An article in the Wall Street Journal caught my attention. The headline read, “Drugs to Lift Depression in Hours Rather Than weeks.”
The gist is that so many medications work quickly, why do people have to wait 8 weeks to get benefit from antidepressants?
The quick answer is that some of the some drugs being developed work on a receptor in the brain related to learning and memory called NMDA (N-methyl-D-aspartate). The neurotransmitter involved is glutamate rather than serotonin which is targeted in the SSRI medications such as Prozac and Zoloft. The thinking is that targeting the NMDA receptor works much quicker than working with serotonin-based drugs which take much longer to activate antidepressant effects.
Anecdotally therapists, including myself, have seen clients react positively to SSRIs in just a few days. Whether this is primarily a placebo effect or whether some individual’s are just more responsive to serotonin based medications I don’t believe is well understood.
So here we are again at the precipice of an old debate. What is the role of new drugs that promise to make people feel better quickly. How is a psychotherapist supposed to react? Echoes of Goethe and Huxley abound. What vision of humanity are we shooting for here? Is a quick fix that covers rather than resolves the causes of depression better than taking the time to do the soul searching and, at times, hard work to get to the psychological causes of depression?
Differing Attitudes Toward Medication
I divide attitudes about medications among mental health professionals into two camps: the ideologues and pragmatists. If a person believes that problems stem from behaviors and brain chemistry is the primary determinant of perception and behavior, then medications become the means of change. In its purist, and some would say, most reductionistic presentation, this is the essence of biological psychiatry.
There are many psychiatrists who subscribe to this point of view and primarily ask about symptoms so they can write scripts at the end of a session.
Many psychotherapists, who believe that psychotherapy is the best means for producing lasting change, only feel this way with clients who are organized enough to come to their office and pay their fee. Get many therapists in the room with an actively hallucinating psychotic patient and suddenly the therapist is all in favor of medications as the primary treatment. Some might even see it as a necessary evil.
Of course there can be anti-medication ideologues who see medications as driven by the Pharmaceutical Industry and which at best help people adapt to bad situations by dulling their senses. This belief was central to the anti-psychiatry movement of the 1960’s and 1970’s. Today many anti-medication advocates avow spiritual beliefs that encourage people to be present to what they are feeling no matter what label might be applied. Embracing what is being felt right now is is what a person can genuinely experience. Drugging away such a state is a temporary fix at best.
Pragmatists, of which I am one, believe that psychotherapy can be a powerful agent in helping people change. From this viewpoint there is openness to medication if it helps relieve pain and spurs health. However it is a matter of degree. Let’s say someone is depressed because her marriage is falling apart or his children are failing at school.
To have depression reduced within hours is mainly of benefit, if one can then address the underlying causes to the issues at hand and one doesn’t necessarily need medication to do that. To merely have relief from depression while not tending to a troubled marriage or children having school problems is not what I would promote.
On the other hand to have an uncontrollable suicidal impulse that needs immediate attention for which a medication can “buy time” would get little argument from most people as an important resource. Hypotheticals aside there are real issues and differences of opinion here.
I have blogged on this subject matter before: http://psychologyofeverything.com/2012/06/
It is amazing to see how much individuals, society and, for purposes of this conversation, therapists keep revisiting the topic. Robots, artificial intelligence, computers, social media: all extend the conversation into different realms. What makes us human and where are we going.
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