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How An Antidepressant Can Hurt Your Patient

Posted Oct 27 2010 1:08pm

Patients want a quick fix. Society wants patients to have a quick fix, so that they can quickly return to their usual performance at work and home.

Patients still have shame about seeking help from a psychiatrist or other mental health professional. So they ask help for their depression from their primary care physician. The PCP feels an emotional pressure to provide the quick fix in that 15-minute appointment – the same pressure that he responds to when prescribing antibiotics to a adequately squeaky wheel of a patient with a common cold. If he does talk to the patient about therapy, the patient balks at the cost (in time and effort, if not in price). Even if the patient doesn’t balk, there may be a wait to get the patient in. In the meantime, to help the patient feel some relief, an antidepressant is prescribed. It helps the PCP and the patient that as a group, SSRIs and the antidepressants that followed them are a lot safer than tricyclics.

This is how PCPs as a group came to write the vast majority of prescriptions for antidepressants, and this class of medications ended up in top 4 by U.S. sales.  Revelations that negative studies about these medications in the past were not reported or that  they may not work a lot better than placebo for those with mild-to-moderate depression, don’t seem to have much impact on sales.

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