropriate”?

These statements are major oversimplifications… that are precisely what people think of when they hear these diagnostic terms. Which is part of the problem, IMO…

Whats wrong with that? As a species, we humans are finally obtaining self determination. Any attempt to make our existence more fulfilling or less painful is a good thing.

The only problem i would have is the idea that anti-depressants could oneday result in no negative experiences. THe idea of losing a close friend or child and being happy the next day seems a little off putting, but i would still support that over emotional derailment for years on end.

I don’t know if this is the appropriate use, but this is the actual use. To be diagnosed with depression, see ‘diagnostic criteria’:

http://www.psychologynet.org/major.html

Also, anti-depressants are not Magical Happy Pills. They are an aid-but if you don’t include counseling, and other techniques, they aren’t going to be much use.

If depression is a physical, biochemical disorder, then why do those criteria state that it’s not major depression if it’s due to a physical illness?

Antidepressants are often given prophylactically to patients recovering from surgery, “in case they become depressed”.

And the criteria for depression are routinely ignored, because insurance companies won’t pay for any type of treatment if people don’t fit within the DSM standards, or the practitioner feels the person would benefit from treatment… or because the criteria are intentionally so broad that no one actually takes them seriously.