The Right Rx for Sadness
Drugs may be an easy choice but not a good one
But primary-care physicians, who diagnose and treat the vast majority of depression cases, may be hard pressed to tease out the origin of symptoms during a quickie 10-minute physical. And without a blood test or brain scan for depression, doctors often rely on standard screening questionnaires to measure the symptoms themselveswhich, like the DSM manual, don't consider the context in which they occur. The forms also don't take into account the impact that symptoms are having on a person's functioning, says Spitzer. That information would help indicate whether grief is progressing into a mental disorder.
Even when a life circumstance is found to be the culprit, doctors may be reluctant to refer patients to grief counselors or psychotherapists for emotional support. That's because managed care doesn't reimburse generously for therapy that entails more frequent and longer office visits, says Carolyn Robinowitz, president of the American Psychiatric Association. About 65 percent of employee health plans put a cap on the number of mental health visits, according to Kaiser's 2006 survey of employer health benefits. And plenty of therapists don't accept insurance.
So what doctors often choose to do is write prescriptions. "It's the easy solution, especially when patients demand a quick fix," says Ellen McGrath, a psychologist in New York and author of When Feeling Bad Is Good. A 2005 study published in the Journal of the American Medical Association found that 55 percent of volunteers posing as patients with a few depression symptoms received a prescription for Paxil after saying they saw it advertised in a commercial; just 10 percent of those who did not ask for any antidepressants walked out with a prescription. Study leader Richard Kravitz, a professor of medicine at the University of California-Davis, says drug companies encourage this trend by bombarding consumers with ads that do not make enough of a distinction between sadness and depression.
But antidepressants are no panacea. While helping some sad folks numb the pain, they are known to tamp down joyous feelings, too. After being diagnosed with cancer several years ago, Barbara Kline of Corrales, N.M., sought antidepressants to help manage her fear of the disease and shock at having her professional life come to a grinding halt. But the 58-year-old public relations executive also found she wasn't able to feel any stirrings of pleasureeven from the masseuse who regularly came to her house. She decided to go off the meds after just four months. "I wanted to examine my feelings and then make something out of them," she says, which inspired her to start a cancer patient support group.
There are also side effects to consider. As many as 60 percent of SSRI users experience such sexual problems as decreased libido and erectile dysfunction, and about 25 percent have sleep difficulties, according to an April 2006 report published in the Cleveland Clinic Journal of Medicine. Young adults and teens face a slightly increased risk of suicidal thoughts during the first month of treatment, and new research suggests elderly users are at risk of accelerated bone loss.