Antidepressants have attracted an exorbitant share of criticism and debate throughout their relatively brief history. In just over forty years, they've moved from being largely unplanned test agents to become some of the world's most commonly prescribed medicines, fomenting controversy every step of the way.
The latest case of their contentious relationship with clinical and popular opinion is the FDA's decision to expand the black warning labels attached to most SSRIs. Their original 2004 report, which followed more than a decade of case reports linking the use of SSRIs with higher rates of suicide in adolescents, created a lively debate despite the very low incidence of deaths that could be directly linked to the drugs. As anecdotal evidence has continued to be collected, the FDA has rewritten that warning to include adults up to 25 years of age. Suicidal ideation was reported in only 0.5% of the medicated young adults who were surveyed, which has only created greater controversy around the question of whether these drugs can exacerbate pre-existing depressive states that contribute to an individual's decision to end his or her own life. The fact that the companies making these drugs have performed very little research involving young people has not eased this concern.
Collected statistics indicate that nearly 1 in 10 Americans are currently taking some form of antidepressant, and yet only 20% of those affected by depression seek treatment. More than half the population sees it as the product of a personal weakness. Suicide or thoughts of it are far less common than other possible side effects: weight gain, reduced libido, erectile dysfunction, insomnia. But despite any negative publicity campaigns or deleterious side-effects, there's no question that millions of patients have found great success with SSRIs. After the positive reports that marked the first decades of their existence, these drugs have even come to be prescribed as part of the treatment for other mental health conditions such as obsessive disorders, anxiety, bulimia, and even various forms of addiction.
This report leads us back to the obvious conclusion that, despite the fact that millions are currently medicated for depression, it is in fact undertreated, and we must work to find successful approaches for each individual without resorting to an overreliance on drugs that some patients (and, more significantly, some GPs) treat as a "call me in six months" solution to a very complex issue. While the prescription rates for related drugs continue to rise, the majority of depressed individuals still do not seek treatment, and studies estimate that the success rates of these medications hover between 30% and 45% - hardly unequivocal results, although working with a doctor to find the right medication can raise this success rate significantly.
Antidepressants are in no way a universal cure, and while they benefit many, a considerable percentage of patients are best treated by combinations of personal and behavioral therapy complimented by lifestyle changes and, if deemed appropriate by a doctor, varied pharmaceutical regimens. Physicians who prescribe antidepressants should be expected to keep a close watch on their patients, noting any significant changes in mood and behavior for better or worse. They will then be better equipped to prevent any potential tragedy - increased supervision and interaction can only be a good thing.
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