subtypes may not be helped by current antidepressants.
Consequently, we agree that a complete cure with antidepressants
alone would not be expected.
(Point 5) Antidepressant treatment has risk
We agree with Ioannidis that antidepressants cause both
known and unknown adverse effects, and both risks and
benefits must be balanced. We also acknowledge that
there have been concerns regarding whether certain
antidepressants may cause suicides.
(Point 6) Over-medicalization
We do agree that there is a problem of over-medicalization
in the treatment setting, where patients and physicians
sometimes look for a “quick fix.” Antibiotics are
widely given when they should not be, but this does not
prove antibiotics are not useful. Over-use or inappropriate
use is common to many treatments and more usefully
discussed as such. When presented with a depressed
patient, physicians want to do something, both because
of the physician’s desire to help and because of the
patient’s expectation to receive tangible treatment (i.e. a
prescription). Therefore, a prescription can sometimes be
almost a reflex, without always considering the full benefits,
risks, and alternatives. However, there is evidence
that most depressed patients are not treated at all or are
under-treated, and more are receiving psychotherapy
without medications than medication without psychotherapy.
Ioannidis does not recommend either or
both. Most psychiatrists would not recommend initial
drug treatment for a person who is simply discouraged.
Finally, direct to consumer advertising may lead to overmedicalization.
We would favor legislation prohibiting
direct advertisements to patients, limiting the amount of
money spent on promotion of medication, and structuring
the pharmaceutical industry, so as to provide more
incentive for developing new medications and less incentive
for selling a costly variant on an old medication,
offering minimal clinical advantage through wide-spread
advertisement. It is true that antidepressants are used for
many conditions, other than depression, and some have
proven efficacious (e.g. for panic attack disease, obsessive
compulsive disease, etc.). Many medical drugs are serendipitously
found to help entirely different diseases,
accountings for almost 50% of the indications for drug
treatment. We do not disagree with many of Ioannidis’s
legitimate concerns, which are widely applicable over all
of science and medicine.
Humanistic Significance of Major Depressive
Disorder
Major Depression is a mental disorder that can have a
devastating impact on the individual suffering from the
condition as well as on those closest to them, such as
family, friends, and colleagues who are affected by the
individual’s loss of function and emotional absence.