[Aedes]

Originally Posted by Didymos Thomas

From what I understand, correct me as needed, antidepressants fix some chemical imbalance in the brain which causes depression. The idea being that the medicine will provide enough relief for the patient to develop a healthy lifestyle so that they can then stop taking the medication and no longer suffer from depression.

Not really. First of all, the commonly used term 'chemical imbalance' is not a useful way of thinking about their mechanism of action. Antidepressents increase the amount of serotonin and (in some cases) norepinephrine in the synapses; antipsychotics increase the amount of dopamine; etc. It's not so much a chemical imbalance as it is a physiologic inability of the cells to secrete enough of the neurotransmitter in question. (or in the case of things like manic symptoms or anxiety it's a type of cellular overactivity).

Psychiatric medications do not eliminate the underlying disease. They're mainly symptomatic treatments. Cognitive-behavioral therapy, incidentally, also will increase the amount of serotonin and norepinephrine in the synapses of depressed people. So in other words this "chemical imbalance" can be treated and improve in non-pharmacologic ways.

But the disease is still there, and probably the best one can hope for is that the treatment will allow the person to get their lives in order (including quitting drugs if that's an issue) such that later on they'll have enough internal resources that they won't need antidepressants.

The combination of cognitive-behavioral therapy and medications is generally better than either alone. But they're both effective. And therapy is extremely expensive -- for people to have hour long sessions several times weekly for months or years is not affordable.

Fortunately the psych medications we have are (for the most part) very safe and very efficacious.

I can certainly imagine cases where this sort of medication will be the best therapy, but usually when we have some problem, we address the cause of the problem, and something must have caused the chemical imbalance in the first place.

It's biology. And there are some biologic things we cannot fix even if we find the root cause. And in the case of most psychiatric disorders, we have a very limited understanding of the basic biology. Furthermore, the diseases themselves are diagnosed syndromically, i.e. based on a collection of symptoms -- we can't make an etiologic (causal) diagnosis of even plain old depression, we can only diagnose it based on the pattern of symptoms and thought processes of the patient.

My fear is that if we medicate to fix the imbalance, the patient will be no less susceptible to future imbalances having never learned how to prevent such an imbalance from occurring. Nor do I like the idea of people going through some terrible cycle of depression and medication with no end in sight.

What's the alternative? Having untreated people who cannot work, who become dependent on drugs, who cannot take care of their families, and who attempt or commit suicide? You don't need to look very far -- there are PLENTY of people out there with untreated psychiatric illness.

Don't knock symptomatic treatment. There IS a huge societal and personal cost to symptomatic depression. These drugs lower that cost because they allow people to actually live their lives. If they need to take Paxil for the rest of their lives, so be it if it means they actually can live productively.