Finally, a position on antidepressants that manages to be both blunt and nuanced. Jonathan Rottenberg, Ph. D. at Psychology Today, discussing recent meta-analyses of antidepressants, conveys the unfortunate news: the primary issue with the treatment of depression is not access, but rather the very limited effectiveness of our treatments.
I've seen many patients who, having been on antidepressants perhaps five or ten years previously, say something like, "But I'm sure newer and better drugs are coming out all the time." At this point I have to resist the temptation to blurt out, "No! They're not!" The menu of options has certain grown bigger as compared to 10 or 15 years ago, but not necessarily better. And then there are those sexual side effects...None of this is a counsel of despair, but in general expectations of antidepressants have been out of control for some time now.
All of this is true as well of medications for anxiety, bipolar disorder, schizophrenia, and substance abuse. Yet the temptation is often to throw the kitchen sink at these disorders when nothing seems to work. Doctors used to be notoriously reluctant to be honest with patients with cancer or some other terminal diagnosis. Even when everything has been tried with a given patient, I think that in psychiatry there may be a similar reluctance to speak what sometimes is the truth: "I don't know that I can help you." The difference is that in psychiatry there is no pathology report or CT scan demonstrating that a patient is in fact beyond help. In psychiatry it is merely...a feeling one gets.