A Doctor Disagrees

By Klitzman, Robert | Newsweek, February 8, 2010 | Go to article overview

A Doctor Disagrees


Klitzman, Robert, Newsweek


Byline: Robert Klitzman

Antidepressants have helped not only my patients, but myself.

The TV screen stayed black. Except for the occasional car whishing by outside, the room was silent. I stared at the white ceiling, unable to get out of bed. Two weeks earlier, on 9/11, my sister had died at the World Trade Center, where she worked. I had helped plan a memorial service for her and empty her apartment. Then my body gave out.

For the first time in my life, I didn't feel like doing anything--reading, writing, or even listening to music. I went to psychotherapy, and visited a synagogue, a church, and a Buddhist sanctuary, where we walked in circles and rang bells.

I didn't think an antidepressant would help me, but I decided to try one. Perhaps I should have experienced my grief longer, as a "growing experience." But I soon felt better, and was glad. I also changed how I thought about disease and treatment.

Last month, The Journal of the American Medical Association published an article that argued that for patients with mild or moderate depression, antidepressants work no better than placebos. Countless patients wondered if they should stop their medication. Others have insisted that Americans are overmedicating themselves.

What should we make of all this? First, some facts: antidepressants have clearly been shown to work for serious major depression. Most evidence shows that they are effective for dysthymia: milder but chronic depression that continues for two years or longer. The question is whether they work for milder depression that may be shorter or less intense.

That's important, since major depression affects almost one out of five people at some point in their lives. And most people with depression do not have severe forms of it.

My own sense, based in part on my own personal experience, as well as that of patients I have treated, is that antidepressants can definitely work for milder depression--not for everyone, but for many. Why, then, the debate and apparently contradictory findings?

In part, the answer hinges on what we mean by "milder" depression. Experiences of depression vary enormously in intensity, length, and impact: from momentarily feeling blue to more major symptoms. …

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